Long Term Care Nursing is Lame

[purplegal]

Having worked in a long term/short-term rehab facility combination for a year now, I have to say that in comparison to other areas of nursing, it's pretty lame.

Yes, we work hard. We have 20 or more patients on our own who require medications. Sometimes they'll have tube feedings, ostomies, JP drains, etc. There are many wounds, blood sugars, bladder scans and emergent situations aren't as rare as you would think. No one is denying people at these facilities work hard.

At the same time, when looking at other areas of nursing, including ICU and ER, it's safe to say we don't really do as much for these patients as these incredible nurses do. For example, I am highly impressed with a cardiovascular surgical ICU in my town, one of the best in the nation. These nurses see and do EVERYTHING. Skills include Skills include TPM, PPM, Chest reopening, chest tubes, trach, PEG, JP, NG/OG, pigtail cat, extubation, sedation, CT/MRI, Bronchoscopy, line placement, cortrac, IR, specimen collection, medications including inotrops, vasoactive, blood administration, insulin, heparin, CPN/lipids, paraltyics, and lines such as arterial lines, Cordis/STCVC, pAC, TDC, TPM wires, PICC, non-VAT blood draws, CRRT, Flexiseal, and pumps including PCA, Medication and Tube Feeding. They have LVADs, ECMO machines and take care of ALL ages from the newborn to the elderly. The MICU is also quite an impressive area, as are all the other ICUS. Plus, you can't beat the top notch nurses in the ER.

Sorry everyone but it's true...there's a reason why long term care nurses/rehab nurses are paid less than others.

[madareebrahim]

Im a Cardiac RN in a busy level 1 trauma hospital on weekend program and i just was offered and accepted a casual 1x night q wewk position in a SNF as i want to expand my skills and experience another form of Nursing which isnt hospital based. Grass isnt always greener... ALL nursing matters... be proud of your experience!

What you (and all LTC nurses) do is impressive. And it makes a difference for all the residents you take care of. Even if you move on to critical care or another specialty, you should feel proud of what you did in LTC. I was a CNA in LTC prior to becoming a nurse, and I understand the challenge. You might not feel like you're making a difference or doing anything special, but believe me...you are.

[amoLucia]

To madaree - welcome to LTC. Hope you'll grow to care for it like the 'regulars' do. It'll be a 'learning experience' for you but you've strong experience.

Some BIG major differences but very doable. Like you said, all nursing matters!

Good luck.

[CapeCodMermaid, RN]

You're lame.... Very lame

[caffeinatednurse, BSN, RN]

I currently work on a short term rehab unit in a LTC facility. Do you know where a majority of my patients discharge from? ICUs, PCUs and trauma care units. That's right, when all of the "impressive" areas of nursing have finished their work, mine starts. I take off the bandages that need to be taken off, change the dressings that need changing, help them remember how to find and use a toilet again, help them learn how to eat independently, and in between I answer the never ending stream of questions about "what's next" and "what happens now." I pass between 80-120 meds during my shift and perform approximately 15 head to toe physical assessments. Then there's the skin assessments, bed baths and treatments. And I catch things, in spite of it all - I catch DVTs in post-op knees, DKA in DM patients, and TIAs in my dementia patient. Not because I have all of the psychomotor skills of a trained ICU nurse, but because I care and I pay attention. I know when they're straying far from their baseline because I work with them over an extended period of time. I think that's pretty impressive.

In any matter, it sounds like you're burnt out in LTC. Do us hardworking, proud nurses in LTC a favor and find another specialty.

FYI to whoever said they didn't understand why a BSN nurse would work in LTC - I've met more BSNs in LTC than I did in my previous hospital job. There's plenty of opportunities for advancement for a BSN in LTC.

[madareebrahim]

Thank you AmoLucia. Im actually thrilled to try it and again...excellent opportunity to learn and experience another type of Nursing!

I begin orientation this week and officially start in 3 weeks!

To madaree - welcome to LTC. Hope you'll grow to care for it like the 'regulars' do. It'll be a 'learning experience' for you but you've strong experience.

Some BIG major differences but very doable. Like you said, all nursing matters!

Good luck.

[madareebrahim]

THIS is why im so keen to try LTC or SNF Nursing on the side. It requires such a diverse range of skills and experience! One major downside to working in a speciality in the Acute or Critical cate setting like I do is one gets pidgeon holed and even kind of "bored" because we see the sane things so frequently that anything different is thrilling and a great excuse to learn and grow... i.e. last night i got a young pt woth a botched gastric bypass...had no idea..but i quickly got up to speed. It was refreshing... ergo...working LTC or SNF Nursing is nothing to be ashamed of!

I currently work on a short term rehab unit in a LTC facility. Do you know where a majority of my patients discharge from? ICUs, PCUs and trauma care units. That's right, when all of the "impressive" areas of nursing have finished their work, mine starts. I take off the bandages that need to be taken off, change the dressings that need changing, help them remember how to find and use a toilet again, help them learn how to eat independently, and in between I answer the never ending stream of questions about "what's next" and "what happens now." I pass between 80-120 meds during my shift and perform approximately 15 head to toe physical assessments. Then there's the skin assessments, bed baths and treatments. And I catch things, in spite of it all - I catch DVTs in post-op knees, DKA in DM patients, and TIAs in my dementia patient. Not because I have all of the psychomotor skills of a trained ICU nurse, but because I care and I pay attention. I know when they're straying far from their baseline because I work with them over an extended period of time. I think that's pretty impressive.

In any matter, it sounds like you're burnt out in LTC. Do us hardworking, proud nurses in LTC a favor and find another specialty.

FYI to whoever said they didn't understand why a BSN nurse would work in LTC - I've met more BSNs in LTC than I did in my previous hospital job. There's plenty of opportunities for advancement for a BSN in LTC.

[klmartin08]

First thank you kindly for the insult. I've worked long term care for 5 years now and it is challenging.

We work in an environment that is long term and difficult. You make actual bonds with you patients and this can be one of the most brutal situations when the end comes.

Also, we have to be able to notice and intervene when things are going wrong for a patient without the incredible amount of resources of a hospital.

We also handle a huge amount of responsibility at work, I've had 50 patients I was responsible for during a shift. QMAs are amazing but not nurses.

I've learned more about wound vacs, peritoneal dialysis, and wound care than a number of my hospital nurse friends. They're often impressed with my abilities in areas they would call in a team to handle.

I cannot believe you are arrogant enough to post something like this. I am rather new to this site and don't post often, but this really touched a nerve. If you don't have any pride in your work or respect for your peers, keep it to yourself please.

[kbrn2002, ADN, RN]

I just don't understand the compulsion some nurses have to insult the career paths of other nurses. I work in LTC by choice and I don't feel the need to go into a lengthy post explaining why what I do is so important. I have a valuable and varied skill set, but so does the ICU nurse, so does the ED nurse, so does the clinic nurse, or the med-surg nurse, or the dialysis nurse, or the school nurse, etc. etc. etc. That is the beauty of nursing, we all do the same basic thing in so many different ways. If you don't like your path, just choose another.

[cecile9155, BSN, RN]

Where I live I am paid MORE at the LTC/rehab facility I work at than I would be at a hospital. I remember your previous posts. Clearly you still have a lot of growing up to do.

[Neats, BSN]

I have worked Med/Surg, Flight nurse training, US Army nurse (sick call office work), correctional nursing (mostly sick call and administration) and LTC. I am also a LNHA.

Anatomy and Physiology is similar anywhere you go (higher altitudes heart shifts to middle of chest). I have found a lot of people who do not like LTC, I happen to love it. Diversity in our field do not make us less of a nurse each specialty comes with a skill set that is similar that we either like or not. I am no better than a cardiac nurse nor is that cardiac nurse better than me. I still have to have my assessment skills, know how to administer medication, know how to start IV's, know how to take care of wounds, change dressings...the pay sucks for LTC not because we are less of a nurse but because of government reimbursement in general and people like the ones who assume I do not know what I am doing. We do have to do better as LTC nurses to stand together and really promote our specialty.

[kjsoncnurse]

I'm an ICU nurse who works as a skilled nurse in a nursing home. I love both and LTC keeps me busier than the unit does. Wanna know what's lame? The nurse who belittles specialties that aren't "heroic" enough for them.

And by the way. Patients can go bad in a nursing home just as quick as one in a unit. Nurses in LTC have to think on their feet. Just like unit nurses do. Just like med-surg, dialysis, School nurse, etc.

[caffeinatednurse, BSN, RN]

Where I live I am paid MORE at the LTC/rehab facility I work at than I would be at a hospital.

Same here. When I started LTC/rehab, I got a raise. Plus, my facility isn't afraid to pay me for my OT, whereas the hospital I worked at expected me to clock out and chart.