Warning, rant ahead. I'm upset by a couple of recent experiences.
1.
So I was running into the store before work the other day and was wearing scrubs. While I'm putting things in my car this middle-aged man at a nearby car asks if I'm a nurse. I said yes, and he asked what kind of nurse I was. Before I could answer he continues, with a big smile on his face, "are you saving lives in the ER? Or little babies in the NICU?"
I responded, "Actually I'm a long-term-care nurse."
The smile instantly vanished and he looked down at the parking lot, and mumbled, "oh... well... that's important, too."
I just responded with a smile and said "Yes, I know it is."
And he quickly left without making eye contact again.
#2
I'm at a party and I'm introduced to another nurse. She looks really excited to talk to me, tells me that works medsurg. I give her the slightly more detailed answer of my facility is primarily LTC with a rehab to home wing.
"Oh..." as she looks down at the floor, suddenly looking evasive with that barely perceptible facial cringe I've grown to expect when I say what I do, "excuse me, I need to say hi to a friend." she says as she slips away and I don't see her again for the rest of the night.
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What is with this perception that LTC nurses are less important, less skilled, or do less valuable work than hospital nurses? The perception in my nursing class was essentially that you only went into LTC if you couldn't get a hospital job, and then it was only for short term experience to get a "real" (hospital) nursing job.
Don't get me wrong, we don't use all the clinical skills that are needed in the hospital. I mean, I had to watch a video on central line dressing changes before doing one the other day, just because we don't get them often and I hadn't done one in four years. But we have our own set of skills that are needed to do our job, and not everyone can do it!
We (in my facility) manage the care of up to 35 different people at once, supervising 3-4 CNAs, and there are only two nurses on the floor at a time, and on night shift only one nurse. We have to know each resident's routine (because they don't stay in their rooms), how/when they take their meds, their individual quirks, their general health history/skin issues and treatments. We also have to know which CNA will need reminders or more direction on tasks, and have to be watching our CNAs and other residents who might be wandering or getting into things while we pass pills, do treatments, and assess our residents. This is all often interrupted by a multitude of phone calls and faxes, and cnas complaining about other cnas and their assignments in general, door alarms and wanderguard alarms, and talking to family, etc. The ability to multitask, stay organized, and prioritize is vital.
We get to take care of the same people every day, sometimes for years. We get to know them and their individual needs. We get to know their families and names of their grandkids.
We know that the first sign that Mrs. Jones has a UTI is repeated fits of anger at the staff, and if we don't address it promptly she'll quickly go septic before she ever has any urinary complaints.
We know that Mr. Smith will stop his PT early and refuse to continue if we don't get him a pain pill before he goes.
We know that if Mrs. Jacobs doesn't complain about taking her medicine there's something wrong.
Our doctors might go two months without seeing someone if they don't have a major change, so it's on us to watch vitals and skin tone and call/fax the doctor to ask for things. Our assessment skills and attention to detail have to be good because elderly persons tend to go bad fast if a problem's not picked up early, and with our patient ratios we don't get much time with them to spot issues.
Our prioritization skills have to be excellent because if three of our people start going south at once, there's only one other nurse in the building to help (and any of her 35 patients might be having issues, too.)
If my coworker is an LPN and someone needs an IV or stat labs (and she's not certified) and I can't get it, there's no one else to try unless someone volunteers to come in during their time off to try it. So that means I have to drop everything else and go try until I get it, because I'm not letting my inability to draw a lab be the reason someone has to leave their home to go to the hospital.
Don't get me wrong, you critical care nurses are bada**. But LTC is also a challenging and important nursing specialty, just in a different way. We're still taking care of people who can't take care of themselves. But instead of working to get someone through something that went wrong, Our focus is providing day to day care to people who've lost the ability to do it themselves. We work to preserve dignity in life and death. We work to encourage someone's highest possible functioning in life, and support and care and advocate for them in death. We reposition them to protect their skin when they can't anymore, and chart bedside while holding someone's hand so they don't die alone. We also sing and dance and laugh and have impromptu mini engagement parties when one of the dementia patients comes up all exciting saying her beau just proposed to her. We see our residents more than their families and in some cases we're the closest thing to family they have. We're necessary for society because the simple fact is that it's incredibly difficult to care for an elderly parent/grandparent and many people are unable to do it safely, especially if there's a dementia component.
I used to be an ER tech. I've been infuriated by nursing home residents that came in soiled and unkempt. But I've also had residents who got up in the middle of the night because they had to pee, tried to hurry to the toilet, then fell in their hurry, smacking their head on the dresser and breaking their hip and obtaining several skin tears, and then becoming incontinent - and then struggling around in pain and covering themselves in blood from the skin tears. I've then made the decision to send them out soiled because my priority then shifted to getting them assessed for serious injury and pain control. Undressing and turning someone who's screaming in pain because of a likely broken hip that hasn't been x-rayed yet, who has no pain meds onboard, in order to clean them up is not something I'm going to do. I am sorry for the times I've had to send someone out in a state of disarray, because I want my residents to look and feel their best! But sometimes things happen. There are bad nurses in every specialty and every location, but there are also good nurses who are doing their best, too.
Can we just... respect each others specialties? If all nurses were hospital nurses there would be so many neglected people in the community. LTC needs more good nurses, not just people who can't get a hospital job, but skilled, observant nurses who want to care for others. There are bad homes, just like there are bad units in the hospital. But as a concept, it's a vital part of the community and people shouldn't be looking down on it!
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TL;DR
Annoyed with people looking down on me for working in a nursing home. LTC is a challenging specialty, too, in its own way.
Let's change the conversation.
What do you love about working LTC?
