Quote from Kasandra
Are you new to nursing? If so, I would recommend against starting out in LTC. This is why: I have been a nurse for two years. I spent most of that time on the floor in the hospital setting before switching things up with LTC. This is what I have seen:
I have encountered the predominant majority of RNs and LPNs in LTC not to be critical thinkers. They do not know the vitals for their residents before administering b/p meds, do not assess, and even give meds they have no idea about because "they are too busy". The month that I did LTC, I had within one week two people that I had to send out when I assumed my shift at 2200: One which was hypotensive with a 80s systolic with frequent liquid diarrhea and emesis and another g.i. bleeder with three large, tarry stools that showed the classic presenting s/s of a g.i. bleeder. For the exception of my assessments, no one had assessed these two. On the former, no one had taken vitals on her since January of this year. I, however, took vitals on those people who did not appear well or who were on any cardiac meds because that is a safe standard of care. For the latter, while getting report on my 36 residents, the LPN happened to mention one tarry stool. No mention of an assessment of the resident. She said she had called the PCP, informed him of the one bm, and was told to do a H&H on the resident the following day. When I spoke with the CNAs from the LPN's offgoing shift, I was told that the resident had three large, tarry bm's. I always assess first, and noted all the textbook s/s of a g/i. bleeder. Regardless, I was sending both residents out.
Lack of supplies is another issue. You will run out of things important for the nursing care you provide.
No training. In the hospital, you will receive never ending training. In LTC (at least where I was), training was non-existent. There was a high turnover. A RN was usually there from a couple days to 2 weeks at the most because of the bad care environment. I was an overachiever: I was there for a month, and am going back to the hospital to stay with a new job.
Another thing that I detested: Paper charting. Too much paperwork! Double, quadruple charting for the same thing. Just ridiculous.
To their credit, I did work with a couple good RNs and LPNs. However, out of the entire staff, I could only say this of 3 of my colleagues who were on point with their nursing care. The rest: not so much.
In a hospital, you will see muliple pathophysiologies. You will grow so much as a nurse. In LTC, you take care of the same people every day who, for the most part, take the same meds every day. You do not develop your critical thinking as well as what you would in a hosptial.
For those nurses in LTC: I do not mean to insult your profession. After a month of full time experience in a LTC, this is what I saw and what I know. If you can provide another point of view, please do. I, however, would not recommend any new nurse to go to LTC. However, if the new nurse really wants LTC, at least get some hospital experience so that you know your abnormal assessments so that you can get the residents help when they need it.
Sounds like you work in Long Term Care (read: Nursing Home). Long Term Acute Care (LTAC)is very very different from that. LTACs handle the same diagnoses as "standard" acute care hospitals, but for longer amounts of time. Pts at LTACs generally would be ICU/SICU/MICU/IMCU pts at traditional hospitals, but d/t CMS, they no longer qualify for care in that setting, or they continue to need intense care, but are generally stable so they no longer qualify for an ICU type setting in a traditional hospital.
We see dialysis, vents (a LOT), complex wounds (a LOT), peritoneal dialysis, continuous bladder irrigation, TBI/ABI, cardiac issues, uncontrolled DM, bariatric care, post S/P pts, post CABG, cancer and end of life patients just to name a few. These patients are VERY VERY sick for the most part. We provide nursing care in the same manner as nurses in standard hospitals.
The facility where I work seems to have ebbs and flows of high turn-over. Mostly it is because of management practices. All of the nurses that I have spoken to (including myself) love the level of care and the types of patients and challenges that we see.
I started my first nursing job at a prison (ACK!) and when I moved, I went to LTAC, so I had never been in a traditional hospital setting. 6 months ago, I decided to give it a try on an Oncology ward... 3 months is all it took for me to know it wasn't for me, and I am now back at LTAC. In LTACs, you get to KNOW your patients... not just their diagnoses. It gives you a more complete picture of their true needs and you're able to more quickly spot any changes.
You have FAR fewer resources. No RRT on standby, MDs not in house 24/7 (although my facility will be hiring 4 in house hospitalists as of Jan 1... we will see how it goes). You have to be able to think on your feet and rely heavily on the experience of those around you as well. You can't operate in a vacuum.
LTAC is not for everyone, but I feel that in LTAC, even though the pace gets HECTIC, I feel that I have the opportunity to provide better overall, person-centered care.
The politics are infuriating, and the governing boards are CHEAP, and yes, there's even some backstabbing among staff, but those things are everywhere. You have to be on your toes at all times.
Bottom line... LTAC is okay for newer nurses IF you find a mentor and ask a lot of questions. Don't assume you know everything. That's a quick way to get yourself or a patient in trouble in LTAC.
Dec 12, '12 by bioniclewomanI don't feel like there is a high turn over in my LTAC. With night nurses maybe, seems like we hire alot of night nureses. Turn over for day nurses is pretty low. The ones that do leave are new grads that get experince, and then move on to something else. We have our group of CNAs that have been around for a long time, and a handful that keep coming and going, but I think that is pretty normal. RTs have had zero turn over since I've been around. Charge nurses and administration has a very low turnover too. Unit secretary is a revolving door, and so is case management.