[sassysteph7]

Yesterday I worked with a nurse who had just started with a different agency than mine. She is a hospital nurse and for some unknown reason they threw her into a LTC facility without ANY orientation. I can't believe she agreed to pick up the shift. Anyway, my point - she was SOOO overwhelmed. She couldn't believe she had 30 people to be responsible for. She passed meds all day. She came to me at 2 p.m. and said I just finished the meds, how do I do the accuchecks? She couldn't believe the CNA's didn't take vitals, get accuchecks, etc. Earlier in the day she had a little lady spike a temp of 102.1, resp 48. You should have seen the look on her face "what, no doc down the hall?" We all helped her get through the day and are wondering if she'll ever come back.

[VivaLasViejas]

Originally Posted by grammyj

I don't defend myself.
I know what I do, and I know that I'm good at it. When I see a smile or get a pat on the hand and an "I'm glad you're here tonight.", that's all the defending I need.
God bless you and all that WE do in long term care.
{{{HUGS******

You said it best, grammyj!

As far as I'm concerned, LTC nurses don't have ANYTHING to apologize for. Instead, we should proudly hold up our heads for persevering in a hard, often thankless job where we have more rules, are responsible for more patients, and receive less pay than almost anywhere else in nursing. I refuse to be labeled "inferior" because of my career choice, and I don't tolerate disrespect from MDs, EMTs, or even other nurses who seem to think we know nothing. We geriatric nurses have chosen to work with members of our Greatest Generation.......how anyone can look down their noses at us is beyond me.

[KYGrace]

I have worked in both settings, hospital and LTC. LTC is more stressful and much more rewarding. In the hospital, you deal with the acute situation then send them home, or back to the LTC facility. It makes a big difference when you have taken care of someone for several years, watched them go from walking the halls to being bedridden and then sit with the family while they are dying. You try hard not to get attached, but it is impossible. I have no desire to anything else but work LTC. I work 12 hour shifts and it is non-stop all day.

[bshaw96]

Yes, we've all felt that. Some of it comes from the misconception that they're not really sick. They're just "old". And back many years ago, that may have been the case. But SNF today are almost like step down units. You get post surgical needs and acuities of all kinds.

Another thing I've noticed is that how "good" a nurse is seems to be somehow linked to how many pieces of equipment the patient she cares for is hooked up to? No equipment= patient not sick. A simple NS peripheral IV= still easy, PICC Line or Central Line= getting harder, etc. Now if you're lucky enough to have a patient hooked up to IV ABT , blood products, and TPN via there central line, while also maintaining their chest tube and drainage tube and NG suctioning, then you are the absolute epitomy of nursing! Nurses that work the ICU or ER with all those bells and whistles are like the gods of nursing!

It does not matter if the nurse has not a clue what any of the above is for, it's simply if she knows how to administer them. None of this has to do with the skills of the nurse. Skills are easily learned, but nursing, truly nursing a patient, holistically, is a gift. Not to knock the above nurses, I was one of them at one time. But I feel I have helped and nursed my patients far more at the end of the day now than I ever did then.

It's sad there are so many posts on here like this, even posted some myself, but I'm truly learning not to care. Take care of your elderly patients, and give yourself a great big hug for the wonderful job you do that most could not!

[Dinith88]

Originally Posted by bshaw96

Another thing I've noticed is that how "good" a nurse is seems to be somehow linked to how many pieces of equipment the patient she cares for is hooked up to? No equipment= patient not sick. A simple NS peripheral IV= still easy, PICC Line or Central Line= getting harder, etc. Now if you're lucky enough to have a patient hooked up to IV ABT , blood products, and TPN via there central line, while also maintaining their chest tube and drainage tube and NG suctioning, then you are the absolute epitomy of nursing! Nurses that work the ICU or ER with all those bells and whistles are like the gods of nursing!
!

I work in ICU and am truly convinced that LTC nurses are just as "good" as any other nurse. I am also convinved that anyone who disrespects or otherwise 'looks down' on LTC/geriatric nurses are simply ignorant and just dont know what they're talking about (to put it nicely). An earlier poster made mention that she took care of a patient in the hospital who was being discharged to a nursing home with a million meds and treatments, etc. So...this patient's nurse had to discharge this patient while caring for (guessing) 4 other patients.
The flip-side is...the LTC nurse has to admit this same patient while caring for...(guessing) 20 other patients...deal with 20 sets of families...has to coordinate care with QMA's, CNA's etc. Anyone who thinks that LTC patients magically become 'easier' the minute they're strapped to a stretcher and sent off to LTC is stupid.

I know i'm preaching to the choir so i'll stop this rant.... but the reason this a pet peeve of mine is because i have CLOSE acquaintences(sp?) who work in LTC and deal with this stuff...and it irks me...

[husker_rn]

I am back in LTC after a few med-surg years. I always point out that hospital nursing focuses primarily on an acute episode while LTC sees multi-system failure on a daily basis over and over. My fellow hospital nurses didn't always look at it for that prospective. We all do a tough job no matter the specialty.

[catnip]

When i got my RN, my classmates could not believe that i was actually WANTING to go into LTC. They constantly told me i would miss out on learning my "basics". Exsqueeze me? In my first 8 months i have had countless tube feeds, checking lung sounds included, Iv ABT's, trachs and a crash course in trach reinsertion (thank HEAVEN for the wonderful experienced LPN i work with). Not to mention the everyday antics that geriatrics pull that occasionally end up with a one way trip to the ED and having to be able to tell what is an acute situation and what can be treated in house. What exactly am i missing out on learning? I just chalk it up to people being under informed on what LTC nursing truly is.

[LTC Lady]

As a Unit Supervisor in LTC i will tell you it is the greatest job i could ever have and far bussier than any other Acute care area i have worked. I have a large volume of residents i am responsible for all with up and down days. I have to manage the care provided by the CNAs, i over see and participate in the med. admin. Participate and run care conferences, talked to Drs, pharmacey and many others. We have to deal with family dynamics, and all that that entails. so if somone told me LTC is "less" or that i "can't handle Med Surg" i wuld suggest they come walk a day in my shoes and see what LTC is really about!!!

[MrsCaseyRN]

I have worked both LTC and hospital. I have found that while both have their challenges, LTC challenges are magnified by the nurse to pt ratio. After being in a hospital setting and caring for a max of 8 pts, I find it scary the LTC facilities give nurses 20, 30 even 40 pts!! Also, many of these pts are not little old ladies waiting to die. We get pts with g-tubes, wound vacs, IVF & IV ABTs, trachs, JP drains, and lot of other things that I believe were not a regular part of LTC years ago. Its like the LTC facilities are becoming more and more like exstentions of the hospital, and if DONs are willing to accept these pts, hospitals are willing to D/C them in stable but complicated condition...but the LTC nurses have like 3x the pts!!
Second, I believe the sigma attacted to LTC nursing does wear on the nurses. At least at the hospital we got some appreciation. But in LTC, it feels like you're always getting the stink eye. Of course there are families that we get close to, but many look at you like your beating their loved ones. While there were nutty families in the hospital, you definately have to work harder for less appreciation in LTC.

And finally: SUNDOWNING, w/o any restraints!!! (I don't know if this is the same in all states) but in our state, LTC is restraint free!
Boy do I miss posies!!:whe!:

[scrapgirl2000]

I am proud that I work in Assisted Living, you should be too! Geriatrics is a SPECIALTY. I heard it in the hospital I used to work at where the "Tele unit nurses thought med surg nurses were dumb or God forbid you give an ICU nurse more than 4 patients or L&D nurses never get dirty". That is non-sense because we all choose which area we love and become well trained in that specific area. Our job as nurses is hard enough as it, so why the competition? A seasoned ER nurse may need help with a patient on a feeding tube because that is not common in ER. Does that make him/her less of a quality nurse? no, we ALL have questions, and are not perfect nurses. Anyways, it is an HONOR for me to take care of an elderly individual who is someone's grandparent, parent, brother or sister. I love that I can be their advocate and treat them with the same kindness and compassion I would as my parents and grandparents. I feel it is an HONOR to work with hospice residents and to be the one holding their hand when they die, so they are not alone. I feel that NO specialty in nursing needs to be defended. Any death or illness is complicated. Taking care of the elderly is very honorable and challenging. If it was so easy there would be no need for LTC facilities. Many nurses and doctors place their families in LTC, so we nurses should be the last to judge and compare of each other!