Losing your skills in LTC - page 4

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   jennyga
    i cant believe i found people who agree with me!!!!
    i am in nursing school and all i hear is go to an acute care setting and get all your skills, well, well, well, i worked in a ltc facility since i was 15 and working there is what inspired me to become a nurse, so why the heck would i want to go to an acute care setting when ltc is what i love?? just today at lunch some other students were talking about where they were going to work and they say " i hate ltc, you loose all your skills, you will never see me there, blah blah blah", so i was sitting there thinking well good we dont want you in ltc if you feel that way, please dont come, go to the hospital i know you will do great there, but dont put down something when first of all you dont even have experience enough yet to judge any type of care and still should'nt even if you are an experienced nurse! okay now now i feel much better.
    thank you all you skilled wonderful, ltc nurses, you each make a difference in someones life everyday and deserve respect and know that we can all stick together!!!!
    Last edit by jennyga on Feb 27, '06
  2. by   chadash
    Quote from jkaee
    Cubby--
    I know exactly what you are talking about. I have been in LTC for 9 years now, and ever since I graduated my dad keeps telling me that I need to "get in a hospital" (note, I am married with 3 kids, but he still gives me career advice!) I have always felt (because of other nurses and docs views on LTC nurses) that I needed to get more skills and be a "real nurse". I was offered many acute care jobs, even one in maternity, and worked on a med surg floor for about 8 months once. And guess what....I hated it! Every time I was offered a acute care job, I thought "Now I can get good experience" as if working LTC isn't experience enough. We are all in the fields we chose for a reason, because we all have special skills and qualities that make us good nurses for the critically ill, the laboring mother, the preemie baby, the rehab ortho patient. I, personally, am sick and tired of feeling like I have to apologize for being a LTC nurse, as if I wasn't good enough or motivated enough to get in a hospital. I am sick of hospital nurses (although by no means all nurses that work in acute care) think that I lack assessment skills. I know plenty of hosp nurses that tell me they couldn't do what I do...and it's a whole different set of "skills" that a LTC nurses uses that acute care nurses don't have to possess. We don't rely on machines to tell us when something is wrong, we don't have doctors in house 24/7, we don't have a lab, or a pharmacy on site. We need to be innovative, creative and compassionate with our approaches to resident care. We know our patients better than we know our own families. And our time management skills are to die for, otherwise we'd never get done a med pass for 30-40 patients.
    We all have invaluable and exceptional skills, no matter what field we choose to work in. A successful IV stick does not a skilled nurse make.

    Jennifer
    Geriatric RN extrordinaire
    Wow! I think it is just fantastic that you are in LTC because you have the drive to excell in that environment.....
    LTC can become what it should be with people like you.
  3. by   dawnb70
    I haven't been a nurse for that long (going on 4 yrs.), but I feel that I am using so much of what I learned in school. I change catheters, insert IVs, do blood draws, do trach. care, deal with G or NG tubes/feedings, do wound care for various stages or types of wounds, have residents with central lines or shunts for dialysis, do pacemaker checks, participate in codes, and the list goes on and on. I know there are a lot things that I haven't been exposed to, but I feel that I'm still learning to be a well-rounded nurse. I also feel that working in a LTC has helped me to do a quick and accurate body assessment. Plus, I have really learned a lot about medications. I feel completely safe when doing my med. pass. I have every one of my residents meds. memorized. That's the benefit of having basically the same routine day in and day out. If a family member asks what meds. a resident is on I can recite them off to them, plus give them a list of the side effects. Not to mention that we know our residents diagnoses by heart, and can remember when certain labs or tests were done. I don't think that LTC nurses get enough credit for what we do, and are capable of doing. I even had a nursing instructor tell our nursing class (when I was still in school) that we should never go into LTC because we would lose our nursing skills, and that most hospitals won't hire a nurse that has worked in LTC for too long. It's just unreal the perception that others have of us. I think we all deserve a pat on the back!
  4. by   suebird3
    Lose our skills? I thinks we re-invent them at times, or as a previous poster said, put a new twist on them. I have been in LTC for many years, the past 6+ at the same facility. Yeah, my folks tell me to apply at the hospitals now I have my RN. Know what? I don't wanna!

    Suebird
  5. by   cuetorn
    Hi Rusty,
    Where Do You Work In Nm? I Have Lived Here For 1 Year And I Am Already Frustrated With My Ltc Positon, Secondary To The Lack Of Direction And Assistance By Nsg Adm; Not To Mention The Extreme Lack Of Staff.
  6. by   AlmostBeth
    Military girl, it is not possible to not get a long term care job. I have always been hired in my interview. They are really desperate. I have worked long term care for 15 years and am an LPN. I agree that getting acute care experience is a good idea. I didn't. I used to think that hospital nurses were better until I had to stay in the hospital. I received poor to negligent care from my nurses and Thank God there were no complications because I would not be here today. Being a good nurse is about knowing your specialty and doing it with integrity.
  7. by   superbratnurse
    the only skills that i feel i have really lost are peds/ob experience....

    i have post surgical patients, cvas, ivs, sometimes with lipids, or tpn, irrigate catheters, not to mention insert them....insert ivs, do various txs.... and we have better survival skills in ltc, i think, than any ol acute care nurse.... how many hospital nurses have ever talked an alzheimers patient off a fence, or for that matter, been hit, bit, spit at, scratched, kicked, urinated on (or at, if you are quick enuff) had feces thrown at them, been called every single thing but an earthling and not been able to do anything but try to redirect them first.... then, if not effective, medicate them in the slightest way that is effective.... in my area, all our residents invariably come back from the hospital, doped up, with restraints (if they are nonamb, or very confused) a foley cath, if incontinent, and almost always with at least one stage one (at the very least) pressure ulcer (the most i ever saw on one pt after an 8 day hospital stay was 27 stage is and 5 stage iis). now (at the risk of starting a riot) tell me who has lost their skills???????? :angryfire



    ~brat
  8. by   snowfreeze
    I have 14 years of nursing, 8 of those in critical care and 5 in LTC. Now I am back to hospital nursing on a telemetry unit and my LTC skills paid off last evening. Dementia patient on heparin and cardizem IVs, pulling at everything, (first half hour took out both her IVs and looked like a drive-by shooting had happened in her blood drenched bed) trying to climb out of bed...all the typical sundowning stuff. Got out of the mitts and pulled out another IV in under 10 mins. I had 4 other patients and no sitter so she spent the evening in the hall with me in a gerichair. She folded washcloths, chatted with other staff, chatted with me a lot but didn't pull out anymore IVs, left her foley alone so by the end of the shift it had yellow instead of red drainage, didn't fall and only took herself off the monitor about 80 times. I didn't get a break but I took care of all my patients and her too.
    It didn't take long for all my acute care skills to resurface after working LTC for 5 years. I think the sub-acute and rehab unit helped me to maintain a lot though. I started IV's put in midlines, placed and replaced foleys and G-tubes. Put a number of trachs back in too. I was always impressed by the cute smile of a vent-dependant patient handing me the trach they just removed.
  9. by   cindyjean
    I found that I have gained skills in LTC. At the hospital( where i worked 25 years) , we had a respiratory dept...at the home..I am the resp therapist at night doing as many as 15 treatments at times ( and there is much to know about this ), I am the physical therapist, continuing with gait training with RW , as patients ambulate to the BR at night.. and following up on PT recommendations. No where else but LLC does one have so much responsibility in assessments..and for the doctor to rely so much on your astute observations. In a hospital, the doctor and others watch the same patients day and night..but in LLC it is you alone and your CNAs until the next shift comes in...and it can happen in 8 hours. I am gaining skills in documentation I never had to have in the hospital setting to such a great degree. Nor do you see such attention given to skin assessments in the hospital for short term stays....which is obvious when the client reaches us.and there is so much more to add...no specialized units...you see it all in LTC and it is a very special person to learn the ways of communication...so add speech therapist and swollow evauation on top of that. ..lets see...how many hearuing aids have I changed batteries on, cleaned and put ionto a patients ears? yes..you are all skillful nurses!
  10. by   BrendaLeeRN
    I am a fairly new nurse, but chose and prefer sub-acute/LTC over working in a hospital. I did a research paper in school on a comparison study between ICU and LTC nurses. ICU's may be where the hi-tech skills are needed, but in LTC / Subacute you use your skills in psychiatric, pharmacology, documentation, extreme assessment and trouble shooting skills, pt. advocate, and IVs, blood draws, catheters, tube feeders, chest tubes, drains, CPMs, physical therapy, etc. In LTC, the doctors seem to be more willing to entertain the nurses suggestions. Most of the time when I call them, they say "What do you suggest?" I love my job, except the short staffing we all suffer!
  11. by   LoriAlabamaRN
    Cubby, I applaud you. I am also an RN in a management position at an LTC facility (night shift supervisor, the only RN in the facility at night, and 165 residents). I do not feel as if I have lost any skills at all, except for maternity or pediatric nursing. My assessment skills are top notch- they have to be. I have no doctor here at night, and my decisions have to be good. As for the IVs, foleys, blood drawing, wound care, etc I have more than my share. I adore working in LTC, and I feel as if I have made a difference every single night. I thrive on that, the feeling that I have made my residents happy and comfortable, and kept them safe. I doubt I will ever go back to an acute care setting- this work is just too fulfilling.
  12. by   lilyflower06
    LTC is increasingly sub acute & many medical wards are holding tanks for those waiting for LTC beds. There isn't a day that goes by in my LTC community that someone doesn't stroke or seizure or experience sudden SOB, chest pain, or fall. There are always urgent situations emerging that we handle on site do to the degree of intervention specified. There are plenty of oppertunities for use of skills & critical thinking. If nurses are self-directed & continue to seek learning experiences & fill their own learning gaps then LTC is a great place to practice.
  13. by   cindyjean
    I guess what I was trying to state is...that where I now work, I can utilize all I have learned over the past 30 years. I have always liked "problem solving" and finding solutions for the residents best care ...would rather be out on the wings than behind a desk. ...so now I can be...that is except when monthly summaries come around and other paper work starts to bog me down. Surely there is a better way to help the nurse stay out on the floor with the patients where she can continue to find solutions and give good care, esp in the more complicated cases. at one facility ( ventilator assisted clients) we used pocket computers (radix) at the bedside for a lot of the charting..and it was very useful to us.

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