LTC and loving it

  1. Why does there seem to be such a stigma against LTC nurses? It almost feels like that is the bottom of the barrell. Even I thought (while working in LTC) that I needed to move up and out- twice- and hated it both times. I started in a hospital, hated being micro-managed, and went back to a LTC. I stayed for 6 years, got my RN and once again felt the need to move on up to the hospital- where I once again hate it, and for the same reasons! I have finally decided that it is okay to just say I love LTC, and this is where I want to stay. My dreams of being the charge nurse in the ICU and ER are gone. My focus in life is to be where I am happy, and that is with my old people.

    I like seeing them, and they appreciate friendly, consistent care. They remember my husband and I bought a house several years ago, and we talk about the work we are doing and the amount of money it costs, and they tell me their new housing days. Or, with my demented patients, we just head off to whereever they are for they day, and discuss related events/news. I even like when I can be a part of their final days- making them comfortable and relaxed, easing their families worries knowing someone they know will be with their loved ones, and so on.

    I write this because I excitedly gave my notice at the hospital and am heading back to LTC where I can be happy with the old people (like my 105yr old who swears by bacon and women being educated as requirements for long term survival!).
    Last edit by Joe V on Sep 16, '12
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    About artsmom

    Joined: Jan '11; Posts: 163; Likes: 346
    from MA , US


  3. by   bankssarn
    You're definitely not alone in this thought. I worked LTC and loved it. I started off in LTC, however, I felt that I was putting my license on the line every day by having 35+ residents under my care. I couldn't give the care they needed, and it wasn't fair to them. If I could have a more manageable nurse to patient ratio, I'd go back.
  4. by   artsmom
    That is certaintly a lot of patients, but I think 5-7 acutely ill pt's while charge on the floor is a comparable number to be afraid of. I find it so overwhelming. I am returning as a supervisor and am excited to learn a new role.
  5. by   itsnowornever
    While I have yet to find my first job, LTC holds some part in my heart. I LOVE the ER, that's also where I want to be, but why do I love the ER? Because of the old patients. They aren't entitled, they have something to offer the younger generation and they are amazing examples of what a person can over come in their life and how a person can soar! I really really hope to find an LTC that is rather small so I can have a relationship with them instead of just supervise.
  6. by   balatro
    LTCs have long had a bad reputation, primarily because before national and state reforms things were, well...nasty (generally). You know the saying, "It takes one sour apple to spoil the bunch?" It works for nursing homes. They had a reputation of poor care - residents going unshowered for weeks, sitting in their waste for hours at a time, staff that were more concerned about their paychecks and socializing with friends rather than putting themselves in the resident's shoes and wondering what their life might be like, etc.

    Fortunately reforms have begun changing this, drastically. My mother worked in a LTC that was eventually shut down by the state for many (and more!) of the complaints I listed above. A lot of the nurses/CNAs I work with have horrible stories of facilities they worked in 15-30 years ago but have noted that, for the most part, these days are fading away and that by the next generation LTCs will have a better reputation.

    I work at a LTC facility myself (CNA - current nursing student) - most of my residents are total dependence care (quite a few with severe emotional/psychological issues but our Memory Care unit is booked so we have to care for them and honestly, we're not able to do it but we try). A resident's son not too long ago asked how I was able to work in a LTC being so young and I must have looked confused b/c he followed it up with "People go to hospitals to get better. People come here to die." Which is true, and perhaps part of the bad reputation...we're a place of death; that unless someone moves, they'll be with us til their last day.

    Anyway, my facility has CNAs caring for 8 residents on 1st, 10 on 2nd, and 10 or 15 on 3rd (depends on the unit). Which is very good but as I do work in one of the Skilled Nursing Units and most of my residents I have to be eyes-on the full 8 hour shift. 2 LPNs a shift, per unit, caring for 15 residents each. During the weekday there's 1 RN per unit (so 30 residents), on the weekend it's 2 RNs for 90 residents in Skilled Nursing and then available as needed in Assisted-Living (LPNs usually cover it fine over in AL - they call the RN for count or if a resident falls).

    I love geriatric patients as well, but I don't see myself still being here a year from now but we'll see. I'm an A-Personality kind of guy that has often been told I thrive on adrenaline rushes and chaos, but remaining calm and unnerved, and honestly - I feel very un-stimulated working in a LTC. I'm also becoming rather cynical about the LTC environemnt here, I'm seeing a lot of CNAs and nurses that cut corners on resident care (nothing illegal, but still enough to raise an eyebrow) and being a higherend LTC (residents start out at the basic level of 3000/month - some are closer to 7; they're also divided by private pay and government assistance, and sadly the quality of care between the two is noticeable).

    /rant off
  7. by   mom_coach_nurse
    This post excited me! I start school Tuesday (ack!) and this has always been my interest. People look at me, and often voice, that I am crazy. Anyway, thanks for the post. Good luck with your new position
  8. by   nutty netty
    I entirely agree with you artsmom. I too love the elderly. When speaking of nursing home stigma, it ****** me off to no end that when speaking of LTC to others, whether it be fellow nurses, [who do not work in this field] potential employers and general public, that they assume we have no "real nurse" experience. Little do they know how much we actually deal with. The residents they are admitting these days are getting quite technical, ie; wound vacs, TPN, to name a couple, as well as very acutely ill people that are being discharged from the hospitals too soon, being spread too thin by employers. Meaning having to take care of up to 25-30 residents at a time. This may include several medicare residents, hospice care, in addition to the ltc residents. I got a kick out of receiving a call from the hospital as one of our residents they admitted had a wound vac and they didnt know how to change it. Also the nurses who left the hospital setting to come to LTC because they were overwhelmed and thought it would be easier. Couldnt help but chuckle under my breath when they had that bewildered look on their face during orientation. People in general also do not realize that we do not have the luxury of having a lot of the support staff that the hospitals do. The responsibility in LTC is tremendous. LTC nurses are anything and everything from maintenance to dietary, respiratory to social services. I was struggling with burn out to begin with, but my last employer [a very large corp] was the last straw. I have never witnessed such chaos, lack of support, total disreguard for the residents wellbeing and failure to acknowledge the substandard of care that was occurring. Rather than address our issues of concern, blame was placed on us when state came to visit. And god forbid dont speak out to your employer about substandards as you'll pay for it one way or another. Needless to say I quit, was denied unemployment [lost appeal] Everyone seems to believe there is a lot of work out there, well not if your LPN with only LTC experience. I loved what I did, I miss those demented, cute old people, and yes even the harborview rejects we were excepting. In a sense I hate what the LTC employers have done to make an almighty buck, and what they have done to my livelihood as a nurse. I am reluctant to go back to this setting. I live in a rural community so resources for jobs are limited. OK I'm done venting now. If anybody has a solution to my current feelings please give me some input.
  9. by   artsmom
    nutty netty- do you have any family owned LTC's in your area? That's who I work for. We are an 86 bed facility and they do make sincere efforts to staff us well. The pay isn't the highest out there, but the overwhelming patient load isn't normally there.
    I just hope other people and new grads realize that LTC is not the worst job in nursing. It is definitly not an ER pace, but even those who dream of being in the ER may find it is not for them, and I hate that it gets discounted before it is tried. I have amazing time management skills and I attribute that to working in LTC and my employers really like that skill.
  10. by   CapeCodMermaid
    Reforms have begun??? Haven't you heard of OBRA (not Oprah)??? The reforms started in the '80s.
  11. by   CT Pixie
    I'm a LTC gal myself and love, love, love it. Don't get me wrong there are days I want to pack up my things, walk to the supervisor and turn in my badge and nursing license and go home...they are far and few between. Most days I'm just generally happy to know Im going to a job I really do like. I have my burnt out periods, but nothing a weekend doesn't cure.
  12. by   LPNnowRNhopefull
    I too have worked exclusively in LTC at the same facility, on the same unit for 10 years now as an LPN. I have recently applied to nursing school for the sole purpose of becoming an RN and to feel a little more long-term security. My DON is aware of my intentions to retain my same position once finished with the RN program. I am not interested, at this point, in working in the hospital.

    Patient loads can get challenging, and being shorted CNA staff is never easy, but I feel so important when I walk in to my job each day. I know the stigma attached to being a LTC nurse, but I have never bought into that feeling. I have never been a person to allow others the privelage of manipulating my self worth. I have also witnessed some hospital nurse's put down LTC nurse's in an ill attempt to boost their own moral.

    But the truth is...we can't all be superhero's saving lives in the ED, or ICU/CCU. Fortunately, nursing is so multifaceted - that there is literally a job for every personality type. For me, there is no better feeling than making a connection with a patient who has a cognitive impairment. And it is truely an honor to hold the hand of patient or provide support to family at the time of demise. Even particularly meaningful when you have an established history with the patient/family.
  13. by   pinkfish333
    I absolutely love long term care as well, and my story is much like yours. I dont care what other nurses or people think about LTC being the bottom of the barrel job, I hope to stay in it for my entire career. It is so rewarding, and I love the role nurses have in our setting. Most of all I love the long term relationship (relatively long compared to perhaps other settings) that we have the privilege to build - with residents and their families. Everyday I have goosebumps when I am there, because of the connection I am making with residents and their families, by trying to do my best to be there for them. Good luck to you! Love to all our old folks!
    Last edit by pinkfish333 on Sep 14, '12 : Reason: forgot to say something
  14. by   nutty netty
    Yes I am familiar with the privately owned and the not for profit facilities and how staff is or maybe treated differently, as well as staffing ratios. Unfortunately there doesnt seem to be to many of those out there these days. I am going to go off a little from my last post and descibe what I've seen, experienced. Over the past 20+ years that I have worked as a nurse in LTC has been with big corporations. My employment history for the most part has been on avg. 3-7 years with each one. A lot has changed over those years and not to the positive unfortunately.

    When I first became a nurse our house supply meds consisted of doss and tylenol. Now the top drawer of the med cart is packed with house supply meds/supps ie: numerous vitamins, various stool softeners,diff doses asa and tylenol, just to name a few as they are no longer formulary. Dressing supplies, over the years, I've noticed is either charged out to each individual resident, or not at all, or there has been a poor system overall. I worked with one administrator that was anal about these charges, we were constantly being dogged about not keeping track and not charging these supplies out as we should. During a staff meeting he informed us that close to 48,000.00 had been reimbursed to them and that was not for a full year. And went on to explain that with this, their budget could be better utilized to benefit both residents and staff. Well after he left or should say was asked to leave, we had an interim admin. from corporate and needless to say we had slacked on these charges, so I inquired to him about this,[charging out supplies] to which he stated "oh that was stupid" and the charge book was eliminated. I still question to this day,. why?

    I'll have to say that some management has been approachable and some not. One proactive administrator at a facility that I worked for for 7 years was always informing us of government changes, cuts, what was to come and that it would be getting worse. Informed us what we could do [write our congressmen] He was always fair, approachable, organized and encouraged out of work activity for staff, such as forming baseball teams and competing against other facilities, bowling, staff recognition and appreciation.

    At this same facility the DNS was forever calling me to her office, I will admit that I didnt have a problem voicing my opinion and standing up for what I believed in when it came to resident care, and we frequently did clash. Half the time, no three quarters of the time it was an issue that needed to be resolved, and usually was, but., what I will always remember is that she always complimented me on my work when the meeting was over. One time I asked her, "why do I seem to be such a thorn in managements side?" To which she stated " you are a good nurse, and we as managers need to learn and know how to work with all different personality types, work styles and such and by no means are you a thorn, you are just a good reminder to us why we are all here and love what we do" [I'm glad that she left out that yes I was a thorn, but.,ha ha] She will never know how much her statement impacted me, and it is truly unfortunate that I have never had the opportunity to work with the above type management style again. That was my first 7 years as a nurse.

    During those 7 years we had 2 near perfect surveys, 2 perfect surveys. 1 of those surveys was almost immediately followed by a federal survey to which we also passed with flying colors. Well, a new corporation took over and things changed up real quick and the management that I spoke of was pretty much eliminated. I left shortly after that. Why things changed so quickly and drastically I will never know especially when the facility had a very good track record. I can only owe it to, because at the end of that time was when government changes/cuts were really kicking it up and possibly a new breed of CEO's, CFO's and large corporations in general had a new idea of how to deal? I will blame my burnout mainly on government cuts as it has forced corporations to do what they do, [I think] I mean, if I had a business I would want to make money, wouldn't you?

    Unfortunately, of course those big corp. people have never worked the floor and have no idea what its like to witness substandard care, and struggle with those feelings when they get home at night. I did a lot of research on the corp. I was working for and it made me understand what and why certain things where occurring. Very, very deep. Needless to say it made me ill. But that's a whole different story. Also contributing to the burn out factor, the industry's inability to see and acknowledge my experience in this field as a real professional that is entirely capable of fulfilling a job role just as well as an RN, if not more so. [have been applying to jobs that I very well qualify for that require RN and up, guess what? thought so]

    So from years 8-20+ I have in general, have just seen a change and general decline in healthcare in the LTC setting. As well as a change in these large corp's that would just as soon throw you out the door than acknowledge resident care. And government continues to cut the benefits of the population that us LTC care workers love so much. I also would like to see that the LTC logo be renamed. It is by no means long term care anymore, [it is for some] In the last 5 years, with changes in medicare funding, not to be confused with medicaid, hospitals are discharging sooner and are dependent on "skilled nursing" facilities for continued rehab/recovery, LTC facilities are admitting a broad range of age groups, anywhere from 16 and up. In the past year I have cared for more 40's age group than I have in my entire nursing career. Some facilities will no longer accept medicaid funding. Very scary. Enough about that, now on to next.

    With reguard to working in this type of facility. Other nursing areas need to acknowledge what we do without reguard to where we work. I will be the first to say that this area is the best learning area to be had, going back to what I said before, we have no support staff, you will learn how to be a respiratory therapist, social worker, rehab worker, SLP, maintainance, dietician, and toilet plungin fool. You will learn how to confidently assess a resident and have the dr. treat based on YOUR assessment. And most of all learn that it is a great feeling that you accurately diagnosed,[did I say diagnosed, shame on me] a problem and anticipated what the tx would be and thats exactly what the dr ordered. You will learn to be organized, multi-tasking definitly will be enhanced. You will learn how to gain the trust of dr's, and family members. You will learn how to deal with end of life issues and provide the psychosocial support to their family members, which will be very challenging at times. You will learn IV skills, wound care assessment and effective tx. You will learn empathy, sympathy, commradery. You will experience and learn all you need to to make you a successful nurse in this and any other industry .

    The drawback from what I have witnessed is that those who intend to move on and broaden their skills. horizons, whatever you want to call it, don't. Don't get me wrong, nothing wrong with that. Its what I chose to do for the past 20 years, I simply love that particular industry, its my specialty. But a word to the warning, if thats all the experience you have for an extended period of time, it may be difficult to get other fields to accept you, unfortunately. Had enough? ha ha I can and will prob find other posts to comment on, hopefully I will gain some followers. Please everyone dont get me wrong, just dissapointed, unemployed, confused on? my profession perhaps. I do love to write and you know, its a great outlet, thanks for reading and hopefully listening and getting my drift. and excuse the spelling ha ha Sincerely, LTC "skilled nurse" at heart
    Last edit by NRSKarenRN on Sep 15, '12 : Reason: spacing