Losing your skills in LTC - page 3

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   NursesRmofun
    Quote from 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!
    Hi there, ToobusyRN! LOL. I knew you meant you were *acting as* a CNA and LPN by working in those positions. You sound like a good DON! I am not sure I'd ever want that job. I am sure there is a lot of pressure. But I will take one step at a time and see where life leads me.
    I would help the nurses and CNAs out on the floor too, if needed....and probably will as a Unit Manager, at times.
    I am glad I found this site too!
  2. by   rascalsmom
    I am going to make this my last response tonight before going to collapse in bed.

    First let me say.. howdy y'all I am new to the BB and so excited to have found it. I am a 34 yr nursing veteran and am currently DON of a 135 bed SNF. I have some of the best nurses I have ever worked with on my team. (and by far the best CNAs in the region).. but I digress from the topic.. Losing skills in LTC.. I too have heard that from my ACute care nurse colleagues.. Let me see.. here is a sample of what happened today at my Center:

    We changed out 2 G-Tubes, started 2 IV antibiotics , 1 IV for hydration on pt with GE, were the eyes and ears of the MD and figured out (since nurses don't dare diagnose) that a resident had CHF and after initially treating with IV Lasix, etc from the doc, sent her to ER, suctioned and did trach care on a new resident, accessed and flushed 3 portacaths, did wound care on a fellow who came from the hospital with 3 stage IV decubs on his coccyx, sacrum and hip that is also infected with MRSA (they forgot to mention that prior to admission) so he is Contact isolation, did I&O caths on 6 residents, and the list goes on. I spent the evening shift with a new nurse (she has spent 17 yrs in acute care) who decided that maybe this wasn't a job for her .. she thought working in the nursing home was going to be like retirement.. her words not mine.

    I have done almost every type of nursing I can think of.. critical care, MD office, Case management, teaching at CNA, ADN, PN and BSN levels, 8 yrs in ER, but nothing excites me more than to round a corner and have an Alzheimers patient light up like a Christmas tree at the sight of me and get a big hug and an I Love You . That is why I am a LTC Nurse.
    As for autonomy.. I empower my RNs and LPNs to be supervisors, call me or one of the nurse managers when they need us but to use their critical thinking skills, time management, etc . I may not always agree with decisions they make, but I support them 100 % as long as it isn't illegal, unethical or immoral but I will meet with them privately and discuss what I didn't agree with and how I would like for them to handle it next time.
    One of the things that has kept me in LTC for 14 yrs is the chance to not only care with my hands but with my heart. Getting to know the residents and their families and seeing them progress.. as not ALL are in the nursing home to die. I average 4 discharges to assisted living or home a month from my skilled unit.

    I am proud to be a LTC nurse ... and I forgot.. we also used our new dopplers to identify patient with peripheral vascular problems and get him referred to surgeon, and did bladder scans on one.

    have I told you.. I LOVE MY JOB>

    hope to get to know y'all better....

    Bre
  3. by   rascalsmom
    Been there and done that. I agree with your entire message. I too as a DON have worked as a CNA and had to go in to do an 11-7 shift as LPN or RN replacement. I also bus tables in the dining room.. (that was another thread)

    I too applaud those DONs who have families as I have a very tolerant retired hubby and my Sir Rascal Boston Terror.. and they just give me lots of love when I get home and pamper me. I love what I do and yes, I have days when I want to jump out the window.. wouldn't help as I am on one level building..
    But it just takes that one hug or a thank you from a family member for taking such good care of momma.. makes it worth while.
    Now , I am going to go lay down before I fall down.. I am not going in until noon today though.. 15 hrs yesterday earned me a respite as I knew I would not wind down quickly.

    Keep up the good work, guys and gals.
    Bre


    Quote from 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!
  4. by   jkaee
    rascalsmom, you sound like a DON that I would LOVE to work with! Thank you for sticking up for your staff, empowering and encouraging them, and helping out in ways that most DON's would never do! Those DON's are few and far between, and I sure hope your staff appreciates you!

    Jennifer
  5. by   NursesRmofun
    [font=franklin gothic medium]i guess it's safe to say that your days are full! :chuckle

    [font=franklin gothic medium]welcome!
  6. by   rascalsmom
    thank jennifer. i like to think that most dons do as i do. at least the ones in my professional organization that i communicate with say they do. and c'mon down to south carolina, got a job for ya. :chuckle as for appreciating me.. some do, some don't.. the grass is always greener, etc etc.. but all in all i have a very caring, responsive group of nurses working with me who have the same goals as i do.. that being to provide the best care for our residents that we can and it takes every one of us to do it.

    god bless, bre



    Quote from jkaee
    rascalsmom, you sound like a don that i would love to work with! thank you for sticking up for your staff, empowering and encouraging them, and helping out in ways that most don's would never do! those don's are few and far between, and i sure hope your staff appreciates you!

    jennifer
  7. by   LisaRNinarkansas
    Ive worked in hospitals b4, but mostly have spent my career in LTC. I think its great. I do feel that I lost some of my procedural skills that I did in the hospital...but when needed, I can still do them. I never missed hospital nursing. I cant imagine ever working anywhere besides LTC.
    I often hear ppl say, "it takes a special person to work with old ppl". I say..yep it does :chuckle and keep on going....
  8. by   jkaee
    :angryfire :angryfire :angryfire

    I got so angry tonight!! It has to do with this topic, so here it goes.

    My mom works in a neurosurgeons office with a nurse that I went to high school with. This nurse is all up in arms because the drs hired some PA's and she found out how much they are making and feels she should be making more, too. So, to force their hand, she put in her notice. She was talking to my mom about it and told her "I'll just get a job in some nursing home and be bored to death, they don't do anything anyway." My mom was like, "Well, I don't know that you'd be bored, but you'd sure make a lot more money." (good for you mom!) I can't believe that some nurses STILL have this view of LTC and their nurses. It is SO frustrating, and if there's one thing that gets me going its that attitude. ARRGGGGRRRHHH!

    Okay, just needed to vent to my fellow LTC nurses. Feel better now.


    And, Bre, if I could move I'd go down to where you are in a second! I love the south!

    Take care everyone!

    Jennifer
  9. by   CoffeeRTC
    Quote from rascalsmom
    thank jennifer. i like to think that most dons do as i do. at least the ones in my professional organization that i communicate with say they do. and c'mon down to south carolina, got a job for ya. :chuckle as for appreciating me.. some do, some don't.. the grass is always greener, etc etc.. but all in all i have a very caring, responsive group of nurses working with me who have the same goals as i do.. that being to provide the best care for our residents that we can and it takes every one of us to do it.

    god bless, bre
    i would love to work for a don like you!!
  10. by   irishnurse67
    I
    Last edit by irishnurse67 on Mar 27, '06
  11. by   CoffeeRTC
    This is a old post, but I'd like to respond anyway.

    I agree, there are quite a few nurses like that in LTC. IV skills is just one of many. I'll be the first to admit,that I won't try to start a peripheral on most of my pts. First of all, since I'm prn, I don't have the opportunity to keep up my practice on IVs and draws...you don't use it you do kinda loose it. Then its rare that we actually have the supplies needed to start the IVs. Finnally, most of my pts have poor viens or need longer term IVs (more than 3 days). Most of our pts will get midlines...saves money, time and is more comfy in the long run.
    Sometimes I will ask the nurse if they can put a line in before they leave or how old the one in is so I can plan for a restart if needed.

    Saying we don't know how to do a nursing procedure or just won't is awefull.
    Remember too, that not all of those services can be done in the PMs or on weekends...Xray, Lab services and pharmacy.
  12. by   johnson0424
    i am so glad u brought this post back up michelle, thanks!!! I love LTC too but it is getting tiring for me. I have been a manger in LTC since 2002 and was at a m/s unit prior to that. I love LTC but the regs are getting so out of hand-at least in maryland...no elderly person(who is on plavix/asa) can have a bruise b/c if they do a whole investigation is under way for it. Now this may be just my facility or my state I dont know. I used to have such great passsion for LTC but do ya'll think an administration can turn you away from your passion? that is what is happening to me. I definately think that you acquire a different skill set in LTC , my assessment skills are keen but i am not so good at IV's anymore like I was when i was in the hospital..i dont know many of the drugs except for the ones we use alot in geriatrics but i think that we are to be the eyes and ears for the md's.
  13. by   sharlynn
    Suctioning is another story - yuck - we don't have trachs because our building is older - no wall suction. Oh well, we can't have everything.[/QUOTE]

    We don't have wall suction either, just portable, and we DO have trachs. Our facility is not old. It just looks more like a home than a hospital or LTC!
    Sharlynn

close