The Cons of Working in Long Term Care - page 3
by TheCommuter 4,582 Views | 23 Comments Senior Moderator
I worked as a floor nurse and supervisor in long term care (a.k.a. LTC, nursing homes, or aged care) on and off for six years. Last year I wrote two articles that placed a mostly positive spin on working in the LTC industry. This... Read More
- 0Dec 6, '13 by pinkiepinkPNQuote from TheCommuterTrue, but we have to recognize that this is not the fault of the newly graduated nurse. I graduated from a 9 month PN program in May and just started my first job a few weeks ago (I had major surgery in July and had to delay job hunting for awhile)...and yeah. I feel pretty clueless and do wish my program had been longer. Sometimes I honestly feel like I have forgotten everything I killed myself to learn, but I am fortunate to work with several LPNs and RNs who are really encouraging and don't treat me like some imbecile when I ask a question, even if it's something I really 'should' know. But you know what? I'm continuing my education because I want to keep learning and expand my abilities...and if someone were ever to call me incompetent, all I can do is realize they don't know me and how fast I really do pick things up when someone is genuinely interested in teaching me.Keep in mind that the particular nurse you're quoting has 35 years of experience. She entered the profession during a time when most nurses graduated from three-year diploma programs. Back in her day, new nurses graduated highly skilled, with thousands of clinical hours under their belts, and were able to hit the floor running at their new jobs without much orientation or training. So in her eyes, today's crop of new grads does seem incompetent compared to the new nurses of 35+ years ago.
People have a way of living up to other people's expectations. The more experienced nurses we have calling new nurses "incompetent", the more "incompetent" nurses there will be.
- 0Dec 6, '13 by mso819People have a way of living up to other people's expectations. The more experienced nurses we have calling new nurses "incompetent", the more "incompetent" nurses there will be.[/QUOTE]
Great point and well said. I do also agree that the new grads today are not being taught what needs to be taught, but thatd not to go for ALL new grads. There really are some new grads who are ready to dig in and get there hands dirty. Then again there are some that is not.
- 0Dec 6, '13 by bluegeegoo2Quote from Chris81In my schooling experience, that was exactly what we were taught: What we needed to pass NCLEX. That's all I heard about. Sure we did "check offs" for skills and such. But who couldn't run a 16f cath into a 24f opening on a dummy? Of course we had to verbalize and at times mime the steps to perform the check off, but c'mon. I graduated without having the opportunity to cath one single human being. Nor did I get to start an IV, or any other handy-dandy nursing skills. I had to learn them on the fly as some poor soul's charge nurse. I felt woefully under prepared to begin to practice nursing. But, hey, I passed the NCLEX. Guess my college gets to add me to their "pass rate" percentage.My use of the word incompetence arises from the basic floor- nursing checklist for skills all nurses are expected to perform,sometimes on an hourly basis,sometimes once every 5 years(vital signs to how you hang TPN&lipids,with a long running IV-ABX). I have been assigned RN students who were very enthusiastic and eager to put their hands on a patient,and the equiptment needed to perform a task and it was a joy to watch them deconstruct a task I had long ago integrated. New nurses I elevated to a higher level,as as evidenced by their graduation and passing NCLEX demonstrated their mastery of content,but to my surprise were unprepared to perform those skills that were maybe done once in a nursing lab. At first I thought they were kidding,no-really,I thought they were just trying to blow my mind. After the first few orientees I came to accept the fact that no,they had never inserted a foley catheter into a male pt.,did not know how to obtain a BP on a female c a complete mastectomy on one side and IVs on the other,or how to transfer a pt.c a CVA. Having worked in a facility that liked to "grow our own" nurses,I worked side by side c CNAs who went onto to school with the intention to return to LTC(yay!),so I heard from them throughout school about what they were not being taught. As The Commuter as sagely noted,nurses graduated from school with all kinds of floor experience,volunteering for procedures big and small,embracing any opportunity to DO something. I fear the nurses of the past decade have been educated to pass NCLEX only. Most environments require competencies be demonstrated yearly by staff nurses,and we expect those newly minted nurses to do it best!-no shortcuts,every step textbook. I've reset my expectations and realize that when I'm orientating a new nurse,I'll be showing you HOW to apply everything you've read,studied and tested on. No insult intended,just disappointment expressed.
- 0Dec 6, '13 by pinkiepinkPNQuote from bluegeegoo2I hate to hit quote every time but I can't seem to find just a 'reply' mode on my phone! Oh wells.In my schooling experience, that was exactly what we were taught: What we needed to pass NCLEX. That's all I heard about. Sure we did "check offs" for skills and such. But who couldn't run a 16f cath into a 24f opening on a dummy? Of course we had to verbalize and at times mime the steps to perform the check off, but c'mon. I graduated without having the opportunity to cath one single human being. Nor did I get to start an IV, or any other handy-dandy nursing skills. I had to learn them on the fly as some poor soul's charge nurse. I felt woefully under prepared to begin to practice nursing. But, hey, I passed the NCLEX. Guess my college gets to add me to their "pass rate" percentage.
Anyway, what you said about nclex is spot on. My school boasts a 100% pass rate (until his year actually- one of my classmates failed but passed the second time) for all three programs for the last 5 years. It IS all about nclex. Every day, every class, embedded in lecture power points were "nclex style questions" and the school even hired us a specialized nclex consultant that coached us in sessions lasting a week. Yeah, they want you to pass.
I as well graduated without getting to do many skills in clinical or do them many times. I didn't do a foley until my very LAST clinical day, and that was on a laboring woman with an epidural. In all the nursing homes we went to, only the night shift does them! Only got to start an IV on a classmate in a covert setting, and only got my hands on a whole list of other skills in lab at school. I just did not get a lot of great opportunities in clinical and trust me it wasn't from lack of looking. We has BSN mentor students trolling the halls in search of IVs, catheters, dig stim, ANYTHING! it was just luck of the draw most times. Heck...I had a rotation with hospice once, and was really looking forward to participating in comfort care and learning the flow of hospice. Guess what I did instead? Sat in the social workers office for 8 hours and watched her type on her laptop! She wasn't even going out on visits that day!!!
But i do refuse to believe that I learned nothing, and when the opportunity comes along at work to do something I only watched once in lab, I'm gonna be honest in saying "I never did that before and need you to show me how" to one of the veteran nurses. No way am I gonna fake my way through something just so I don't look "incompetent." That's advocating for myself AND my patients...a truly incompetent person wouldn't ask for help when they really need it!