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USA nurse career paths: jobs in nursing homes

  • Publish Date: Posted about 5 years ago
  • Author:by Kate Andrews

Out of all occupations across the U.S., registered nurses (RNs) represent a career path that is expected to see the most significant new job openings by 2026. According to the U.S. Bureau of Labor Statistics, more than 438,000 new RNs are expected to join the workforce between now and then.

The Bureau of Labor Statistics also states that out of the 4 million RNs in the U.S., 61% are employed at state, local and private hospitals. The remaining 39%, accounting for approximately 1.6 million RNs, choose to explore other job options and facilities in the medical field including home healthcare, community health centers, and nursing homes.

Over the past two decades, nursing homes have played a fundamental role in the healthcare landscape in the U.S., reaching a point where they are increasingly considered one of the nation’s most prominent employers. With that in mind, it's worth discerning how your skill set meshes with the needs of long-term care nursing practitioners.

Conexus MedStaff works closely with international registered nurses to help place them into a broad range of healthcare positions across the U.S., including within leading nursing homes. In this article, we take a closer look at the nursing home market, the qualifications you need to work in them, the different types of homes, and just some of the roles available to healthcare professionals working in them.

The long-term care market

The nursing home market is growing due to an aging population in the U.S. and an increased reliance on healthcare services. This means that there is a greater demand for nursing home professionals, with positions becoming available at an ever-growing rate.

Most U.S. nursing homes are operated either as single-location or multi-location entities, with some working across state borders. They can be publicly subsidized through America’s Medicare and Medicaid programs, with the expanding market. Additionally, the U.S. Government has emphasized nursing home markets as a priority, with the goal of ensuring supply meets demand, increasing the need for funding even further.

This growing requirement for healthcare professionals to fill nursing home roles means there are numerous opportunities for international nurses looking to further their career in the USA.

What it takes

The structure of the legislative powers in the U.S. means that requirements can vary from state to state. Some individual states have significant powers when setting workforce frameworks. It is not uncommon to see particular industries or fields of healthcare promoted above others. With this in mind, it is worth spending time researching which states have a growing need for nursing home staff, and those that are experiencing significant skills shortages.

Reminder: Conexus MedStaff only sponsors and places registered nurses from overseas. But it's good to be aware of the positions we mention below, as they cross paths regularly with an RN's working life.

The routes to nursing home employment include:

Formal training

Professionals looking to become licensed practical nurses (LPNs) need to earn a diploma or certificate before they can qualify for the National Council Examination for Practical Nurses (NCLEX-PN). RNs, who play a critical role in nursing homes, spend two to four years earning a diploma or degree before taking the National Council Examination for Registered Nurses (NCLEX-RN) to become fully licensed.

International certificates

Candidates with relevant international certificates are also recognized. In this case, there is an additional requirement to complete work experience. For example, a job in an officially recognized private- or publicly-funded residence in their country of origin. Furthermore, degrees from recognized universities can help international candidates secure employment in the U.S. However, nurses must still seek licensure from the state they are working in to become fully registered.


Usually, your working permit/visa in the U.S. will specify employability in one state, but some positions might require multi- or dual-state requirements where the proper registration must be sought. This is less common in larger states, such as California or Texas, or isolated states like Alaska where an RN would typically carry out all of their duties within one state. Instead, you will find this in the smaller states that neighbor one another, such as New Jersey and the State of New York.

Roles in nursing homes

While RNs and LPNs are in the highest demand, nursing homes offer a wide range of roles, from medical professionals to administrative staff and support workers. Additionally, each nursing home may have special requirements for its workforce, whether that is physiotherapists or maintenance personnel.

Reminder: Conexus MedStaff only sponsors and places registered nurses from overseas. But the positions we mention below cross paths regularly with an RN, so it's here as an indicator of who you will be working with.

Almost every nursing home requires professionals for the following roles:


Nursing home administrators act as chief executive officers who are responsible for budgets and the overall running of the care home. Many RNs eventually progress into this role, which is more about the broader business than resident care. Employers are usually looking for more than a decade of experience from RNs looking to move into an administrator role.

Registered Nurses (RN)

As mentioned above, this role is what the Conexus MedStaff team is solely focused on for recruitment purposes.

RNs have an overall focus on patient and resident care and are less focused on immediate care. They have the broadest patient/resident responsibilities, including managing care plans, having complete oversight of a patient’s care, and deploying checks and tests such as physical exams.

Licensed Practical Nurses (LPNs)

LPNs work under the supervision of RNs and administrators, taking care of the daily running of care homes, carrying out medical care, and monitoring patients/residents.

Support aides and nursing assistants

Support aides and nursing assistants work under the supervision of LPNs to carry out tasks that focus on the patient/resident’s welfare and hygiene. These can range from toilet duties, bedsore prevention and the transportation of residents.

Types of nursing homes

Each type of nursing home has its own requirements which may impact your duties and responsibilities.

Residential long-term residencies

Often called ‘board and care,’ these are residences that offer both living and care facilities.

Assisted Living Facilities (ALFs)

In the U.S., these primarily describe care residences for older people or those with disabilities that require assistance. Individuals in these facilities usually do not need 24-hour medical care.

Skilled Nursing Facilities (SNF)

These tend to provide essential care. More traditional types of nursing homes tend to fall into this category and are usually reimbursed by Medicare.

Finding the right staffing partner

A knowledgeable and experienced staffing agency can help you select and secure your ideal role in the U.S. Whether you want to further your career in a leading hospital or make a real difference in an outstanding nursing home facility, you must choose the right staffing partner to help you make this a reality.