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.

[Kooky Korky, BSN, RN]

I'm personally not a fan of when people associate "incredible" nursing with psychomotor skills. Yes, critical care nurses are capable of many great things (I am one), but I will tell you that some of the nurses that I work who are particularly skilled in things such as IV insertion are not necessarily "great" nurses. They are handy to have around if I have a patient who needs IV access, but their soft skills need a lot of work.

I'm teaching clinical at a nursing home right now, and it's interesting to see the differences between critical care and long-term care nursing. After working with the nurses at my clinical site, I've found that they are particularly skilled at providing wound, orthopedic, and dementia care. As a critical care nurse, I too am competent in these areas but I would definitely not consider them my strengths. Our skillsets are very different. Similarly, I HATE that my hospital floats our critical care nurses to med-surg areas. Their specialized skillset becomes very apparent to me when I'm expected to manage a 6-7 patient assignment (our normal ICU ratio is 2 patients to 1 RN). I've never been one to consider that "a nurse is a nurse is a nurse."

It's always been my opinion that nursing excellence is achieved when you have a good balance of things like psychomotor skills, critical thinking, and emotional intelligence in your practice.

Plus some common sense and common courtesy.

[Kooky Korky, BSN, RN]

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.

I dare say that not all physicians become physicians for the money.

[sewersurfin]

I'm certainly impressed by LTC nurses. It's a huge patient load, and a job i could never handle.

[cyc0sys]

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.

Yeah I said that, with the exception of ADON, DON, or the occasional Facility Director, I don't understand why OP would choose LTC with a BSN.

Of course you can work as a floor nurse, MDS, Risk manger etc with a BSN but all of those positions only require an ADN or LPN in some cases.

I'm unaware of any opportunities, outside the previously mentioned, which would provide growth or pay for that level of education in LTC. We do have outside contractors come in on a PRN based to do specialized wound care or diabetic education. They have BSNs but aren't specific to LTC or Geriatrics.

Hospitals in the north eastern US are requiring a BSN for entry level RN.

Please enlighten me on these opportunities. Things must be different here.

[Nkda]

I recently left an ICU step down, critical care telemetry speciality with many of the skills/responsibilities you mentioned. I moved to a rehab hospital. The knowledge and experience I gained has helped me tremendously, and I wouldn't trade my time there for anything because of this. Because of this knowledge, I have been able to transition to a rehab/sometimes med-surg facility with ease and I have opportunities to educate other nurses when acute situations arise. I was hired to be a supervisor because of my job experience, and I'm now actually making more money than I was in the fast-paced acute care setting. I also work "on the floor" with direct patient care when needed also. I might would go back to that skill set one day, but sometimes the experiences can be somewhat traumatic and I found myself becoming too emotionally hardened. Nurses are needed in all specialities, and no nursing specialty is "better" than another...just different. They're all vital to healthcare. No nurse is "too good" for a nursing position. If you feel this way, maybe you should transfer to a high acuity setting?

[Vonique]

I don't see what the point is in insulting other nurses or specialties unless it is just to get a response (however negative) and also attention. At my LTC we do trachs, central lines, and other things seen in ICU and/or MedSurg, plus a million other things. LTC is NOT lame, just different and I love it!

[Florida_nurse1219]

I some how really doubt that you are as good as you think you are... 😕

[foxden1126]

Long Term Care Lame? Define Lame? Geriatric nursing is a gift - as with any specialty area. It took me many years to realized how blessed I was to have this gift. Don't feel bad, we are far and few between. But those of us that have it, well we feel honored to care for His elderly. I hope you find your gifted area soon- it will give you the satisfaction needed to counteract all the workplace garbage our "caring" profession provides.

[QuietIsntAWord]

I work for an upscale assisted living unit and thought the same thing at first. I've been with them for 2 years now and I'm pretty impressed with what I do. I somehow manage to take care of 30 patients AND their families daily. Not only are we dealing with 30 people who are all fall risks but we are med techs and dementia specialists. I think having a son with ADHD prepared me for this position because there's nothing worse than when you are "pouring" natcotics and room 115 is at your med cart asking you for the 50th time if she's gotten her synthroid for the day (which was given 12 hours ago). Anywho, if you wanna degrade what LTC nurses do then go ahead. I love it.

[NFuser]

Purplegal, it intrigues me that - a year into it - you continue to be concerned about the "status" of your position. Or is it your career in general?

IMHO, the "status" of a nursing position - or even as a career choice - is irrelevant. Good LTC nurses do more with less than any other specialty I've ever worked in (my favorite expression is that we've been doing so much for so long with so little that we now feel qualified to do anything with nothing ), and require expert assessment and intervention skills; something learning all the procedures in the world may not necessarily teach. As another poster said, we can make chicken salad out of chicken crap - and do so, every shift. Who needs status when we make magic happen?

[ComeTogether, LPN]

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

Then again many facilities give great raises and sign on bonuses to those who have what it takes. Those who don't cut it and are merely there to fill a slot in the schedule..... well, that's another story.

[Lapishsunsmile]

My state actually pays ltc nurses more. A ltc new grad lpn and med surg new grad to make exactly the same in my town.