Losing your skills in LTC - page 2

I hear frequently on this BB, other BBs, Nursing magazines and other Nurse friends that "If you go into LTC you loose all of your skills" This is so untrue, it makes my blood boil. I know that we do... Read More

  1. by   leslie :-D
    i have to agree with frazzledrn.....very well put. i've worked icu, med surg, oncology, hospice and now ltc, with the focus/subspecialty on hospice. we're a small facility, 80 beds. my particular floor sometimes feels like an er since half of my pts. are dnh's and are treated at the facility. we treat cancer patients, trach and frail 90 y.o.'s with central lines because their children cannot let go. and it's so true that we exemplify the nursing process at its' finest, especially our assessment skills. more times than not, these pts. do not present with your typical s/s, and will usually start manifesting s/s when a process is in its' advanced stages. treating the geriatric population presents itself with its' own unique set of challenges and i for one, honor every one of these people and want to ensure that when they are sick or at the end of their life, there will be a very skilled nurse who will understand their very unique physiological and psychosocial requirements.
  2. by   BRANDY LPN
    It is not just you LTC nurses who hear "You're gonna lose all your skills" , I have been in OB for 3 years now and worked LTC for 2 years before that. I hear all the time that I should float to the other units in my hosp. (med/surg and ICU) or I am gonna lose all my skills, this is usually form one particular RN on the ms floor, and it drives me nuts, no I shouldn't float over there, for one thing I HATE it and that is not good for anyone the pts, my coworkers or me, and another thing is like some one else pointed out it is a whole different set of skills used to work Ob, Not worse or lacking but different, just like nurses who work in ER, ICU, Ortho, LTC ect each specialty area has different skills. That is WHY there are specialty areas.
  3. by   tmoorelpn
    I use my skills in LTC, I also work on a skilled unit but I still use all of the skills that I learned in school. Suctioning, catheters, trachs, etc. But I have learned one new skill since graduating and that is the skill of time management. I am the only nurse on the floor for 22 residents, I am responsible for 2 CNAs and a float CNA and a non-certified and I usually have to be in three different places all at the same time. It can get very stressful in LTC but I'd rather do that anyday than work in acute care/hospital setting.
  4. by   TooBusyRN
    Anyone who feels that nurses in LTC are in danger of 'losing their nursing skills' has not worked in LTC. If anything, the LTC nurses have a more well-rounded practice than nurses working in other sub-specialties. Think about it...we have cardiac, pulmonary, renal, GI, oncology, psych, etc., etc, all under one roof. We have to multi-task like no other 'specialty' does. We have to have an all-around knowledge base to deal with any potential problem that these residents could possibly present. LTC IS 'acute' care nursing if it is anything else. As for the comment someone made in one of the earlier replies that 'these folks are dying,' I have to disagree. Some LTC residents may live 10-15 years in a nursing facility and this is their HOME. As a DON, I encourage my charge nurses to feel empowered to not only make suggestions, but to present me with solutions for how to implement any improvements they think will improve work performance or patient care. It is vitally important that the charge nurses feel that they are exactly that....in charge. LPN's have much more freedom to act autonomously in the LTC setting as well. They shouldn't have to feel that every decision to be made has to be run through the nursing administration. Suggest that your facility have standing orders if it doesn't have them already. Request a meeting or inservice with your DON and Medical Director, if possible, to open a discussion about how the LPN's can be given more decision making abilities. The physicians are funny about some things. Some get perturbed with every phone call you make to them, no matter how serious the situation. Others want to be called for the slightest thing. Determine what your MD's want and set into motion a program for what your docs want. They would love for you to make their life a little easier too.
  5. by   sharlynn
    I'm in charge of 70 residents who are only seen by a doctor every sixty days. He's not there to recognize problems when they are just beginning. It's all left up to me. Lose my skills? I'd better not!
  6. by   leslie :-D
    Quote from sharlynn
    I'm in charge of 70 residents who are only seen by a doctor every sixty days. He's not there to recognize problems when they are just beginning. It's all left up to me. Lose my skills? I'd better not!
    GREEEEAAAAAATTT point sharylynn, absolutely great. as one md told me, we are their eyes and ears. you go girl.
  7. by   debRN0417
    I am so happy to hear of so many nurses who, like me, love geriatrics and LTC. I have worked everywhere...ER, ICU, House Supervisor in Acute Care, Med/Surg, Pediatrics...and more, but I always come back to LTC. I appreciate so much hearing nurses say that they get to know their patients as HUMANS and that they become "family". It really does my heart good! I am considering a position as Director of Nursing in LTC...I hope I can instill in my staff (if I decide to take the job)..to not be afraid of getting close to their patients, to treat them like they would want to be treated, or have a member of their family treated. Long term care can be viewed as the same thing "over and over"...but the poeple are not the same everyday. There are days when I too want to be the "Wal-mart greeter"...but then one of my patients takes my hand and thanks me for just being there...that's what it's all about.
  8. by   NursesRmofun
    [font=franklin gothic medium]i think it depends on what skills you want to be proficient at. some kind of jobs are better (but not exclusive) for some kinds of skills. i worked hospital the most number of years. the skills i use there are not always the same as the skills i use in ltc. but the skills i use in ltc are not nothing either. as a new unit manager, i am learning more about managing and supervising, which is new to me. i didn't do that in the hospital. i was not responsibile for so many people there....patient/residents and staff included.
    Last edit by NursesRmofun on Apr 8, '04 : Reason: Spelling
  9. by   FrazzledRN
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    Quote from nursesrmofun
    [font=franklin gothic medium]i think it depends on what skills you want to be proficient at. some kind of jobs are better (but not exclusive) for some kinds of skills. i worked hospital the most number of years. the skills i use there are not always the same as the skills i use in ltc. but the skills i use in ltc are not nothing either. as a new unit manager, i learning more about managing and supervising, which is new to me. i didn't do that in the hospital. i was not responsibile for so many people there....patient/residents and staff included.
    very true and well put!
  10. by   TooBusyRN
    I just have to say that I've watched this thread closely and love so many of the comments everyone has made. In LTC we are multi-talented, multi-tasking, autonomous, well-rounded nurses who should have no fear of losing anything while working in long term care. I do have to agree that there are some poorly run facilities, but I disagree with the solution offered of just leaving and going to a better-run facility. Then who cares and advocates for those residents in the 'poorly-run' facility??? You have to be proactive as a nurse. If changes need to be made, let it begin with you! It's not always easy rocking the boat, but if the boat is sinking and folks are drowning, someone has to throw out the life-line and get them back onboard. Start with talking to supervisory nursing staff about some of the problems you're having on the floor. If they don't listen when you talk to them, write them a memo, if they don't respond, then write another one and give a copy to the administrator. If you don't get any response there, then request a meeting with both the Director and the Administrator to discuss problems. And it helps if the LPN staff is united and wants a 'group session' instead of just one or two lone nurses who might appear to be griping. You can make a change. You just have to care enough to want to. As a Director, I've had to work the floor as an LPN, I've gone in at 3 in the morning to work as a CNA, and had days where I've worked around the clock and then some. It's frustrating for the floor staff, I know. But if your nursing supervisors/administrators have never 'walked a mile in your shoes' then they may not have a clue what's really going on. THEY have to care, too! We may not have the respect of the rest of the nursing community because we're "just" LTC nurses, but we don't lose a darn thing. We gain knowledge, compassion, integrity, love, and the respect of the people who matter - our residents, their families, and our staff - when we do a great job.
  11. by   NursesRmofun
    Quote from TooBusyRN
    I just have to say that I've watched this thread closely and love so many of the comments everyone has made. In LTC we are multi-talented, multi-tasking, autonomous, well-rounded nurses who should have no fear of losing anything while working in long term care. I do have to agree that there are some poorly run facilities, but I disagree with the solution offered of just leaving and going to a better-run facility. Then who cares and advocates for those residents in the 'poorly-run' facility??? You have to be proactive as a nurse. If changes need to be made, let it begin with you! It's not always easy rocking the boat, but if the boat is sinking and folks are drowning, someone has to throw out the life-line and get them back onboard. Start with talking to supervisory nursing staff about some of the problems you're having on the floor. If they don't listen when you talk to them, write them a memo, if they don't respond, then write another one and give a copy to the administrator. If you don't get any response there, then request a meeting with both the Director and the Administrator to discuss problems. And it helps if the LPN staff is united and wants a 'group session' instead of just one or two lone nurses who might appear to be griping. You can make a change. You just have to care enough to want to. As a Director, I've had to work the floor as an LPN, I've gone in at 3 in the morning to work as a CNA, and had days where I've worked around the clock and then some. It's frustrating for the floor staff, I know. But if your nursing supervisors/administrators have never 'walked a mile in your shoes' then they may not have a clue what's really going on. THEY have to care, too! We may not have the respect of the rest of the nursing community because we're "just" LTC nurses, but we don't lose a darn thing. We gain knowledge, compassion, integrity, love, and the respect of the people who matter - our residents, their families, and our staff - when we do a great job.
    Good message. I was a CNA years ago and a LPN for a long time. I like to be hands on, so I won't be someone always sitting at the desk...although I do have to get my paperwork done. I have to find a balance.
  12. by   NursesRmofun
    Quote from frazzledrn
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    very true and well put!
    ty, frazzledrn.
  13. by   TooBusyRN
    Reply to NursesRmofFun/RN - Girlfriend, I didn't mean that I used to work as a CNA and then an LPN...I meant as the DON I find myself having to fill in when needed on the floor just to meet staffing sometimes, and others just when my staff is feeling overwhelmed and they need the extra encouragement of seeing me out there busting tail WITH them and not railing AT them to get their work done. I have always maintained an open door policy and it's true that you have to find a balance and get your paperwork done. My staff and other department heads know that if my door is shut, it means I'm either trying desperately to catch up on paperwork, counsel with someone, or meet with a resident or family member and they'll usually slip a note under my door and know that I'll get to them as soon as I can. But, more often than not, I find myself doing my paperwork on my "off" time - whatever that is. To any of you out there who have husbands and younger children, I have to applaud you because I don't think I could do it all and have any time left over. I've worked hard the last year to find that balance, still have time for myself, encourage and educate my staff and not burn out. We have to hold each other up. That's one reason I'm so glad I found this BB!

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