ANYTHING good about LTC?

  1. Okay, another request for career advice. Please don't pass this up because I really want advice from LTC nurses.

    I know I want to go into nursing and have been admitted to a program, have been a CNA for 11 years including LTC, homecare and hospital, adn know I love geriatrics best, but the working conditions! I loved my job when I could do it, when staffing was good, but when does that happen? You all have to put up with so much with so little support, and the pay doesn't seem great. I don't THINK I want to work in a hospital, and if LTC's are as universally bad as all of that, maybe I could look into another field. I just don't know.

    So- my question is are there any good nursing homes? What would you suggest so someone starting out who wants to work geriatrics? Any advice is appreciated.
    Thank You!
  2. Visit germain profile page

    About germain

    Joined: Dec '03; Posts: 128; Likes: 4

    31 Comments

  3. by   leslie :-D
    hi germain,

    first of all you can check with your online state's dept of public health and see how a specific nursing home has been rated; if it has any complaints against and overall satisfaction. I believe it's called Nursing Home Compare, and i think it's nationwide. i'm from massachusetts.

    secondly if you choose one, take a walk through, notice any strong odors; observe the residents, i.e., are they all strapped in their wheel chairs, or restrained in other ways. ask the DON how many pts the cna's have on days, eves and nocs. if a cna has 10 pts during the day(i'm talking about in a skilled nsg facility) then staffing is horrible. ask how they've done on their annual surveys. ask same questions re: how many nurses per shift.

    the bottom line is if you enjoy the geriatric population, you will derive great satisfaction when developing relationships.

    but do as much homework as possible.

    good luck.

    leslie
  4. by   snowfreeze
    OK germain here goes.
    LTC is not as bad as many people will try to tell you. Everyone has to find their place as a nurse though. I never liked working with this population but now love it. Things change and so did I and my needs during my career.
    I love where I work, I found this place through agency placement.
    LTC is becoming filled with sicker patients, find a facility that recognizes that many patients are now classified as "skilled" and do require more care from all the staff. If you want to learn how to heal wounds, pressure sores etc. then LTC is for you.
    If you want to wean patients from ventilators then LTC is for you. If you want to help a hip fracture learn to walk again and go home then LTC is for you. If you want to watch a closed head injury from a motor vehicle accident finally wake up after 6 months of kinda following commands then LTC is for you. If you can deal with someone with ALS, MD, MS, Lupus, end stage cancer, polio, and ARDS then LTC is for you.
    If you want to take care of fairly independant elderly with a touch of dementia or other little hinderances that keep them from living home alone then go to assisted living or personal care.
    LTC has become what Med/Surg nursing in a hospital was 15 years ago. All venues of nursing have taken a few steps up the ladder in the medical arena. Every time medical science advances we get sicker patients.
    Go where your heart takes you, nursing is such a vast field that there is no reason to get bored. Working in a teaching hospital is an experience, you have to babysit the interns. Working in a Level I trauma facility shows you that the human body is so resiliant. Working in neuro shows you just how funky the human mind really is. I could go on and on.
    Good luck in school and in your career.
    Be a patient advocate all the time and you will not fail.
  5. by   dbsn00
    I agree with the above poster - you should check with your state's DOH - you can usually access info from there as to the facilities last survey results.

    Do a walk through if possible before your interview (all interviews I've been on the DON does a tour of the units anyway-but if they don't offer request it) and take notice of the surroundings - atmosphere, residents & other staff. Ask questions - do you have a separate units for individual resident's needs - sub acute, Alzheimers, vent, etc.? What kinds of activities are there for the residents? What is the staff to resident ratio - how many residents for how many nurses & CNAs? What's the policy for overtime, are there frequent call-ins? Why is the position open, is there a high turn-around rate? Who does the staff consist of & what would your duties be, does the charge nurse do more than care plans or will you be repsonsible for EVERYTHING (don't use my exact words though! ). When you're working understaffed teamwork & organization can make a big difference.

    Unfortunately, many facilities are understaffed - administators/owners don't regard the importance of enough staff to take care of the needs of the residents & then there's the whole insurance/$$$ issue (don't get me started on that!) :angryfire :angryfire :angryfire

    My facility is clean & reputable BUT disorganzied, short staffed a lot (at least 3 times a week I'm asked if I could stay the next shift & I learned a long time ago to turn my phone ringer off at night if I'm off from work the next day), nurses are not backed by management & we're always made to feel that we never do enough. But I love my residents & I know I make a difference in their lives, which is why I went into this profession to begin with. Good luck!
  6. by   tracytoon
    I don't think all LTC facilities are bad. The advice to do your homework is excellent. Most locals also know the reputations of the facilities.
    Long term care nursing means developing relationships with residents and families. Our facility is small and very family oriented, for some nurses this is more satisfying than seeing someone else in the beds every few days. It may not provide much satisfaction for someone who is looking for new, diverse clinical challenges. My satisfaction is knowing I've done the best I can to care for my residents in a less than ideal setting and system for their golden years. And while I grieve each time one of mine passes, I'm reminded of why I chose this vocation when I get thank yous from the families for the little things we do that make an impression. It truly isn't always a thankless environment.
  7. by   PHTLS
    Med Surg Pro's from an LVN POV:

    1) Higher pay
    2) Supplies
    3) Benefits
    4) Pension
    5) Career advancement
    6) Better Staffing
    7) Better equipment
    8) Code blue team


    LTC pro's:

    1) Old folks are easier to take care of than some whiny young patient who wants Roxanol every damn 5 minutes.
    2) You're the boss
    3) Quieter if you're used to the demented resident yelling the whole night (Just give 'em an Ativan).
    4) Code blues are a rarity (mostly DNR)
    5) No stupid beeping sounds
    6) Family atmosphere
    7) No surprises and consistency. I know my residents so well, I don't even have to look in the MAR or treatment binder to do my nursing care ( of course I check my MAR anyway along with new MD orders). I also know their habits and that helps save time.
    Last edit by PHTLS on Mar 6, '05
  8. by   CapeCodMermaid
    Quote from PHTLS
    Med Surg Pro's from an LVN POV:

    1) Higher pay
    2) Supplies
    3) Benefits
    4) Pension
    5) Career advancement
    6) Better Staffing
    7) Better equipment
    8) Code blue team


    LTC pro's:

    1) Old folks are easier to take care of than some whiny young patient who wants Roxanol every damn 5 minutes.
    2) You're the boss
    3) Quieter if you're used to the demented resident yelling the whole night (Just give 'em an Ativan).
    4) Code blues are a rarity (mostly DNR)
    5) No stupid beeping sounds
    6) Family atmosphere
    7) No surprises and consistency. I know my residents so well, I don't even have to look in the MAR or treatment binder to do my nursing care ( of course I check my MAR anyway along with new MD orders). I also know their habits and that helps save time.
    To disagree: plenty of room for good nurses to advance in LTC.
    1)an old guy with COPD is just as whiny as a young one looking for Roxanol
    or worse...the 65 year old with a knee replacement who tells you that getting HIS staples out is worse than having a baby
    2)give 'em Ativan and they fall and you'll do the incident report
    3) plenty of full codes on a sub-acute floor
    4) beeping sounds from everything imaginable..IV pumps, GTube pumps, door alarms, personal alarms, bed alarms, chair alarms
    5)family atmosphere??? Not in sub-acute or these days on most other floors
    6) PLENTY of surprises...that little old lady who looked so darned stable ten minutes ago now has had a sig. change in vitals and mental status,and oh, by the way, she's 93 and also a full code and her doctor is on vacation and the covering is a dork and you're the only nurse around and it all depends on your skill level.
    LTC....can't lump 'em all together.
  9. by   tracytoon
    Have to agree with the mermaid--sometimes there are surprises, and we have beeping from pumps, call lights, motion detectors...the list goes on! I am actually compensated much better than the nurses who work hospital med/surg in my area. I also have a pretty good 401K and benefits. Many of the hospital nurses ask me how I can stand such a boring job. While I don't have to hustle as consistently as they do, it is rarely boring!
  10. by   donmomofnine
    Preach it, Mermaid! You're telling the truth!

    Seriously, I say to look into faith based communities and not for profits. Those are fine facilities in the area I live! And as far as that list of LTC vs hospital goes, all of those items are tangibles. I guess I'm in it for more intangibles... I love my residents..the kisses, the thanks, being family and friend to them...
    Last edit by donmomofnine on Mar 6, '05
  11. by   dbsn00
    Quote from CapeCodMermaid
    To disagree: plenty of room for good nurses to advance in LTC.
    1)an old guy with COPD is just as whiny as a young one looking for Roxanol
    or worse...the 65 year old with a knee replacement who tells you that getting HIS staples out is worse than having a baby
    2)give 'em Ativan and they fall and you'll do the incident report
    3) plenty of full codes on a sub-acute floor
    4) beeping sounds from everything imaginable..IV pumps, GTube pumps, door alarms, personal alarms, bed alarms, chair alarms
    5)family atmosphere??? Not in sub-acute or these days on most other floors
    6) PLENTY of surprises...that little old lady who looked so darned stable ten minutes ago now has had a sig. change in vitals and mental status,and oh, by the way, she's 93 and also a full code and her doctor is on vacation and the covering is a dork and you're the only nurse around and it all depends on your skill level.
    LTC....can't lump 'em all together.
    You summed it up perfectly!!! :yeahthat:
  12. by   Antikigirl
    Just going to throw this out...why LTC? Is it because you are familiar with it and feel this would be more of your thing, or do you have the comfort level in yourself to try something else, maybe something you deny yourself because you feel it is out of your comfort zone? (read on...I would ask this of ANY area....this is not a diss against LTC, just bear with me...I do have a point..LOL!).

    I have asked this of many of the nurses I have worked with that have gone from CNA to LPN or RN and I am always greeted with the fact that that is what they feel they can do, and don't consider the wonderful opportunities out there that they too can find great joy and satisfaction in!

    Just make sure if you are picking any certain area, that it is what you WANT to do, not because you feel it is what you HAVE to do, or is all you can do comfortably...I have a few RN's that have made that mistake and now are labled LTC nurses and can't seem to move onto other choices if they wish to test out other opportunities..something to consider...

    Other than that...ehhhh, I am less than excited about LTC...my path just wound up there. BUT you learn so much, make so many connections to care and the actual results, are faced with many ethical/moral dynamics where you can make one heck of a difference for a patient. You can get to learn about many elders fasinating lives and learn about the history of your communities (I love this personally...even my meekest of little old ladies have such interesting pasts!!!! I love it, wish I could write a book on growing up in my community as a woman from early 1900's to now using their stories!).

    I have learned so very much, and that is the reason I have stayed...
  13. by   mattsmom81
    Quote from TriageRN_34
    . You can get to learn about many elders fasinating lives and learn about the history of your communities (I love this personally...even my meekest of little old ladies have such interesting pasts!!!! I love it, wish I could write a book on growing up in my community as a woman from early 1900's to now using their stories!).

    I have learned so very much, and that is the reason I have stayed...

    You SHOULD write a book about the memorable people you have met...get their family's permission and write a book from their nurses' perspective...what a lovely tribute!!

    Even in acute care, we hear such interesting stories and I've enjoyed getting to know my elders there. I cared for a lovely gentleman who at 14, lied about his age to get into WW2 and told me about his experiences following his parachuting into Normandy on D Day. Gave me chills, and I'll never forget him!
  14. by   Antikigirl
    it is so interesting isn't it!!!!!!!

    I had a patient that was living in Europe and had a MD as a father..nurse as a mother. The mother went off to a war as part of her duties..and came back different..go figure..war nurse? So the father left her, and wanted no part of her..took their only child..a girl..and went somewhere else....

    BUT to protect themselves he cut her hair and had her live her life as a BOY! OMG I can just imagine!!!!!!!! She lived from the age of 4 to 18 as a boy! Then they moved here..and she was able to be herself once her father felt ill..but still laid a heavy guilt trip on herself to continue as a boy..even though she so wanted to have babies, family, husband and live her life as she wanted!

    She didn't get the chance till 22, when her father finally passed...tried to find her mother who was dead with no other family to find....so she found a man she adored after having to move where she could introduce herself as a woman (and many learning experiences about being a woman after so many years as a male)...settled down..and had three daughters..go figure..for some reason..all nurses!

    She is so interesting...a kind spirit who lived her entire life as something other than herself, never gave up, and still could find herself afterwards and get her dreams!

    Now...rest home, DNR, and family never visits........

    Sad..but a real interesting journey I would love to document!!!!

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