LTC and loving it

nutty netty · Sep 15, 2012

Yes I am familiar with the privately owned and the not for profit facilities and how staff is or maybe treated differently, as well as staffing ratios. Unfortunately there doesnt seem to be to many of those out there these days. I am going to go off a little from my last post and descibe what I've seen, experienced. Over the past 20+ years that I have worked as a nurse in LTC has been with big corporations. My employment history for the most part has been on avg. 3-7 years with each one. A lot has changed over those years and not to the positive unfortunately.

When I first became a nurse our house supply meds consisted of doss and tylenol. Now the top drawer of the med cart is packed with house supply meds/supps ie: numerous vitamins, various stool softeners,diff doses asa and tylenol, just to name a few as they are no longer formulary. Dressing supplies, over the years, I've noticed is either charged out to each individual resident, or not at all, or there has been a poor system overall. I worked with one administrator that was anal about these charges, we were constantly being dogged about not keeping track and not charging these supplies out as we should. During a staff meeting he informed us that close to 48,000.00 had been reimbursed to them and that was not for a full year. And went on to explain that with this, their budget could be better utilized to benefit both residents and staff. Well after he left or should say was asked to leave, we had an interim admin. from corporate and needless to say we had slacked on these charges, so I inquired to him about this,[charging out supplies] to which he stated "oh that was stupid" and the charge book was eliminated. I still question to this day,. why?

I'll have to say that some management has been approachable and some not. One proactive administrator at a facility that I worked for for 7 years was always informing us of government changes, cuts, what was to come and that it would be getting worse. Informed us what we could do [write our congressmen] He was always fair, approachable, organized and encouraged out of work activity for staff, such as forming baseball teams and competing against other facilities, bowling, staff recognition and appreciation.

At this same facility the DNS was forever calling me to her office, I will admit that I didnt have a problem voicing my opinion and standing up for what I believed in when it came to resident care, and we frequently did clash. Half the time, no three quarters of the time it was an issue that needed to be resolved, and usually was, but., what I will always remember is that she always complimented me on my work when the meeting was over. One time I asked her, "why do I seem to be such a thorn in managements side?" To which she stated " you are a good nurse, and we as managers need to learn and know how to work with all different personality types, work styles and such and by no means are you a thorn, you are just a good reminder to us why we are all here and love what we do" [i'm glad that she left out that yes I was a thorn, but.,ha ha] She will never know how much her statement impacted me, and it is truly unfortunate that I have never had the opportunity to work with the above type management style again. That was my first 7 years as a nurse.

During those 7 years we had 2 near perfect surveys, 2 perfect surveys. 1 of those surveys was almost immediately followed by a federal survey to which we also passed with flying colors. Well, a new corporation took over and things changed up real quick and the management that I spoke of was pretty much eliminated. I left shortly after that. Why things changed so quickly and drastically I will never know especially when the facility had a very good track record. I can only owe it to, because at the end of that time was when government changes/cuts were really kicking it up and possibly a new breed of CEO's, CFO's and large corporations in general had a new idea of how to deal? I will blame my burnout mainly on government cuts as it has forced corporations to do what they do, [i think] I mean, if I had a business I would want to make money, wouldn't you?

Unfortunately, of course those big corp. people have never worked the floor and have no idea what its like to witness substandard care, and struggle with those feelings when they get home at night. I did a lot of research on the corp. I was working for and it made me understand what and why certain things where occurring. Very, very deep. Needless to say it made me ill. But that's a whole different story. Also contributing to the burn out factor, the industry's inability to see and acknowledge my experience in this field as a real professional that is entirely capable of fulfilling a job role just as well as an RN, if not more so. [have been applying to jobs that I very well qualify for that require RN and up, guess what? thought so]

So from years 8-20+ I have in general, have just seen a change and general decline in healthcare in the LTC setting. As well as a change in these large corp's that would just as soon throw you out the door than acknowledge resident care. And government continues to cut the benefits of the population that us LTC care workers love so much. I also would like to see that the LTC logo be renamed. It is by no means long term care anymore, [it is for some] In the last 5 years, with changes in medicare funding, not to be confused with medicaid, hospitals are discharging sooner and are dependent on "skilled nursing" facilities for continued rehab/recovery, LTC facilities are admitting a broad range of age groups, anywhere from 16 and up. In the past year I have cared for more 40's age group than I have in my entire nursing career. Some facilities will no longer accept medicaid funding. Very scary. Enough about that, now on to next.

With reguard to working in this type of facility. Other nursing areas need to acknowledge what we do without reguard to where we work. I will be the first to say that this area is the best learning area to be had, going back to what I said before, we have no support staff, you will learn how to be a respiratory therapist, social worker, rehab worker, SLP, maintainance, dietician, and toilet plungin fool. You will learn how to confidently assess a resident and have the dr. treat based on YOUR assessment. And most of all learn that it is a great feeling that you accurately diagnosed,[did I say diagnosed, shame on me] a problem and anticipated what the tx would be and thats exactly what the dr ordered. You will learn to be organized, multi-tasking definitly will be enhanced. You will learn how to gain the trust of dr's, and family members. You will learn how to deal with end of life issues and provide the psychosocial support to their family members, which will be very challenging at times. You will learn IV skills, wound care assessment and effective tx. You will learn empathy, sympathy, commradery. You will experience and learn all you need to to make you a successful nurse in this and any other industry .

The drawback from what I have witnessed is that those who intend to move on and broaden their skills. horizons, whatever you want to call it, don't. Don't get me wrong, nothing wrong with that. Its what I chose to do for the past 20 years, I simply love that particular industry, its my specialty. But a word to the warning, if thats all the experience you have for an extended period of time, it may be difficult to get other fields to accept you, unfortunately. Had enough? ha ha I can and will prob find other posts to comment on, hopefully I will gain some followers. Please everyone dont get me wrong, just dissapointed, unemployed, confused on? my profession perhaps. I do love to write and you know, its a great outlet, thanks for reading and hopefully listening and getting my drift. and excuse the spelling ha ha Sincerely, LTC "skilled nurse" at heart

nutty netty · Sep 15, 2012

I absolutely agree, it makes me feel really good to hear this and cudos to you for your dedication

nutty netty · Sep 15, 2012

that was for pink fish, not me. Am I doing this wrong?

sistasoul · Sep 15, 2012

Why does there seem to be such a stigma against LTC nurses? It almost feels like that is the bottom of the barrell. Even I thought (while working in LTC) that I needed to move up and out- twice- and hated it both times. I started in a hospital, hated being micro-managed, and went back to a LTC. I stayed for 6 years, got my RN and once again felt the need to move on up to the hospital- where I once again hate it, and for the same reasons! I have finally decided that it is okay to just say I love LTC, and this is where I want to stay. My dreams of being the charge nurse in the ICU and ER are gone. My focus in life is to be where I am happy, and that is with my old people.
I like seeing them, and they appreciate friendly, consistent care. They remember my husband and I bought a house several years ago, and we talk about the work we are doing and the amount of money it costs, and they tell me their new housing days. Or, with my demented patients, we just head off to whereever they are for they day, and discuss related events/news. I even like when I can be a part of their final days- making them comfortable and relaxed, easing their families worries knowing someone they know will be with their loved ones, and so on.
I write this because I excitedly gave my notice at the hospital and am heading back to LTC where I can be happy with the old people (like my 105yr old who swears by bacon and women being educated as requirements for long term survival!).

Artsmom,

I agree 100 percent with you. I worked for 5 months at a LTC facility when I first graduated in 2008 and have now been at my hospital job for for 3.5 years. I got a job at the hospital because I felt as a new grad there was so much I needed to learn. I hate the hospital and am looking to get back to some kind of LTC environment. I am a lot more stressed at the hospital then I ever was at the LTC facility. Of course I was so new that I probably didn't know enough to be afraid. I absolutely adore old people too. This generation was brought up differently than the middle aged and younger. The older folks are much more complex to take care of but their attitudes are usually easier to deal with than the entitled younger folks.

balatro · Sep 15, 2012

Reforms have begun??? Haven't you heard of OBRA (not Oprah)??? The reforms started in the '80s.

The reforms began in the 80s, yes but there are still LTCs out there that don't follow it to the T. Slowly they're being handled but they're still out there - quite a few in fact.

The 80's, in my mind, wasn't that long ago -- a good number of my colleagues have been working in LTCs since the 60's and still do things that are questionable.

But it's cool, because our DON is buddy buddy with the state investigation team that gives her a heads up when they'll be rolling into town (and by heads up, I mean "We'll be there on this date, at this time - days in advance).

My fiancee's mother works on an investigation team in the Western part of the state - I shared that story with her and she said it happens ALL the time. The DON gets a week or two heads up - they change schedules around, everyone gets re-oriented on exactly what violations the team will be looking for, rooms get super cleaned up, ALL residents are given showers a day or two before they come, CNA staffing goes from 4 to 6, etc.

SarcasticLVN · Sep 15, 2012

After doing all my clinical rotations in Ltc facilities I vowed I wouldn't work in one. Right after receiving my license I was fortunate enough to get a job opportunity in Ltc and told myself "feel luck and blessed and take it." I did and I love it too! The relationships I have formed with Mh patients is indescribable. I would like to venture out someday but Ltc is great. Glad some of us agree on that!

Elainehall34 · Sep 15, 2012

O I f t e s w

ellen 12 · Sep 15, 2012

Maybe the low status of aged care nurses relates to the general lack of status afforded to older people in society.

I think it's interesting that hospice work is considered high status - whereas care of the dying elderly is right there on the bottom most rung. Both require a palliative approach.

I work in aged care and I love it. I have the priviledge of caring for people who are extremely frail, with multiple diagnoses, incorporating medical and psychosocial -- most patients require palliative approach to care.

The work has depth and is interesting --but there is need to understand and grasp the complexities of care.

bankssarn · Sep 15, 2012

That is certaintly a lot of patients, but I think 5-7 acutely ill pt's while charge on the floor is a comparable number to be afraid of. I find it so overwhelming. I am returning as a supervisor and am excited to learn a new role.

Yes, I agree. I work on a tele unit, and have 6 patients each night. There are many nights that we take overflow from the ICU (the more stable patients, of course), so juggling that patient load can definitely be challenging, especially if one of your patients takes a turn for the worse. One of my patients crashed the other night; I spent 3 hours in her room alone, but I still had 5 other patients that needed me. It has most definitely been a learning experience. I've been told by many of the veteran nurses that if you can survive in tele, you can survive anywhere.

CapeCodMermaid, RN · Sep 15, 2012

I've been in the business since the mid-seventies and have seen all the changes. I do NOT believe anyone gets a heads up from the DPH about the date of survey. There are significant fines and job loss for any surveyor who gets caught doing this. Maybe it's because I work and live in Massachusetts where we do things the right way....except for the Red Sox and the Democrats.

NurseKatie08, MSN · Sep 15, 2012

There's a stigma against LTC nursing for many reasons...one I believe is because we allow it to happen by allowing society to only hear about the bad LTCs. I think if they were more aware of the good facilities that are out there it would help break down the stigma. Also, the elderly in American society are generally devalued, which contributes some to this problem. Lastly, the media portrays nurses through shows such as ER, Nurse Jackie, Hawthorne, etc...these nurses work in hospitals, so it perpetuates the idea that long term care is bottom of the barrel.

That being said, I worked in a skilled nursing facility for the first 4 years of my career (up until just this past week) and I am and will remain a huge advocate for LTC, the elderly and LTC nursing. Not everything was perfect, but it was a generally awesome facility with a high reputation in the area. I left and accepted a position in an academic teaching hospital for reasons that are multifactorial: better pay for less hours worked (I was extremely burned out), opportunity for growth and a recent relocation making me closer to this hospital than my previous facility among other reasons. I cried when I gave my notice at the LTC because I knew I would miss my co-workers and residents/patients so much, but it was time for a change.

joanna73, BSN, RN · Sep 15, 2012

I love my seniors. I've worked LTC for two years as a charge nurse. I've also worked Acute Care. Not much difference between the two, if you ask me. I could work with geriatric patients for the rest of my career and be quite content.