This article examines the current skilled nursing landscape, highlights foundational team roles, explains new staffing mandates, and presents innovative solutions that enable facilities to optimize their workforce. Read on to learn more.
What is a skilled nursing facility?
A skilled nursing facility (SNF) is a clinical setting that provides around-the-clock professional nursing services and rehabilitation for patients who require ongoing medical care but do not require hospitalization.
Many people use "skilled nursing facility" and "nursing home" interchangeably, but they serve distinct primary functions. A nursing home is typically focused on long-term custodial care, helping residents with activities of daily living (ADLs) over the course of months or years. A skilled nursing facility, in contrast, is largely focused on short-term, post-acute care.
Patients are often admitted to an SNF directly from a hospital following a qualifying stay to receive services that will help them recover and return home. To qualify for SNF care under Medicare, a patient must have a qualifying hospital stay and require skilled services related to that stay.
SNFs provide intensive and varied care. The following table shows key differences between SNFs and other common care facilities.
A snapshot of typical SNF services includes:
- Physical, occupational, and speech therapy (rehab)
- Complex wound care
- Intravenous (IV) medications and feeding
- Monitoring of complex chronic conditions
- Post-surgical recovery
The typical resident population in an SNF is diverse, including post-acute patients recovering from surgery (like a joint replacement), subacute patients stabilizing after an illness, and patients needing short-term rehab after a stroke or cardiac event.
Key team roles and staffing models in skilled nursing
A coordinated disciplinary team drives a successful SNF. Nurses and aides deliver most direct care, supported by clinical and administrative professionals.
Clinical staff roles in an SNF include:
- Registered nurse: The RN in an SNF leads assessments, care planning, complex treatments, and supervises clinical staff.
- Licensed practical/vocational nurse (LPN/LVN): LPN/LVN jobs focus on administering medications, performing treatments, monitoring patients, and nursing charting.
- Certified nursing assistant (CNA): CNA roles in SNFs are the foundation of direct care. CNAs help with ADLs, take vitals, and report condition changes.
- Therapists: Physical therapists, occupational therapists, and speech-language pathologists are essential for rehabilitation.
- Nurse leader SNF roles: These include the director of nursing (DON), who oversees all clinical operations, and the unit manager.
- Minimum data set (MDS) coordinator: A nurse who completes the minimum data set assessment, a federally required process essential for planning care and for Medicare billing.
Nurses and CNAs in SNFs manage demanding responsibilities, balancing complex clinical tasks with rigorous documentation. Schedulers or nurse managers coordinate shift assignments and continuously match the facility’s census with available staff.
Nurse recruitment, onboarding, and credentialing
With ongoing workforce shortages, skilled nursing staffing becomes a core business function. Facilities no longer just hire full-time staff; they now use a blended model:
- PRN/Per diem pools: An internal float pool of PRN nurse jobs in SNF. This per diem SNF nurse staff is already known and credentialed.
- External staffing: When the internal pool is insufficient, facilities turn to external sources, comparing agency vs platform nursing jobs.
After CNA roles, facilities demand RN and LPN/LVN jobs. Regardless of origin, every staff member must complete credentialing.
This includes:
- Verifying active licenses
- Running background checks
- Checking CPR certifications
- Confirming clinical skills
For PRN nursing staff, a rapid onboarding is key so shifts get filled. The best way for SNFs to quickly onboard PRN nursing staff is to:
- Use digital credentialing to check documents instantly.
- Focus on facility culture and hands-on mentoring from day one.
- Provide a quick orientation on essentials like eEHR access and emergency codes.
Technology platforms, such as the Nursa app, make this easier. They connect facilities with pre-credentialed nurses and CNAs, helping fill skilled nursing staffing gaps for individual shifts or contracts, simplifying credentialing and onboarding.
Flexible scheduling and payroll optimization
A rigid schedule is a primary driver of nurse burnout. Flexible scheduling is no longer a perk; it's a core component of a modern staffing strategy. The most common scheduling challenges in an SNF include covering weekend shifts, holidays, and managing last-minute call outs or census spikes.
Strategies to manage this include:
- Flexible options: Offering self-scheduling, block shifts (e.g., all weekends for a higher rate), or 8-hour vs. 12-hour shifts.
- Technology: Implementing SNF scheduling software that provides a real-time view of coverage and allows staff to view and pick up open shifts from their phones.
- Overtime controls: Using a blend of internal staff and external platform nurses to fill gaps before resorting to costly, unplanned overtime SNF.
Technology enables SNFs to improve nurse scheduling. It replaces paper logs or spreadsheets with dynamic, interactive systems, enhancing workflow efficiency and helping control staffing costs.
Payroll optimization is a direct benefit. Facilities can better manage shift differential pay for undesirable shifts. Using PRN shifts can reduce payroll costs. The hourly rate for a PRN nurse may be higher, but the facility avoids the high costs associated with benefits, paid time off, and insurance typically tied to full-time staff. This makes PRN a cost-effective solution for variable staffing needs.
Nurse retention, burnout prevention, and workplace wellbeing
High turnover is financially devastating and disruptive to resident care.
The causes of high turnover in SNF settings are clear:
- Burnout in SNF
- High workloads
- Documentation burden
- Feelings of being undervalued
Burnout risks unique in SNF clinical teams often stem from moral distress. This stems from the inability to provide the level of care residents need due to time and resource constraints. To improve nurse retention in SNF facilities, leaders must focus on more than incentives. They should create a positive work environment.
A successful retention program includes:
- Wellness initiatives
- Recognition
- Professional development
- Team-building
Incentives that work for keeping skilled nursing talent are often non-monetary. Flexible scheduling, involvement in decision-making, and strong, supportive nurse leaders are consistently cited as top reasons nurses stay in a job.
Compliance, training, and regulatory documentation
In skilled nursing, compliance is not a department; it's an operational mandate. Facilities must adhere to a complex web of rules from CMS, The Joint Commission, and state departments of health.
Key compliance requirements for SNFs are vast, but training is a central pillar. Nurse training in SNF is not a one-time event. Staff must complete annual competencies on a wide range of topics:
- Infection control standards
- Emergency preparedness and disaster staffing
- Resident rights and abuse prevention
- Safety protocols
- Preparation for state survey audits
Documentation standards are equally rigorous. Nurse charting, care plans, and handoff communication are legal records subject to audit.
The most important piece of documentation for reimbursement is the MDS. The MDS is a comprehensive resident assessment. It is critical because its data is used to calculate the facility's reimbursement rate under Medicare's Patient-Driven Payment Model (PDPM).
An inaccurate or late MDS can result in significant financial losses. This assessment, along with care area triggers and resident assessment protocols (RAPs), forms the basis of the individualized care plan.
Safety protocols, infection control, and quality improvement
A strong staffing plan is the foundation of a safe facility. Core SNF safety measures are directly linked to nursing vigilance. These include:
- Fall prevention
- Pressure injury prevention
- Medication safety
Facilities track and report safety data through incident reports, which are then analyzed by the quality team.
Infection prevention is paramount. This involves rigorous adherence to infection control standards, including hand hygiene, correct use of PPE, contact precautions for ill residents, and thorough environmental cleaning.
All of these elements contribute to the facility's Quality Assurance and Performance Improvement (QAPI) program. This is a data-driven process where teams proactively seek to improve care. When an adverse event, like a resident fall, occurs, the team conducts a root cause analysis.
This process identifies system breakdowns (e.g., poor handoff communication, faulty equipment) rather than blaming an individual, enabling the facility to implement lasting performance improvements.
Interdisciplinary coordination and communication in SNFs
No single clinician can manage the complex needs of an SNF resident. Care coordination improves SNF outcomes by ensuring the entire team—nurses, therapists, social workers, and physicians—is aligned.
This coordination is achieved through structured communication protocols:
- Daily huddles
- Shift change handoff
- Care conferences
Intra-team communication, such as the flow of information from an RN to a CNA or from a nurse to a therapy provider, is critical. This ensures that a CNA's observation about a resident's change in condition is escalated to the RN, who can then coordinate with the rehab nurse or physician for a timely intervention.
Technology in skilled nursing staffing and care delivery
Technology is a key enabler for modern skilled nursing staffing and care. Tools like scheduling apps, digital charting, and telehealth in SNFs are now essential.
SNF leaders use apps like the Nursa app SNF for real-time staffing. These platforms provide a dashboard to post open shifts, view credentialed clinicians, and fill gaps in minutes—a vast improvement over making phone calls. This technology in SNF staffing also offers data analytics to track spending and patterns.
In care delivery, technology streamlines work. Electronic health records (EHR) create a central hub for nurse charting. An eMAR (electronic medication administration record) reduces medication errors via scanning, and telehealth in SNFs allows for remote monitoring and virtual physician consults.
Technology also supports compliance for nurse staffing. SNF scheduling software can track hours per resident day (HPRD) in real-time, alerting managers before they violate CMS mandates. Digital credentialing dashboards confirm every RN or LPN has a valid license.
Using Nursa to cover hard-to-fill SNF shifts illustrates this. A DON with a last-minute call out can post the shift and have a pre-verified, local RN or LPN clock in, ensuring care continuity without forcing overtime.
Frequently asked staffing questions
Find answers to common questions here.
Are agency nurses still widely used, or are platforms like Nursa taking the lead?
While traditional agencies are still in use, tech platforms like Nursa are gaining popularity. Agencies act as intermediaries, charging high fees and requiring long-term contracts. Platforms connect facilities directly to nurses, offering more flexibility and better cost control.
What should a new nurse know about working in an SNF?
Working in an SNF is a fast-paced role that builds strong assessment, time management, and leadership skills. New nurses will be responsible for making key clinical decisions and must excel at prioritizing tasks, communicating with their team (especially CNAs), and managing documentation.
How can innovative staffing models help address nurse shortages in long-term care?
Innovative staffing models create a flexible, blended workforce rather than just seeking full-time hires. This involves utilizing internal PRN pools, offering flexible schedules, and leveraging technology platforms. These platforms connect facilities to a large network of local, per diem clinicians, turning a shortage into an on-demand supply.
Which compliance changes in 2025 will most impact SNF operations?
The new CMS rule on staffing ratios is the biggest change. It requires a 24/7 on-site RN and 3.48 total nursing hours per resident day (including 0.55 from an RN). This necessitates significant operational and financial changes, particularly for rural facilities, and is reshaping budgets and hiring practices.
Find out more about skilled nursing.
