Losing your skills in LTC

  1. 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 not HAVE to do alot of the procedures that Nurses in Acute care settings are asked to do, but there are alot of human skills that we have to have in abundance to succeed in LTC.
    I did not go into Nursing to become a LTC Nurse. I did go into Nursing to help anyone and at every chance I could. Geriatrics gives me that opportunity. We don't just treat the ill, the infirmed. We have to see the big picture. My residents are not just sick and in the hospital. They are dying. And I take a great honor in being able to help them and their families prepare for this finality. I get to know these people as human, I know their children, their grandchildren, even their dogs/fish. The staff of a LTC facility are often the only family these forgotten souls have. I take great pride in being a LONG TERM CARE NURSE. And there is nothing lacking about my skills, there are different thats all.
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  2. 76 Comments

  3. by   cursenurse
    i have worked in LTC X 7 years and i do feel that you lose a lot of skills. it's not that the work isn't challenging or important, but i feel that administration (in a lot of places where i've been) doesnt allow the staff nurses to think for themselves. there seems to be a very pervasive attitude of just "pass the pills, do what you're told and shut up". often the nurses in management disregard the ideas that staff nurses suggest to improve quality of care. i have seen nurses obtain a drs order to send a resident to er for obviously good reasons only to have the order overridden by a DON or nurse manager, and have heard of not even being able to phone a dr about a concern w/out having to clear it with a supervisor. i have seen many formerly good nurses who can no longer make simple "critical thinking" decisions because of having been lulled into what i believe to be intellectual sluggishness secondary to being used to being told what to think and do. i have been fighting against this myself for the past couple of years, and that is why i have made the decision to leave long term care. i love the residents but i find it more and more difficult to shut up ignore poor quality of care.
  4. by   dekatn
    I have to agree with Cursenurse, I've been in LTC for 3 yrs., we are the "charge nurse", but, we are anything but in charge. As far as ideas go, I have quit suggesting anything anymore, our DON will ask for suggestions and when we take the time and energy to research how things work in other LTC, that just MIGHT work for us, it's always the same thing, "that won't work", I have found out by experience, if management didn't think of it first, it just won't work!
  5. by   Cubby
    I am beginning to think I did not make myself clear. I know we do not do the procedures Acute care Nurses are able to do, (Guess what, I don't want to do them either). I like the skills we as LTC nurses are able to utilize-things like a new twist on an old problem, How do you get so and so to eat....Ours is more of a thinking outside the box specialty.
    By the way I am an RN in an mid managment position,and I do understand what you are saying, regarding the "Good Ol' Girl Network" It is in every branch of medicine. I like my job and remain proud to be a LTC Nurse.
    PS Ive been in LTC for 32 years-yes, I have bad weeks (Months Years...)
    But still. I love my Geriatrics
  6. by   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
  7. by   AlixCoastRN
    Cursenurse - come work in our facility! The charge nurse is in 'charge' and we feel we don't need an order to send someone to the ER or to release a body when the soul has departed. We do a lot of skin care, we inherit a lot of decubs, we draw a lot of our own labs, take out PICC lines, staples, sutures etc. We replace G-tubes and foleys, do PVRs around the clock. We dont' need approval from the DNS or administrator to do any of this! Sure, I dont' start an IV everyday, or insert a foley everyday - but I can still do that stuff. 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.
  8. by   Rn Stuff
    Hear, hear! Hoooorray to all the LTC nurses :hatparty:

    I currently work in the pharma research industry after grad school (MS Nsg) -before which I worked in acute care for 4 yrs., and before that as an LTC nurse (4 yrs). Absolutely right, LTC nurses have a different skill set, but this does not stop them from being effective and productive in other settings, e.g., acute care, research, home care - no matter what the hiring managers think and what their SOPs dictate. My heart still belongs to my LTC years and colleagues - we still are in touch and very much friends. It's a different and unique culture, patient-wise and colleague-wise.

    To dekatn and cursenurse - I understand your situation. It's time you present your managers an evidence based argument. Go out there, do a literature search, study the theoretical framework/strenghts/limitations of your suggestions - and if they are not convinced, then you can move your suggestions up further in the chain of command. It's time you unite your fellow LTC nurses and let your boss know that you are practicing with knowledge and using the current scientific literature out there to promote evidence based practice.
  9. by   Rustyhammer
    I work in LTC.
    I start IV's, do complete body and systems assesments, have a broad knowledge of meds, do trach care, handle vents with confidence, treat even the nastiest wounds, advise docs on appropriate meds for geriatrics, hone my supervisory skills, deal with families like the best social worker, contact and advise, visit and love my residents, provide grief counseling, inservice ancilary staff and who know WHAT tomorrow will bring.
    Lose your skills in LTC?
    I challenge the mere hospital nurse to walk a week in my shoes.
    -Russell
  10. by   jkaee
    You said it, Russell!!!!

    GERIATRIC NURSES CAN DO ANYTHING!

    Jennifer
  11. by   military girl
    I have worked at a facility here in the state of Michigan for 2 years. It is supposed to be a rehab unit, but it's anything but. As for losing your skills working in long term care, to some extent I feel that you do.
    First, doing meds for 30-40 people to me is unsafe. I guess coming from an Stepdown unit to a unit where we have to do meds on 10 - 13 people was overwhelming. But the thing is, we are not to do IVs, no IV pushes, no EKGs, no blood draws. What we are to do is pass meds and wipe butts. Don't get me wrong, there are days when I like my job, but I feel that long term care is doing the same thing over and over, with no change. And yes, there are nurses that feel when you go to a hospital job, that no matter how long you have been a nurse, there are things that you should just know. It doesn't matter that you have worked in a LTC, you should just know it.
    I believe that all nurses should have some type of acute care experience. What would happen if you had to go to a facility because of a spouse's job. Would you not work just because you couldn't get a LTC job?
  12. by   jkaee
    military girl, I respect your opinions, but I'm afraid that I have to disagree. Every area of nursing has their own set of skills, does that mean that a nurse should experience every area of nursing in order to be a well rounded nurse? I know that that's probably not the point that you are trying to make, but an OB nurse would have a really difficult time on a Med-Surg, even though OB is acute care, and M/S is acute care. I recall one OB nurse in particular that was telling me that she threatened to quit her job because she had to take care of someone that had an NG tube on the Maternity floor (it was M/S overflow), and she never had to work with them before. Just like a M/S or ICU nurse would most likely be lost in the OR. It just doesn't matter. I have worked acute care before, and I felt that having 10-12 fresh post-op or medically complex patients was unsafe, and I know a lot of nurses that have left acute care because of that reason. I am NOT saying that LTC is better than acute care, each has pros and cons. But I never feel in LTC that I'm doing the same thing over and over again. With the geriatric population living longer with a myriad of complex medical problems, there is always something new happening, or some puzzle to figure out. I'm sorry that you feel all you do is "pass pills and wipe butts", but there is SO much more to the geriatric population than that. No offense meant, but if that's the way you feel about it then maybe geriatrics isn't the place for you. And that's okay. But I am confident enough in my skills as a geriatric nurse to know that's not all I do, and I feel honored to be caring for the people that have done so much to make this country the place it is, and I don't feel that I'm "losing" anything by caring for these people. In fact, I have gained much, both personally and professionally.
    My biggest pet peeve (and I have mentioned this over and over) is not feeling respected as a LTC nurse. I don't need recent acute care experience to make me a "better" nurse. I can, and have, been offered jobs in different areas of acute care. Like many nurses, I'll always have a job. And I know that I'm always needed. Like I said before, a proficient skills checklist does not make a skilled nurse.

    Jennifer
    Last edit by jkaee on Mar 4, '04
  13. by   FrazzledRN
    Oh my...what a can of worms was opened here....lol! But I must put in my 2 cents. I have worked in LTC for 9 years...have also worked acute care and am still prn at our local hospital. I MUCH prefer long term care, not because I am a poor nurse lacking skill enough to do anything else...FAR FROM IT! Because I love the geriatric population, I love coming in and knowing my residents, what is normal for them and what is not. I am able to perform all of the skills at the acute care level without a problem. I did from the first day that I started the acute care job (after 7 years of long term care)! I acclimated just fine to acute care and have been much complimented by other nurses for what I know and my multi-tasking abilities. At my job in LTC we have had numerous acute care nurses come and go. Saying it was too overwhelming for them and they were not trained to babysit staff, and do everything that was expected of them in LTC. Not saying that as a gerneralized statement about all acute care nurses....just the one's that I have experienced. Long term care is an eye opener and acute care nurses do not realize what it all entails until they have walked a week in those shoes. When they do they are more understanding. We are ALL nurses who have gotten into this profession with the intent to help people....whether it is acute care (who also see a lot of the geriatric population and with the aging of the baby boomers they'll see alot more) or long term care, we are all helping our fellow human beings. Having worked both I personally prefer LTC. I feel more of a "team" atmosphere in LTC, where the staff knows each other and we all know the residents well. I do not feel anyone loses skills in LTC. I acclimated quite well in acute care from day one. The geriatric population have multi-system disorders, and attempting to discern what the current problem stems from is a challenge. It requires the use of every aspect of the nursing process and fine tunes your assessment skills as you have no physician to tell you what is wrong. You have to be able to explain it to the physician via phone so that that resident gets the proper care that they require. It is the nursing process at its best. You also receive such respect and gratefulness from most of those residents. They see what you do for them on a day to day basis. The physicians know who is calling them and know if your assessment skills are on target. It is a field for nurses that aren't afraid of autonomy, and requires excellent assessment skills. For some who have worked or currently work in a facility that is not up to snuff then your perception of LTC will be a poor one. But that is not a blanket statement for ALL of LTC. There are some wonderful places out there with outstanding staff. I feel bad for anyone who is employed at a poorly run facility-it is frustration and breeds apathy from those who you are surrounded by. My suggestion is to find a better place to work-there are better facilities. It is a matter of finding them and seeing what LTC is truly about. I am currently interviewing for a DON position, which means that I will probably have to give up my prn acute care job. I will miss my colleagues there also. But I feel good about my time there because I think I was able to change their opinions about LTC nurses. That, as with any area of nursing you have some bad eggs- but some DAMN FINE nurses also who love what they do.
    Thanks!!
  14. by   FrazzledRN
    Very well put Jennifer

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