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Nursing home care appeals to nurses who like the stability of a long-term care population coupled with the variety of issues that arise in elder care. Many also enjoy working with clients in a more holistic way.

Quanadra Denise Hatcher, LPN, works in a nursing home, caring for the nation's most vulnerable citizens in an industry dominated by regulations, comparably low pay and high turnover.

Six days a week, Hatcher tends to as many as 36 patients, checking in on them and managing their medicine, as well as writing assignments for nursing assistants and conferring with doctors at the Beverly Health and Rehabilitation Center in Columbus, Ohio.

"It's a constant balancing act, and it's hard when you have so many patients and the patients are demanding," said Hatcher, who is working toward her RN license.

Care of the elderly is a sensitive field that is often the focus of publicity only when heart-wrenching tales of abuse surface. Now, the federal government has published online quality measures for homes, distinguishing one from another with disheartening statistics such as the number of residents with pressure sores, pain, restraints and infections, followed by a list of regulation violations. Without differentiating between levels of acuity, the Web site compares average nursing hours per patient to state and country averages.

While many homes welcome the scrutiny-many states already had more detailed versions of the federal Web site-the numbers listed do not always fairly represent what goes on inside the home, said Deborah Cloud, vice president of public affairs for the American Association of Homes and Services for the Aging.

"If a nursing home percentage looks out of line in one of those areas, there may be a valid reason why that's so," she said.

The information has placed added pressure on directors of nursing like Nyra England, RN, director of nursing at Beverly Health and Rehabilitation Center. England cited the bedsore statistic as an example.

"We have a low rate of people developing [wounds] here, but we have a high rate of accepting them from the hospital and healing them," she said. "You don't see that in the paper and on the Web."

The Centers for Medicare & Medicaid Services, the division of the Department of Health and Human Services that reimburses nursing homes for Medicare patients and publishes the Web site, found that homes should have a minimum of 4.1 hours of nursing per resident to avoid jeopardizing patients' health.

Scramble for staff

Yet many homes say they cannot keep their staffs full during a nursing shortage when hospitals are able to pay higher wages and sign-on bonuses, said Cindy Shemansky, M.Ed., RN, president-elect of the National Gerontological Nursing Association.

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