Long Term Care Nursing is Lame

Specialties Geriatric

Published

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.

Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF.
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!

You will see everything (and I do mean everything) in short term rehab units, especially if they're part of a larger LTC community or retirement community - after all, these people want to come back to their home to recover, no matter what has happened to them or what stage of their life they're at. I've had victims of MVA who spent weeks on a trauma care unit, patients who discharged from a neuro unit post-craniotomy, patients who are post-pacemaker insertion, and of course many fractures (hip, knee, shoulder, etc. post-fall). More often than not, it's not just one issue - they've got CKD, CHF, and COPD. Foleys, nephrostomy tubes, wound vacs, PICC lines, and IVs are not uncommon. Many are opioid dependent. Then I get the occasional pt w/cancer that declines and we end up providing ATC comfort care (which is not a bad thing, but it gives you an idea of how quickly we have to switch our priorities and change gears). The assessment skills stay the same, you just arguably use them more often for a larger group of patients. You also have considerably less resources than in a hospital. I am my own treatment nurse, wound care nurse, RT, and IV team. :nurse:

You will get some mad time management skills though, and you will learn to do more with less, and to rely on basic assessment skills and gut instincts - all very valuable skills that will help you no matter what area of nursing you work in. :yes:

Specializes in BNAT instructor, ICU, Hospice,triage.

I was an ICU nurse for 12 years, med-surg nurse for 7 years, hospice nurse for 5 years. I believe that the ideology and concepts of ICU are futile and unnecessary treatments that hurt people. There are worse things than death. I do not believe in these expensive treatments to torture people. I am glad that it opened my eyes, but I think LTC nurses are the bomb. ICU, cardiac crapola crap, not so much.... I have never worked LTC because I do not have enough courage. You gals are amazing and awesome to the core.

Actually I totally understand a bit where you are coming from, OP. I won't sit here and say that I wasn't a bit upset about the title, but I get you. I have been in ltc ever since I started this career when I was 19 and someone drove me to a local nursing home and said "get a job there" (didn't know a thins about nursing homes and absolutely no nurse aide training in the late 70's. While doing the nurse aide work I tried to go to the local RN program. (and kept failing not because I couldn't do the college work but due to multiple reasons mainly my difficulty with family issues. I thought as I started watching some of those LVN's that I could at least do what they did. (Didnt' look to me that they did anything but pass a few pills, and sit at the desk or back in the smoking area doing a bit of charting. Didn't look like much was going on. I was very naïve and have since learned just how much those nurses did and how smart most of them were.

Long story short, I aced lvn school and started this long journey of working in ltc. I tried working agency , home health and other things and dabbled in thinking one day I would get my RN and be that great nurse that others look up to

I always thought tho that I wasn't smart enough, good enough to do it tho. Was always too scared to do it.

I always go back to ltc and since 1988, have pretty much worked ltc only and I know now at this age that this is ok, that this is what I do.

The older ones become a part of my heart, a part of my life that I am so glad to have gotten to know 99 percent of them

Yes we do more now in nursing homes than we used to do.

A part of me still is afraid that I don't know enough to do what is required of me, (thank goodness for allnurses and youtube , lol. My brain or something in me always says I'm too stupid to know how to do that. \

My point maybe is this. Don't keep doing it if you don't want to and can get that other job you stated you wanted. It is totally ok to do that..

Maybe my point is that ( I think ) that you are young enough to know that you want to go out there and do something else and perhaps are afraid you aren't good enough. You probably are. ( I don't really know as I have only read your posts here.

And if for some reason you stay in ltc or have to stay there cos there may really not be other jobs in your area ,it is ok not to like it (just don't show it)It's ok to keep trying to do something else. And frankly a little bit of it is lame. Now I might get someone upset, but seriously the charting is routine mostly. I have probable killed a couple of forests in my lifetime as a ltc nurse due to all the paperwork, and really how many places do you have to sign out a narc................sigh. yes sometimes it is. Sometimes all you can do is groan.....and then put on a mostly happy face and go on and do what you have to do.

A part of me has wanted to reach out to you since you first wrote here and I hope I have helped you a little bit.

ok I rambled enough. Just wanted you to know that someone understands you and that someone has been around a very long time.

Actually I totally understand a bit where you are coming from, OP. I won't sit here and say that I wasn't a bit upset about the title, but I get you. I have been in ltc ever since I started this career when I was 19 and someone drove me to a local nursing home and said "get a job there" (didn't know a thins about nursing homes and absolutely no nurse aide training in the late 70's. While doing the nurse aide work I tried to go to the local RN program. (and kept failing not because I couldn't do the college work but due to multiple reasons mainly my difficulty with family issues. I thought as I started watching some of those LVN's that I could at least do what they did. (Didnt' look to me that they did anything but pass a few pills, and sit at the desk or back in the smoking area doing a bit of charting. Didn't look like much was going on. I was very naïve and have since learned just how much those nurses did and how smart most of them were.

Long story short, I aced lvn school and started this long journey of working in ltc. I tried working agency , home health and other things and dabbled in thinking one day I would get my RN and be that great nurse that others look up to

I always thought tho that I wasn't smart enough, good enough to do it tho. Was always too scared to do it.

I always go back to ltc and since 1988, have pretty much worked ltc only and I know now at this age that this is ok, that this is what I do.

The older ones become a part of my heart, a part of my life that I am so glad to have gotten to know 99 percent of them

Yes we do more now in nursing homes than we used to do.

A part of me still is afraid that I don't know enough to do what is required of me, (thank goodness for allnurses and youtube , lol. My brain or something in me always says I'm too stupid to know how to do that. \

My point maybe is this. Don't keep doing it if you don't want to and can get that other job you stated you wanted. It is totally ok to do that..

Maybe my point is that ( I think ) that you are young enough to know that you want to go out there and do something else and perhaps are afraid you aren't good enough. You probably are. ( I don't really know as I have only read your posts here.

And if for some reason you stay in ltc or have to stay there cos there may really not be other jobs in your area ,it is ok not to like it (just don't show it)It's ok to keep trying to do something else. And frankly a little bit of it is lame. Now I might get someone upset, but seriously the charting is routine mostly. I have probable killed a couple of forests in my lifetime as a ltc nurse due to all the paperwork, and really how many places do you have to sign out a narc................sigh. yes sometimes it is. Sometimes all you can do is groan.....and then put on a mostly happy face and go on and do what you have to do.

A part of me has wanted to reach out to you since you first wrote here and I hope I have helped you a little bit.

ok I rambled enough. Just wanted you to know that someone understands you and that someone has been around a very long time.

Yeah, I probably won't continue this kind of work forever, since, still after a year, I am not content with the job I have. Actually, there are many days that I'm angry I have to go work there, so I'm thinking that's a sign it's not what I should be doing. I hate to admit that I probably don't go above and beyond the way I should because I resent being there. I'm constantly looking at the clock and waiting for my relief at the end of my shift, instead of making sure that I have given my all. Which isn't right, since I'm dealing with people who need help just like any other patient, and who will receive the best help from those who want to be there for them.

At this point, I know I'm still not at the level of nursing that they need for the floor I mentioned in my first post. It's possible and likely that I won't be ready for years. I may never be ready. It's possible I'm not meant to be an ICU nurse, no matter how much I would like to be. Also, I feel like the position I would like would be extremely difficult to get, given my past. However, at this point, I do feel ready for a change. I do feel like I could handle a slightly more challenging area of nursing than what I am doing right now. Now, I just have to decide what my new challenge is, and pick an opportunity that is realistic for this point in my career.

Let me preface this by saying that I know nothing... Less than nothing; I'm a pre-nursing student slated to start a BSN program in the fall.

I have a lot of options, I've run a small business for over a decade and have clients all over the world. I love what I do... but I'm starting a second career in nursing very specifically because I want to work in gerontology and be there to care for the moms and dads and grandmas and grandpas and elders with no family left to call them precious.

Maybe it's not the sexiest of paths, but I believe I've been called to it. I sincerely hope you are able to move on to something that suits you better, because it sure sounds like your patients aren't getting the best that you have to give.

I hope with deep sincerity that I can some day be the kind of nurse that people trust with the long term care of their oldsters, the kind of nurse I want looking after my precious old ones.

Deleting for irrelevance!

Specializes in med-surg 5 years geriatrics 12 years.
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.

One big difference you overlook....those nurses in prestigious jobs have physicians, specialists, available within minutes. LTC nurses don't have that luxury...you had better know what you are seeing and know what to do right away. Not everyone can do what you do. I have been both med-surg and LTC and know that to be very true.

Specializes in SICU, trauma, neuro.
I'm starting a second career in nursing very specifically because I want to work in gerontology and be there to care for the moms and dads and grandmas and grandpas and elders with no family left to call them precious. [/Quote]

Sorry to get off topic... becoming a geriatric RN is a very admirable goal. :yes: That said, I would caution you against the notion that their families have abandoned them. Sure you'll have *some* residents who never get visitors, and it is heartbreaking. But most families don't take this decision lightly.

Two of my grandparents went into LTC.

My paternal Grandma had severe dementia, and was a wanderer. If she was awake, she was walking. During family get togethers, we'd take turns just walking with her to make sure she was safe. Her husband of 30 years cared for her at home, with the aid of an adult day program and her kids, who would take her out to lunch or for walks. He installed some bells from the lintel of their doorway, so if she got up in the night the bells would wake Grandpa.

But he was 85 yrs old and didn't get around too fast, having multiple joint replacements...and her wandering behavior was escalating. For her safety, her family made the difficult decision to place her in a memory care home.

My maternal Grandpa had been extremely healthy and strong. The son of Danish farmers, he was living in the very house he was born in, and had continued to run the farm into his 70s!

When he was 102 years old however, he had taken a couple of falls. He subsequently had multiple bouts of pneumonia and acute kidney injuries, and never recovered his strength. He was a tall, broad man, and his family could NOT safely transfer him.

His mechanically gifted son-in-law outfitted an old van with wheelchair accessibility, and would bring him home for Sunday dinner every week. He only missed it for hospitalizations. My kids were heartbroken when he died. My then-8-yr-old son, between sobs said "That's the saddest news I've ever gotten!" My then-5-yr-old daughter -- now 10 yrs old -- still sometime cries for him. This past year she wrote a story about him. The final line read: "even though he's dead, he will always be my great-grandpa, and I will never forget him."

They were definitely well-loved! :)

Specializes in OR, Nursing Professional Development.

Thank you, Here.I.Stand! So many misconceptions about those who are in LTC facilities. My family did our best to keep my grandparents in their home for as long as possible. When it was just Grandma with major health issues, it was doable with overnight PDN and family providing care during the day. But when Grandpa, who was already dealing with significant Parkinson's, had a little run in with the sheep buck and broke his hip, we had to move to 24 hour PDN. Then, Grandma succumbed to her CHF, and Grandpa's Parkinson's became very severe, to the point he didn't recognize family and was extremely combative. Home care couldn't provide what he needed and family wasn't able to keep up with his medical needs, and we had no choice but to place him in a structured care environment, where Parkinson's and old age claimed him a few months later.

Then, there's the other type of LTC residents whose families don't visit due to their own faults. In college, I worked in the same LTC where my grandfather would eventually reside. We had an interesting resident who would often try to pinch female employees' rear ends or breasts. He never had any visitors. It eventually came out that he had continuously molested his daughters while they were young- I certainly can't blame them for choosing not to visit and to pretty much cut him out of their lives.

Specializes in LTC, Rehab.

Just as with almost anything else in life, there's a wide spectrum of reasons as to why someone is in a nursing home, but yes, they certainly all don't fall into the 'abandoned' category. Similar to one of Here.I.Stand's examples, I had an aunt who had Alzheimer's, who was dearly loved and cared for by my uncle. But as he told me, after he put her in an Alzheimer's-only facility, he'd taken a nap one day, and she'd gone out the door and walked down the street, and she probably didn't get lost only because someone who happened to know her and her situation saw her and brought her back home. As he said, 'I can't stay awake 24 hours'.

To each their own... everyone has their "thing". I love long term care. I'm intrigued by critical care and emergency work, however long term care is where my heart is. And as for them getting paid more... sorry to say, I make more working in a nursing home than friends working in ICU and post-crit in hospitals in surrounding larger cities (significantly more). I take much pride in caring for our community's elderly. Our jobs may be "TAMER" but they most definitely are not not LAME.

I'll confess that LTC wasn't my first choice (AD RN here, working on my BSN), and I will grant that it is predictable, it can be boring on some days, upward mobility is limited unless you want to be a manager (no thank you!) and I am constantly keeping my eyes open for a way out.

But to say LTC is lame stings a little. Reading the comments on this thread, I am reminded of some of the dismissive attitude I have had to endure from acute care nurses when I sometimes have to send my elders to the ER--and as a male nurse, I am shielded from a lot of their condescension!

If you are unhappy now but are limited on prospects, here is what I suggest: if you are so good at your job that you finish your med pass, MDS assessments and clear all of your alerts that your electronic chart flags for your elders, check your facility policy on how to destroy controlled substances. If you as an RN can destroy narcotics with a second nurse to cosign for you, imagine how much time you will save counting narcs! When I started at my current job, I ended up cleaning out almost half of the narcotics that we had on hand since they no longer had orders. Counting narcs at change of shift became a cinch!

Ask yourself if you are implementing the nursing process to your elders' full advantage. A major part of our job as LTC nurses is to optimize our elders' quality of life. For instance do you have an elder who could benefit from a different sized wheelchair? I recently came back from a vacation and had a new admit on my unit who was using a loaner wheelchair from our TCU. It was a standard sized wheelchair, and this gentleman was at least 6'6" tall when standing, also he was on hospice. Poor guy was using that little wheelchair for about four days before I collaborated with hospice to get him a high back wheelchair.

It isn't always about money. That is why we are nurses and not physicians, right? If you aren't feeling challenged at your current job, I invite you to look for opportunities to shine. Your coworkers and your patients will love you for it.

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