I have worked in Geriatric/LTC nursing for over 20 years. The same scenario has played out hundreds of times in my career. It goes something like this: I meet a new person who asks me what I do for a living. I tell them I am a nurse. They are impressed and ask which hospital I work at. I tell them that I actually work at a nursing home. As I watch their face it is usually always the same. The expression changes from awe and wonder to disappointment and sometimes disgust.
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It is as if being a nurse is an admirable thing that one should be proud of unless you are a LTC nurse, in which case, you are not a "real nurse" because you don't work in a hospital. Many times, not knowing what to say, they will simply reply, "I could never do that." I have to bite my tongue at this point because I want to say to them that I agree, they probably could never do that.
Usually, this is the end of the conversation because many people have the belief that you are a nursing home nurse because you are not "smart enough" or "energetic enough" to work in a hospital. However, there are other times when this is not the end of the conversation and someone will ask you why you work in a nursing home. It took me asking myself that question and really thinking about it to come up with the answers that people needed to hear.
There is so much to learn in a nursing home! A lot of nursing homes are free standing and have to contract services. This means that the everyday services that the hospital nurses are calling upon ancillary staff to deal with, the nursing home nurses are having to learn and experience themselves.
When the diabetic patient needs dietary counseling and there is no dietitian in the facility, this responsibility falls upon the nurse. When a patient is newly diagnosed with gout, it is the nurse that will explain the need for the dietary restriction of protein. And when your patient has COPD and wants to know why he or she cannot have another pitcher of water, guess who gets to explain that? You guessed it, the nurse.
Another set of contracted services is physical, occupational, and speech therapies who work mainly Monday through Friday and for only a few hours a day if you are at a small facility. This means that for the rest of the day, the regular staff is working with the patients on these things. It is up to the nurse to know how to do a range of motion correctly, assist and instruct the patient in the proper ways of using their new occupational tools and silverware. It is also up to the nurse to train the CNAs on proper techniques for doing these things as well since the therapists have little time to do this training.
There is usually no lab contained in Long-Term Care Facilities like there are in hospitals. This means the nurses draw their own blood and start and maintain their own IV's.
Podiatrists? Maybe every 63 days since that's what Medicare allows. In between who has to deal with foot issues? That's right, nurses. There is no one to call to come to the floor to consult on a "bad toenail," or something that looks like fungus. The nurse learns what fungal characteristics look like and then make phone calls.
And then there are the phone calls. Character building phone calls at all hours of the day and night. Drs. very seldom make rounds in the LTC facility, therefore, the nurse is responsible for learning medical terminology that will describe a condition to perfection in order to obtain the proper interventions and orders.
Despite popular belief, LTCs and nursing homes are not places that people go to die. Therefore, not everyone is a "no code." For the nurse, this could mean running a code in the middle of the night with one other staff member in the building. There is no "code button" on the wall that you can push and a dozen available people come running. For staff in LTC, a code means calling 911 while you run down the hall on your way to retrieve an Ambu bag or AED machine and hope that there isn't a fire in town or you may have to wait a while for your volunteer EMTs to arrive for assistance.
I could go on and on but the bottom line is this: nowhere else do you obtain what you get working in geriatrics and long-term care. I have learned more and continue to learn more every day working as a charge nurse in a nursing home than I ever did in a hospital. So when I am looked down upon and asked why I work in a nursing home, my answer is because I CHOSE to get the education and experience that I cannot get anywhere else. And when they reply that "They could never do it" I secretly smile and think to myself, "nope, you probably couldn't!"
