Why do RN's avoid LTC positions?

[amyca]

What are the pros and cons of working as an RN at a LTC facility? It seems as though many RN's avoid LTC positions.

Is it the nature of the job (LTC duties)? Lack of variety? Do hospitals look view LTC experience as unfavorable experience?

I'm pretty new to the nursing world, but am learning that hospital jobs are highly sought after, while LTC facility jobs the ones to avoid. (Not necessarily my opinion, merely an observation.) Just looking for some insight/opinions!

[SuesquatchRN, BSN, RN]

Bortaz, RN said:

Yes, you. Dunno why the quote didn't work. ?

N, S, E or W?

Texoma. North of Frisco, south of Sherman.

[Bortaz, MSN, RN]

Ah, yes. Well, belated welcome!

[NurseLoveJoy88, ASN, RN]

I worked LTC on and off for the pass 2 years or so. It is not my first choice but I'm grateful for a job and do the best I can. My biggest con is understaffing and the mega med pass. Sometimes I feels that no matter how hard I try I can never meet the needs of my 40-60 residents under my care. I'm currently doing night shift in LTC, at which I'm excited about. I like night shift because it is less chaotic, however I'm miserable on my days off trying to catch up on sleep. Sometimes I feel like I don't know if I'm coming or going. I refuse to do evenings or days on a regular basis, waaay too much. As a LPN job choices are limited. I take my RN boards on monday, I'm praying that I pass so that can open up more doors. If I don't pass, I'm ever so grateful to still have a job, even if its' LTC.

OAN: My residents light up my world. If I ever won the lottery, I would pay for each of them to have a one on one nurse aid.

[fmxkrazyone]

As a new grad I took my first job at an LTC mainly because I needed the experience because the city I am in is saturated with new grads and I took what was offered. I received 3 days orientation with 3 different nurses, who mainly spent most of the shifts telling me how awful it was there. I didn't think it was that bad at first, but when I was left on my own I changed my opinion.

I had 45 patients each night from 7p-7a to pass meds on and then do treatments. The med pass was insane, on a good night with everyone behaving and taking their meds without fighting me I'd be done by 12am or 1. Then, I would do treatments and the rule was, "limbs on days and sacrums on nights" which made the least sense in the world to me. I can change a hand or foot dressing while they sleep, but to change a sacral dressing you actually have to wake people up and sometimes cause them pain to do this. Then I would chart and I never got any training on the computer system so that would take forever and then by 4am I would have to start morning med pass including blood sugars on 30 or so people.

I was so stressed out that I would cry every day and dreaded going into work every shift. Not one person, my unit manager, who I never even saw, or the DON ever bothered to check in with me. After about 5 weeks of this I went to a job fair at a major hospital in my city and landed a job on a med surg floor, which I love. I received many weeks of orientation and have been set up to be a successful nurse, not set up to make a med error and fail like I felt I was at the LTC.

This is only my personal view but LTC life can be tough for a new grad. Some nurses may be stronger than others and some nurses love working in the LTC facilities, I just found out that it wasn't for me, especially as a new grad I really need the support that a hospital has to offer.

[DixieRedHead, ASN, RN]

thecommuter said:

I have worked in ltc on and off for the past six years, so I will comprise a list of what I believe are the cons of this type of nursing.
Cons:

1. The acuity level in ltc is rising due to pressure to get patients out of the hospital faster. The ltc facility where I am employed often gets patients who are only 2 days postop. We deal with jp drains, surgical incisions, iv antibiotics q4h, central lines, and other stuff that you'd typically see on a med/surg floor

So there is variety some seek.

2. Due to low reimbursement rates from medicaid and medicare, the typical ltc nurse is responsible for providing care to a large number of residents (often 30+).

Where I work, the case load is 20:1

3. Supplies are often nonexistent. For example, we currently have a comatose trach patient with orders to change his inner cannula every shift. However, the facility does not always keep the correct size inner cannula in stock because it is too 'expensive.' we cannot find colostomy bags when we need them. Equipment such as feeding tube pumps and nebulizer machines can be hard to locate.

Don't know what the deal is, we have what we need.

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. You must take off your own orders and do your own admission paperwork because there's no unit secretary to do it for you. You must perform all respiratory treatments because there will likely be no respiratory therapist to do it.

There will be no respiratory therapist, and no unit clerk. As a manager I do the admission paperwork, assessments, and admission orders. Otherwise the nurses take care of it.

5. 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 ignores patient concerns to the point that it turns into a code situation.

Nurses must learn to police themselves and their co-workers. If you put up with it, you deserve it, the residents don't.

6. Society tends to view the frail, isolated elderly with much disdain. However, many people fail to realize that the ltc population is actually a mixed bag of younger adults, middle-aged baby boomers who are sick due to hard living, and the elderly. My youngest resident was in her late 20s and stayed at the ltc while receiving iv antibiotics q4h for infective endocarditis after slamming heroin.

Ltc is nursing of all ages, ethnicity, and lifestyles.

7. 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 couple of days of orientation.

Brand new nurses receive three weeks of orientation, more seasoned nurses less.

Please don't tar us all with the same brush.

[OR-RN2011]

I worked in LTC for 4 months after graduation. I had 12 weeks of orientation. My manager and supervisor were fired during the orientation. I showed up for work one day and the manager was gone. I looked out the window during a med pass and saw the supervisor being walked out. I was asked to work an extra shift, when I get there I found out I was training someone! They left that part out. I was just off orientation myself. I called the DON and told her I was not comfortable training anyone since I was new and thought it was dangerous. It fell on deaf ears two weeks later they asked me to cover the same shift and this time I said no.

I learned a lot in the time I was there. LTC nurses that are good are good! They are taking care of some very sick patients with very few resources.

I work in an OR and love it. The OR is where I wanted to be from day one.

Good luck

[Sfisher09]

I am an RN who went from school directly to LTC in 2009. I was told to go to MedSurg because that is where I would get the most experience. I had quite a few friends who went to scute settings in the hospitals. I have been with my company for a couple of years now and I have found several advantages to LTC.

1. You get plenty of experience. You are the IV nurse, the phlebotomist, the respiratory nurse. You do it all. I have taken care of a wide variety of conditions and have never felt that I wasn't learning every day.

2. You get to know your patients. In a hospital setting, the patient may stay for a couple days or even a couple weeks, but in LTC you get to know their stories, their families, their routines. I know my residents. They are like family to me. I feel like this helps me provide excellent care.

3. The pay can be better. Many of my friends who went into the hospitals started off well below me on the payscale. This may vary from facility to facility and/or state to state, I don't know.

4. RN's have the ability to be promoted quickly. I started as a PRN floor nurse and eventually went part-time. Within a couple months, I was offered a supervisory position (most LTC facilities prefer 24hour RN coverage) and loved it. Learned so much in that role. About 6 months later, I was offered a job as an MDS coordinator, which I absolutely love. I have been fortunate to be able to see how the facility runs from a few different perspectives now.

So, anyway, I just wanted to share a point of view from someone who has not had a negative experience in LTC. Best of luck!

[NoahscoopsRN]

I'm a newly licensed RN starting out in LTC, I also was an aide in a very busy LTC facility for 6 years also and let me tell you it is HARD work and VERY VERY busy. Im lucky if I have time to go to the bathroom once per shift (HELLO uti!!!). I applied to several hospitals after I was licensed with no call backs due to the fact that a lot of them were asking for prior med surg experience. Was I sad about not starting out in a hospital? sure, but am I also happy with my experience thus far in my LTC facility? YES, I have seen a LOT of things and it is a good way (at least I think) to start out. I definitely won't be there forever, but until I get more comfortable with skills, I don't have an issue with it.

[Tina, RN]

I've said it before, and I'll say it again...

LTC is TOUGH! I did it a long time ago, for about 3 months. I ended up going back to the hospital. I couldn't stand the endless med passes, lack of resources, constant short staffing, etc. I missed patient turnover, and seeing new faces. While I was there, I met some nurses that were absolutely made for it. They did their jobs so well, and clearly loved it. It really takes someone special to be able to do LTC.

I went from a hospital to the LTC center. I'll admit that I was sure it would be "easier". It was different, but not at all easier! Like I said, I hightailed it back to the hospital! LOL

[JZ_RN]

I am an RN, a new one, and the only places that even called to give me a shot were LTC facilities. The first one I worked at, they were giving me plenty of orientation on one hall, with another nurse (an LPN) and it was fine, I did afternoons. Then I agreed to take a 4 hour shift for another LPN on the other hall. I figured, no big deal, I got this, but off of the rehab hall and onto the LTC hall was miserable. Med pass from you know where. Why do the elderly get 20 pills at one med pass? And trying just to take people's vitals can be a fight with these people. I didn't know any of them, and it sucked as much as you can imagine, so then the nurse called and said she wasn't coming in for the rest of the night! Instead of finding me relief because I hadn't slept and couldn't be up all night killing myself on this ridiculous assignment, they told me that if I left I'd be abandoning patients and at risk for losing my license. I stuck it out and quit the next day.

The place I am at now I work on nights. I am the only nurse for over 40 people. I sometimes have 2 aides, sometimes 3. No one medicates themselves, and many are combative (I've been punched right in the face, kicked in the stomach, pinched, slapped, pushed, etc.) and I hate it. They are almost all confused. Some of them scream all night long for no reason. The infected bedsore dressings (I have been there for more than half a year and there are some people with the same infected wounds as when I came.) And all the treatments get stuck on nights cause they figure I do nothing. I change so many dressings it sometimes takes me 3 hours. My aides have no respect, barely speak English, are insubordinate and do not help. Many are lazy and I find them hiding, sitting, or even sleeping. I end up answering call lights when they are too lazy to do so. No matter how much I write people up, nothing changes. I do 6 hours of med pass on nights (4 at the start of my shift then 2 in the morning) and do all my own vitals and blood sugars. I also constantly have to do things like irrigate foleys with combative patients and turn morbidly obese patients without even a spare hand to help. None of these things are so horrible by themselves, but when my job is always difficult, I never get to sit or rest during my shift, all the treatments get passed on to me, and management doesn't care about you (denied me more than 2 shifts of orientation, told me I could quit if I didn't like it) it gets old. I am going to be getting out of long term care as soon as possible. And the constant falls and neuro assessments make me want to scream. I just want to scream at some people sometimes, STAY IN THE DAMN BED. I work completely alone and I hate it. I didn't become a nurse to kill myself like this or be abused and I feel like my care is not as good as it could be were we safely staffed. As of now, I just need to pay my bills, and I can see the care declines when I am not there.

[Good Morning, Gil]

Some people say that working in a hospital is more difficult than LTC as the patients are more acute, order changes, more prioritizing, etc. (This couldn't be more wrong). I think each have their challenges, and LTC in a poorly run facility or one with very high ratios definitely has to be more challenging than acute care, that is, acute care that has good or decent ratios.

My worst night in the ICU with 2 patients (even if both were to decompensate at the same time), still is less challenging than LTC with 40 residents. I always can visualize my patients, so I know what they're doing, monitored, if they're trying to crawl out of bed, etc. Not being able to see your patient or wondering if you're demented patient is crawling out of bed again would be more stressful. In my previous job, which was not LTC, but pretty close, I worked with 10-12 patients, med pass, etc, lower acuity, and I would take 2 critical patients any day of the week. LTC is definitely not an easy job. Even on a good night, 20-30 residents is a lot, and I can imagine med pass must take a while.

[OCNRN63, RN]

I don't have the patience for it, and it just doesn't interest me. I know someone has to do it; it's not just me. To me, it's like trying to push a rock up a steep hill, only to have it roll back down. It sort of gags me to have to crush meds and put them in applesauce for an adult; I don't know why. I wouldn't want to have to give meds to that many people; help in the dining room; do all that documentation; deal with falls every day, etc.

To me it's on par with working OB. I wouldn't want to do that, either.