Thinking of switching from acute care to LTC

You are going to find that a lot of the sick med/surg patients that seem to get discharged too early end up in LTC facilities. As an RN in LTC you are likely to get placed on their Medicare wing, if they have one. That means you'll get those patients coming from the acute hospital that are sick and you will be very busy with them.

I've worked both LTC and acute hospital and I like both venues. In LTC you really need to be well organized and hone your leadership skills. You will be a charge nurse and will have to handle all kinds of problems and squabbles that come up with the CNAs. This will be new to you as this kind of stuff doesn't necessarily go on in the acute hospitals. The work, for the most part, however, is fairly routine. But, you will be constantly busy. You will get to know your patients very well.

LTC is highly regulated and there are a lot of laws that they have to follow. You'll hear your other charge nurses mention this all the time. Much of this regulation came about because of abuses going on many years ago when patients were literally dumped in these facilities and treated terribly. The states and federal government had to step in to clean it all up. The laws stayed. You can view them here:

• http://www.cms.hhs.gov/CertificationandComplianc/12_NHs.asp the Medicare Conditions of Participation (Title 42, Section 483 of the federal law) that apply to nursing home - to view the actual laws, click on the "42 CFR Part 483" link at the bottom of this web page.

I never felt that LTC was in any way inferior to hospital nursing. It is just a different venue. There has, for many years, been an attitude that LTC nurses are second-class. I think that comes from the perception that old nurses that can no longer keep up with hospital nursing, or who "flunk" out of hospital nursing, go to nursing homes. While you might run across a few of these people, the "flunk outs" are the ones to be leery of because some of them are truly dangerous practitioners. I always kept my nursing ethics and standards high. All patients, whether they are in a nursing home or the acute hospital, deserve that.