Is long term care that bad? and Long Term Care To Psych

mandykal, ADN, RN · Oct 22, 2009

bottom of the barrel? i don't think so. many have different opinions. ltc is still a specialty as far as i'm concern, and it isn't meant for all. stabled chronic care. i've worked with people who worked in hospital settings, and when attempted ltc, they couldn't do it for whatever personal reasons, and other people vice versa. as for working your butt off, sounds like all specialties have similarities. for now, it is a job to which many people in your area still don't have. don't resist it, find peace to enjoy it. ltc can be just as rewarding as many different specialties. there is psych in ltc. as a matter of fact, i wish they'd implement psych in nursing assistant training. if you really want psych, work ltc for a couple of years for experience, at the same time do your research, you may also want to consider moving as your only option. good luck and smile b/c you have a job.

TheCommuter, BSN, RN · Oct 22, 2009

LTC is (mistakenly) regarded as "bottom-of-the-barrel" nursing due to the patient population that is involved. Whether anyone wants to admit it or not, the isolated elderly are generally devalued by society. We place high value on infants, children, teens, and younger adults, but the elderly get the short end of the stick in many measures.

In addition, nursing specialties seem to gain prestige if more equipment and higher acuity levels are involved. The ICU nurse deals with high acuity patients and plenty of equipment, whereas the LTC nurse deals with stable patients and a chronic lack of equipment and supplies. Guess who gets demonized for having less to work with in the first place?

nyteshade, BSN · Oct 22, 2009

(Deep sigh). I believe our speciality is considered "bottom of the barrel" because of the stigma created by the public, nursing schools, and hospitals. Yes, some LTCs need a good clean up...but as a traveller, I worked in hospitals that should have been shut down. So, I don't feel it's the bottom. It is very hard to leave LTC at times because recruiters at hospitals or even some nurse managers feel that LTC nurses are just pill pushers. Sad, but true. Also, schools are promoting it...let's pump everyone into med-surg, or ICU, etc where "real nurses" are. Even the lay public seem to share this view, ie; "Why don't you work at a hospital? It's soooo much better.". Or so I've been told. I just smile. I see no reason why you can't get into psych...dementia pts are a handful, and it takes a certain person to deal with that population. The stigma really is sad, we all will eventually get old, and I speak for myself when I say I don't want a nurse taking care of me that feels he/she is too good to be there...

husker_rn, RN · Oct 22, 2009

Not everyone considers LTC the bottom of the barrel; I've worked many years in that specialty and loved my residents. No doc in house, had to recognize what I was looking at quickly.....it's not for sissies. Unfortunately we talk about caring for our elders but as a society I think we're falling short.

SunnyAndrsn · Oct 22, 2009

I do think there is a perception that LTC nursing is scraping the bottom of the barrel. Why? Because it's the lowest paying specialty that I'm aware of, and in general, it's not "exciting". The skill set required for an effective LTC nurse is different, of course, than any other specialty. I think it's speaks volumes that the general public--and our nursing counterparts--seem to feel this way. It's indicitive of how we as an American culture feel about our elderly.

I have seen new grads, cardiac nurses, and peds nurses try to make the switch or start in geriatrics. The cardiac and peds nurses failed, both acknowledged the pace was way too much for them. The new grads, about 75% don't last more than a month or two. For the same reasons. Most LTCs do not have a HUC, therefore, we have to be able to input our own orders, as well as have a high pt. load. My facility has a TCU as well, so my skill set has developed in surgical wound care, orthopedic protocols (hip and knee arthroplasty precautions), coumadin awareness, cardiac valve replacement and all that goes along with it (sternal precautions), etc...we do take pts. with IV's and central lines in my facility as well. In addition, we have the LTC wings with the dementia, the choking issues of the elderly, wound care, pressure ulcer prevention, diabetics, and depression, grief and loss, and of course death and dying.

Bottom of the barrel? No way, but until you've worked as an LTC nurse, you won't think so. The biggest difference I see is that we in LTC help people leave this world peacefully and with as much grace and dignity as possible. We are not looking at returning our pts to the community, rather we strive to make the winter of their lives comfortable, happy, and as fullfilled as possible. It's a huge challenge. When we have a significant change of condition with a patient, we look at code status, advanced directives, and turn to the pt. and family to see if medical interventions would even be appropriate "What benefit do you (family and pt) see in aggressive medical treatment?" We get creative with our nursing interventions...

Anyway, it sucks that my pay is so much lower with a much higher patient load of "stable" patients. My patients this week include:

unexplained vomiting and chronic hyperkalemia,

c-diff and infected, MRSA venous stasis ulcers,

fistula care to a cancer pt. who was septic and is waiting to start chemo,

a women with labs so out of wack the MDs sent her to us to die, they can't explain why her labs are the way they are, and medical interventions have failed. Looks like her heart is beginning to fail now based on her sudden edema and BNP.

early onset Alzheimers, she likes to try and choke us.

A TKA whose PT/INR regularly hits 6+, thankfully she's A&O x4;

a CVA with chronic pain,

another TKA, full of anxiety and won't let staff near her...she's also incontinent and I finally got her to let me at least look at her incision (I get to take the staples out tomorrow if I can convince her)

-a brittle diabetic with lymphedema

Nearly all of my pts. are medicare, so full vitals on them daily. Add in all the wound care, ACE wraps for edema when TEDS won't work, handing out methadone and other narcs like candy, weekly skin checks, etc...I'm a very busy nurse!

But I love it! I am leaving this facility for another TCU that pays a lot better. I never thought I'd want to stay with this population, but I really do enjoy it.

I have had several co-workers leave to go to psychiatric care without a problem.

RubyDeeRN, ADN, LPN · Aug 6, 2011

This thread was last commented on almost two years ago, but I feel the need to add to it for anyone else out there reading...

LTC may seem to be "the bottom of the barrel" as far as nursing specialties, but as far as experience, there's no where else will you care for patients with such a full spectrum of health issues. Yes, most of the patients are nearing the end of life, sadly, but the majority come along with a whole range of diseases and conditions that they have dealt with for far longer than the time they've been in LTC. Advanced age just tends to makes these things more chronic - not excitingly acute as in most hospital situations - yet it also makes the patient more fragile, which complicates the care involved. From cardiac issues to chronic renal failure to COPD to uncontrolled diabetes to wound patients with MRSA to multiple sclerosis to Huntington's to Parkinson's to schizophrenia to bipolar disorder to Alzheimer's....*takes a deep breath* I've seen all that, and I didn't even finish the list. And I've only been working as a nurse for five months now. I graduated just last December. I expect to see a lot more in the years to come in this field.

I know the OP has probably found their answer and moved on, but like I said, this post is for anyone else out there wondering if LTC is really "that bad." No, it's not bad at all. It's hard work, sometimes exhausting and extremely frustrating, but not "bad." You get to know your patients in a way you can never do in an acute care situation, and they come to realize, after time, that you are now part of their "family." The LTC facility where you work is actually their home. You get to leave; they don't.

As far as going from LTC to psych, it honestly seems like a logical leap to me. Anyone who has worked in LTC has to deal with psych issues, at least from time to time. Even if, as a nurse, you work in an ideal LTC situation where no one has a past DX of dementia, schizophrenia, bipolar disorder, etc. (which is rare), still, most residents have at least a DX of depression and/or anxiety. Who wouldn't, after being displaced from their home and re-placed in LTC? And, as the nurse, you have to deal with these issues accordingly. Psych issues are huge with the geriatric population, and no wonder. No longer able to care for themselves, plucked out of the homes they've lived in for the last forty years, a lot of the time dealing with the fact that they've lost their spouse in the last few years, and placed in a LTC facility by well meaning family...of course LTC involves a lot of psych issues. A lot of my time, when I'm not passing meds, charting, or helping an aide toilet a resident, is spent holding hands and chatting with residents, even if they are completely demented and we're talking about the bridal shower they're planning on throwing for the sister who died 20 years ago.

I'll step off my soapbox now. I just want to conclude, LTC could never be considered "bottom of the barrel" as far as nursing experience, and especially so if you want to move from LTC to psych. While I was in nursing school I did clinicals in four different hospitals, one hospital on different floors, so that's five different acute care experiences over the course of a year, yet I never saw the diversity of health issues there that I have working at my LTC facility for the last few months.

And, for those of you who think it matters, yes, I'm "only" an LPN.

rose-n-arrows · Aug 7, 2011

Balsadragon, thanks for commenting on this post, thereby bringing it to the top. I am excited at the prospect of starting my first job as a nurse in a SNF. Throughout school, it bothered me to hear LTC referred to as the least desirable nursing position. I enjoyed my clinical time in the ECU and dealt mostly with a geriatric population in the community where I attended college. I have already heard the comment, "Well, you have to start SOME where." I don't look at my upcoming job as a stepping stone to something else, as though I'm just biding my time. That's an insult to the patients/residents who will be trusting me to provide the best care. I'm glad this specialty is listed so that I can gain a smidge of insight before beginning my fantastic new career in a couple of weeks :redpinkhe

pixie120 · Aug 9, 2011

LTC is not scraping the bottom, and we get paid far more than Assisted Livings and hospital nurses, and we have to figure it out all on our own.. no MD's except by phone and have to have great assessment skills and critical thinking skills. Not for all, some come here and fall right on their face. Have to be organized, smart, personable and be a great sales person for care, leadership for the CNA's and have to learn a little about everything, wounds, coumadin, complicated med regimens, PT/OT/SLP and psych issues, lots and lots to learn.

debRN0417 · Aug 13, 2011

It is sad. LTC is hard work, but it is not the bottom of the barrell. Those words are spoken by people who have never worked in LTC and have no clue what it is all about.

suzi0612 · Aug 18, 2011

I have been a LPN for about a year now... I have worked in LTC as a CNA for a total of 2 years and a year as a nurse. Taking RN boards again at the end of September. Hoping I'll pass this time! :) I believe LTC is hard work. When I started working on the floor as a nurse I was overwhelmed... thankfully I worked at the facility before as a CNA so I knew all the residents. Sometimes with all the behaviors, alarms, falls, calling oncall because your attending physcian is n/a on the weekend, pharmacy and lab closed on the weekend, the amount of residents you are assigned to, helping your CNA's, I get no breaks and always on the run! I love geratrics but I feel sometimes I have to pass my medications to one resident and move on to next resident because its always so busy! I feel I need to do more with my degree when I get my RN and learn new experiences- sometimes I feel I lose my skills working as a nurse in LTC because its the same thing every day. It seems I just pass medications to 20+ people a shift, do treatments, orders, and paper charting. The skills I learned in school that I have used the most in my job are putting caths in, nursing care with a wound vac, and Gtube nursing care. I just hope me working in a nursing home for a year is enough experience to get a RN job somewhere. To your comment about going from LTC to psych... in the elderly there are so many behaviors due to dementia. If you look at all of the medications you give. In our facility I see a lot of zoloft, cymbalta, seroquel, ativan, xanax, and haldol. So I believe you have the experience with depression, anxiety, and mood disorders! :):) I also believe nurses at the hospital do not understand how hard LTC nursing is! Caring for 20+ residents is very hard... I know sometimes it not complex nursing problems and complex nursing interventions( like IV, PICC lines, TPN, and different procedures) but its hard managing care for all the residents especially when the whole facility gets sick! I do believe that LTC nursing gives you a different kind of experience with nursing :):)