Nurses in long term care, LPN and RN, are expected to be competent in many areas that hospitals deem "specialty" areas and assign entire floors to them and devote time training nurses to be competent in this one area. Long Term Care nurses will work many different areas in one day all on their one unit: pysch, wounds, dialysis, hospice, infectious disease, cardio, pulmonary, and sometimes trauma. ETC
Nurses in long term care must report any and all changes in a resident's condition to the attending physician and the family. The physician is only required to assess their patients every 30 - 60 days. Therefore, in the long term care setting, the nurse calls the doctor and tells him what is wrong with the resident, what the resident and/or family needs are, if they are declining, improving, need a med change, need lab work, or need to see a doctor. In a hospital, the doc makes rounds once or twice a day and tells the nurses what to do.
It takes a very special, calm, self assured,assertive, organized, independant thinker, patient person to be a long term care nurse.