Residents are arriving sicker, respiratory conditions are more common than ever, and the nurses at the bedside are the first line of care.

Respiratory care used to be something long-term care could largely refer out.

A resident with worsening breathing was sent to the hospital, treated, and returned. That model no longer reflects reality.

Residents in skilled nursing and assisted living settings today are older, living with more chronic conditions, and arriving with higher acuity than at any point in the industry’s history. Chronic obstructive pulmonary disease (COPD) affects millions of older adults, and respiratory infections—including pneumonia, influenza, RSV, and COVID-19—remain among the leading causes of hospitalization and death in this population.¹ Pneumonia and other lower respiratory infections are consistently among the most common reasons residents are transferred out of skilled nursing facilities, and many of those transfers are avoidable with earlier recognition and confident bedside intervention.²

The question facing every director of nursing is no longer whether their nurses will manage respiratory treatments at the bedside. It is whether those nurses have been trained to do it well.

The Bedside Is Where Respiratory Outcomes Are Decided

A resident’s respiratory status rarely declines all at once. It declines in increments—a little more effort to breathe, a slightly lower oxygen saturation, a subtle change in mental status—and the nurse at the bedside is the person positioned to notice.

“By the time a resident is in obvious respiratory distress, the window for the simplest interventions has already narrowed. The nurses who catch the early signs—and who can deliver a nebulizer treatment, titrate oxygen appropriately, and reassess with confidence—are the ones keeping residents in their home community instead of in an emergency department.”

That skill set covers more ground than many training programs acknowledge: administering nebulized medications and metered-dose inhalers correctly, managing oxygen therapy safely, using incentive spirometry, positioning residents to optimize breathing, suctioning when appropriate, and—just as important—knowing how to assess before and after every treatment so the intervention is actually informed by what the resident needs.

Why This Matters in Skilled Nursing and Assisted Living Specifically

In a hospital, a respiratory therapist may be steps away. In a skilled nursing facility or assisted living community, the nurse often is the respiratory resource—for the resident, for the CNAs and unlicensed staff watching for changes, and for the family asking what’s happening with mom’s breathing.

That reality raises the stakes in three ways:

There is also a person-centered dimension that is easy to overlook. Breathlessness is frightening. Residents experiencing respiratory distress are not just physiologically compromised—they are often anxious, and anxiety worsens breathing. A nurse who explains what they are doing, positions the person comfortably, and stays present through the treatment is providing clinical care and emotional care at the same time. In long-term care, those have never really been separate things.

Competence Is Built, Not Assumed

Many nurses working in long-term care learned respiratory skills years ago, in a different setting, with different equipment and different residents. Licensure alone does not guarantee current, setting-specific competence—and research on clinical skills consistently shows that competence degrades without deliberate practice and periodic validation.³

High-performing organizations treat respiratory care the way they treat medication administration or infection prevention: as a defined competency with clear expectations, structured education, and documented skills validation. Not because nurses can’t be trusted, but because residents deserve a system that verifies readiness rather than assuming it.

That is the gap this new course—and the competency tools coming behind it—is built to close.

A Course Built for the Nurses Doing This Work

Bedside Respiratory Treatments for Nurses is Healthcare Academy’s new one-hour, ANCC-accredited continuing education course designed specifically for nurses in skilled nursing and assisted living settings. The course walks through the respiratory treatments nurses are most likely to deliver at the bedside—grounded in current evidence, focused on correct technique and assessment, and written in the practical, plain-spoken style frontline nurses can actually apply on their next shift. Because it is ANCC accredited, nurses earn contact hours toward licensure requirements while building skills their residents benefit from immediately.

And the course is just the beginning. Healthcare Academy will also be releasing new eCompetencies supporting bedside respiratory treatments—structured skills checkoff tools that let your organization validate hands-on competence at the bedside, not just knowledge on a post-test. Together, the course and eCompetencies give directors of nursing a complete pathway: educate, demonstrate, validate, document.

References

1. Centers for Disease Control and Prevention. (2024). Chronic obstructive pulmonary disease (COPD). U.S. Department of Health and Human Services. https://www.cdc.gov/copd/
2. Agency for Healthcare Research and Quality. (2023). Potentially avoidable hospitalizations among long-term care residents. U.S. Department of Health and Human Services. https://www.ahrq.gov/
3. Institute for Healthcare Improvement. (2023). Closing the gap between clinical education and bedside competence. http://www.ihi.org/

For information about continuing education and competency validation programs for long-term care, visit healthcareacademy.com.