I don't want to work in a nursing home...

Double-Helix, BSN, RN · Aug 16, 2012

If you think that working as an RN in LTC is "only doing ADLs" and has "nothing clinical" about it, then it's clear you actually have no idea what it's like to be an RN in LTC.

That statement reveals your inexperience with the real world of nursing and unfortunately reflects the inaccurate picture that many nursing students seem to have of LTC settings. Nothing could be further from the truth.

I highly suggest reading this article written by The Commuter- an admin at AllNurses.com. I really hope it will educate you a bit and help you understand what LTC nursing is really about.

https://allnurses.com/geriatric-nurses-ltc/long-term-care-746461.html

NurseDirtyBird · Aug 16, 2012

When I was a CNA and just starting out in nursing school, I too thought "I will never work in a nursing home." I saw the nurses at the med cart constantly and wondered why anyone would want to just pass meds all day and never do anything exciting. I also figured the nurses in nursing homes must just be awful and can't find a job anywhere else.

...then stuff got real...

In my med/surg clinical rotations, I learned I had no desire to work in a hospital. It was one of those things you had to experience in order to learn. I've never wanted to work L&D, the OR bored the crap out of me. CCU/ICU/ED all seemed like super exciting places where I would get to be a hero all the time and everybody would always respect and admire me for working there. Then I had a family member who ended up in CCU and learned what life was really like for nurses in those units. I greatly admire and respect nurses in all of these fields. You've heard the saying "It takes a special kind of person to do this job?" I think that about all hospital nurses. It is SO not for me, and I'm happy there are so many who enjoy it so I don't have to do it.

So I went and got a job in a nursing home. It was a struggle at first, it's hard work. There's no such thing as being bored in a nursing home. Emergencies happen all the time. People die, people go home better, people suffering from delerium take swings at everybody. Never a dull moment. Always on my feet, running around putting out fires. And I love (almost) every minute of it. It took me a while to find a good place to work, there are plenty of nursing homes everywhere that treat their staff like garbage, especially in this economy, because they can. I'm now at a place I'd recommend to anybody getting out of the hospital but still needing more care.

To make a long story short, if I would have gone with my original assumptions about LTC/SAC nursing, I would be very unhappy in a job that wasn't for me. This is something you just don't know until you get some experience with it. Don't jump to any conclusions before you really see what it's like. LTC may not be for you. It certainly isn't for everyone. But it's taken me the last 7 years of nursing to realize where I want to be in the next 10. Just see what happens...

Sorry I'm such a wind-bag, I have a day off!

TheCommuter, BSN, RN · Aug 16, 2012

I've worked in nursing homes on and off for six years. The nursing homes of today are not the same as the ones of yesteryear.

LTC facilities are taking more acute patients to make up for shortfalls in Medicare and Medicaid reimbursement rates. Many of my nursing home residents would have PICC lines, central lines, Mediports, Permacaths, and peripheral IV access. Many of them were receiving TPN, Procalamine, IV antibiotics every four hours, and normal saline for hydration purposes.

Nursing homes now receive short-term residents who are there for post-op recovery. Most of the time they are only two to three days post-op when they are admitted to the nursing home for total knee arthroplasties, total hip replacements, ORIFs, laminectomies, colectomies, kyphoplasties, CABGs, craniotomies, hysterectomies, gastric bypass, and other major surgical procedures.

Some short-term residents also get admitted for recovery from medical issues such as pneumonia, CVA, MI, cancer, COPD exacerbation, debility, and so forth.

LTC nurses perform skills such as surgical staple removal, IV therapy, wound care, trach care, ostomy care, respiratory therapy, nephrostomy tube maintenance, emptying of JP drains, continuous ambulatory peritoneal dialysis, continuous positive motion, Foley catheter insertion/care, enteral feedings through gastrostomy tubes, and so forth. Some nursing homes have respiratory units where all residents have either tracheostomies or are on stable ventilators.

The short-term residents typically stay at the nursing home for a few weeks to one month while they recover from their various issues through rehab. They receive physical therapy, occupational therapy, and sometimes speech therapy. Once they are reconditioned and strong enough, their attending physician discharges them to home. Every single nursing home where I've been employed has a rehab unit for short term residents.

It takes a special nurse to do what LTC nurses do. I would not discount the experience so early in your nursing career.

Esme12, ASN, BSN, RN · Aug 16, 2012

Heed the words of wisdom.......

You may find that acute care position elusive as you graduate in today's job market. Might I suggest you also learn what a LTAC (long term acute care) is as well. Patients aren't staying in the hospital for their recoveries and are sent to Long term care quickly.

I think you have judged harshly and prematurely.

Kimynurse · Aug 16, 2012

Most LTC/nursing homes, have all kinds of different units.

Sub-acute rehab

Vent/respiratory units

Dementia/Alzheimer's units

TBA units

None of the above are boring, or routine.

Most of us have an idea of there ideal nursing job, they were going to work at when they became a nurse.

I "knew" I didn't want LTC or overnights.

When I became a LPN I started overnights in a LTC facility on a rehab unit.

I am now on days , and love it. I start an RN program in January, and know my experience will help me through school. When I graduate I plan to stay while I do a RN to BSN program.

Keep an open mind, the perfect job will find you.

Good luck

Don't listen to other people, follow your heart.

CT Pixie, BSN, RN · Aug 16, 2012

I'm a LTC/rehab LPN. Gone are the days of the long term chronic patient. Due to the changes in insurance coverage etc, many (MOST) patients, especially the elderly, are discharged out of the hospital way before they are really able to safely be at home. Those people are still very sick and in need of round the clock care. Guess where they end up...with me and all the other RN/LPNs who work LTC/rehab.

They are no more 'well' at discharge from the hospital than they were the day before, yet we get them. I have learned so much and done so much more than I ever thought I would in LTC. (although my heart has always been in geriatrics). My job entails a lot of 'clinical' work, as well as inforcing great assessment skills and time management. With the exception of starting an IV (even the RNs in our LTC can't start them, we have an IV nurse that comes out and starts any that we need to start, although most of our patients/residents don't require IVs) we pretty much do it all at my facility. Also add in, that in the nursing home we don't have the consultant/doctors etc on hand that the hospital does. So almost all the problem solving falls to the nurse.

Before you judge the work of a LTC nurse as monotonous, the field as depressing or feeling that you are only performing ADL;s (thats what our CNA's do) I think you'd do well with shadowing a LTC nurse to see what its actually like. You'd be very surprised at how wrong you are about the job being monotonous or using no skills

ProudStudent · Aug 16, 2012

Heed the words of wisdom.......
You may find that acute care position elusive as you graduate in today's job market. Might I suggest you also learn what a LTAC (long term acute care) is as well. Patients aren't staying in the hospital for their recoveries and are sent to Long term care quickly.
I think you have judged harshly and prematurely.

Woah!!! Ok, I appreciate the responses from everyone but need to make myself VERY clear. I did say "In order to stay open minded, I'm curious to find out why others may desire to work in LTC environments." I never meant to discredit anyone who works in the field, nor did I have intentions of having judged harshly and prematurely and I don't see how what I said was any different than someone saying "I don't want to work in Oncology" or "I don't see myself working in Pediatrics"; etc.

Kimynurse · Aug 16, 2012

What are something's you like? Or dislike?

What clinicals have been your favorite?

CT Pixie, BSN, RN · Aug 16, 2012

Woah!!! Ok, I appreciate the responses from everyone but need to make myself VERY clear. I did say "In order to stay open minded, I'm curious to find out why others may desire to work in LTC environments." I never meant to discredit anyone who works in the field, nor did I have intentions of having judged harshly and prematurely and I don't see how what I said was any different than someone saying "I don't want to work in Oncology" or "I don't see myself working in Pediatrics"; etc.

I think this was where it sounded as you were discrediting LTC nurses and this is is also how its different than saying you don't want to work in oncology or peds --->I find it depressing, monotonous and I cannot see myself spending my career doing ADLs and nothing really "clinical". I really have an urge to be inside the hospitals, performing skills to help those needing acute care.

I am not judging you, I was answering your question and letting you know that your thoughts of what a LTC nurse does/doen't do weren't based on the reality of a LTC nurses job.

MedChica · Aug 16, 2012

Our elders need our help, too.

...and I've found nothing monotonous or depressing about the nursing home environment. Old people say the darndest things, y'know.

There are good times. Lots of good times.

Just because they're in the home doesn't mean that they're dead.

They're living and breathing. They sing. They dance. They play instruments, too.

One of my little ladies plays the violin. Her fingers aren't as nimble but she can bang out a tune. She has pictures all over her wall of her in concert. One of the little guys in my unit plays the guitar. The LTC even set a time for him to play on weekends and all the residents go into listen to it.

They're just not as spry as they used to be.

We, grad and student nurses, all have goals and such. Nothing wrong with it. I love hospital culure. Always have. But... I've simply had my fill of this, "Eww...a nursing home. Ew...old people. Eww...I'm too good for this" attitude.

There is a sort of strange visceral reaction to working with elders that really isn't observed elsewhere. I dealt with this attitude throughout nursing school from the 'I wanna play with babies all day' crowd. They were far and few. Still - it was annoying. I don't necessarily want to work with children, but I would. I've always been uncomfortable with Peds b/c they're so fragile. In my head, at least. I could never work NICU b/c I can't handle dealing with child abuse cases and infant mortality.

It's rough.

Pedi is a skill that I wouldn't mind developing, I'll say.

I'm not a nurse, yet. Just a GVN, but there is absolute honor in being an LTC nurse. In working LTC.

My nurses could work in hospitals. They simply don't want to. They like elders and some just don't like the hospital environment.

If I ever hit 70 or 90 and end up in a home? I can only hope that someone cares enough about me to stretch my limbs or brush my hair and teeth or feed me or cleanse my body or speak softly to me or turn me over because I can't do it myself or socialize and talk to with me or comfort me when I'm lonely or calm/redirect me when I'm afraid and lashing out, etc....

They care for the most thrown away members of our society (with the mentally ill running a close second)...and they don't do it for the 'fame' or the bragging rights that come with working a fabulous hospital job.

This is the essence of nursing, imo. They render care, when no one else will. Not even the family members...though I refrain from judgement most of the time.

I'm at a psych LTC. I could've gone to the hospital. Had a contact in there, but eh...

I have no desire to work with the military right now. Spent too long with that org and honestly? Me and the military? Frankly, it's akin to a bad marriage. I'm just not ready....LOL

Civilian hospitals pay too little for me. I rather like my little ladies (though they drive me completely crazy...most of the time), anyway.

I think -- there are many virtues to working LTC. You learn how to prioritize and some serious time management skills, that's for sure.

So, tell me? Are you currently working as a PCT in a hosptial? Are you networking your way into a hosptial position as we speak? Do you have contacts?

If so? Great.

If not? Trust me... your tune will change come graduation and no one wants to hire you....

That's not a dig. It's just non-sugar-coated realism.

Double-Helix, BSN, RN · Aug 16, 2012

Woah!!! Ok, I appreciate the responses from everyone but need to make myself VERY clear. I did say "In order to stay open minded, I'm curious to find out why others may desire to work in LTC environments." I never meant to discredit anyone who works in the field, nor did I have intentions of having judged harshly and prematurely and I don't see how what I said was any different than someone saying "I don't want to work in Oncology" or "I don't see myself working in Pediatrics"; etc.

The difference is, you don't know what working in LTC is like. You're dismissing it as a job opportunity based on a false pre-conceived idea of what it is like. It's one thing to say that you don't have a passion for a certain field because you've experienced it, and you know the skills/patient population aren't for you. It's quite another to say that you never want to work in a specialty because "

I cannot see myself spending my career doing ADLs and nothing really "clinical"

when that is not an accurate description of the specialty. I fail to see how you can find a field depressing and monotonous when you have never worked in such a capacity.

One could compare it to saying, "I know that I don't want to work in pediatrics because I don't want to spend my career changing diapers all day." Pediatric nurses do much more than change diapers. We care for a vast variety of patients with complex medical needs. We perform many various clinical skills on a daily basis.

If you actually learn what a LTC nurse does, you will find that it is far more than performing ADLs. The Commuter gave some excellent examples of the type of patient you might see. She is completely right that patients who were cared for in the hospital 5 or 10 years ago are now going to LTC. It's not uncommon to have patients who are 2-3 days post surgery, with wound care needs, tube feedings, IV medications, respiratory treatments, etc.

If you still don't want to work in LTC after gaining an understanding of the reality of the specialty, that's okay. But the reason you are being perceived as judgmental is because you have labeled the LTC specialty as monotonous and comprising of no clinical skills (which is, frankly, an insult to nurses who work in LTC) without having any real understanding of LTC nursing.