You will lose your skills in LTC

aCRNAhopeful · Feb 25, 2009, 08:00 PM

Originally Posted by Thornbird

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!!!!

Thank you for your informative response. The last paragraph (the one quoted above) really describes my experience with LTC. I work in a mostly rural area and the LTC centers hire mostly LPN's, many of which are strait out of school. Then on top of that the residents who may become acutely ill are shipped out. So these nurses may never care for an acutely ill patient and may never be forced to think through disease processes like nurses in acute care, at least in my area. That is why I said LTC does not promote new learning. I can see from your post that this is not the case in all LTC facilities and that there are some that truly value critical thinking. Thanks again for staying objective and offering informative feedback

ellen 12 · Feb 25, 2009, 10:11 PM

Originally Posted by aCRNAhopeful

I only pointed out the fact LTC (in most cases) does not promote new learning.

I work in long term care and at times learning can be a painful process.

I learn something new everyday.

ellen 12 · Feb 25, 2009, 10:21 PM

It is the individual nurse who will avail herself to new learning - through critical assessment and keeping up to date with best evidence when planning interventions.

I have come across nurses who get away with doing things the same old way and not taking time to effectively assess. The fact they get away with this - is related to poor quality systems. Elderly people and aged care is considered low in status..and coming from the top at a governmental level - there is a lack of desire to effectively promote ideals in care of the aged.

Your thoughts that nurses working in LTC don't get to critically assess - lack knowledge and don't have the opportunity for new learning, is simply another reflection of a sick health care system.

cxg174 · Feb 26, 2009, 03:09 AM

SKILLED assessment is not part of the realm of the LPN. They are not taught the critical thinking skills of the RN as part of their education. You cannot expect the same level of depth of learning, though they are often great nurses.
They are taught to recognize and report signs of illness or abnormalities, but their training programs or more based in the practice of nursing skills- hence the term practical nurse. That is why they generally function under an RN.

In the program I taught at, the RN and LPN students had the whole first year together, then the LPNS did peds, maternity, LTC in the summer and graduated. The RNs came back in the fall and did psych, LTC, maternity, peds, critical care, leadership/case management, home health. The RNs spent more in depth time in each of the specialties and had additional areas like critical care which develops many of the critical thinking skills about acute illness.

This is not to say RNs are better, but the education is different.

southernbeegirl · Feb 26, 2009, 08:56 AM

as yall can tell, this is such a sore subject for me. I have devoted all most my entire career to geriatrics. to have other nurses say I have no critical thinking skills or that i'm not as good as a hospital nurse just chaps my hide!

i worked in your precious hospital for 6 whole months. wanna know who my patients were on the med surg/telemetry floor??? they were my nursing home patients!! at the hospital, i had 6, maybe 8 patients at a time. had lab techs to draw the blood, iv teams to start the ivs...heck, in the hosptial theres a "team" for everything! the only thing i basically did was admin. meds and do an assessment on them. i was bored outta my mind! it cracked me upto hear the other nurses complain about having so many patients.

in LTC one nurse does it all. we draw the labs, make the appts, round with the doc, do the admits, do the d/c's, do the treatments, do the procedures...if our pt needs it, we do it. we have no "teams" to call. everything is done based on our assessment.

over the years, esp. the last 5 years, patients are being admitted to SNF units much sicker than before. IVs, CVLs, PICCs, ports, trachs, drains, wounds...you name it, we get it.

the only thing i did at the hospital that i dont do at my SNF is hang blood. when i worked in the hospital, i was constantly being complemented on my work and my skill knowledge. it cracked me up to see their faces when i told them my career history. it was nice to help break that ceiling about LTC nurses.

i dont think it makes a hill of beans difference WHERE you work these days. they are ALL sick.

JeanineLPN1984 · Feb 26, 2009, 05:51 PM

"Lose your skills in LTC"", HA-HA, right. More like "Lose your Mind" !!!!!!!! Been there, done that, made it all better.

**TheCommuter** · Feb 26, 2009, 06:00 PM

Since I'm inherently lazy, I prefer a laid-back, unstimulating work environment. However, I have not found that in LTC.

I work at a nursing home (LTC/SNF combo). However, I work on a short-term rehabilitation unit where the typical patient is discharged home in 2 weeks.

I deal with mostly postsurgical patients who are too deconditioned to go home. These patients are CABGs, knee and hip arthroplasties, thromboembolectomies, hysterectomies, post CVAs, fractures, and so forth. One time I received a gentleman who was badly beaten and robbed, and needed reconditioning. Many of my patients are middle-aged, and wouldn't fit the description of the average nursing home patient.

I regularly give drugs via IVPB and IV push, especially antibiotics. I remove sutures and staples, dress complicated wounds, operate CPM (continuous positive motion) machines, iceman machines, oxygen tanks, concentrators, and PEG tubes. I had been employed on a traditional long term care unit for a year, and I had not been exposed to some of these skills.

There's always something to learn at my workplace. The opportunities might not be so obvious, so you have to be aggressive and seek them out.

ellen 12 · Feb 26, 2009, 08:47 PM

Originally Posted by cxg174

SKILLED assessment is not part of the realm of the LPN. They are not taught the critical thinking skills of the RN as part of their education. You cannot expect the same level of depth of learning, though they are often great nurses.
They are taught to recognize and report signs of illness or abnormalities, but their training programs or more based in the practice of nursing skills- hence the term practical nurse. That is why they generally function under an RN.

In the program I taught at, the RN and LPN students had the whole first year together, then the LPNS did peds, maternity, LTC in the summer and graduated. The RNs came back in the fall and did psych, LTC, maternity, peds, critical care, leadership/case management, home health. The RNs spent more in depth time in each of the specialties and had additional areas like critical care which develops many of the critical thinking skills about acute illness.

This is not to say RNs are better, but the education is different.

I am a registered nurse - and I work in long term care.

Some people will never learn to evaluate situations in critical manner - whatever their education.

Other people instinctively know how to evaluate and think along critical lines.

Critical thinking can develop through experience and learning in the work place. It is not simply the realm of RN's to be able to engage their minds in a critical manner.

Schmoo1022 · Mar 03, 2009, 12:17 PM

Well,
I have not had a PICC, or IV ABX in several years, No TPN,Trachs or vents ever! We don't take those patients. So, I guess it all depends on where you work. I have lost my skills (my own fault) now I can't even find a med-surg job in a hospital. I guess I need to go to a more acute LTC huh?

missyd1991 · Mar 04, 2009, 03:46 AM

I have worked in LTC now for over 14 yrs starting as a CNA and now am a LPN and I have to say we get alot of acute cases. We are attached to a hospital so the cases we get sometimes are pretty invovled. I feel everyone has their place in nursing and no one should be made to feel like they are not worthy of other nurses. We all have to support each.