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.
Specializes in Med nurse in med-surg., float, HH, and PDN.
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.
Don't forget this: less staffing for more physically demanding work.
Working as a CNA in LTC put me through nursing school without a student loan. I was offered a job (ugh, med cart) after I finished school and got licensed, but six months of passing meds to 30-40 residents about drove me insane. Working LTC did help my transition into dialysis, though. Having a group of patients that you get to know really well in both LTC and dialysis has been very rewarding. I've always been in "The Rest of Them" category.
Acute Care requires some serious mental gymnastics and decisiveness.
I work both in acute care and LTC, My fulltime job is in an ICU, and then I work the critical care floor of a LTAC, as well. Both work equally as hard, and both use all thier skills. I actually learned more about wound care, TPN, and starting IVs from the LTAC than I did on my ICU or even before that my med-surg experience. We are all nurses and no one particular section is better than the others. There are different specialities for each nurse out there. My mother-in-law is a psych nurse, while I could not do that she loves and they love her. Each nurse is different and there is something out there that suits each of us to a "T"
I've done critical care for about half a decade. That is a hospital's money maker. They don't let screw ups stay there and cost them money, so yes, it can lead to a sense of pride. Doctors respect your opinions more and you are allowed more autonomy.
LTC/nursing home settings are stigmatized in the healthcare community because of the patient populations they serve. Bluntly put, the frail elderly are very devalued by US society, which results in LTC's dubious status as a 'low value' workplace setting.
Meanwhile, infants, children and younger adults are highly vauled. Hence, specialties such as pediatrics, L&D, antepartum, emergency nursing, NICU, PICU, postpartum, sports rehabilitation, reproductive medicine, aesthetic plastic surgery, and trauma ICU are assigned a high value in the healthcare community.
There are many, many different areas of nursing. Some enjoy one thing over something else. There are nurses who can't imagine doing anything but long term care, and love it.
I think that your bragging classmates may find that in acute care, a BSN may be required....
Eh, I've worked 2 acute care jobs that didn't require a BSN. Plenty of ADNs in my current acute care job.
That said, I've found critical care to seem more elite in the hierarchy. But yes, definitely LTC, home care, etc aren't seen as desirable generally. LTC is notorious in general for bad staffing and conditions.
I do cry about it all the way to the bank at the end of my Mon-Fri work week..
This reminds me of a classmate that went straight into psych and I said something stoopid from my then acute care perch, she shot back, anytime you wanna come try to do my job you're welcome to it..
All that even matters is that everybody is competent in their role.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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 confusion. There is no nursing shortage. That is media hype based off of numbers that were projected that included a massive retiring workforce that never retired and before the economy crashed taking our saved 401K savings so we can't retire. It also didn't include the number of nurses having to return to the workforce after thier husbands lost thier jobs and benefits.
There is presently a glut of nurses in most areas.
Depending on where you live your friends in your program are in for a rude awakening for most acute facilities are only hiring BSN new grads. This has moved the ADN RN to LTC and pushing out LPN's sadly.
While many jobs are posted....many positions are on hold with hiring freezes. The managers keep interviewing to keep the position in the budget...on paper.
Use the search feature on this site and type in no nursing shortage. It will be enlightening.
Specializes in Certified Med/Surg tele, and other stuff.
There are many, many different areas of nursing. Some enjoy one thing over something else. There are nurses who can't imagine doing anything but long term care, and love it.
I think that your bragging classmates may find that in acute care, a BSN may be required....
Very true. It depends where you live and select hospitals!
My only concern is that SNF and LTC is very understaffed, especially given the ever increasing acuity of patients as hospitals discharge people sooner. I wouldn't want to be in the position of having 14+ patients in rehab and being the only RN in the building, when many of these patients could be in the hospital and then only 5-6 patients a piece! LTC and you are talking 20-30 even 40+ patients a nurse depending on place and location. I think that is simply too much to safely care for! Also you cannot use restraints, ativan or sitters for people in LTC they must be free to move as they please and consequently fall all over. At least in the hospital we have different options for treating confused, demented and sometimes violent patients. The one thing must LTC places are better than hospitals is regarding lifts. They generally have a lot more lifts and use them often whereas many hospitals don't have adequate lifts to move people. God bless the people who do work in LTC they are needed. I just don't know how they do it!
My only concern is that SNF and LTC is very understaffed, especially given the ever increasing acuity of patients as hospitals discharge people sooner. I wouldn't want to be in the position of having 14+ patients in rehab and being the only RN in the building, when many of these patients could be in the hospital and then only 5-6 patients a piece! LTC and you are talking 20-30 even 40+ patients a nurse depending on place and location. I think that is simply too much to safely care for! Also you cannot use restraints, ativan or sitters for people in LTC they must be free to move as they please and consequently fall all over. At least in the hospital we have different options for treating confused, demented and sometimes violent patients. The one thing must LTC places are better than hospitals is regarding lifts. They generally have a lot more lifts and use them often whereas many hospitals don't have adequate lifts to move people. God bless the people who do work in LTC they are needed. I just don't know how they do it!
Of course I can't speak to other facilities but my patient load is 24, a pretty stable bunch for now anyway so it is manageable. You are absolutely right about our inability to use any kind of restraint whether physical or chemical. We do utilize "sitters" in extreme cases. We do have several residents with psych diagnoses that use scheduled and prn ativan, haldol, xanax etc. The only restriction is even if the MD orders a psychotropic IM we can't administer it that way, it has to be an oral dosing. In the most extreme cases of agitation that result in violence, especially if another resident is involved, that person is sent to the ER and if they come back to us they are assigned a sitter until they are transferred to a geri-psych unit for management...boy, there's a place I wouldn't want to work! Staff that can deal with that day in and day out must be amazing. We've only had two residents that we refused to readmit; one [a woman] had choked staff members on three different occasions and the other [male] had multiple incidents of striking female residents.
You are also right about the lifts. We are a no lift facility and we do follow that, if a resident requires a mechanical lift for transfers we use them.
No Stars In My Eyes
5,653 Posts
Don't forget this: less staffing for more physically demanding work.