Losing your skills in LTC

Specialties Geriatric

Published

I hear frequently on this BB, other BBs, Nursing magazines and other Nurse friends that "If you go into LTC you loose all of your skills" This is so untrue, it makes my blood boil.

I know that we do not HAVE to do alot of the procedures that Nurses in Acute care settings are asked to do, but there are alot of human skills that we have to have in abundance to succeed in LTC.

I did not go into Nursing to become a LTC Nurse. I did go into Nursing to help anyone and at every chance I could. Geriatrics gives me that opportunity. We don't just treat the ill, the infirmed. We have to see the big picture. My residents are not just sick and in the hospital. They are dying. And I take a great honor in being able to help them and their families prepare for this finality. I get to know these people as human, I know their children, their grandchildren, even their dogs/fish. The staff of a LTC facility are often the only family these forgotten souls have. I take great pride in being a LONG TERM CARE NURSE. And there is nothing lacking about my skills, there are different thats all.

I just have to say that I've watched this thread closely and love so many of the comments everyone has made. In LTC we are multi-talented, multi-tasking, autonomous, well-rounded nurses who should have no fear of losing anything while working in long term care. I do have to agree that there are some poorly run facilities, but I disagree with the solution offered of just leaving and going to a better-run facility. Then who cares and advocates for those residents in the 'poorly-run' facility??? You have to be proactive as a nurse. If changes need to be made, let it begin with you! It's not always easy rocking the boat, but if the boat is sinking and folks are drowning, someone has to throw out the life-line and get them back onboard. Start with talking to supervisory nursing staff about some of the problems you're having on the floor. If they don't listen when you talk to them, write them a memo, if they don't respond, then write another one and give a copy to the administrator. If you don't get any response there, then request a meeting with both the Director and the Administrator to discuss problems. And it helps if the LPN staff is united and wants a 'group session' instead of just one or two lone nurses who might appear to be griping. You can make a change. You just have to care enough to want to. As a Director, I've had to work the floor as an LPN, I've gone in at 3 in the morning to work as a CNA, and had days where I've worked around the clock and then some. It's frustrating for the floor staff, I know. But if your nursing supervisors/administrators have never 'walked a mile in your shoes' then they may not have a clue what's really going on. THEY have to care, too! We may not have the respect of the rest of the nursing community because we're "just" LTC nurses, but we don't lose a darn thing. We gain knowledge, compassion, integrity, love, and the respect of the people who matter - our residents, their families, and our staff - when we do a great job.

Specializes in Registered Nurse.
I just have to say that I've watched this thread closely and love so many of the comments everyone has made. In LTC we are multi-talented, multi-tasking, autonomous, well-rounded nurses who should have no fear of losing anything while working in long term care. I do have to agree that there are some poorly run facilities, but I disagree with the solution offered of just leaving and going to a better-run facility. Then who cares and advocates for those residents in the 'poorly-run' facility??? You have to be proactive as a nurse. If changes need to be made, let it begin with you! It's not always easy rocking the boat, but if the boat is sinking and folks are drowning, someone has to throw out the life-line and get them back onboard. Start with talking to supervisory nursing staff about some of the problems you're having on the floor. If they don't listen when you talk to them, write them a memo, if they don't respond, then write another one and give a copy to the administrator. If you don't get any response there, then request a meeting with both the Director and the Administrator to discuss problems. And it helps if the LPN staff is united and wants a 'group session' instead of just one or two lone nurses who might appear to be griping. You can make a change. You just have to care enough to want to. As a Director, I've had to work the floor as an LPN, I've gone in at 3 in the morning to work as a CNA, and had days where I've worked around the clock and then some. It's frustrating for the floor staff, I know. But if your nursing supervisors/administrators have never 'walked a mile in your shoes' then they may not have a clue what's really going on. THEY have to care, too! We may not have the respect of the rest of the nursing community because we're "just" LTC nurses, but we don't lose a darn thing. We gain knowledge, compassion, integrity, love, and the respect of the people who matter - our residents, their families, and our staff - when we do a great job.

Good message. :) I was a CNA years ago and a LPN for a long time. I like to be hands on, so I won't be someone always sitting at the desk...although I do have to get my paperwork done. I have to find a balance.

Specializes in Registered Nurse.
undefined :) :)

:) very true and well put!

ty, frazzledrn. :)

Reply to NursesRmofFun/RN - Girlfriend, I didn't mean that I used to work as a CNA and then an LPN...I meant as the DON I find myself having to fill in when needed on the floor just to meet staffing sometimes, and others just when my staff is feeling overwhelmed and they need the extra encouragement of seeing me out there busting tail WITH them and not railing AT them to get their work done. I have always maintained an open door policy and it's true that you have to find a balance and get your paperwork done. My staff and other department heads know that if my door is shut, it means I'm either trying desperately to catch up on paperwork, counsel with someone, or meet with a resident or family member and they'll usually slip a note under my door and know that I'll get to them as soon as I can. But, more often than not, I find myself doing my paperwork on my "off" time - whatever that is. To any of you out there who have husbands and younger children, I have to applaud you because I don't think I could do it all and have any time left over. I've worked hard the last year to find that balance, still have time for myself, encourage and educate my staff and not burn out. We have to hold each other up. That's one reason I'm so glad I found this BB! :balloons:

Specializes in Registered Nurse.
Reply to NursesRmofFun/RN - Girlfriend, I didn't mean that I used to work as a CNA and then an LPN...I meant as the DON I find myself having to fill in when needed on the floor just to meet staffing sometimes, and others just when my staff is feeling overwhelmed and they need the extra encouragement of seeing me out there busting tail WITH them and not railing AT them to get their work done. I have always maintained an open door policy and it's true that you have to find a balance and get your paperwork done. My staff and other department heads know that if my door is shut, it means I'm either trying desperately to catch up on paperwork, counsel with someone, or meet with a resident or family member and they'll usually slip a note under my door and know that I'll get to them as soon as I can. But, more often than not, I find myself doing my paperwork on my "off" time - whatever that is. To any of you out there who have husbands and younger children, I have to applaud you because I don't think I could do it all and have any time left over. I've worked hard the last year to find that balance, still have time for myself, encourage and educate my staff and not burn out. We have to hold each other up. That's one reason I'm so glad I found this BB! :balloons:

Hi there, ToobusyRN! LOL. ;) I knew you meant you were *acting as* a CNA and LPN by working in those positions. You sound like a good DON! I am not sure I'd ever want that job. I am sure there is a lot of pressure. But I will take one step at a time and see where life leads me. :)

I would help the nurses and CNAs out on the floor too, if needed....and probably will as a Unit Manager, at times.

I am glad I found this site too!

I am going to make this my last response tonight before going to collapse in bed.

First let me say.. howdy y'all I am new to the BB and so excited to have found it. I am a 34 yr nursing veteran and am currently DON of a 135 bed SNF. I have some of the best nurses I have ever worked with on my team. (and by far the best CNAs in the region).. but I digress from the topic.. Losing skills in LTC.. I too have heard that from my ACute care nurse colleagues.. Let me see.. here is a sample of what happened today at my Center:

We changed out 2 G-Tubes, started 2 IV antibiotics , 1 IV for hydration on pt with GE, were the eyes and ears of the MD and figured out (since nurses don't dare diagnose) that a resident had CHF and after initially treating with IV Lasix, etc from the doc, sent her to ER, suctioned and did trach care on a new resident, accessed and flushed 3 portacaths, did wound care on a fellow who came from the hospital with 3 stage IV decubs on his coccyx, sacrum and hip that is also infected with MRSA (they forgot to mention that prior to admission) so he is Contact isolation, did I&O caths on 6 residents, and the list goes on. I spent the evening shift with a new nurse (she has spent 17 yrs in acute care) who decided that maybe this wasn't a job for her .. she thought working in the nursing home was going to be like retirement.. her words not mine.

I have done almost every type of nursing I can think of.. critical care, MD office, Case management, teaching at CNA, ADN, PN and BSN levels, 8 yrs in ER, but nothing excites me more than to round a corner and have an Alzheimers patient light up like a Christmas tree at the sight of me and get a big hug and an I Love You . That is why I am a LTC Nurse.

As for autonomy.. I empower my RNs and LPNs to be supervisors, call me or one of the nurse managers when they need us but to use their critical thinking skills, time management, etc . I may not always agree with decisions they make, but I support them 100 % as long as it isn't illegal, unethical or immoral but I will meet with them privately and discuss what I didn't agree with and how I would like for them to handle it next time.

One of the things that has kept me in LTC for 14 yrs is the chance to not only care with my hands but with my heart. Getting to know the residents and their families and seeing them progress.. as not ALL are in the nursing home to die. I average 4 discharges to assisted living or home a month from my skilled unit.

I am proud to be a LTC nurse ... and I forgot.. we also used our new dopplers to identify patient with peripheral vascular problems and get him referred to surgeon, and did bladder scans on one.

have I told you.. I LOVE MY JOB>

hope to get to know y'all better....

Bre

Been there and done that. I agree with your entire message. I too as a DON have worked as a CNA and had to go in to do an 11-7 shift as LPN or RN replacement. I also bus tables in the dining room.. (that was another thread)

I too applaud those DONs who have families as I have a very tolerant retired hubby and my Sir Rascal Boston Terror.. and they just give me lots of love when I get home and pamper me. I love what I do and yes, I have days when I want to jump out the window.. wouldn't help as I am on one level building.. :uhoh3:

But it just takes that one hug or a thank you from a family member for taking such good care of momma.. makes it worth while.

Now , I am going to go lay down before I fall down.. I am not going in until noon today though.. 15 hrs yesterday earned me a respite as I knew I would not wind down quickly.

Keep up the good work, guys and gals.

Bre

Reply to NursesRmofFun/RN - Girlfriend, I didn't mean that I used to work as a CNA and then an LPN...I meant as the DON I find myself having to fill in when needed on the floor just to meet staffing sometimes, and others just when my staff is feeling overwhelmed and they need the extra encouragement of seeing me out there busting tail WITH them and not railing AT them to get their work done. I have always maintained an open door policy and it's true that you have to find a balance and get your paperwork done. My staff and other department heads know that if my door is shut, it means I'm either trying desperately to catch up on paperwork, counsel with someone, or meet with a resident or family member and they'll usually slip a note under my door and know that I'll get to them as soon as I can. But, more often than not, I find myself doing my paperwork on my "off" time - whatever that is. To any of you out there who have husbands and younger children, I have to applaud you because I don't think I could do it all and have any time left over. I've worked hard the last year to find that balance, still have time for myself, encourage and educate my staff and not burn out. We have to hold each other up. That's one reason I'm so glad I found this BB! :balloons:
Specializes in Gerontological Nursing, Acute Rehab.

rascalsmom, you sound like a DON that I would LOVE to work with! Thank you for sticking up for your staff, empowering and encouraging them, and helping out in ways that most DON's would never do! Those DON's are few and far between, and I sure hope your staff appreciates you!

Jennifer

Specializes in Registered Nurse.

i guess it's safe to say that your days are full! :chuckle

welcome! :) :) :)

:) thank jennifer. i like to think that most dons do as i do. at least the ones in my professional organization that i communicate with say they do. and c'mon down to south carolina, got a job for ya. :chuckle as for appreciating me.. some do, some don't.. the grass is always greener, etc etc.. but all in all i have a very caring, responsive group of nurses working with me who have the same goals as i do.. that being to provide the best care for our residents that we can and it takes every one of us to do it.

god bless, bre

rascalsmom, you sound like a don that i would love to work with! thank you for sticking up for your staff, empowering and encouraging them, and helping out in ways that most don's would never do! those don's are few and far between, and i sure hope your staff appreciates you!

jennifer

Ive worked in hospitals b4, but mostly have spent my career in LTC. I think its great. I do feel that I lost some of my procedural skills that I did in the hospital...but when needed, I can still do them. I never missed hospital nursing. I cant imagine ever working anywhere besides LTC.

I often hear ppl say, "it takes a special person to work with old ppl". I say..yep it does :chuckle and keep on going....

Ive worked in hospitals b4, but mostly have spent my career in LTC. I think its great. I do feel that I lost some of my procedural skills that I did in the hospital...but when needed, I can still do them. I never missed hospital nursing. I cant imagine ever working anywhere besides LTC.

I often hear ppl say, "it takes a special person to work with old ppl". I say..yep it does :chuckle and keep on going....

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