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.
I think a lot of it too depends on the skillset required. RNs in LTC don't have do to so much in terms of skills (BUT, that doesn't mean all you do is just pass pills -- that just means you have amazing time managment because now you have extra things that throw off your med admin times). As others have said, the pt ratio is out of this world. Acute care, depending on the state, is very reasonable and that makes the possibility that you will be able to provide satisfactory care all the greater. It is also flashy and skills intensive and crazy with the codes and the more invasive skills and higher level assessments and what not.
In LTC, nurses should be able to provide more for the psychosocial needs of the pt, however, this is an entirely unreasonable expectation (though, I will argue, it should not be considered a "it would be nice if we could" type of situation -- it is really vital for these pts but priorities are what they are). In LTC, nurses should be able to provide care for the total pt, but it's simply not a viable situation. This, as others have mentioned, is a symptom of the socioeconomic place the frail/elderly occupy (in other words, it's low and they become disenfranchised). This won't likely change until preventive medicine truly takes hold and older people are dying of heart attacks at marathons or from falling off a mountain and not from being obese and having DM and COPD and CHF, ya dig?
In many LTC facilities you do not get the opportunity to practice the myriad of skills needed on an acute care floor, which also leads to many LTC nurses being pigeon-holed into that area of nursing. However, some people really enjoy working with that population and in that setting. It all depends on what you have a passion for. I did some CNA work in LTC, it was incredibly boring in my opinion. I now work trauma and love it.
I think a lot of it too depends on the skillset required. RNs in LTC don't have do to so much in terms of skills (BUT, that doesn't mean all you do is just pass pills -- that just means you have amazing time managment because now you have extra things that throw off your med admin times). As others have said, the pt ratio is out of this world. Acute care, depending on the state, is very reasonable and that makes the possibility that you will be able to provide satisfactory care all the greater. It is also flashy and skills intensive and crazy with the codes and the more invasive skills and higher level assessments and what not.
In LTC, nurses should be able to provide more for the psychosocial needs of the pt, however, this is an entirely unreasonable expectation (though, I will argue, it should not be considered a "it would be nice if we could" type of situation -- it is really vital for these pts but priorities are what they are). In LTC, nurses should be able to provide care for the total pt, but it's simply not a viable situation. This, as others have mentioned, is a symptom of the socioeconomic place the frail/elderly occupy (in other words, it's low and they become disenfranchised). This won't likely change until preventive medicine truly takes hold and older people are dying of heart attacks at marathons or from falling off a mountain and not from being obese and having DM and COPD and CHF, ya dig?
Sigh...yet another case of nurses that don't work in LTC believing that our skill set is limited, or at least not utilized much. Honestly you'd be surprised at what we do. We regularly get admissions that just a few years ago would have been in the hospital, not a SNF. The only two procedures we will not admit [per company policy] is TPN and vents. Other than that, it's pretty much anything goes.
Specializes in Med nurse in med-surg., float, HH, and PDN.
I thought LTC was awful because there are too many patients the nurse has to pass too many meds to, do treatments on, and the ungodly number of interruptions, plus the endless (and redundant) amount of paperwork, all of which is deemed more important than the actual patient. When LTC workers, both nurses and CNA's have only time for the schedules and tasks involved in the physical maintenance of these people, there is very little time to squeeze in the personal exchanges that reinforce the real, genuine needs of a person who aches for real connection and understanding. Sad.
Sigh...yet another case of nurses that don't work in LTC believing that our skill set is limited, or at least not utilized much. Honestly you'd be surprised at what we do. We regularly get admissions that just a few years ago would have been in the hospital, not a SNF. The only two procedures we will not admit [per company policy] is TPN and vents. Other than that, it's pretty much anything goes.
You need to remember, if you are an RN at LTC or SNF, you are the only one or one of just a few which is why the ratio seems so high. LPNs are doing the med passes, CNAs are doing baths, RN are primarily responsible for assessments, and to do the things that the LPNs are not qualified or legally allowed to perform (which varies from state to state). Its is all about your temperament what area you end up practicing in. You make your career what you want it to be. There are so many different ways to be a RN.
I didn't know there was a stigma, but I can tell you LTC nurses work their TAILS off. It is a whole different animal. They usually have over 20 patients and I've seen med passes take several hours only to be followed by the second pass the minute they finish the first. Add to that wound care, anxious family members and CNA's saying "Mrs. S has a hangnail" every two seconds, in addition to a couple "I need the bathroom's". One isn't better or worse than the other, they're both totally different.
I guess the real question is...why do you care about some "pecking order" at work? It's a job. It doesn't define you. It doesn't make you who you are. It doesn't assign your "value". I've sat there and watched the just-off-orientation nurse make all the assignments, tell me which patients I have, etc. and not blink. I am the most senior employee on either rotation for that shift on my floor, save for 2 people, both of which charge, neither of which were there. Even the house supervisor asked me "Who made these assignments? Why did you let *name* charge?"
My response?
"The assignments are competent and I'm not getting any differential for charging this one shift, so why not?"
People seem to have a lot of ego invested for no reason.
Specializes in Medical and general practice now LTC.
Guess it doesn't matter what country you live in this perception occurs too. Have seen this both in the UK and Canada.
When I first qualified back in 88 I didn't want elderly so gained experience elsewhere but in 2010 I tarted working in LTC and love it. I also feel at this time in my life it is the right place for me to be in. This may change in a few years but at least I am where I want to be not where I have no choice to be.
I thought LTC was awful because there are too many patients the nurse has to pass too many meds to, do treatments on, and the ungodly number of interruptions, plus the endless (and redundant) amount of paperwork, all of which is deemed more important than the actual patient. When LTC workers, both nurses and CNA's have only time for the schedules and tasks involved in the physical maintenance of these people, there is very little time to squeeze in the personal exchanges that reinforce the real, genuine needs of a person who aches for real connection and understanding. Sad.
I always found time to give a reassuring squeeze, a hug, and had conversations during meds passed; I have been able to put out fires, mange wandering pts and frustrated families without any issues; I learned that from the nurses I worked with in LTC.
It doesn't work for everybody, but nurses do find time, do things the right way, and do maintain strong relationships with their residents, peers, and families in LTC.
None of the LTC/SNF around here admit vents. There are a few specialized "vent houses" that would shudder at the thought of going out of business if the LTC's started taking vents.
When I was a LVN I worked in LTC. I honestly loved it, taking care of the residents. What I hated was the chronic understaffing of CNAs and deplorable conditions some of the residents were left in. I remember one night I was charge with one CNA with 50 residents. I was furious. What I was not going to do is have one CNA do all the work. We were a team that night. After the first round I told her get some rest. I will catch your lights and we will begin again at 5am. When the administrator walked in I let him have it. I can see where the stigma comes from but truth be told LVN/RN work hard and manage a large amount of patients. Acute care is also an option but it is not the holy grail of nursing. You can find an area of interest and take it from there. No matter where a nurse chooses to work his/her foundation can still be enriched from the experience.
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la_chica_suerte85, BSN, RN
1,260 Posts
I think a lot of it too depends on the skillset required. RNs in LTC don't have do to so much in terms of skills (BUT, that doesn't mean all you do is just pass pills -- that just means you have amazing time managment because now you have extra things that throw off your med admin times). As others have said, the pt ratio is out of this world. Acute care, depending on the state, is very reasonable and that makes the possibility that you will be able to provide satisfactory care all the greater. It is also flashy and skills intensive and crazy with the codes and the more invasive skills and higher level assessments and what not.
In LTC, nurses should be able to provide more for the psychosocial needs of the pt, however, this is an entirely unreasonable expectation (though, I will argue, it should not be considered a "it would be nice if we could" type of situation -- it is really vital for these pts but priorities are what they are). In LTC, nurses should be able to provide care for the total pt, but it's simply not a viable situation. This, as others have mentioned, is a symptom of the socioeconomic place the frail/elderly occupy (in other words, it's low and they become disenfranchised). This won't likely change until preventive medicine truly takes hold and older people are dying of heart attacks at marathons or from falling off a mountain and not from being obese and having DM and COPD and CHF, ya dig?