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| No. 21 | 
Feb 24, 2009, 05:07 PM
 Re: You will lose your skills in LTC
I would have to say that it is possible to lose your skills as far as critical thinking and assessment if you didn't have experience in the acute care setting already. After nursing school one really has just the minimum competency to be a nurse and requires lots of on-the-job training. If someone didn't have knowledge and assessment skills of the acutely ill patient then things will be missed and residents wont get the medical attention they need because nurses weren't knowledgable enough to help. Of course if a nurse had a strong acute care background that could be avoided but LTC, IMO, is not a place that encourages new learning and strong assessment skills.
 | | No. 23 |
Feb 24, 2009, 09:10 PM
Re: You will lose your skills in LTC Originally Posted by aCRNAhopeful  I would have to say that it is possible to lose your skills as far as critical thinking and assessment if you didn't have experience in the acute care setting already. After nursing school one really has just the minimum competency to be a nurse and requires lots of on-the-job training. If someone didn't have knowledge and assessment skills of the acutely ill patient then things will be missed and residents wont get the medical attention they need because nurses weren't knowledgable enough to help. Of course if a nurse had a strong acute care background that could be avoided but LTC, IMO, is not a place that encourages new learning and strong assessment skills.
Perhaps you have never worked in LTC? This is exactly the attitude that LTC nurses feel is demeaning. Many of the patients in LTC have complex medical problems and are discharged early from hospital because they will be going to a nursing facility. Even those who are just there for "custodial care" become acutely ill at times. They develop infections, have CVA's & MI's, CHF, aspirations, exacerbations of COPD, I could go on and on. The nurse must be able to recognize these s/sx because there is no physician making rounds daily on them. Yes, there are nurses in LTC who are lazy or incompetent (just as there are anywhere) so the challenge is that much greater for those who do their job right. When you have an emergency or an acute illness, you are dealing with it in a situation with minimal help and minimal equipment waiting for EMS to get there. Not all of these patients are DNR and not all DNR's are not to be hospitalized for emergencies. You have no phlebotomist, IV team or respiratory therapists to come do any part of the job for you. You call the pharmacy for a "stat" order and it may take 8 hours or more to get to you. It is a huge challenge to try to get meds and treatments and charting done for 20 to 40 patients on a unit and get decent assessments done. There are mountains of regulations that have to be followed that hospital nurses never have to worry about. It is very easy for a nurse to get caught up in trying to get everything done on time and end up skimping on the assessments. But, the fact is that strong assessment skills are essential. Learning has to be continual. There is nothing these days that is seen in med-surg that is not seen in LTC. The work can be overwhelming, the recognition non-existent and then to have other nurses (who should know better) demean it is the final straw. No wonder burnout is so high.
| | No. 24 |
Feb 24, 2009, 09:38 PM
Re: You will lose your skills in LTC
What is a CRNA?
Thanks Thornbird --- the demeaning attitudes of some nurses towards their professional colleagues who take up the challenge of nursing in LTC facilities can be incredibly offensive.
| | No. 26 |
Feb 25, 2009, 07:28 AM
Re: You will lose your skills in LTC
I was not trying to generalize all LTC nurses into a single category, I apologize if I made it seem that way. I was generalizing LTC as a place that doesn't promote new learning (there may be some that do). Maybe it's only my facility (working part-time while in school), but I see many nurses who simply don't understand pathophysiology and acute illness. My assessment as to why they don't understand is not that they are an unintelligent group of people but that they have not been pushed to learn more. Maybe my facility is a minority, that's a possibility, I get it. I think that with that increased autonomy mentioned above, a nurse in LTC needs solid experience because there is no doc making rounds, there is large workload, etc. etc., and it takes a knowledgeable nurse to pull that off. I've never heard of any LTC facility requiring a 6 month orientation with a preceptor or even 3 months for that matter. The nurses should already have that background knowledge because, IMO, an unexperienced nurse is not going to get it going directly into LTC. Now unless I am mistaken I did not say anything offensive about any group of nurses in this post, I only pointed out the fact LTC (in most cases) does not promote new learning.
| | No. 27 |
Feb 25, 2009, 07:35 AM
Re: You will lose your skills in LTC Originally Posted by aCRNAhopeful I would have to say that it is possible to lose your skills as far as critical thinking and assessment if you didn't have experience in the acute care setting already. After nursing school one really has just the minimum competency to be a nurse and requires lots of on-the-job training. If someone didn't have knowledge and assessment skills of the acutely ill patient then things will be missed and residents wont get the medical attention they need because nurses weren't knowledgable enough to help. Of course if a nurse had a strong acute care background that could be avoided but LTC, IMO, is not a place that encourages new learning and strong assessment skills.
I invite you to work in my LTC for 2 days and then you come say this to me again, k?
| | No. 28 |
Feb 25, 2009, 07:37 AM
Re: You will lose your skills in LTC Originally Posted by aCRNAhopeful I was not trying to generalize all LTC nurses into a single category, I apologize if I made it seem that way. I was generalizing LTC as a place that doesn't promote new learning (there may be some that do). Maybe it's only my facility (working part-time while in school), but I see many nurses who simply don't understand pathophysiology and acute illness. My assessment as to why they don't understand is not that they are an unintelligent group of people but that they have not been pushed to learn more. Maybe my facility is a minority, that's a possibility, I get it. I think that with that increased autonomy mentioned above, a nurse in LTC needs solid experience because there is no doc making rounds, there is large workload, etc. etc., and it takes a knowledgeable nurse to pull that off. I've never heard of any LTC facility requiring a 6 month orientation with a preceptor or even 3 months for that matter. The nurses should already have that background knowledge because, IMO, an unexperienced nurse is not going to get it going directly into LTC. Now unless I am mistaken I did not say anything offensive about any group of nurses in this post, I only pointed out the fact LTC (in most cases) does not promote new learning.
let me rephrase what i said...
when you are a NURSE....get back to me, k?
| | No. 29 |
Feb 25, 2009, 10:15 AM
Re: You will lose your skills in LTC
A CRNA is a Certified Registered Nurse Anesthetist. I believe that could mean a CRNA hopeful is an RN at this time.
Do not judge all LTC by any one. They vary tremedously in tye of patients, quality of care, staffing ratios and anything else you can think of. LTC's in urban areas are actually just as likely to have very complex, acute patients due to proximity to more medical centers. Most provide ongoing inservice at minimum to cover care of patients being admitted with "new" equipment or treatments.
Preceptorships are uncommon in LTC because they are cheap, profit-motivated corporate entities in most cases, not because they are not needed. Things have changed in that respect. When I moved from hospital to LTC, I received 6 weeks orientation and had an asigned preceptor for the first 3 months that I was on my own. It was an excellent facility and that amount of help at the beginning has made me forever a great LTC nurse. And that was over 20 years ago when there was a lot less to learn. These days a lot of hospitals don't provide that much preceptorship to a new grad. If you are not yet an RN, look into how much preceptorship new grads actually get in your area hospitals. You may get an unpleasant shock.
One problem with assessments in LTC are that many LTC nurses are LPN's. Because of the raging BS about "Assessment" as an RN only skill, there are LPN programs that are not properly teaching the basics of assessment that an LPN needs to practice. Then these unfortunate people get their licenses, get a job in LTC (the most common place to employ LPN's) get 3 days of orientation and thrown to the wolves. If they are lucky, a more experienced nurse will help them out. If not so lucky, they learn the hard way. Perhaps, you, CRNA hopeful, can advocate with your state for ensuring that new LPN's are trained in basic assessment because they certainly will be expected to assess their patients!!!!
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