Losing your skills in LTC - page 5
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... Read More
Mar 23, '06Joined: Mar '06; Posts: 13As I was graduation PN school all of my classmates were getting excited abut working for the hospital or home health and here was lil ole me excited to go to the nursing home. I worked LTC as a CNA and now as an LPN for a total of 7 yrs LTC. In the beginning my main concern was my skills; I won't be using all that I learned in school.
However, what I do enjoy about LTC is that your residents prepare you even more for med/surg...if you really think about it every disease, ailment and most line of care is right there in the facility. Working LTC allows you to look at the full picture and if you go to MED/SURG you will know what to look for (its fresh in you skills)
I look at LTC as the root of MED/SURG just branching out into different areas of care....after all when residents come from the hosp back to the home the same care r/t hosp stay is our focus
IV therapy is usually the only skill (in this state) you won't use in LTC....I am currently working part/time for an agency for the hospital experience to widen my job opportunities
Apr 3, '06Specialty: A little of this, a little of that.... ; Joined: Apr '06; Posts: 63Remember, it is Long Term Care. We see people "Long Term". How CAN we loose skills? Esp. in assessing people....
Apr 3, '06Occupation: Hospital - Medical-Surgical Floor Specialty: LTC and MED-SURG ; Joined: May '04; Posts: 534; Likes: 87As a newly graduated LPN student, my opinion is that I don't like LTC and prefer working in a hospital. However, after reading some of the posts here, I have a better understanding and appreciation of nurses of work LTC. What I've learned is that it is up to the individual nurse to learn, use and practice skills in the LTC arena. This gives me a basis for developing a better and more professional attitude toward whatever position I secure after passing boards.
Apr 3, '06Joined: Apr '06; Posts: 1I have worked in LTC since graduating. The facility I work in has suck a variety of patients from young to elderly, from trach pts. to hospice care. I have 38 residents of my own. I feel like I "know" my little people. I can walk the floor during shift report and look at them and assess that something is not right. When you work this closely with your patients you rely on your instinct as well as your assessment skills. We, in our facility, have the ability to make decisions whether or not to contact the MD or send someone out without getting permission first. And the MD's learn your skills quickly, and know whether they can trust your judgement. They know if I call and say "something just isn't right about so and so" that I am usually right. I love my residents, they feel more like family to me. I am honored to be a part of their lives. It is my goal in life to just make a difference if only it is to make someone smile.
Apr 4, '06Occupation: orthopedic nurse Specialty: 11 year(s) of experience in geratrics, orthopedy, anesthesia ; Joined: Aug '05; Posts: 32; Likes: 10Dear friends and colleagues!
Thank you very much for your post! I'm very glad that there are such people
in "nursing community" and so many!
I'm Israel-graduated RN and work in Nursing Home only 11 month. But only
here I understand what is it nursing. I worked 7 years as CRNA since my
graduating in USSR in 1979, graduated from Medicine College and continued
as physician. Didn't worked in medicine some years after my immigration
and now I'm back. Believe me, to start IV or although to do intubation of
trachea - can do some person without some medicine training, because that
is "hand skills". I think that "brain skills" and "heart skills" are main in nursing.
I would say that they exactly nursing are. Excuse me for my broken English.
I think that each nurse have begin his/her way in nursing from LTC.
Thank you and good luck!
Apr 13, '06Occupation: Happily in Nursing Education! Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc ; From: US ; Joined: Oct '04; Posts: 2,757; Likes: 415Quote from cursenursei have worked in LTC X 7 years and i do feel that you lose a lot of skills. it's not that the work isn't challenging or important, but i feel that administration (in a lot of places where i've been) doesnt allow the staff nurses to think for themselves. there seems to be a very pervasive attitude of just "pass the pills, do what you're told and shut up". often the nurses in management disregard the ideas that staff nurses suggest to improve quality of care. i have seen nurses obtain a drs order to send a resident to er for obviously good reasons only to have the order overridden by a DON or nurse manager, and have heard of not even being able to phone a dr about a concern w/out having to clear it with a supervisor. i have seen many formerly good nurses who can no longer make simple "critical thinking" decisions because of having been lulled into what i believe to be intellectual sluggishness secondary to being used to being told what to think and do. i have been fighting against this myself for the past couple of years, and that is why i have made the decision to leave long term care. i love the residents but i find it more and more difficult to shut up ignore poor quality of care.
I totally agree, totally did the same thing! I mean, when I want to put a bandaid on someone and need a dr order...PLEASE! My autonomy as a nurse was nothing anymore to them...it was all CYA and "jump through our hoops monkey!"....I got too sick of it!
Now I am agency working in a hospital and yes...I did loose some skills...but remembered them and learned them again quickly! However...hospital is just different and sometimes if 'you don't use it you loose it' is appropriate...doesn't mean LTC RN's are not skilled...holly cow...with the hoops we jump through for every little thing...the conflicts...uhgggggggg we are super nurses!
I tried to get a job when I left, and I actually did have an interview that said "ohhh you went to LTC..that is the elephant graveyard of nurses..and you are so young...that is too bad!". I was stunned and very upset...she didn't ask about what I can do, didn't even look past the last employer on my very impressive resume...didn't see that I was the only ACLS trained nurse ON MY OWN DIME that handled and sucessfully treated over 20 codes in one year and only had ONE die!!! I love my skills and use them, I also volunteer, and go on ride alongs with paramedics to keep my emergency skills up! Nope...she saw LTC and that was it....too bad for me that happened many times after that too!
I went agency and now those people that wouldn't give me the time of day want to buy out my contract! LOL!
As I said...LTC now a days with all the hoops to jump through and increasingly complex patients (drive by hospitalizations)...we are awesome!!!!!!!
Apr 14, '06Occupation: RN LTC From: US ; Joined: Jan '03; Posts: 3,757; Likes: 1,820You don't loose them, you don't use them all the time.
This weekend, I had to do trach care, pin care, change central line dressings, work with a pt on a CPM machine, deal with a pt getting continuos epiduaral pain med infusion, change a few foleys and a pulled g tube and insert an ng tube...oops I drew blood and started an IV too. I also had a few difficult wounds to care for...OMG one had montgomery straps.....I haven't seen them in years!!
Sep 13, '06Joined: Sep '05; Posts: 937; Likes: 136Quote from Cubbymy initial impression would be that they are thinking about our technical skills - for instance iv starts, ng tube placement , maybe even our assessment skills - but i for one say we do not loose them - i have found it to be kinda like riding a bike - once y get it it stays there when you need it lol - i was so afraid when i quit for a few yrs and went back that i had lost my skills and found them to be quite right where they needed to be when i needed them . as for anyone thinking our thinking skills are lacking - i do not find mine lacking as i am always on my toes questioning rationales and addressing issues i am not comfortable with. i do see the administration is often stubborn against any change they did not think of first and will balk and may outright deny any idea. but i fond my assessment skills are right up there ( need to be as when LTC you call doc he isn't coming in so you had best be right with what you tell him lol - and we get the added bonus of the skill of people pleasing - we deal a lot with emotional issues and issues that really er, icu or short term facility has to deal with a lot less - ( not that they dont do it at all mind you - i know they do have to deal with it but its short term - i am just saying we have to learn to deal with it every day all day ) i do recommend to any new grads to never start OUT in LTC as i do not feel they can adequately gain the technical skills as easily and as readily as in a hospital - but after a few yrs come on in wed love to have you ( wed love ya there anyway really - i just think it is much better to get those skills under the belt completely and a LOT before going to a place it isn't used so much. ) i will never regret my yrs in the hospital as i learned a lot from there but i know i belong where i am and will never go back to the hospital and i dont feel i am lacking in any of my skills ( other than the fact i hate being charge lol - that is my weakness haha)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.
Sep 13, '06Joined: Sep '05; Posts: 937; Likes: 136Quote from TooBusyRNyou sound like a great DON and i wish you were mine in the last yr i worked here we have had 4 DON and one ADON and its sickening that even the one we have now ( who was a floor nurse prior to taking the job and was one who complained with the rest of us why the DON Wouldn't get off her butt and help ) anyhow -kudos to you and keep up the good work.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!
Sep 13, '06Joined: Sep '05; Posts: 937; Likes: 136Quote from sharlynnWe don't have wall suction either, just portable, and we DO have trachs. Our facility is not old. It just looks more like a home than a hospital or LTC!Suctioning is another story - yuck - we don't have trachs because our building is older - no wall suction. Oh well, we can't have everything.
we get em too and our suction is portable - lol probably as old as me and looks it too - but its adequate to suction but we are not allowed to deep suction non trach residents - trach care is doable but the RN has to do it which puts some LPNS in an uproar which i dont blame them especially the ones who have been trained. there are times i really get frustrated that our LPNs are not utilized as well as they could be. then again some dont mind they'd rather just pass pills and not do that sort of thing - to each his own i guess.
Sep 13, '06Joined: Sep '05; Posts: 937; Likes: 136Quote from AlmostBethMilitary girl, it is not possible to not get a long term care job. I have always been hired in my interview. They are really desperate. I have worked long term care for 15 years and am an LPN. I agree that getting acute care experience is a good idea. I didn't. I used to think that hospital nurses were better until I had to stay in the hospital. I received poor to negligent care from my nurses and Thank God there were no complications because I would not be here today. Being a good nurse is about knowing your specialty and doing it with integrity.
wow - that's great - around here we are having a harder time getting into LTC as census is low - bad part of nursing in the small areas -
Sep 13, '06Joined: Sep '05; Posts: 937; Likes: 136Quote from snowfreezeLOLOL yeah ya just gotta love them alzheimers - i cant help but love em - how can ya not when they do stuff like that then ya get those big puppy eyes as they have no clue what they just did was wrong lol - ahhhhhh such sweet times. i truly enjoy my alzheimers dementia residents the best - it can get frustrating when an alert one does the same dang thing and i dont deal well with that - "they just didnt want it" or whatever their excuse is but they knew exactly what they were doing - sigh....I have 14 years of nursing, 8 of those in critical care and 5 in LTC. Now I am back to hospital nursing on a telemetry unit and my LTC skills paid off last evening. Dementia patient on heparin and cardizem IVs, pulling at everything, (first half hour took out both her IVs and looked like a drive-by shooting had happened in her blood drenched bed) trying to climb out of bed...all the typical sundowning stuff. Got out of the mitts and pulled out another IV in under 10 mins. I had 4 other patients and no sitter so she spent the evening in the hall with me in a gerichair. She folded washcloths, chatted with other staff, chatted with me a lot but didn't pull out anymore IVs, left her foley alone so by the end of the shift it had yellow instead of red drainage, didn't fall and only took herself off the monitor about 80 times. I didn't get a break but I took care of all my patients and her too.
It didn't take long for all my acute care skills to resurface after working LTC for 5 years. I think the sub-acute and rehab unit helped me to maintain a lot though. I started IV's put in midlines, placed and replaced foleys and G-tubes. Put a number of trachs back in too. I was always impressed by the cute smile of a vent-dependant patient handing me the trach they just removed.