Help me understand the stigma Acute Care Vs. "The Rest of Them"

[SNBTaylor]

Hello! I'm an ADN student about to graduate in May and I'm currently looking at job opportunities. I've heard my classmates brag and state that they can't wait to graduate as RN's so they can work in acute care and be able to stay out of SNF's and LTC's. I was wondering if someone could explain the stigma about working in Longterm care or Skilled nursing? I know some people must like it! It feels more and more like Acute care nurses thing they're better than the rest when they seem to be the first ones to burn out.

Please tell me why you chose your field?

Thank you guys!

[Not_A_Hat_Person, RN]

To add: there are not enough specialty nurses to fill needs and hit the ground running.

In short: there is a experienced nurse "shortage".

The same facilities that refused to hire new grads for years now complain they can't find experienced nurses. Funny how that works.

[DYS NP]

kbrn2002, if I end up in an LTC, I hope you're my nurse.

[toomuchbaloney]

meh

most places that hire nurses these days are deeply concerned about the cost of nurses vs the profitability of the agency/facility.

Nurses are largely devalued within the institution because to highly value them in a professional and public setting allows nurses a dangerous bit of "power" to negotiate safe staffing or appropriate compensation, etc. Give than the majority of nurses have always been women who have learned for generations to be polite, not argumentative, and (the Christian addition of "submit to men") this has worked well while more and more $$ resources have been sucked from the bedside and into the executive suites and board rooms.

[Emergent, RN]

I worked LTC when I got out of nursing school over 20 years ago. At the time, there was a glut of nurses and the acute care jobs had dried up, I wanted to start working immediately, close to home. We had been advised that we "must" get a hospital job to get that experience.

I found it a perfect first job in nursing for me. It was a nursing home with low acuity, no piccs or IV treatments. There was a gal in a persistent vegetative state with a G tube. There were lots of Alzheimers, a couple of DD adults with severe cognitive disabilities, Parkinsons, a cranky old racist lady over 100 who refused her meds all the time.

It wasn't super technically challenging other than time management and learning to deal with patients, families, co-workers, and a totally incompetent DNS who kept a bottle locked in her drawer and wore a lab coat stained with coffee. One thing I DID NOT like about LTC was that the nurses were outnumbered by the CNAs, and some of them were difficult to deal with, overbearing, and didn't take direction well from a new nurse who wasn't very bossy.

The pay was much less than the hospitals, and I wanted more variety. So when jobs opened up I switched to hospital nursing. You get different patients and families every week so you don't get sick of people. There are more nurses than CNAs, and the pay is better. Eventually I got bored with med/surg, did a few years of small hospital ICU, changed jobs to a bigger hospital, did a few years of Tele and floated, then moved into ER, which has the most variety and lots of technical skills happening on every shift.

Once you are in the hospital, you sort of stick with it. If I go back to LTC it'll be a couple days a week to supplement my retirement.

[LadyFree28, BSN, LPN, RN]

The same facilities that refused to hire new grads for years now complain they can't find experienced nurses. Funny how that works.

Agree.

But it is funny how they are, at least in my area, looking for nurses to train in those specialities, and are willing to give people that training, as long as they have some nursing experience, after all, at least in my area with a glut and no true shortage in 20 years.

[BuckyBadgerRN, ASN, RN]

Oh boy. Did your school tell you there was a nursing shortage? There is no nursing shortage outside of a very few areas of the country.

Why do you say over supply of nurses? I thought there was supposed to be a shortage? and it always seems like some SNF or hospital is hiring?!

I'm kind of confused by your statement?

[No Stars In My Eyes]

Whatever type of nursing someone does, no matter how excellent they are, put them in a different nursing environment and for a while they will be a fish out of water. Some of the basic skills transfer, but the manner of using them is different.

For instance, when I was working Home Health, a hospital nurse signed on to work with us and was freaked out at the lack of any number of services the hospital nurse depends on. I loved being challenged to come up with something that would work for a particular situation/patient.

I tried working at a Dr's office and suffered from being in one small area of the building all day every day.And don't get me started on dealing with rush-hour traffic!

And once as an agency nurse I was put on a busy med-surg, mixed services floor in a hospital, and was in tears by lunchtime because everything was soooo different. I was expected to be able to know their charting with no orientation, and had an admit and a discharge and a post-op going south, and an infant (with no peds experience!).

The med system depended on your finger print and mine wouldn't show up, no matter which finger or thumb I used; I would've rather they used eye scans!)

So we all have horror stories and have all felt totally on top of things or inept at one time or another.

I say it's a good thing that it takes all kinds to make the world go 'round, or I'd be lost and miserable instead of happy and content with my work!

[PMFB-RN, RN]

Why do you say over supply of nurses? I thought there was supposed to be a shortage? and it always seems like some SNF or hospital is hiring?!

I'm kind of confused by your statement?

Uh oh, not another one. There is a huge glut of nurses. There is no nursing shortage and hasn't been one in a very long time, if there ever was one. You are a victim of false propaganda.

[PMFB-RN, RN]

It's a (dysfunctional) part of nursing culture. Your classmates who can't wait to get into acute care will fine themselves being treated condescendingly by step down nurses, who are treated that way by ER nurses and ICU nurses look down on everyone, except the rapid response nurses. Then there are the critical care transport nurses who lord over everyone.

Speaking for myself I have always avoided LTC. It's not because I look down on them, but rather its simply much more work and less pay.

[KelRN215, BSN, RN]

Why do you say over supply of nurses? I thought there was supposed to be a shortage? and it always seems like some SNF or hospital is hiring?!

I'm kind of confused by your statement?

You thought, or were told, wrong. Hospitals in my area have been having hiring freezes and lay offs off and on for the past 7 years since the economy first tanked.

[eroc]

I have worked LTC, acute and now critical care.

In my limited experience each one works on sort of a sliding scale. The higher the acuity the more medical knowledge is need to survive (mental), the more task oriented (physical)…... the lower the acuity.

LTC job was extremely easy to get.

Acute care job was because I knew someone.

And the critic care job was based off my resume and interview….luck also.

[firstinfamily, RN]

I think another reason the LTC facilities get a bum rap is because they are reimbursed differently and to keep costs down the pts usually have less services, older, proven medications, less equipment etc. Whereas, the acute care facilities are reimbursed at a higher rate and the patients usually get the "latest and greatest" in medications as well as interventions and equipment, procedures etc. I also like the ability to get to know your patients and their families in sub acute and LTC. It does seem that if you start out in LTC you get labeled with that type of nursing and it is very difficult to get other positions outside of LTC.