Losing your skills in LTC - page 6
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
Sep 13, '06Joined: Sep '05; Posts: 937; Likes: 136Quote from michelle126OMG one had montgomery straps.....I haven't seen them in years!!
i hadn't even learned about em till about 3 yrs ago when a friend who's been an LPN for 30 plus yrs showed m them = i LOVE them for residents who have sensitive skin and have passed this age old idea on - very simple to make and use from just what we have around tape and gauze!!
Sep 16, '06Joined: Nov '02; Posts: 6,062; Likes: 9,201Just read most of these postings again and at the risk of sounding like thepolice.....
Sep 18, '06Occupation: Nurse Specialty: 5 year(s) of experience in nursing home care ; Joined: Sep '06; Posts: 231; Likes: 21We may lose some physical skills in long term care but we gain a lot in psychological/ emotional and social skills. Our residents prosper with us but when they are admitted to hospital, they come back malnourished and with pressure sores! Surely the need to feed people who cannot do so themselves and the need to regularly assist in repositioning a frail elder are basic nursing skills - so why do those in acute care seem to be ignorant of these! We have the reward of truly making a difference, of making life enjoyable and building friendships not just with our residents but with their families.
Sep 19, '06Occupation: Wound Nurse, LTC, Hospice Specialty: 43 year(s) of experience in ICU, CCU,Wound Care,LTC, Hospice, MDS ; From: US ; Joined: Mar '03; Posts: 320; Likes: 89I'm glad to know this isn't just a problem in the US! I've seen it in the three states I have worked in. I agree these are basic nursing skills.
Sep 21, '06Joined: Sep '05; Posts: 1,277; Likes: 359Quote from RustyhammerRusty - you are my hero!!I work in LTC.
I start IV's, do complete body and systems assesments, have a broad knowledge of meds, do trach care, handle vents with confidence, treat even the nastiest wounds, advise docs on appropriate meds for geriatrics, hone my supervisory skills, deal with families like the best social worker, contact and advise, visit and love my residents, provide grief counseling, inservice ancilary staff and who know WHAT tomorrow will bring.
Lose your skills in LTC?
I challenge the mere hospital nurse to walk a week in my shoes.
My facility doesn't do vents, which I used to be proficient in, but I have had a lot more experience in LTC with things like tube feedings, psychotropic drugs, etc.
Every job you do presents learning experiences that add to your overall knowledge base.
I remember my old supervisor commenting that she couldn't wait to retire and go work in a low-stress nursing home!! Won't she be surprized?
Sep 23, '06From: UP ; Joined: Sep '06; Posts: 64; Likes: 22Our nursing instructors told us to get at least one year of hospital experience before trying another area of nursing. I had almost that much when I began working in a nursing home in Ohio where I used to live (live in VA now). I didn't know if I was going to enjoy it but after a short time I found out I loved it. I don't know about anyone else, but LTC is where I learned the most about nursing. As far a tech. skills, I have done almost everything you would do in a hospital--even checking chemotherapy pumps! As a LTC nurse I learned about every body system there is and also learned how to deal with human behaviors. I have been a counselor to the fearful pt. and consoler to the family member who just lost a loved one, a subsitute family member for the little lady or man who has no one come and see them, especially on holidays. I would bring my children to visit them and to this day my children love the elderly. I could go on, but the point is I did not lose any skills, but kept the ones I had and gained so many more. I met some wonderful people and have many great memories. It was like a family. I worked around 16 years in nursing homes, extended care facilities,& rehabs, and worked 7 months as a office nurse and home health nurse. I worked 8 yrs in clinical research (neurosurgery depart of large Univ.) Now, I am going to be working with Hospice soon and I look forward to using my skills I have obtained over almost 30 years of nursing.
Oct 12, '06Occupation: LPN Joined: Oct '06; Posts: 11Quote from debRN0417:yeahthat:I am so happy to hear of so many nurses who, like me, love geriatrics and LTC. I have worked everywhere...ER, ICU, House Supervisor in Acute Care, Med/Surg, Pediatrics...and more, but I always come back to LTC. I appreciate so much hearing nurses say that they get to know their patients as HUMANS and that they become "family". It really does my heart good! I am considering a position as Director of Nursing in LTC...I hope I can instill in my staff (if I decide to take the job)..to not be afraid of getting close to their patients, to treat them like they would want to be treated, or have a member of their family treated. Long term care can be viewed as the same thing "over and over"...but the poeple are not the same everyday. There are days when I too want to be the "Wal-mart greeter"...but then one of my patients takes my hand and thanks me for just being there...that's what it's all about.
Oct 21, '06Joined: Oct '06; Posts: 3I work in LTC and it is my first job. Have been a nurse for about 1 year and there are days that I regret not going to a hospital (med-surg) floor to get a variety of skills. On the other hand, I love geriatrics (the residents bring a smile to my face) and I am going through school to become an RN so the money helps out and I would not get as much in the hospital (where I live anyway). Back to the question, if there is a skilled unit/hall I would try to work that area because you will get plenty of skills. Catheters, IV, wound tx, etc. The one thing I hear is that you get better time management skills in a nursing home (do not know if it true, never worked in hospital). Also, an option would be to do PRN at a hospital and still work at LTC place (if you feel like LTC is not enough). Good Luck!
Nov 1, '06Joined: Dec '05; Posts: 404; Likes: 13Quote from curse nurseI am a nurse manager on a Medicare unit. I support/defended the nurses if they want to send a patient to the hospital to anyone, the DON and up. I have been on both sides of the fence. My attitude is cover my licenses and you protect the resident. If i still meet have a problem from DON, I chart it! I have become tired of being a nurse. To many politics in LTC/ hospitals. I Have to say, that our DON supports the nurses decision. I could say more, but I am to tired to do so. About skills, I have not lost them do to the fact we have many sick residents.i 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) doesn't 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 Dr's 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.
Nov 1, '06Joined: Sep '06; Posts: 98; Likes: 84I was fortunate to do clinicals at a few LTC facilities and Hospitals and this is my take on it. The nurses who work in the LTC facilities that have clients who function at a high level may not practice a lot of the "skills" acute care nurses see, but does that mean they have lost them. Inserting a foley, trach care, ventillators, iv push meds etc...do you really forget how to do those things. There is a difference between losing skills and being a little "rusty" and perhaps needing a refresher. In my opinion, out of all my clinical rotations ..... If no one is talking about the nurses in same day surgery or mother baby losing skills then they certainly shouldn't talk about LTC.
Nov 11, '06Joined: Jul '06; Posts: 84; Likes: 9Our LTC has trachs, tube feeders, wounds (III and IV - NOT facility acquired) up the ying yang, isolation cases, etc. We do IV's, cath's, etc. I just finished managing a hospital unit. They had darn near the exact patients there with a 6:1 ratio. I guarantee that if one of my nurses in the hospital got planted in the LTC with a 24:1 ratio they would have a heart attack!!! They used to scream when it was 6:1 because 3 of them would be post stroke (everyday occurance in LTC) and the other three had more than 7 pills (try the usual 13+ in LTC). You can take a LTC nurse and put her in a hospital and she will survive and thrive. Do the opposite? NO WAY.
Nov 11, '06Joined: Sep '05; Posts: 937; Likes: 136Quote from pyroladyOur LTC has trachs, tube feeders, wounds (III and IV - NOT facility acquired) up the ying yang, isolation cases, etc. We do IV's, cath's, etc. I just finished managing a hospital unit. They had darn near the exact patients there with a 6:1 ratio. I guarantee that if one of my nurses in the hospital got planted in the LTC with a 24:1 ratio they would have a heart attack!!! They used to scream when it was 6:1 because 3 of them would be post stroke (everyday occurance in LTC) and the other three had more than 7 pills (try the usual 13+ in LTC). You can take a LTC nurse and put her in a hospital and she will survive and thrive. Do the opposite? NO WAY.
i think the main reason i suggest to new grads to go to a hospital med surge floor is at least around here the preceptor programs and orientation are a LOT longer and better so they have a chance to gain the skills and learn new things. in our area LTC generally gives a few days, regardless of new grad or not , orientation and they are left to thier own devices and that is just not fair to them and its not fair to the residents either that their nurse has to constantly run off to get help ( if anyone is nice enough to help which isn't many ) and or look things up before they can do anything. i get scared for my license being an experienced nurse with some of the crap that goes on in LTC i can only imagine how a new grad feels!! i help when i am there and i hear a sigh of relief when i walk in from those that are on - but i feel so bad when i listen to how badly they were treated on such and such a day..... even when i was on like last week- the "charge nurse by default" as we joke about cause she is full time i am casual - we get along great however i was horrified how she was treating this poor new grad and we had a tad bit of a argument - she would rattle off to her what she had to do and make her do it and go off and come back and ask her if she did it ,and if she didnt shed rattle off instructions ( even told her get a paper and take notes!! good suggestion but wasn't said nice- and i know it wasnt directed at the grad but out of frustration that the facility failed to give her an adequate orientation - ) anyhow- i took over and went down - made her do things but stayed with her to see she did right and if not to guide her - of course the other charge nurse was out at 1030 and i was there till almost 12 cause i had to get my work done then, but i felt so bad- unfortunately i will get called i office for over my time that night i am sure but dang - there is not enough time in a shift to do training with someone who is supposed to be doing her own work. and its NOT the grads fault its the facility - who is to damn cheap to give em a proper orientation. i did have to tell my friend i was sooo gglad she didnt orient me or id have crapped my pants and ran the other way on day one hahha. hopefully next time she will be a bit less firm.