Why do RN's avoid LTC positions? - page 5

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... Read More

  1. by   CherylVermilyea
    It is very easy to misinterpret long term care based on negative experiences in your clinical training but you shouldn't condemn the industry entirely based on that experience. ..times have changed, rules change everyday! LTC is one of the most regulated industries, right up there with nuclear energy. We in LTC are asked to do more with less everyday and we do it in spite of overwhelming odds. It is a completely different kind of Nursing compared to hospital nursing...you have to treat each patient holistically, not just the diagnosis...we have to see the whole person...emotionally, psychosocially, spiritually, culturally, clinically, psychologically and then their families too! They don't just discharge and go home in a few days. ..they come to adjust to a different way of life...not necessarily the end of the road as people often believe but to live life to their fullest within their expressed wishes and ability! It is very hard work and emotionally demanding but the rewards are worth every bit of it! The people who need long term care need the clinical expertise of licensed nhrses, especially RNs and allied health personnel as well...they also need that part of Nursing that cares, that wants to help the person, that wants their quality of life to be the best it can be...the LTC nurse has the opportunity to practice every aspect of nursing...technical skills, wound care, psychiatric nursing, social worker, public health, infection control trol, education, assessments of all sorts everyday...communication skills are essential for physician and family and team function. Are some managed not as well as others...of course! We don't live in a perfect world...but that applies to every industry, goverment, society in this world. Truly the adage "don't judge a book by its cover" applies to many areas in nursing as well as life! You are correct though, not everyone can be a LTC nurse...it is a gift and technically oriented nurses generally don't last in the environment but, the nurse who truly wants to make a difference and values the diversity in working with chronologically challenged individuals, or otherwise challenged and requires LTC will thrive in it. For myself, I started as a CNA in LTC and didn't like what I witnessed in some nurses I worked with. I felt there had to be a better way and went on to become a licensed nurse...30 years later I can tell you there is a better way and we can make it happen ! I hope you found your niche in nursing but please don't judge LTC by your experience during clinicals...you might miss some very meaningful and stimulating opportunities.
  2. by   Vernie08
    Well I have to say I tried LTC 3 times and this time I'm gone for good. Back to the hospital I go. I was in charge of 58 patients and 2 LPNs and like my last 2 times returning to the specialty, it is horrible. (Please don't throw tomatoes). Management is just as bad as ever. Patients are sicker which increases the acuity level. Staffing is a nightmare. Most of the time I'm on the med cart and in charge due to excessive call outs. I'm gonna stop right now because I'm depressing myself just thinking about it. Anyways, I'm out for good this time.
  3. by   monday2016
    Hello All, in response to the OP's question, RN's avoid LTC for a variety of reasons, judging by the responses given. Prioritizing and organization are two of the greatest strengths needed in working in long term care today. I have worked in many roles in LTC: CNA, RN floor nurse, and RN evening supervisor. Is it a lot of work? Yes, but knowing what your priorities are, and how to go about accomplishing them will definitely guide you in providing nursing care. Working with elderly, chronically ill patients and their family members requires a certain patience, compassion and commitment in dealing with their issues on a daily basis. As a floor nurse, you can only do the best you can with what you have to work with, in relation to staffing shortages/supplies. LTC is not for everyone, as stated in many of the responses here.
  4. by   deltoid_chevron
    I couldn't have described my own experience in LTC better if I tried! You nailed every point. While, I also believe the frail & elderly are in desperate need of quality care, the management (corporate AND DOH) will continue to devalue their care in favor of money in their pockets.
  5. by   Kingsbridge
    I think those are some valid points How would your propose fixing some of the issues you talked about?
  6. by   LPNTOBE2017
    This is just my opinion. But I do not think that LTC nurses should be frowned upon. I think that LTC nursing is just as real as being any other type of nurse it has its good and bad points. I am going to nursing school and I am hoping to become a geriatric nurse( having previous experience as a CNA in A LTC facility). I look at it this way. I may some day end up in a facility and I would want to think that I am being cared for by a nurse who wants to work there rather than hating being there wishing she/he where doing a nursing job some where else.
  7. by   Coolbeanz
    You are absolutely right .I admire your desire to make a difference. I had been working at a LTC facility for 2
    months and i came in to work with the same vision. Be ready to deal with all types
    of nurses. The time you have in your hands is not enough for the amount of patients you are required to take care of. It is really challenging. I recently received a job offer at a hospital in a New nurses program with a contract of 2 years. I was told by a fellow nurse "are you ready to be a real nurse" my question to her was "so the elderly are not considered real people" I guess the fact that we dont deal with daily emergencies make us less nurses in the eyes of the hospital nursing staff. Maybe that is the reason why hospitals rarely hire nurses from LTC
  8. by   Vernie08
    Omg!!! It has NOTHING!!!! to do with the elderly. I have elderly patients everyday in the hospital. In fact, when I last left the nursing home there were lots of patients in their 30s and 40s. It's not just a nursing home for the elderly, it's a skilled nursing facility with rehab/therapy which makes the facility big bucks. The population has is all ages. My point is management in these facilities don't care and the impossible nurse to patient ratios. And everyone, please please understand that just because a nurse does no desire to work in a nursing facility does not mean it has anything to do with caring for the patients. Like I said before, I take care of elderly patients everyday.
  9. by   NickiLaughs
    It has more to do with severe understaffing, increasingly higher acuity and I lasted a whopping 4 months in one before I quit. I had 38 patients by myself. The only RN was our manager who she said we could call her anytime, but not really. On night shift I had two night med passes, 15 sugar checks, and two pegs.
    The day nurse never did her wound care treatments, she just signed she did it and left the old dressings on. I had issues getting a hold of a doc on nights regarding an issue with an insulin not arriving for a patient and what other options we had because her sugars were high and I was documenting this issue. I got written up despite the effort I had made while this other nurse who was signing off things she wasn't doing got nothing. After that, I quit.
    There are great and terrible nurses in LTC. I recently got a pt in the ER from a SNF whose foley had 25 mLs of saline in a 10 mL balloon and he had purple to drainage all around the catch. Diagnosis was urosepsis. These situations give the LTC a bad name, but I know that there are many truly amazing nurses and CNAs working in them with rockstar attitudes because of the situations they deal with daily.
  10. by   Coolbeanz
    Yup! Sometimes is not really bad CNA's or bad nurses. Like i said the ratio is simply out of this world. You are forced to do minimum care before moving to the next patient. Tonight i have 29 patients and is simply a matter of hoping i can manage my time to get medpass done by 11pm so i can start my charting to then start again at 5am why 5am? Because if i dont start by 5 i will not leave on time. Terrible. I know i am going to the hospital now and it will not be easy. But i need to know that there is more to nursing. I feel so frustrated. I hope it goes a bit better.
  11. by   superdave386
    I got my first nursing job at a Rehab and LTC facility. I've been there 3 months now and I love it. I love having the same patients and can provide continuity of care. I felt the same as a lot of my classmates in nursing school did, that LTC seems somehow not as glamorous or exciting as working in a hospital but I quickly changed my mind. I don't know if I could go back to a hospital now, I really do love taking care of my people. And as a pure bonus, they pay way better than the hospitals in my area do.
  12. by   ShelbyaStar
    I'm a new nurse that took a LTC job. I can't say I've experienced working elsewhere, though my clinicals were at some pretty good hospitals.

    As much as I would've liked to have worked at a hospital, many of the new grad positions I saw were only part time or nights. The hospitals here act as though you should be kissing their butts for the opportunity to work for them, and in LTC it's the other way around. I was able to start full time on evenings in LTC. I am being paid competitively with a generous retention bonus. There are also programs in place for encouraging nurses to go into LTC, such as loan forgiveness and tuition reimbursement, so most of my education will end up being paid for. I know some hospitals do this as well, but I doubt it's as common.

    I feel I'm getting pretty good experience. As previously mentioned, LTC is higher acuity than it used to be. You move up pretty quickly- I laugh to myself when I see I'm "charge nurse" for the night- I have no idea what I'm doing! I did have a decent amount of orientation as well, though it did get cut somewhat short due to a lack of staffing.

    Cons- chronically understaffed, it seems as soon as one person is hired another walks out without notice.

    Busy! I have at least 10 patients but often more like 20, even 40 when it's night shift. Many of whom need multiple med passes, diabetic care, treatments, wound care, doctor calls... you will learn time management for sure. I end up staying 2-4 hours after every shift to get to things I just couldn't get to during my shift.

    Admin at my actual work place has been really helpful and understanding, however, corporate that sees a low census has different ideas about how many aides should be working, whether there should be shift bonuses, etc.

    Cheap and low tech- get used to paper charts and running out of supplies. Bring your own scissors- learned that the hard way last night wasting 20 minutes looking for a pair of scissors that you would think would be in the treatment cart, just in case.

    I'm new, I'm stressed out, I end up crying after a lot of shifts just being so overwhelmed but I think that would be the same at the hospital, only my mistakes would be more devastating. Thing is there has been a lot of cracking down on hospitals to ensure better staffing, etc, but that hasn't really bled into LTC. Yet.

    I'm switching to night shifts to give it a shot. It'll still be busy but at least no admits, big med passes, etc to worry about. I'm also pregnant, so taking a shift that's a bit heavier on paperwork vs cares sounds nice for now. So it's definitely busy and stressful and my clinicals in the hospital seemed like a piece of cake by comparison, but I don't regret taking the job I did. It gets my foot in the door and some valuable experience, and ultimately I do enjoy taking care of my patients and getting to know them. It has its perks, I just definitely won't be doing this forever.
  13. by   kummerspeck
    There is a stigma about LTC, which I personally find to be completely stupid. Of all the populations out there, the elderly need nurses who are competent and caring. I graduated last year and a lot of the people I went to school with busted their rears to get into a hospital position (many did-which is amazing because we're in NE and it was an Associate's program), but I purposely sought out LTC because I felt it would be a good place to start my career. I wanted to focus on getting competent with my assessments, providing effective care, developing a healthy skill set, and since I am in a BSN program now, I chose a position that did not increase my stress level.
    I think LTC is a great place to start, and even stay your whole career, if you can find the right one for you. It took another friend three tries before she found a LTC that was well run and supportive of its nurses. Good luck!

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