The Cons of Working in Long Term Care
Based on my experiences as a floor nurse, charge nurse and supervisor in the long term care industry, I have compiled a list of cons associated with this type of nursing. Keep in mind that some facilities are managed far more effectively than others. Your mileage may vary.
I worked as a floor nurse and supervisor in long term care (a.k.a. LTC, nursing homes, or aged care) on and off for six years. Last year I wrote two articles that placed a mostly positive spin on working in the LTC industry. This year I will attempt to balance the beam by discussing the drawbacks of working in nursing homes.
I have constructed a list of various cons associated with long term care nursing. Some facilities are staffed adequately, managed competently and stocked with abundant supplies while other nursing homes have neglected to rise to the occasion, so your mileage may vary.
1. The acuity level in LTC is rising.
The acuity level in LTC has increased greatly in recent years due to pressure to discharge patients out of the hospital faster. Some of the LTC facilities where I once worked often received patients who were only two days postoperative. I dealt with JP drains, surgical incisions, IV antibiotics Q4h, central lines, and other stuff that was once the within the strict realm of the acute care hospital.
2. High nurse/patient ratios are typical.
As a result of dwindling reimbursement rates from Medicaid, Medicare and other payor sources, the typical LTC nurse is responsible for providing care to a large number of residents (often 30+).
3. Shortages of supplies are typical.
Supplies such as tracheostomy cannulas, colostomy bags and indwelling urinary catheters might be unavailable or difficult to locate when the nurse needs them. Equipment such as feeding tube pumps and nebulizer machines might very well be unavailable, depending on the LTC facility.
4. The lack of staff is prevalent.
I've worked at multiple nursing homes. None of them have employed a unit clerk, a full time respiratory therapist, and so forth. Nurses and CNAs call off at the last minute, which causes staff to work short-handed. The LTC nurse must take off his or her own orders and do all admission paperwork because there's no unit secretary to do it. The LTC nurse must perform all respiratory treatments because, in many cases, no respiratory therapist will be on staff.
5. Incompetent employees can fly under the radar.
Incompetent employees can somewhat fly under the radar and still maintain employment at certain LTC facilities. You might have aides who sleep during the night shift. There will be the occasional nurse who continually ignores residents' concerns until relatively minor situations turn into code blues.
6. Society devalues the frail elderly.
Our society views the frail, isolated elderly with a certain degree of disdain. However, many people fail to realize that today's LTC population is actually a mixed bag of younger adults, middle-aged Baby Boomers who are sick due to hard living, and the frail elderly. For instance, my youngest resident was in her late 20s and stayed at the LTC for several weeks while receiving IV antibiotics every four hours for infective endocarditis that was caused by slamming heroin.
7. New employee orientation / training time is minimal.
The lack of orientation time is prevalent. Some fortunate nurses have posted that they received several weeks of orientation. Personally, I have never received more than a few days of orientation at any LTC facility.Last edit by Joe V on Jan 10, '15
About TheCommuter, BSN, RN Senior Moderator
TheCommuter is a moderator of allnurses.com and has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a registered nurse.
TheCommuter has '10' year(s) of experience and specializes in 'Case mgmt., rehab, (CRRN), LTC & psych'. From 'Fort Worth, Texas, USA'; 35 Years Old; Joined Feb '05; Posts: 36,182; Likes: 64,446.Nov 27, '13 by bluegeegoo2, LVNI have found that in the last 6 years of my nursing career, all of which is LTC, the average age of the residents has dropped. There are far more young people there. (<55. I currently have a 37 y.o. a/o x 4). Also, I have seen a mighty increase in "straight psych" residents who pose a host of nursing challenges themselves in addition to the more traditional elderly set I had grown accustomed to. Of course, with less staff than I used to have. I'm rather concerned with where all of this will lead for the balance of my career. I have plenty more to say, but, alas, night shift delirium is setting in and I must crawl off to bed. Interesting points, Commuter. I hope to come back to this when my cognition improves.Nov 27, '13 by TheCommuter, BSN, RN Senior ModeratorQuote from bluegeegoo2Same here. I just arrived home not too long ago after working a 12-hour night shift, so I will be jumping into bed soon!I have plenty more to say, but, alas, night shift delirium is setting in and I must crawl off to bed. Interesting points, Commuter. I hope to come back to this when my cognition improves.Nov 27, '13 by vampiregirl, ASN, RNI'm somewhat amused - the facility I work at is currently identifying it's most pressing concerns and trying to figure out how to address them.
I could have written the OP's list myself, except for shortage of supplies. I am so fortunate that we have a supply guy who stays of top of things. We usually only run into issues with new admits that have specific needs that we are unaware of until their admission.
I appreciate this article, there are many issues/ concerns in LTC if you face reality. If we don't identify them, we can't begin to address them.Nov 27, '13 by TheCommuter, BSN, RN Senior ModeratorQuote from vampiregirlAlmost every LTC facility where I've worked has had a central supply manager in charge of ordering and reordering supplies.I am so fortunate that we have a supply guy who stays of top of things. We usually only run into issues with new admits that have specific needs that we are unaware of until their admission.
However, many of these places use the central supply person as two managers in one to save money. One facility made the central supply person do scheduling and transportation arrangements. Another place used the central supply person as a staffing coordinator during the week.
When the people in charge of keeping the place stocked are burdened with too many duties, some things are bound to fall through the cracks.Nov 28, '13 by amoLuciaPer your norm, Commuter, a spot-on article. I would like to add to your acuity category that LTC is also seeing a significant number of pts with major behavorial and psych issues. These pts just get BLENDED in the general geri population. As you note, staff freq has limited training dealing with certain issues, and we know that these pts are high maintenance with a population of staff who are already stretched to the bare limit.
These are the pts that I think are even MORE devalued than the general LTC pts. They NEED specialized knowledgeable care.
Waiting for your next installment...Nov 30, '13 by Chris81Spot on,Commuter.Have also followed your posts regularly and agree. SNF 34+ yrs myself(started at the starry-eyed age of 19) and have recently(thankfully) had the opportunity to continue in LTC in AL/MC 1 month ago,when present SNF taken over and expanded to CCRC. Couldn't have come at a better time,as my generally upbeat self was being eroded by increased acuity,decreasing age of admits,increased incompetence in new nurses,decreased education from management,increased QAPI,decreased resident face time,increased hours spent at work,well,you completely get the picture. Signed-Beaten down,but not out!Nov 30, '13 by TheCommuter, BSN, RN Senior ModeratorQuote from Chris8134 years in the nursing battlefield? Wow! Thank you for your many years of being in the profession. I'm sure you've seen many changes as time passes.SNF 34+ yrs myself(started at the starry-eyed age of 19) and have recently(thankfully) had the opportunity to continue in LTC in AL/MC 1 month ago, when present SNF taken over and expanded to CCRC.Nov 30, '13 by Chris81Funny-the crisis when I was a year-old nurse was the introduction of DRGs-veteran nurses were warning us we'd get "fresh radical necks","chest tube with glass bottles on the floor,grab your hemostats" being admitted to nursing homes,booted from hospitals by the "bed counters". Never did see a radical neck,mostly hips,amputations,worse wounds(ST III-IV PUs),post CVAs and plain old OBS(prior to Alzheimer's as a diagnosis).Staffing then same as now-2 nurses,7-8 aides,60 pts. Difference now is higher admission/discharge rate,higher technical education/profiency for nursing and despite efforts to reduce/eliminate it,the silo mentality persists in management reducing productivity,efficiency and engagement with our elders. Enough said for a Saturday morning-punching out!Dec 1, '13 by savoytruffleExactly why I left SNFs. This list only scratches the surface of what's wrong with long term care. Working at these places has made me regret ever becoming a nurse. I left feeling defeated and depressed. I will never set foot into these places again. If fate decides to twist cruelly on me in my twilight years, and I become a resident, I will devote my entire wretched existence to eloping.Dec 1, '13 by OrganizedChaos, LVNI never had to deal with any high acuity patients but everything else is spot on! I don't remember how many nursing homes I have *tried* to work in, but it's been too many. It's always the same. Too much work, not enough time, high nurse to patient ratio, not enough supplies, etc. I got so tired of working my @$$ off for the little pay & constantly being disrespected by family & administration. I'm only one person, with 2 arms & I can't be everywhere & do everything at once.Dec 3, '13 by sunshyne17Quote from Chris81Why are new nurses dubbed as incompetent and not inexperienced?increased incompetence in new nursesDec 3, '13 by TheCommuter, BSN, RN Senior ModeratorQuote from sunshyne17Keep in mind that the particular nurse you're quoting has 35 years of experience. She entered the profession during a time when most nurses graduated from three-year diploma programs. Back in her day, new nurses graduated highly skilled, with thousands of clinical hours under their belts, and were able to hit the floor running at their new jobs without much orientation or training.Why are new nurses dubbed as incompetent and not inexperienced?
So in her eyes, today's crop of new grads does seem incompetent compared to the new nurses of 35+ years ago.
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