Why do RN's avoid LTC positions? - page 6
What are the pros and cons of working as an RN at a LTC facility? It seems as though many RN's avoid LTC positions. Is it the nature of the job (LTC duties)? Lack of variety? Do hospitals look... Read More
Sep 16, '16Joined: Jul '11; Posts: 11What is the best way to evaluate a LTC facility?Last edit by Emeraldturtle on Sep 16, '16
Sep 17, '16Joined: Dec '07; Posts: 573; Likes: 502Quote from EmeraldturtleGo there and ask to take a look around. Talk to current staff - do they seem like people you would want to work with? Do they seem reasonably happy, or excessively stressed? Look at the residents - do they look clean, well-cared for, and overall reasonably happy? Look at the activities calendar and current activities - do they seem to have worthwhile things going on, or is it all BS and TV? Does the facility seem clean? How does it smell? Facilties are required to post their census/staffing. Look at that. Does it seem reasonable?What is the best way to evaluate a LTC facility?
Go to multiple facilities if possible so that you have a basis for comparison. Even if you have no intention of applying, going to multiple places will give you a better idea of what is normal. All facilities are going to have some occasional smells, residents with behaviors, alarms going off, etc. But some more than others.
Look at what the facilities provide compared to your career goals. Some facilities have post-acute rehab, ventilated patients, and so forth. At some you'll do IVs, blood draws, and complex wound care. Others have just fairly straightforward long term care patients. A facility with more acuity and opportunities for skill development is a better option for a newer nurse hoping to transition to a hospital. For that matter - is it affiliated with a hospital? If so, it could be a foot in the door, giving you networking opportunities and access to internal job postings.
On the other hand, someone whose isn't a skillsy person, who is looking for a slower-paced environment, or has LTC as their long-term career goal might want a lower acuity facility.
Look at online reviews, keeping in mind that people who are unhappy are more likely to post reviews, and that you're only seeing one side of the story, which may not be totally accurate.
If you know hospital nurses, ask them. They're likely to have some opinions on based on patients that are transferred to them.
Look at Nursing Home Compare. That will give you an idea how the facility is doing, by official measures, compared to others in the area. That said, don't write off a facility based just on that - I've worked at both on-paper "good" and on-paper "bad" facilities. The "bad" facility proved to be a better fit for me. Use the info to find things to ask about during your interview or when talking with staff.
Mar 3, '17Joined: Jun '16; Posts: 18; Likes: 7Thank you! I worked in pediatric oncology for 5 months and resigned. Now I'm considering LTC care. I love the geriatric population and interviewing today for RN supervisor position. Thanks for this post it makes me feel a lot better.
Mar 4, '17Joined: Mar '17; Posts: 2I am very blessed to have found this site. I started out as a RN who merely wanted to serve the people, and found myself to be hired in a LTC environment. As most of you mentioned the pros and cons of working in ltc, I do believe in working in a place that you are happy with. Surely everyone has their opinion and am thankful for them. I am not here to belittle anyone's opinion but simply put, happy to have read your concerns and thoughts. I have been a RN for a short time, and during my experience, it was tough to say the least. I experienced a lot of what you have most concerns of, but through it all, I maintained my goal of learning and learning and learning. Because of all my mentors, and positive attitude, I became DON not only for one, but two buildings, while maintaining my happy staff with appropriate chosen patients, competitive salary, simple incentives and compassion that I express for all my patients and staff. I am a single parent, and almost in completion for my FNP. So again, I thank you for your concerns in the world of LTC, as I will continue to revise my building to eradicate some of those negative outlook for ltc buildings. I cannot fix them all, but we all can make a difference, even in a minute scale. Best wishes to all, and it's a pleasure to read your posts.
Mar 7, '17Joined: Mar '17; Posts: 29; Likes: 37I work at a nursing home as an RN after 25 years in case management, home health, wound consulting, busy urgent care. Unpredictable schedule, plenty of uncompensated work, and too much driving got to be exhausting as I got older. I loved geriatrics and decided that a nursing Home would be my last job until retiring in about 12 years.
I had had no idea that intentional understaffing, shortcuts, and outrageous and logistically impossible workload expectations were the norm for nurses and CNAs. 30 patients, 1 nurse, or even an entire facility to 1 nurse. Not safe or sane. Unfortunately, its legal.
Nursing homes are for-profit and owned by corporations or businessmen:The states and government have tackled the issue of understaffing years ago to come up with a bare bones minimum staffing requirements that vary per state (which are still inadequate and outrageous)
What you see as far as staffing at these places is about as good as it will get. Profit driven owners will not increase staffing until the laws change. They seem to use the guidelines as a "maximum" staffing. Ever wonder why many of these facilities will have bed quantity that ends in a 9? It's because of the staffing requirements. For instance in California you would need two RNs, one of them being a DON 8 hours per day in a facility with 60+ patients / residents. Thus, many "59 bed" facilities. More requirements for 150+ beds.. thus, 149 bed facility.
Most LTC facilities that I know of are 8 hour shifts. This could be a plus to older nurses like myself who tire more easily than the youngster nurses. Or, it could be a minus because you have to be at the LTC facility more days than if you worked 12 hr. shifts.
As a nurse in one of these places, you will be expected in an 8 hour shift to care for, administer all meds (usually two med passes), sugar checks, treatments and wound care for about 30 patients. You're also responsible for new admissions which can take hours worth of paperwork, leaving you totally behind and the boss frowning upon overtime.
As as far as skills, there is an occasional IV. You'll also become proficient with administering GT feeds via pump blindfolded.
With understaffing comes wounds.. from falls, from pressure sores. You'll get to see first-hand the various stages of decubitus ulcers and treating them.
It it will be seen as a badge of honor, a loyal and dedicated nurse if you work through your lunch like many of the other nurses.. or if you clock out and continue working.
You'll bring home a smaller paycheck, as these facilities pay less than hospitals. You must understand that these owners and administrators have huge Home mortgages, cars, and lifestyles to pay too. They have to juggle the per-day bed rates they get from Medicare and MediCaid (more than the cost of a fancy hotel room plus you get 2 roommates). They have to juggle the cost of cheap supplies (always running out), generic food for the residents.. it's just not profitable to pay higher rate to nurses or even consider additional staffing.
You'll learn a whole lot about various isolation and all sorts of bugs (MRSA, C-DIFF, etc.). Its impossible to wash hands before and after each patient in a "fast paced" 30, 40+ assigned residents. If the hand sanitizer device in a resident's room is actually filled and in working order at all, use it, but don't count on everyone else to. One the plus side, you'll grow to develope a resistance to all kinds of viruses and infections.. eventually.
These are are of course just a few of the perks of being a LTC nurse.
As as far as the cons..
You may clock out and leave your shift overwhelmed, and with a heavy heart that you alone with 30+ patients in 8 hours could not logistically give each one the individual care and attention they deserve.
Jan 19Specialty: 1 year(s) of experience ; From: MA, US ; Joined: Jan '18; Posts: 4; Likes: 8You nailed it head on!!! I'm at a LTC facility which I've been tolerating because it's close to home, flexible with scheduling which is a huge plus in my book since I have little ones. I'm beyond frustrated with the 30 patients, 8 days of training(fresh out of nursing school), no supervisor on duty during my shift and now why're on a writing up staff mission. I recently got written up because I didn't catch that another nurse didn't sign off as doing a skin check and another doing a norton scale. I don't work the same shift as them nor the same day! I took one shift on the floor and never ever had one of the patients they wrote me up for. How can I be to blame that others didn't do their job?! LTC In my experience is horribly managed!
Jan 24Joined: Dec '17; Posts: 19; Likes: 33Quote from FLmomof5I worked in LTC for 14 months (my first nursing job) before I went on short term disability (now I am a school nurse), and it was everything as horrible as you have explained and more. I'm an LVN and I was 1 of 3 charge nurses for the whole facility, we had only 1 RN, who mostly sat on her phone, gave the rare IV med (and complained heavily about it or having to do anything), and assisted a little with codes. I was responsible for meds as charge nurse OR treatments as tx nurse (depending on the day), and had 50 *let me say it again* 5 0! PATIENTS! 9/10 of them were diabetic, and about 1/4 were GT, 1/8 had sores or major tx orders. Plus any admissions, discharges, transfers, etc. My co-workers were horrid people (save a couple) and the administration were asses too. Every day my license felt like it was in jeopardy. I even had to report 5+ nurses (from a staff of about 30!), absolute worst place. But the good in it was, that that is and always will be the hardest nursing job I've ever done, and not only did I exceed my Bosses expectations and went above and beyond my duties, I did it whilst extremely sick and with very little help/guidance from above me. I was constantly mandated for 16 hour shifts, yelled at if I had (legitimate) overtime, and was bullied by staff for doing my job more efficiently than them, because it reflected badly on them. That is now a closed chapter in my life, and I know that even though every nursing job has its difficulties, that never will I have such a hard job and situation again, and at the very least, I will never STAY in a job similar to that again.I started in LTC. Unlike the poster above me, it was horrible!
First, you got only 5 days orientation. 30 pts with no name bands and old pics on a 5 inch thick MAR. The MAR had the common name of the drug, but the boxed in the cart had the generic in itty bitty print. Of the 30, nearly 1/2 were diabetic so you had to do the accuchecks on them. Four of the 30 were g-tube fed. It was an 8 hour race to pass the meds. You were on your feet for the full 8 hours and I was exhausted and my feet hurt (wore sketchers).
If you were lucky, you got the last hour to do your documentation. Your shift was ruined when you had an admit or if one or more of your pts went south and needed to be sent to the hospital. Then there were the falls!
For the first month, I was constantly there until 1 AM (I worked 3 - 11). I got chewed out for that. Geez. Finally, I got to the point where I could be out by 11, but when those 'special' events occurred, there was no way to be out on time. Then the nurses were threatened with criminal charges if we weren't clocked out on time, but were reminded that for OUR protection, we couldn't leave anything undone. Verbally told to work off the clock. Of course, if a resident went postal and we were there off the clock, we weren't protected.
The residents who got the best attention were AOx3 or if a fam member was there constantly. They were the ones who could complain.
I was so stressed out that my hubby told me that I should just quit. He hated seeing me so miserable. I couldn't do anything on my off days, but sleep.
I did quit. It took me 2 months to find a Med/Surg job. I love it where I am now!!!!
God bless the nurses who do LTC, I couldn't do it ever again.
Rant over, haha.
Jan 26Joined: Oct '13; Posts: 431; Likes: 272Quote from NurseVal93this is exactly what happened to me at my first LPN job back in 2005. It taught me a very valuable lesson. I will never work anywhere, where bullying is tolerated or overlooked, or work at another place where you are "shunned" in a way for going above and beyond to help your patients/residents, and it is causing some of the other nurses to look bad. Never will i ever again, and i haven't!!was bullied by staff for doing my job more efficiently than them, because it reflected badly on them. That is now a closed chapter in my life, and I know that even though every nursing job has its difficulties, that never will I have such a hard job and situation again, and at the very least, I will never STAY in a job similar to that again.
Rant over, haha.
Mar 22From: SC, US ; Joined: Mar '16; Posts: 30; Likes: 15Hello NocturneNrse, I am 56 and finishing my ADN degree in May. Everyone in my class are looking to go to the hospitals to work upon graduation. Some of them have already secured a position. I was thinking of looking at LTC for my first position, but am afraid to mention it to my peers. Right now we are also in a class that is discussing the correct job match, and hospital work does not look lke the correct match for me. I would like to make a difference in someones life and having a caring nurse who wants to be there is for the elderly client is needed regardless of the type of facility. I was encouraged to hear your words and will probably start on my job search at LTC soon.
May 14Joined: Apr '18; Posts: 109; Likes: 59Quote from ChronicallychangingFollow your heart. LTC definitely needs nurses that want to be there.Hello NocturneNrse, I am 56 and finishing my ADN degree in May. Everyone in my class are looking to go to the hospitals to work upon graduation. Some of them have already secured a position. I was thinking of looking at LTC for my first position, but am afraid to mention it to my peers. Right now we are also in a class that is discussing the correct job match, and hospital work does not look lke the correct match for me. I would like to make a difference in someones life and having a caring nurse who wants to be there is for the elderly client is needed regardless of the type of facility. I was encouraged to hear your words and will probably start on my job search at LTC soon.
Jun 1Joined: Mar '13; Posts: 179; Likes: 549Quote from TheCommuterI have worked in LTC on and off for the past six years, so I will comprise a list of what I believe are the cons of this type of nursing.
1. The acuity level in LTC is rising due to pressure to get patients out of the hospital faster. The LTC facility where I am employed often gets patients who are only 2 days postop. We deal with JP drains, surgical incisions, IV antibiotics Q4h, central lines, and other stuff that you'd typically see on a med/surg floor.
2. Due to low reimbursement rates from Medicaid and Medicare, the typical LTC nurse is responsible for providing care to a large number of residents (often 30+).
3. Supplies are often nonexistent. For example, we currently have a comatose trach patient with orders to change his inner cannula every shift. However, the facility does not always keep the correct size inner cannula in stock because it is too 'expensive.' We cannot find colostomy bags when we need them. Equipment such as feeding tube pumps and nebulizer machines can be hard to locate.
4. The lack of staff is prevalent. I've worked at multiple nursing homes. None of them have employed a unit clerk, a full time respiratory therapist, and so forth. You must take off your own orders and do your own admission paperwork because there's no unit secretary to do it for you. You must perform all respiratory treatments because there will likely be no respiratory therapist to do it.
5. Incompetent employees can somewhat fly under the radar and still maintain employment at certain LTC facilities. You might have aides who sleep during the night shift. There will be the occasional nurse who ignores patient concerns to the point that it turns into a code situation.
6. Society tends to view the frail, isolated elderly with much disdain. However, many people fail to realize that the LTC population is actually a mixed bag of younger adults, middle-aged Baby Boomers who are sick due to hard living, and the elderly. My youngest resident was in her late 20s and stayed at the LTC while receiving IV antibiotics Q4h for infective endocarditis after slamming heroin.
7. The lack of orientation time is prevalent. Some fortunate nurses have posted that they received several weeks of orientation. Personally, I have never received more than a couple of days of orientation.
Jun 3Joined: Dec '17; Posts: 719; Likes: 1,450I am an NP consultant in numerous LTC facilities.The largest issue by far from my perspective is the for-profit motive, and the fact that state fines for poor patient care are seen as no big deal, merely the cost of doing business, as long as the place is not actually shut down.
The place develops a poor reputation, and it is hard to attract decent employees who consistently come to work. The benefits are poor, and there is no clinical ladder. The nurses who are there are repeatedly mandated extra shifts, which many can't do. They have families, they aren't young anymore, or they just want to have a life outside of work.
Totally incompetent employees? Can't fire 'em because we have nobody to replace them.
I have seen nurse fired for patient care issues, and re-hired less than a year later.
It is the employment of last resort. Apparently.
I hate when I come back from vacation, and several of the decent nurses have left, or been walked out. But this is becoming commonplace.
There was a time 20 or 30 years ago, where being an RN in a nursing home was a long-term, respected, if unglamorous job. Now it seems not to be.