Geriatric Nursing

I've been a nurse for 25+ years, and I  now work  part time in community health nursing with developmentally challenged adults.  My passion will always be LTC.  LTC isn't a glamorous area of nursing.  There are several stigmas surrounding it.  For example, LTC nurses can't get "better" positions and their skills are less than nurses in other areas.  In fact, the opposite is true.  Assessment skills have to be top notch, because there's no doctor rounding daily.  Some shifts you do housekeeping, phlebotomy, transport and anything else that arises.   I worked dementia for nineteen years.  Whenever I told askers I worked at a nursing home, the response was generally "I guess somebody has to do it".  No, I didn't deliver babies or do chemotherapy.  What I did, hopefully, was help usher your parent out of this world with dignity and compassion.  I don't know if anything in this rant answers your questions, but thank you so much for your interest in working in geriatrics.  The people you will be charged with taking care of have seen more in their lifetimes than most of us ever will.  They have made me a far better nurse, and hopefully a better human being.  

To answer your questions 1) was a nurse for 47 yrs. I started in rural nursing, moved to pediatrics and then float nursing eventually focusing in OB/GYN NICU until the last 4 yrs when I returned to my love of geriatrics.  During Covid, I was infection control in SNF and Rehab facility, and floor staff and then moved to Nebraska and was DON in a SNF for 2 +yrs.   (2, 3) currently retired and working as a sub in a school district with handicapped SPED. 4)  Shortage in geriatric nursing focuses on inexperience offered during nursing school in my thinking.  Also the work is not easy and usually you are the only professional nurse overseeing the entire facility and the multiple diagnosis.  (5,6,) In the SNF, you see a variety of elderly.  Add rehab to the scenario and you have a different approach.  The is dementia, obesity related dx, some familial issues, physicians do not always feel the same way r/t the age and dx of an individual over-medication can be an issue, end of life support, wound care and wound vac, and resident safety. With the changes r/t sepsis ( was cardiogenic shock when I went to school) and the sudden onset of changes, the focus on reducing bedsores and encouraging the CNA's to follow through with preventative measures, this adds to ones daily routine.  I feel that the lack of criteria to individualize care (acuity)and most facilities needing to fill existing beds over addressing individual needs has moved the nurse or care staff to having significant work loads and less time to adequately assess resident needs.  This leads to either short term employment and increased dissatisfaction w/I the role of geriatric nursing.  To encourage nurses to try geriatrics, the facility needs to show support and make the position manageable and satisfying.  When we were able to focus on acuity, there was a greater personal satisfaction but w/ CMS guides to make numbers the issue and 1 nurse for 40 residents - we are not going to find many nurses willing to exert themselves to this abuse.  (8) As far as ageism goes, I do see more older nurses assuming the care of the elderly.  Often the older adult does relate better to an older nurse or CNA over a younger person.  Experience in medical nursing, good orientation/extended support systems, and the evidence based practice focus aids in preparing a nurse for this roles, however, most support is very short-term and you find yourself from the frying pan into the fire.   As the DON, I was often involved in many treatments to relieve the staff nurse of some overload.  This is rare that a DON even comes to the floor, let alone hands on care.  I was told this often.  Time management also is essential.  All staff need to be onboard and focused.  Sorry this became so long but I loved and still love my residents, support those families that frequently visit, answer question to the best of my knowledge and even though I am retired, I still enjoy researching issues that relate to older adults and publish a news worthy article for our church and assist in education.