ANYTHING good about LTC?

Antikigirl, ASN, RN · Mar 7, 2005

it is so interesting isn't it!!!!!!!

I had a patient that was living in Europe and had a MD as a father..nurse as a mother. The mother went off to a war as part of her duties..and came back different..go figure..war nurse? So the father left her, and wanted no part of her..took their only child..a girl..and went somewhere else....

BUT to protect themselves he cut her hair and had her live her life as a BOY! OMG I can just imagine!!!!!!!! She lived from the age of 4 to 18 as a boy! Then they moved here..and she was able to be herself once her father felt ill..but still laid a heavy guilt trip on herself to continue as a boy..even though she so wanted to have babies, family, husband and live her life as she wanted!

She didn't get the chance till 22, when her father finally passed...tried to find her mother who was dead with no other family to find....so she found a man she adored after having to move where she could introduce herself as a woman (and many learning experiences about being a woman after so many years as a male)...settled down..and had three daughters..go figure..for some reason..all nurses!

She is so interesting...a kind spirit who lived her entire life as something other than herself, never gave up, and still could find herself afterwards and get her dreams!

Now...rest home, DNR, and family never visits........

Sad..but a real interesting journey I would love to document!!!!

germain · Mar 8, 2005

Why LTC? Gee, I don't know. Maybe I won't- I'll decide in the program. I feel very comfortable in the hospital too, and have done homecare. But you all said it best, I LOVE that connection with the past. I also want to advocate for younger disabled folks. ANd I want to work in a rural setting. EVERYONE I'm in school with says- Long Term Care- NO WAY. It has no prestige, as you all know. But I like the idea of actually getting to KNOW people.

I've worked for all sorts of interesting folks too. One fellow remebered the San Francisco earthquake. Another woman was a pianist in a silent movie theater, used to play piano for us- amazing. And I can say I was proposed marriage by a man of 105. How many people can say that? Okay, all of you... :) If it weren't for the administration/ medicare/ money issues, if staffing were decent, if old people were valued, the job would be great. The job would be great, if we could do it!

danu3 · Mar 8, 2005

Why LTC? Gee, I don't know. Maybe I won't- I'll decide in the program. I feel very comfortable in the hospital too, and have done homecare. But you all said it best, I LOVE that connection with the past. I also want to advocate for younger disabled folks. ANd I want to work in a rural setting. EVERYONE I'm in school with says- Long Term Care- NO WAY. It has no prestige, as you all know. But I like the idea of actually getting to KNOW people.
...

It is interesting that each profession has their own little area hierarchy in terms of prestige. Within nursing, it is no different. I wonder what give a nursing area more prestige than the other though?

Here is a guess, pure speculation that is. One possibility is our culture is so instant and action oriented. So area that require lots of actions (or percieved to have lots of action) are highly valued. That is areas that require you to have a type A personality or better yet, a type A+ personality. So areas like ER are highly value for example. Areas that are percienved to have little actions are not value as much an may even percieved to be "easy". For examples, LTC as mentioned in this thread, psych nursing, even night shift nurses, ... etc.

The unfortunate part is that the highly valued areas tend not to be relational intensive areas (you just don't have the time due to the circumstances) which is a sad.

What do people think?

-Dan

PHTLS · Mar 8, 2005

To disagree: plenty of room for good nurses to advance in LTC.
1)an old guy with COPD is just as whiny as a young one looking for Roxanol
or worse...the 65 year old with a knee replacement who tells you that getting HIS staples out is worse than having a baby
2)give 'em Ativan and they fall and you'll do the incident report
3) plenty of full codes on a sub-acute floor
4) beeping sounds from everything imaginable..IV pumps, GTube pumps, door alarms, personal alarms, bed alarms, chair alarms
5)family atmosphere??? Not in sub-acute or these days on most other floors
6) PLENTY of surprises...that little old lady who looked so darned stable ten minutes ago now has had a sig. change in vitals and mental status,and oh, by the way, she's 93 and also a full code and her doctor is on vacation and the covering is a dork and you're the only nurse around and it all depends on your skill level.
LTC....can't lump 'em all together.

1) An old guy is just ONE Person. You work acute, a majority of the patients will be bugging you left and right (half of them are on PCA's already). And guess what? You'll be bugging the doctors too for pain orders

2) You're supposed to monitor them after you give them anything that puts them at risk for falling AND THEY SHOULD BE IN BED WITH THE SIDE RAILS UP after giving Ativan.

3) Not as much as ICU and Med Surg. I've work for years in LONG TERM CARE and I've only heard/been involved in codes 3-4 X. I've worked 8 years in Med Surg and intensive care and there's always a code every week practically. I've also placed deceased pt's in the local hospital morgues more than a dozen times.

4) You forgot Telemetry machines. Do the ratio. Who do you think uses the most beeping machines? Acute or LTC?

5) Just $0.02

6) Really? I just yawn half the time showing up for work and the only changes I see are....*thinking* ... :rolleyes:

PHTLS · Mar 8, 2005

Here's another difference between Acute and LTC.

Doctors and interns.

When was the last time you saw an "intern" write screwed up MD orders in LTC only to have him/her change them 5 minutes later driving the Unit Coodinator mad along with the LVN/RN? When I worked acute, I had 20-30 patient charts that I carried out with the licensed staff and minutes later, an HBS doctor will come by and re-write the interns orders.

LTC? Only the established doctors visit and write legit orders.

PHTLS · Mar 8, 2005

And yet another one:

Admissions and discharges!

The Med Surg floor I worked in as an LVN, clerk, and CNA had discharges/admissions every shift (mostly days and some on PM).

LTC? Our last admission was 3-4 months ago? Discharge? 1 resident a month ago.

LTC and Acute care are as different as night and day.

CNA's?

CNA's in convalescent hospitals worked there butts off with them Hoyer lifts, while PCA's in Acute think taking vitals every 4 hours is hard.

donmomofnine · Mar 8, 2005

" Really? I just yawn half the time showing up for work and the only changes I see are....*thinking* ..." I feel a little offended by that comment. I am getting out, it's rather hot in here.:chair: :angryfire

CoffeeRTC, BSN, RN · Mar 9, 2005

1) An old guy is just ONE Person. You work acute, a majority of the patients will be bugging you left and right (half of them are on PCA's already). And guess what? You'll be bugging the doctors too for pain orders
2) You're supposed to monitor them after you give them anything that puts them at risk for falling AND THEY SHOULD BE IN BED WITH THE SIDE RAILS UP after giving Ativan.
3) Not as much as ICU and Med Surg. I've work for years in LONG TERM CARE and I've only heard/been involved in codes 3-4 X. I've worked 8 years in Med Surg and intensive care and there's always a code every week practically. I've also placed deceased pt's in the local hospital morgues more than a dozen times.
4) You forgot Telemetry machines. Do the ratio. Who do you think uses the most beeping machines? Acute or LTC?
5) Just $0.02
6) Really? I just yawn half the time showing up for work and the only changes I see are....*thinking* ...

Sounds like not much goes on in your LTC.

As far as the demanding and highly skilled residents like your first example....got them here...at least 8 or 9.

#2...rarely are we able to get prn orders for that ativan...Side rails up is not always the norm..then these people still need monitored.

#3...no Codes are common, However...choking incidents/ himlick (sp) common..and keeps us on our toes...had 3 codes this year

#4...bed, door, IV, Feeding pump alarms..not as bad as acute..but some days I go home and my head is spinning and ears ringing

#5..My 2 cents...All facilities are different.

#6...I'm coming to your facility...so I can yawn and sit back because right now I'm busting my butt!

We've had 10 admits and 8 discharges this month! Many on days and eves..quite a few on the weekend..

Its nice to get orders from one doc :rolleyes: When you can get ahold of them!

southern_rn_brat · Mar 9, 2005

And yet another one:
Admissions and discharges!
The Med Surg floor I worked in as an LVN, clerk, and CNA had discharges/admissions every shift (mostly days and some on PM).
LTC? Our last admission was 3-4 months ago? Discharge? 1 resident a month ago.
LTC and Acute care are as different as night and day.
CNA's?
CNA's in convalescent hospitals worked there butts off with them Hoyer lifts, while PCA's in Acute think taking vitals every 4 hours is hard.

In my facility we admit at least 10-15 new patients A WEEK! To do that...we discharge just as many! We have a great, great, great therapy staff and their #1 goal is to rehab them and get them back home! I have been at this facility for over a year now and have had only 3 deaths, and 2 of those were on the long term care side, only one was a skilled patient.

Admissions in LTC SNF are a NIGHTMARE too! It takes me about 2 hours to completely get one finished, by the time I write out the physicians orders, write out the mars, get the patient AND THE FAMILY oriented to our facility and their room, then do the assessment and chart the million assessment papers that we are required to chart...like the falls assessment, braden scale, 10 page nursing assessment, initial care plan..etc., find out the foods they like, mark all their laundry, unpack all their clothes, and then get them settled in the bed for a rest because not long after they are admitted therapy will be there to take them for their assessment!

All my CNAs have to worry about is a hoyer? The lifts we use now are not hoyers and they are really good for patient and staff. I spent 30 minutes talking with a patient the other night because she was in tears because she is overweight and was embarrassed. I showed her how I can help her to the bathroom by myself when I use the lift. When I left the room, she was no longer crying! THATS what made me remember what I went into nursing for.

My CNAs are used to having to get vitals q4hours if I ask them too. We have a much more acute type of patient in LTC now than when I started 12 years ago. Your description sounds like it was way back then, it is definitely not how it is now.

I have worked both LTC AND med surg in a hospital. When I started med surg and they told me I would have 6 patients I thought I had died and gone to heaven:p . Don't get me wrong, I did work hard there....but I work much harder in LTC!

Yes, we have major staffing problems. I don't understand administrative decisions about that and it is country wide. It makes no sense to me. I have no power over that except to express my opinion, which I do often to him:chuckle .

Those 6 patients I took care of in the hospital? They were mostly patients that had been sent from nursing homes. Imagine having 20 of those patients at once.

I have SUCH a great respect for my DON. Bless her heart I don't know how or why she does her job. I've also seen her work all day and THEN come out on the floor and pass pills, do rounds as a CNA, feed people and WORK IN THE KITCHEN.

sorry for getting sidetracked here, I am very passionate about LTC and very defensive of it as well.

Why go into LTC? Because I have THE BEST PATIENTS IN THE WORLD!!!! :)

CapeCodMermaid, RN · Mar 9, 2005

1) An old guy is just ONE Person. You work acute, a majority of the patients will be bugging you left and right (half of them are on PCA's already). And guess what? You'll be bugging the doctors too for pain orders
2) You're supposed to monitor them after you give them anything that puts them at risk for falling AND THEY SHOULD BE IN BED WITH THE SIDE RAILS UP after giving Ativan.
3) Not as much as ICU and Med Surg. I've work for years in LONG TERM CARE and I've only heard/been involved in codes 3-4 X. I've worked 8 years in Med Surg and intensive care and there's always a code every week practically. I've also placed deceased pt's in the local hospital morgues more than a dozen times.
4) You forgot Telemetry machines. Do the ratio. Who do you think uses the most beeping machines? Acute or LTC?
5) Just $0.02
6) Really? I just yawn half the time showing up for work and the only changes I see are....*thinking* ...

Glad you don't work for me.

I have a 41 bed sub-acute unit....1 guy??? that'd be a pleasure. Have had 20 new patients in a week and they ALL want something different

Hello...NOT allowed to put 2 siderails up at LTC...ever hear of restraints?

Hmmmm....41 patients...6 gtubes, 5 IV's, 12 bed alarms, 27 chair alarms...you tell me...who uses more?

I"ve worked med/surg. If a patient goes bad...reach your hand out and you'll bump into 4 other nurses and God knows how many doctors who will respond because they work "acute" care. If my patient goes bad, it's ME they have to rely on because of docs with attitudes like your's who take too darned long to call back.

germain · Mar 10, 2005

There are different levels of nursing homes, right? From "Its almost assisted living" to " its almost the hopital" I think we all know the acuity is going UP everywhere. I never doubt that it takes skill to work LTC! What I want to know is if I will find a supportive environment to work in, anywhere, ever. Seems like yes, but I have to look hard.

I hope so, because I love this population and want to make a difference.

Antikigirl, ASN, RN · Mar 11, 2005

I agree with you there big time, my assisted living facility has become more SNF with only one nurse per shift! The ones that keep coming in are getting more complex by the day, and I fear that I am not able to provide for so many on my own (our facility is HUGE...average 140-160 residents!!! CNA's do all med pass and direct care).

With this trend that seems pretty universal in geriatrics as people are living longer lives I fear that some very serious steps must be in place to really define these types of care facilities and qualifications for admissions be much stricter than they are now! My facility...a nurse really doesn't do much as far as assessment for qualification...managment does, so many times a patient comes in and are far more needy than assisted living can provide! But once they move in...well, they are not likely to leave till they pass (families like the facility and want 'mom' or 'dad' to stay there come what may..and the managment has no probelm with that *cha ching!*).