Do acute care nurses look down on LTC nurses

Maria,NP · Mar 28, 2011

WOW! I just logged on and this is the right post at the right time. I have been working in LTC for almost 2yrs. I am looking to expand my wings and I am very nervous about it. I have the same feelings posted here. I feel I do a great job in LTC, but going to a critical care facility, I am nervous. What are they going to think about me, my skills, etc.

Yikes! I will let you know how my transition goes. :icon_roll

MouseMichelle · Mar 28, 2011

By the way in my town I make more than acute care nurses in hospital.........much more...that should say a lot

MouseMichelle · Mar 28, 2011

WOW! I just logged on and this is the right post at the right time. I have been working in LTC for almost 2yrs. I am looking to expand my wings and I am very nervous about it. I have the same feelings posted here. I feel I do a great job in LTC, but going to a critical care facility, I am nervous. What are they going to think about me, my skills, etc.
Yikes! I will let you know how my transition goes. :icon_roll

Have you thought about home health. Many people in home health are elderly. I was hired after I worked in LTC to home health and it's a blessing...give that a shot.

AmericanRN · Mar 28, 2011

Just wondering. Back in the day when I started LTC, I always felt that I was a "bad" nurse for going into LTC, that I was not competent. However I'm extremely competent. Having over 50 patients under my belt on my shift, I think I do a very very good job in dealing with emergencies, safety issues, dealing with abusive patients, etc. I have no backup as I'm the only nurse on my shift, so it's all up to me.
Is the stigma of LTC nurses for acute nurses still that way, do acute care nurses look down on us?

I started in LTC but I'm an acute care nurse now. Most of the acute care nurses don't know much about LTC other than some vague memory of clinicals. Once in a while I meet one who says something negative about LTC nurses I let them know what the current LTC experience is like. 30+ pts 20 of which might be total care, wounds, trachs, vents, no rapid response teams, no on site pharmacy. My current manager was absolutely blown away by the amount of work LTC nurses do and in short that is why she hired me and another former LTC nurse. She didn't realize that LTCs now take acute care cases long term, the acuity levels are higher now than when she was a new nurse. She also didn't know that some LTCs take vents, trachs, picc lines, central lines and that the nurses also do all the neb treatments in addition to everything else.

I'll level with you I left LTC not because I thought it was beneath me but the reality is I couldn't cut it anymore. The patient load was entirely too much for me even though managment always said I was doing a good job.

General E. Speaking, RN, RN · Mar 28, 2011

I think you don't know what you don't know. Before I did state audits of immunization records, I had NO IDEA what school nurses had to deal with. Chronically ill kids on lots of side-effect prone meds, neb treatments, kid's with trachs, diabetic kids with insulin pumps.

I have a HUGE respect for school nurses now.

joanna73, BSN, RN · Mar 28, 2011

That's the other thing. If you work at night, and you need meds for your pt that started to go downhill, after the Dr sees them, you are the Pharmacy. Meaning, Pharmacy went home hours ago. So then you have to go to wherever the night cupboard is located, find what you need, and write it up, until regular stock comes.

Also, a med pass for 30 people takes 2 hours. And that's IF everyone is agreeable with taking their meds. In LTC, we also have more Standing Orders. Based on your dx, you decide what med to give from the SO. Unless it's serious, we aren't calling the Dr for every little thing.

Deb, RN · Mar 28, 2011

ALL nurses are unique and special, regardless of what area in which they choose to excel. :nurse:

However, it is true that... as in all areas of life.... there is prejudice, even within the ranks: I've worked many years in large and a few small hospital environments, as well as agency and LTC. I've noted that, in general, one group can never fully understand another... evidently... unless they have walked in the others' shoes! That being said, I would not worry about what others think... the naysayers are unobjectively judging, anyway.

Just keep enjoying being where your heart takes you and your light shines! :up:

leslie :-D · Mar 28, 2011

i agree, that those who judge, speak from an ignorant perspective.

they haven't a clue as to what the job entails.

if ltc nurses are looked down upon, i seriously believe it's r/t an aversion to working with 'old' people.

we just do not revere old age in this country...

rather, we do everything to avoid or reverse growing old.

my 1st job as a new grad, was in ltc.

my pcp (as well as other dr's) have to come to the facility 1x/month, to see their pts.

one day, my pcp was there sitting at nurse's station, and she turned to me and whispered (with a scrunched face), "everyone is so old here".

ya think? :rolleyes:

my point being, her comment pretty much sums up how others feel about working with the aged.

since ltc, i transferred to palliative icu...which is all acute, emergent care...

and having worked both, no one will EVER tell me that ltc nurses, aren't "real" nurses.

when it comes to assessing, organizing, prioritizing, time mgmt...no one tops them.

ea and every ltc nurse, would transition just fine to acute care...NO problems whatsoever.

can't say the same about acute care nurses, transitioning to ltc...

can anyone else?

leslie

Deb, RN · Mar 28, 2011

i agree, that those who judge, speak from an ignorant perspective.
they haven't a clue as to what the job entails.
if ltc nurses are looked down upon, i seriously believe it's r/t an aversion to working with 'old' people.
we just do not revere old age in this country...
rather, we do everything to avoid or reverse growing old.
my 1st job as a new grad, was in ltc.
my pcp (as well as other dr's) have to come to the facility 1x/month, to see their pts.
one day, my pcp was there sitting at nurse's station, and she turned to me and whispered (with a scrunched face), "everyone is so old here".
ya think?
my point being, her comment pretty much sums up how others feel about working with the aged.
since ltc, i transferred to palliative icu...which is all acute, emergent care...
and having worked both, no one will EVER tell me that ltc nurses, aren't "real" nurses.
when it comes to assessing, organizing, prioritizing, time mgmt...no one tops them.
ea and every ltc nurse, would transition just fine to acute care...NO problems whatsoever.
can't say the same about acute care nurses, transitioning to ltc...
can anyone else?
leslie

There are difficulties for both sides in transition.... each brings their own talents, tho. I've noted that acute care nurses need help learning extreme time management and increased working knowledge regarding po meds when transitioning to LTC, and it is a true blessing when the LTC nurses recognize this and are supportive.

By the same token... it helps when acute care nurses understand that LTC nurses (in general) need some help with standard/quality issues, especially in the area of infection control and administering meds closer to exact timeframes.

All in all, if everyone respects each other and comes together as a team, ANYTHING is possible. And, the future is definitely going to require this brand of teamwork, as hospitals become even more acute and LTCs become more indundated with higher skill level Rehab patients in addition to their LTC residents. We are all in for an interesting and... as always... ever-changing future.

Black Jade, BSN, RN · Mar 28, 2011

Just wondering. Back in the day when I started LTC, I always felt that I was a "bad" nurse for going into LTC, that I was not competent. However I'm extremely competent. Having over 50 patients under my belt on my shift, I think I do a very very good job in dealing with emergencies, safety issues, dealing with abusive patients, etc. I have no backup as I'm the only nurse on my shift, so it's all up to me.
Is the stigma of LTC nurses for acute nurses still that way, do acute care nurses look down on us?

LTC nurses, Acute nurses, Psych nurses...we are still dealing with patients. The same is being said about clinic nurses. They look down on us because people think that it is an easy job and we don't do a lot. I used to work in a busy community clinic where I handled triage, codes, wound care, IVs, delegating tasks, dealing with front desk and back office issues, demanding patients, etc... Sometimes I had to deal with priority and time management where I had to deal with two or three patients at a time such as Walk-in, triage, patients who have nurse appointments and patients who's provider ordered an injection. I rarely had time for breaks. There were several occasions where I had a front desk staff or a provider follow me when I took a five minute break to go to the restroom. It also depends on where you work, because in other clinics the nurses don't do much.

I admire LTC Nurses who love their job and take good care of their patients. They handle a high volume of patients at a time that I often wonder why there is only one nurse in charge. There is a high safety issue and I'm pretty sure the level of stress is quite high as well. Depending on where you go, there will be nurses who don't know how to do a certain skill. So I don't think it's a competency issue. I personally would not want to work at a LTC unless I can work as a team with another nurse to help me with the patients and have great support from management. I fear that I will not be able to give the best of care to my patients if I am on my own. Everytime I read a thread about LTC or hear about it, I imagine the nurse running like a chicken with its head cut off. It's not an easy job and it's not for everybody. You shouldn't be look down based on the fact that you are an LTC nurse, but based on what you do and how well you do your job. :twocents:

linearthinker, DNP, RN · Mar 28, 2011

The nursing homes near us sent pts to the ED in pretty poor shape and when we spoke to them, those nurses would demonstrate an appalling lack of understanding of the most basic conditions, medications etc. Now, I will also add that they had a complete lack of leadership, so much of the blame lie there. So yes, we generally had a very low opinion of those nurses. I don't think anyone would extrapolate from that that all nurses at nursing homes are subpar.

tiroka03, LPN · Mar 28, 2011

The same can be said about the quality of the pt we recieve to LTC from the hospital. It's like they were never cared for. Usually constitpated and in pain when they arrive. And I have had more than once hospital nurses asking me on LTC, so what should I do now that I got them? Do you think they need me to take their blood sugar, ect. I sent in a GI bleed the other day, and the hospital nurse wanted to know if she should monitor their b/p, or not. I don't know about you, I don't trust the nurse sending someone to me, I always retake my vitals, blood sugars and reassess the pt, thats just common sense. Only when you get them from me, I give you a written list of whats wrong, the history, and vitals. I send them, not because I want to get rid of them, but because we don't have the manpower and the capabilities to do labs and tests that they can get quickly done in the hospital -(unless it's the night shift there too.)