What exactly is so bad about LTC??

Specialties Geriatric

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serenidad2004

119 Posts

Specializes in Dialysis.
And one more thing....working on a unit of an LTC is NOT below the education of an RN. It's apparent to me that you have not been in the kinds of facilities I have. We have medically complex residents on every unit. I need more than a med cart pusher.

I spent the first 8yrs of my nursing career in LTC/skilled.... and let me tell you it has done a 360 degree turn even since i started. Those people arent all little grandmaz an grandpas that need their daily ASA and prilosec... theyre SICK unstable dialysis pts, brittle diabetics, new tube feedings, wound vacs, a host of psych issues, COPDers that go in to acidotic resp failure quick, hospice etc the list goes on. Not that i dont think an LPN can do it... i started as an LPN but as our LTC population becomes sicker and sicker I believe RNs are very much so needed in LTC. I did much more than push a med cart

BrandonLPN, LPN

3,358 Posts

All I was saying, was that the LPN education totally prepares them to care for the pt at the LTC level. I don't think, actually, that the LPN should be the primary nurse at the acute level. Our scope is too limited. But we are perfectly prepared to be nurses in nursing homes. I have nothing against RNs working the floor in LTC.

But let's not be naive and say the reason we are seeing more RNs in the nursing home is because the acuity level is suddenly too much for a LPN. The ONLY reason more RNs are taking non-management roles in LTC is because of the economy. Nursing home administrators can put the new grad RN on the floor of LTC because they know these new grads are desperate for a job, any job. If the hospitals were still hiring new grads we would not be having this discussion. My ex roomate who graduated with his BSN started out recently as a staff nurse in a private nursing home making 21.00 dollars/hr. That is a PATHETIC wage for a RN. I started out as a LPN where I work at 20.00 per/hr. Most LTC places I investigated, there is only a 3 or 4 dollar an hour difference between LPN and RN. That is so unfair to RNs who spent 4 years in school. They are being taken advantage of.

As soon as the job market improves all those extra RNs in LTC will be gone with the wind.

tjharris

3 Posts

There's a LOT of truth to these comments. I've been working in an SNF for a year now, first as an LPN and now as an RN (with a BSN from a highly respected school, even). The job description is the same for me. The facility doesn't seem to give much credence to the difference the state nurse practice act delineates between the two licenses.

There's some things that I notice that can be universally generalized: Nurses are not "in demand" the way it was even four years ago. This paints a [editorialized] disheartening picture for me. An RN with a BSN makes barely three dollars more than an LPN does in a SNF that has a LTC unit and that LPN makes more than an RN in a hospital regardless of level of education when compared to starting wage and experience. Acuity is high but sub-hospitalization-ish on the "medicare/medicaid" floor. Twenty-two patients with still-open beds for one RN. I have no bargaining power for power for more support. I go to a 12 hour shift and I don't dare think of leaving until I've been there for at least 14.5. There's a lot of safety issues to the nurse (LPN or RN- remember they're the same here) ratio.

This isn't about complaining or whining, either. The commenter who posted about coming home feeling like you climbed Mt. Everest just by getting most of your work done has it spot on. I have never felt so unsure of myself. I always go to bed wondering what I missed or what mistake I made. It's never ending. I think that it's because I genuinely want the very best for the people I take care of. There's a lot of them. They all have unique needs and I want them to feel well cared for and that their needs (read: not wants) are met. The problem is that this is fantasy and that causes frustration that's orders of magnitude higher than I've ever before felt in life... and I'll only ever get one license in the mail. I'd hate to lose it over a job.

LTCs and SNFs are very necessary. They serve a more important function than they're given credit for. Geriatric nursing- though not all patients in an LTC or SNF are technically geriatric- is going to be a burgeoning care population. People live longer. Chronic disease hangs around longer. Critical care might have cool tubes and monitors but there will never (excluding the random outlier) be a more medically complex patient than the older human adult.

Specializes in ICU,Med-Surg, Sub-Acute, SNF, LTC.

Some things that bug me (RANT):

30-60 residents with less than 5 minutes to see each resident. Staff that should never be in charge of care for people. Staff that are completely uneducated. Staff with educations that still do things like reuse blood contaminated, single-use products. Nurses that lie about passing meds because there are too many residents and not enough time. Nurses that lie about whether they gave a suppository or not (I counted---you lied!) Lack of oral care for residents. All of the therapeutic conversation and dignity stuff learned in school is looked upon as a waste of time when put in practise. Ambiguous orders from a doc that oversees 3 LTC facilities of 60-99 residents each and has private clinic time. PAPERWORK PAPERWORK PAPERWORK. Lower pay than hospital counterparts.Noise levels that are grating on the nerves constantly. DONs and administrators that could care less about the actual humans being cared for. DONs that don't back up their nurses when it comes to giving CNAs direction. CNAs that smoke pot in the parking lot. Nurses that steal drugs. Call-offs. ETC ad nauseum.

These are not particular only to LTC. But these are problems I have faced.

HHLinda

25 Posts

LTC facilities are hiring RNs because of the sicker patients. A LVN can't do everything a RN does. My facility has a lot of post op orthopedic patients and those receiving IV medications. It's a great place for a new grad to work.

Yes, there are lots of meds to pass and it's hard to fit everything into an eight hour shift but it can be done.

TigerxLiLy

139 Posts

Specializes in LTC-Geriatric-PPS-MDS.

Im 5 yrs grad from RN school-- went straight to LTC after graduation due to 9months of trying to get in hosp but no bites.

I have started IVs almost every week, deep suctioning (which our LPNs cannot do), picc lines, pulled mucous plugs out of pts about to code (turning blue!!but struggling to breathe), done a crap ton of assessment skills that have saved the pt from going back to hosp-- that if we did t have a RN our LPNs would've just shipped the pt to hospital instead.

Our census is low now-- our medicare census is REALLY low- so we are fighting to keep our pts (we are able to hang ivs, draw blood, administer brthing txs, chest xrays, etc just like the hospital) the only the we cant do at our facility is ACLS and vents. Which i wish we could!

Our pts are increasing in their needs like one poster said... (peg tubes,trachs,wound vacs, ivs,piccs,dialysis,etc)

Our LTC facility is even trying to make a Post surgical unit w/ specially trained RNs assigned to that hall only.

Tori11

16 Posts

AtheistRN are u sure ltc nurses make less than hospital counterparts? Well not in my area. Ltc pay is the same if not more. Pay isn t this issue for me it s all the stuff you can not possibly do in 8 or 12hours. It s ridiculous i will graciously take a paycut for piece of mind.

Specializes in ICU,Med-Surg, Sub-Acute, SNF, LTC.
AtheistRN are u sure ltc nurses make less than hospital counterparts? Well not in my area. Ltc pay is the same if not more. Pay isn t this issue for me it s all the stuff you can not possibly do in 8 or 12hours. It s ridiculous i will graciously take a paycut for piece of mind.

I've seen anywhere from 8 to 20 dollars more an hour for acute care RNs. I have never heard of a nursing home RN getting paid more unless DON, DSD, etc. In No. CA, at least.

LindaB73

66 Posts

I've seen anywhere from 8 to 20 dollars more an hour for acute care RNs. I have never heard of a nursing home RN getting paid more unless DON, DSD, etc. In No. CA, at least.

In my area NW PA - I started in LTC making $6 per hour more than my classmates who started in the hospital. My best friend makes $9 an hour more than hospital new grads. New grads in the hospital start at $18.41.

NC4RN

17 Posts

Specializes in Med-surg, tele.

I just graduated, got my RN, and started in an LTC because hospital jobs are scarce here right now. My experience with the (very nice, very expensive) LTC where I am currently working has been excellent and awful, at the same time. The excellent comes from the residents. All of them have from mild dementia to late-stage Alzheimers, and have completely stolen my heart. The awful comes from the business end. Yesterday, I was the only RN in the entire facility, and I didn't even know it until the LPN orienting me let me know. Last week, on my fifth day of orientation, the RCC decided I needed to pass meds on two halls, for forty residents, for the AM med pass. That allowed me 3 minutes per resident, if you break it down evenly. Some of the residents have 15+ meds that have to be crushed. That, in itself, can take 10 minutes. I let my LPN orienter know that it wasn't safe for the residents, that I am protecting my license, and that I would gladly take one hall, but not both. Whatever kind of game the RCC thought she was playing to test my speed was totally inappropriate, and putting residents and ME at risk for med errors.

Forget quality of care or anything you learned in nursing school. I am now a glorified Medication Aide, hired because the RN after my name improves the facility's rating. The biggest travesty is that the residents are bored, sad, and confused, and I don't have time to properly nurse for them.

CoffeeRTC, BSN, RN

3,734 Posts

What is bad about LTC?

Having to do more with less...Medicare and insurance cuts. LTCs/ SNFs are having to take mroe complex residents and do more but still get reimbursed the same or less. That trickles down to the staff and resident care. Locking the suply closet for simple supplies, cheaper meals, doing away with certain products or maybe only ordering one type of it (briefs, soaps etc)

I can't complain about our staffing. The only time it stinks is when we have call offs and that isn't always the facilities fault. We really are trying to staff higher.

ltcnurs5

3 Posts

I often wondered the same thing - what's so bad about LTC. I quickly learned the main thing is ridiculous expectations, managment who have very bad memories of what nursing REALLY entails. Once the economy improves, all of the RNs will run for hills. After all is said and done, you have to keep reminding yourself "I am here for the patients" because they are the ones that make all of the hard work worth it.

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