Told I'm too smart for LTC

Editorial Team / Admin · May 16, 2017

LTC is a specialty of its own right, and just like the hospital isn't where you want to work, other nurses don't want to work in LTC either. We all have our own niche; some just struggle to find it. If LTC is where you want to be, then just ignore what the others say. (Disclaimer: I haven't worked in LTC; however, I do work OR and heard similar things to what you did- I love the OR and I'm glad I didn't listen to those people.)

SummerGarden, BSN, MSN, RN · May 17, 2017

Two of my favorite former classmates within my ADN program worked as LTC CNAs with past histories in the hospital setting. Both of them went into LTC right out of school. Like you, OP, they had no desire to work in the hospital setting and both wanted to work with geriatric patients full-time. One had continued her education to become an expert in Geriatric Nursing. With that said, they heard the critics while we were in nursing school too!

They heard the laughter even from a few lay people who were elderly! In any case, they did not let it phase them. They both had very good paying jobs right out of school (the hospitals where we lived paid less compared to LTC and Home Health/Hospice for new grads). Plus, both had no regrets!

Be your self and stick to your plan. No one can tell you how to live your life and what will make you happy but you. Many of your classmates and even the nurses that are laughing at you, are confused lost souls that do not know what will make them happy and will find out the hard way that what they think they want (and the type of nurse they wish to be) is not the specialty or job function that will make them happy. My classmates and you are very lucky that you know yourself and nursing well enough right out of school to do what will make you happy despite the naysayers.

Good luck to you!

Neats, BSN · May 18, 2017

I have heard all the snarky comments about LTC and being a BSN with 3 Master degrees! I am a Licensed Nursing Home Administrator and RN, I have worked in LTC, in Corrections', in Hospital emergency rooms, and currently as a Case manager while I am going to school.

I started out in LTC when I was 14 years old. From Nurses aid to now LNHA I know what it takes to be successful in geriatrics. Years ago I remember most of the geriatric men wore "Vet hats" and were in WW1 and WWII, I reflect what an honor to be able to have taken care of these wonderful hero's, this is where I learned how to be a wonderful competent nurse.

LTC skills are paramount and you have to have the best assessment skills to be good at what you do. You also have to know lab values, to be aware of a variety of diseases, to be aware of wounds, vents, dialysis, mental health issues, poly-medication issues to include IV hydration/medication/TPN and Enteral, nutrition, palliative/hospice, chronic care, regulations, types of therapy (OT/ST/PT), social and activity involvement, be aware of budgets AP/AR, and QA concerns, how to win friends and influence people are important because you are dealing with a broad range of family and friends over a long period of time, and you have to accept autonomy on a daily basis; all for people in the age range from 18 to over 100 years of age. To me this sounds like a well rounded nurse who could function in a hospital setting on a Med/Surg unit, in the emergency room, or a variety of other units with exception of pediatric.

Misconception of LTC is rampant after all no one wants to face on a daily basis the reminder of getting old, of seeing your ability to NOT perform your ADL's, to lose body functions in short to have to depend on another person for all personal needs. Secondly, LTC has a sordid past, in that this environment was once an environment that did not treat patients and staff on a daily basis humanely. With all the regulations LTC currently has; you must be compliant with those required regulations that are at the very least annually surveyed. We in LTC are continuing to be a reflection of a more professional, more service health industry that require highly competent nurses who come with great skill sets. As more time goes by I anticipate an even greater need for LTC skilled nurses and it is my greatest wish to have staffing ratios become CMS mandated with of course reimbursement to reflect those mandated staff ratios. Once this happens I really do think there will be an increase of RN's who would consider LTC as a career.

Good Luck to you and you are never too smart to work in LTC, in fact servicing geriatric patents we need all the smarts we can get for these people have so much wisdom, life experience they can discern a good nurse from a not so good nurse and why would anyone not think we all deserve a smart nurse taking care of them, seems to me the person who told you that really needs to reflect on their words and educate themselves about geriatrics.

HyzenthlayLPN · May 18, 2017

When I started nursing school, I didn't think I would want to do LTC. During nursing school, I found that LTC was where my heart was and I have no regrets :) Everyone has their own niche. I know folks who LOVE hospital nursing...I am not one. When I was a LTC nurse I LOVED that I knew my residents and their families. When I did clinicals at a hospital, I hated the constant patient turnover.

You have already working in LTC. If that is what you love, go for it!!!

Here.I.Stand, BSN, RN · May 21, 2017

My gracious, our elders NEED bright and dedicated nurses!!!! And assessment skills? I actually think geriatric nurses need keener assessment skills than I do as an ICU nurse -- because I have monitors, imaging, and stat labs at my disposal. I'm sorry (well not really), but anyone who would mock a desire to specialize in geriatrics is a despicable human being.

caliotter3 · May 21, 2017

The people who make fun of you now won't be tailing along when you seek work after graduation. Do what you want to do. You always have the option to change specialties later, just like they do.

Neener_RNBSN · May 24, 2017

I just have to say something here. To be honest, LTC gets a bad rap, but for no real reason other than the stigma! I graduated from a great BSN program at a respected university. When I had trouble finding a traditional acute care job due to the economy, I gave LTC/rehab a try. I fell in LOVE with it! I've been in practice at my current facility for 7.5 years. It's not something I had ever thought I'd be interested in, but I truly fell in love with my patients. You have so much autonomy in LTC, especially in smaller facilities. You're almost like a mini physician in a lot of ways--since the docs aren't there all the time, you learn what is important to focus on/report. You're almost like a case manager. You learn invaluable pharmaceutical skills. You learn to manage dozens of patients at a time.

Contrary to what most people surmise, it's not just "popping pills." You have to learn to think outside the box, manage multiple critical cases at once, and be able to react to any unexpected situation in an instant.

My LTC/rehab facility compensates very, very well for what we do. You get to build priceless relationships with the residents, who are so incredibly appreciative of what we do.

Although originally it wasn't my dream job, I have learned so much that I can't even begin to describe. Like you, I have been told countless times that I am too good for my job or too smart...that I belong in acute care. But why? Only dumb nurses work in long term? Come on! Nursing is a versatile profession with a plethora of specialties...one specialty does NOT invalidate another!

LTC is a unique specialty all its own. I don't care what anyone tells you, I've lived it. It's true. Don't you dare let anyone make you feel less than because you're not in an acute care setting.

Although I am a bit burned out in my current position, it has nothing to do with LTC itself. It's just the culture of my current facility. I am looking into transitioning into subacute care, or a bigger, more intense skilled setting.

Bottom line..if that is what you love, go for it! You will be rewarded many times over. I've known countless RNs from my facility who have transitioned to acute care and say, "Wow--it's so much easier!" We are used to managing 25-30 patients at a time.

I will never regret my wonderful, intensive, 7.5 years in LTC/rehab regardless of where I go next.

Best wishes and you can do it!!!