Long Term Care Nursing is Lame

Specialties Geriatric

Published

Having worked in a long term/short-term rehab facility combination for a year now, I have to say that in comparison to other areas of nursing, it's pretty lame.

Yes, we work hard. We have 20 or more patients on our own who require medications. Sometimes they'll have tube feedings, ostomies, JP drains, etc. There are many wounds, blood sugars, bladder scans and emergent situations aren't as rare as you would think. No one is denying people at these facilities work hard.

At the same time, when looking at other areas of nursing, including ICU and ER, it's safe to say we don't really do as much for these patients as these incredible nurses do. For example, I am highly impressed with a cardiovascular surgical ICU in my town, one of the best in the nation. These nurses see and do EVERYTHING. Skills include Skills include TPM, PPM, Chest reopening, chest tubes, trach, PEG, JP, NG/OG, pigtail cat, extubation, sedation, CT/MRI, Bronchoscopy, line placement, cortrac, IR, specimen collection, medications including inotrops, vasoactive, blood administration, insulin, heparin, CPN/lipids, paraltyics, and lines such as arterial lines, Cordis/STCVC, pAC, TDC, TPM wires, PICC, non-VAT blood draws, CRRT, Flexiseal, and pumps including PCA, Medication and Tube Feeding. They have LVADs, ECMO machines and take care of ALL ages from the newborn to the elderly. The MICU is also quite an impressive area, as are all the other ICUS. Plus, you can't beat the top notch nurses in the ER.

Sorry everyone but it's true...there's a reason why long term care nurses/rehab nurses are paid less than others.

Specializes in ICU.

I work in one of those super high acuity areas, and let me tell you... I could never do what you do. I would be ready to throw myself off a bridge having to take care of 20 patients. I hit almost basket case level when I have three. Props to you for succeeding where I would fail!

Specializes in ED, psych.

Oh nooooo, Purplegal. Don't do this. Aren't you the one that posted a year ago about something similar and it took *forever* to get people to back off?

I work Geri psych/adult psych at our state hospital. We see patients come in from the ED, their homes, rehab, from LTC. And like another poster stated, we know when a patient came from a poor quality LTC. Not even just from pressure ulcers, but from their BMI, quality of communication (many times they are afraid to ask for help from staff, and you can often separate this from the s/s of the dx they came in with), and the cleanliness (among others).

I'm not in ICU or the ED. My husband is an ICU APRN, and I know in my heart that that's a job not for me. Despite its "exciting" challenges and opportunities ... meh. I wouldn't be good at it because my heart isn't in it. As for the ED, THAT's not all that's cracked up to be either; our particular hospital's ED is a miserable place to work (high turnover rate, high census, poor management, etc). One of my closest friends works there and while she loves the staff, she is pretty unhappy. Often times she reports, among the "exciting things," with most other complaints patients certainly don't need to go to the ED for.

I'm in a field people don't typically LOVE (psych). I'm the only one in my graduating class who did so. Who cares? I'm happy and enjoy what I do.

The grass isn't always greener.

Specializes in public health, women's health, reproductive health.

I don't even know how to take this post. I'm not an LTC nurse, but I have to say, I still feel slightly offended. Getting over that, however, you decide how you view your job and the pride you put into it. If viewing it as "lame" suits you, then go for it. Otherwise, you can begin to change your perspective and put a different focus on what you do and how important it actually is to those you care for. Believe it or not, one could compare the job of an LTC nurse to that of an ICU nurse and have the LTC nurse come up the "winner". It's a lot about perspective. But I wonder why we have to compare specialties and declare some not as good as others. Many times it's like comparing apples and oranges. You do different work but different does not mean better or worse.

You're the one who picked to work long term care so I fail to see the point of you calling your own choice "lame". Be an adult and get another job if you don't like your current one instead of whining about how lame and dumb it is. Usually I find that those who do a lot of complaining are the ones who tend to be inadequate at performing the very job they're complaining about.

1 Votes

You're impressed by flexiseal skills?

LTC friends, I would not be insulted by her post... she's clearly being facetious,.

I hope you weren't one of those excellent LTC nurses who took such wonderful care of my mom :/

If so, they did a grat job of covering up their disdain for the work they did making sure the last 6 months of her life (and mine) were bearable

1 Votes
Specializes in ICU, LTACH, Internal Medicine.

OK, in LTAC I work right in between ICU and LTC, if one likes it to be put this way. I can honestly say that there are good, bad and ugly things done BOTH ways.

There are LTCs where patients are better cared for than in some ICUs - at least, I cannot imagine someone getting the whole hand first pale and pulseless, then purple and then almost black before it was finally noticed (a-line, thrombosis, no Allen done, AEA) in there. Moreover, there are group homes with one RN on duty for 60 clients, rest run by LPNs who never in their lives did anything "technical" and I doubt that any of them still remember anything about pathophysiology. While these nurses have no "acute" skills at all, I admire them because they know each of their patients literally inside out.

At the end, skills are just what they are. A monkey can be taught to insert any line in human body. But not many humans can suspect that something is very wrong by noticing that patient smells bad doesn't matter how much he is washed and has sudden difficulties to make his favorite puzzle. The LPN who noted it got doctors on in the middle of the night and insisted in sending patient in hospital. Ammonia 70+, acute liver injury due to averse effect of medication; if the LPN would wait till morning, the poor guy will probably die.

1 Votes
But you've impressed me, purplegal...

She's impressed me, too. Negatively.

Purplegal, if you want to make a change, do it. There is no need to put yourself down, along with many great LTC nurses - like ME!!!!! I'm a damn good nurse and I don't need you to tell me I'm not impressive. I have been there, done ICU and didn't really like it. I was not especially impressed with ICU. How about them apples?

Maybe you didn't mean to be insulting to those of us who work in what you might think of as a calmer setting, but we think we're doing good things for people, even if we don't ECMO and CPN and artline everybody. If you meant this in an insulting way, congrats, you made it. And if you meant it insultingly, go fly a kite.

Oh nooooo, Purplegal. Don't do this. Aren't you the one that posted a year ago about something similar and it took *forever* to get people to back off?

I work Geri psych/adult psych at our state hospital. We see patients come in from the ED, their homes, rehab, from LTC. And like another poster stated, we know when a patient came from a poor quality LTC. Not even just from pressure ulcers, but from their BMI, quality of communication (many times they are afraid to ask for help from staff, and you can often separate this from the s/s of the dx they came in with), and the cleanliness (among others).

I'm not in ICU or the ED. My husband is an ICU APRN, and I know in my heart that that's a job not for me. Despite its "exciting" challenges and opportunities ... meh. I wouldn't be good at it because my heart isn't in it. As for the ED, THAT's not all that's cracked up to be either; our particular hospital's ED is a miserable place to work (high turnover rate, high census, poor management, etc). One of my closest friends works there and while she loves the staff, she is pretty unhappy. Often times she reports, among the "exciting things," with most other complaints patients certainly don't need to go to the ED for.

I'm in a field people don't typically LOVE (psych). I'm the only one in my graduating class who did so. Who cares? I'm happy and enjoy what I do.

The grass isn't always greener.

Each of us has our niche And viva la difference. And that niche can change over time.
Specializes in ICU, trauma.

I work in the level 1 trauma/neuro ICU and i think your understanding of what we do is unrealistically high.

Yes we do things like sedations, intubations, extubations, lines, machines....etc but these things just all become routine overtime, just like what you're describing. In fact there are many nights when my patients will have NONE of these things.

Also would like to point out all the things you described we do in the ICU as well. If you're hoping to get away from blood sugars, tube feedings, and wound changed this is not the place lol.

There will soon be a point in your ICU career where you walk in a room and aren't wow-ed by an ET tube or an art line. When i first learned CRRT I was SOOO pumped to do it, but now i'd rather just take regular patients than a crrt patient :yawn:

work is work wherever you go, but it's up to you whether or not to make it an enjoyable experience.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

When I worked psych I cared for a lady who had just had a baby, but she became wild and crazy and spent a night in restraints before she settled down. The next day she was calm and asked if she could see her baby. I had to give a lot of reassurance to the NICU nurse to be allowed to bring her up there.

While we were there and the patient was holding her baby, I commented to the NICU nurse that I found those tiny babies very intimidating. She said "That's how I feel about YOUR job!"

So to each his own. Hopefully we're not all in it to impress each other.

Specializes in LTC, Rehab.

In a way, I get what you're saying re: skills required vs. some higher-acuity types of nursing. But the only things we can do are to do the best we can in whatever type of nursing we're currently in, and if we don't like it, move to another type.

Another commenter said 'well, you chose to do long-term care nursing' - I don't know if the OP did or not, but I didn't. After school, I had several interviews with a psych hospital, a hospital, a hospice facility, and a couple of specialty hospitals, and none of them took me, and I ended up at a LTC facility totally by accident. Another fallacy: one of the managers at work, lecturing nurses and CNA's in a little meeting, said 'You knew what you were getting into when you decided to work here'. Nope, that's not true either. I had little idea what I was getting into. :^)

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