Don't feel sorry for me because I work in long term care...

[rose-n-arrows]

I love working in long term care. In nursing school, LTC was touted as being the least desirable job in nursing. Instructors warned students that assessment skills would be lost and future employment opportunities outside of LTC would be nil.

When I proudly attained my first job as an RN, I was surprised at how many people, (lay persons as well as healthcare workers) responded apologetically when I told them my job was at a LTC/SNF. "Everybody has to start somewhere", and "You'll find something better, don't worry" were the typical comments, instead of "Congratulations!".

After two-plus years in LTC, I still love it. While each day presents challenges, each day also brings joyous rewards. I am surrounded by people who have made amazing contributions to society throughout a lifetime. Their generation worked hard to help build our country into a land of promise. There are so many who sacrificed. Brilliant men and women from every walk of life. Women who stepped way outside of societal norms of the day to pursue master's and doctorate degrees. Men with full-ride scholarships who gave up that opportunity to serve in the armed forces. Talented authors, actors, musicians, engineers. The list is endless.

So here they are. These amazing people who have given so much and lived so much and their greatest joy is that I greet them with a smile and a gentle touch on the shoulder and give them a few minutes out of my day. I am humbled to be among such greatness.

I am a registered nurse. I choose to work in this specialty. I applaud all nurses in their chosen specialties. Be proud!

By the way~my assessment skills are just fine!

[nicernurse1]

LTC where I work is Acute, we try our best to treat them here ..now if they are really critical we send the to Hospital for further evaluation! I love working with elderly, some days are happy and easy other days are hectic and sad! Now working on Dementia floor can get really crazy, thank God we get some in services on how to deal with stress in this kind of setting!

[rose-n-arrows]

I have spoken to my former instructors about what my job entails. They have given me their blessings to share my experiences with current nursing students. They can't speak from experience regarding the role of a nurse in a SNF/LTC in today's health care system. They recognize that patients are discharged from the hospital far earlier than in years past and know that the patients aren't ready to be released to home, but they missed the piece where they come to us. We get patients straight from the ICU-bypassing Med-Surg entirely. It's not necessarily the best option for the patient, but health insurance being what it is, it has become the trend. We are expected to deal with very acute patients without the benefit of a doctor in the building. Our medical director comes in twice a week and is reachable by phone most of the time, but we must pay close attention to the subtle nuances in behavior that cue us to major problems brewing. It can be very intense at times. The level of intensity is matched, however, by the laughter and singing and general amusement one enjoys on a daily basis.

[xoemmylouox, ASN, RN]

I don't feel sorry for you. It takes a special Nurse to thrive in LTC. I think some of the success depends on the team at the LTC. Where there is a good team that want to provide good care residents fare better than in the places where staff is miserable. Good luck with your continued career in LTC.

[JBMmom, MSN, NP]

When I was in nursing school LTC was the last place I thought I wanted to be as well. I ended up taking a part time position for my first RN job and now I'm not sure I see myself going anywhere else. I've also had former classmates give me their sympathy when I tell them where I work. I'm old enough that I don't feel the need to do the "I'm not as much of a nurse as....", but I feel for all those that are affected by these attitudes. I'm not saying one is harder or easier, but I'm sure there are many hospital nurses that couldn't handle my 30 resident med pass. Maybe I don't have the acuity they do, but they don't have the relationships that I do. I'm making sure that my residents spend their last days with peace, comfort and dignity, that's what matters to me. I wish you a long and successful career.

[Concerto_in_C, BSN, RN]

We get patients straight from the ICU-bypassing Med-Surg entirely. It's not necessarily the best option for the patient, but health insurance being what it is, it has become the trend. We are expected to deal with very acute patients without the benefit of a doctor in the building. Our medical director comes in twice a week and is reachable by phone most of the time, but we must pay close attention to the subtle nuances in behavior that cue us to major problems brewing. It can be very intense at times.

Agreed 100% and this is the reason I will no longer work in LTC because those places take advantage of the nursing staff. The one where I used to work was trying to operate like a general medical floor in a hospital, except as you describe there is zero support for the nurse. There are telephone orders from the physician. However, by the time you make the phone call the patient is very acutely ill.

If we are going to play this game of an imaginary hospital in a nursing home then I may as well make it easier on myself and transfer to a real hospital. I did, and I found out the patient acuity was similar, except now I had an extensive support system with surgeons, hospitalists, medical students, therapists, etc. all rounding on the patient and giving competent care, with emphasis on competence.

[Vernie08]

Agreed 100% and this is the reason I will no longer work in LTC because those places take advantage of the nursing staff. The one where I used to work was trying to operate like a general medical floor in a hospital, except as you describe there is zero support for the nurse. There are telephone orders from the physician. However, by the time you make the phone call the patient is very acutely ill.

If we are going to play this game of an imaginary hospital in a nursing home then I may as well make it easier on myself and transfer to a real hospital. I did, and I found out the patient acuity was similar, except now I had an extensive support system with surgeons, hospitalists, medical students, therapists, etc. all rounding on the patient and giving competent care, with emphasis on competence.

I don't feel sorry for you but i do admire you for being able to work in those conditions in which you described. I did LTC-SNF for five years and got out as soon as the opportunity came. It was too unsafe. With no support system and a high nurse patient ratio it was very scary to have these acutely ill lives in my hands.

[Concerto_in_C, BSN, RN]

I don't feel sorry for you but i do admire you for being able to work in those conditions in which you described. I did LTC-SNF for five years and got out as soon as the opportunity came. It was too unsafe. With no support system and a high nurse patient ratio it was very scary to have these acutely ill lives in my hands.

The nursing home industry is a predatory industry that usually hides behind the facade of a "Christian ministry". What kind of Christians are they if they work their staff like draft oxen? They invest a fortune in decorating their church/chapel, but they don't pay their nurses a shift differential for working nights. Sad. Nuff said.

[Ruby Vee, BSN]

The nursing home industry is a predatory industry that usually hides behind the facade of a "Christian ministry". What kind of Christians are they if they work their staff like draft oxen? They invest a fortune in decorating their church/chapel, but they don't pay their nurses a shift differential for working nights. Sad. Nuff said.

Huh?

Granted, my experience with LTC is limited to having a mother, a godmother and a mother-in-law IN long term care, but I don't recall any Christian ministries (or facades) when we were seeking placement. Only one of the LTCs I've been to visit even HAD a chapel and that was a nondenominational chapel, used by visiting priests and ministers of every flavor.

[GARY_FL_NURSE]

I've been in LTC for 12+ years and have never regretted it. I like working in Geriatrics. So what if I don't use all the "skills" hospital nurses use. I still earn a good salary and I still feel good about my work with senior citizens. Some of the most amazing things I have learned over the years have come from senior citizens. Plus in LTC I get to really know my patients and have them as patients most times for a long time.

Hospital nurses serve a vital function in medicine and so do nurses in LTC.

[LadyFree28, BSN, LPN, RN]

Ditto that. It's my assessment skills that saves lives. First day off orientation I sent my resident (who was in for rehab) to the ER and it turned out he had a PE. With my assessment skills I notify the MD and report my findings. For example, the x-ray order that we nurses obtain from the MD because we suspect pneumonia and the following antibiotic therapy that gets started. Losing assessment skills....pffft.[/quote']

Similar story; sent out one pt one week found new onset cancer; next week sent another resident out with new onset A-Fib.

My assessment skills are JUST fine...never better!

[chavezm1109]

I feel exactly the same way. I have been working at a SNF for 3 months. I am a new grad. I enjoyed LTC during clinical but I had a hard time with death and didn't think I could handle it. I originally only took this job bc my husband and I needed the money. However I love it. I have am amazing supervisor. I love my patients and even after a rough day I love knowing I made a difference.

[generalRN2008]

Med surg and SNF are not highly regarded is society but highly needed.