Long term care, you can move on (but don't have to)

[JBMmom, MSN, NP]

I started out in long-term care over five years ago, I've been a charge nurse and supervisor and still work per diem because I really like my coworkers and residents. I transitioned into an acute care med-surg position this past summer and I'm transferring to the ICU in the next month. I've seen many new grads lament that the *only* thing they can find is LTC positions and will that effectively end their career if they start there. I wanted to share to not only let you know that a long-term care position is not only NOT the end of a career, but you shouldn't underestimate the value of the skills that you will develop in that care environment.

When I first started, I had classmates that would apologize to me when I told them where I worked, as if their hospital positions were what I really wanted, but just couldn't get. In reality, the schedule options of LTC worked for me, not a hospital job. Learning how juggle med passes, treatment passes, dealing with families, getting lab and test results, calling MDs, and spending time with patients with a 30 patient assignment was a great way to learn time management. Having many stable patients, not everyone gets daily vitals, I had to develop strong assessment skills to identify patients that had a change in condition (like a non-verbal quadriplegic going into sepsis). On our short term rehab unit we've had probably 20 of the 30 patients that were easily as acute as the patients on my current med-surg floor, IVs, wound vacs, dressing changes, etc. And it's a 4-hour med nurse and the charge, for all 30 patients, with 3 CNAs. Those were some run-your-butt-off shifts, and my hat is off to my coworkers that pull those shifts day in and day out. Point being, the skills of prioritization and assessment are key to success in that environment and those skills are hugely beneficial when faced with a 6-8 patient acute care assignment.

When I started in the med-surg position, I was a little intimidated at first by the change in acuity, would I know when someone was facing a crisis? Could I handle the higher acuity environment? Turns out, the skills I developed in LTC continue to come in handy and my new manager in the ICU even commented that she has found that nurses with similar backgrounds have to have strong assessment skills and when they're given the extra tools of constant monitors in the room, they often find success. I hope that will be the outcome of my story and I'm excited for the new challenge.

I hope that my story helps others considering or currently in long-term care positions that don't feel they're putting themselves in a position to move out. And for those that love LTC and want to stay there, more power to you, we're all nurses and we're all using the skills we learned to make a positive impact on the lives of our patients.

[mejsp]

Your article is convicting. It is downright goofy to want to work in a "cool" setting. It is like everyone in high school saying they plan to major in marine biology or something. We've all known and respected those nurses who felt a real calling to care for those who aren't in the prime of life. Do you think it is because we recognize our day will come? Part of the preconceived negativity is that nursing homes are always hiring. We assume they have a high turnover because they staff so scantily.

I will always be grateful for the nurses who cared for my strong-willed mother who lived 1,000 miles away from us. She behaved poorly and never would have put up with such antics from her children. For example, they didn't have the food she wanted on her evening tray. She called the local grocery store and said, "Can you please come help this home? They seem to have run out of food." She made similar calls to the hospital when her nebulizer treatment was late and even to 911 when her call light wasn't answered promptly.

I called the staff to apologize for her mistreatment of them. This one gracious nurse with the patience of Job said, "You know, I believe her intentions are good. She is trying to remain resourceful, but there is so little left in her life that she can control." I was grateful for this longterm care nurse's wisdom and compassion. Her words come back to me when I encounter the cantankerous.

[Crystal-Wings, LVN]

I wish I had the capability to work in LTC. I love the elderly and working with them! Unfortunately, I can't keep up with the pace and stress of LTC because of my anxiety issues. I salute all the nurses that are able to work in LTC and would like them to know that you have such an important job!

[knight-]

Turns out, the skills I developed in LTC continue to come in handy and my new manager in the ICU even commented that she has found that nurses with similar backgrounds have to have strong assessment skills and when they're given the extra tools of constant monitors in the room, they often find success. I hope that will be the outcome of my story and I'm excited for the new challenge.

You know, this is reassuring and comforting to know. I have been working for almost 2 years in a sub-acute facility. It's never easy working in LTCs, but we survive. Thank you for some sort of validation.

[QuietIsntAWord]

I did 2 years of private duty nursing and now going on 3 years LTC. Boy are you right about needing excellent time management skills and assessment skills. I have learned so much working in this environment!

[Sour Lemon]

My previous, hospital employer did away with their tiny new grad program and started hiring LTC nurses who wanted to move into acute care, instead. One was a real weirdo, but the rest had mad skills and transitioned very easily. I'd try to show an orientee something (or help them with something) only to find out that they'd already "done it half an hour ago". It was a super-busy, high acuity unit, too.

[Davey Do]

Great post, JBmom! Embracing your lot in life! Or the job doled out to you.

JBMmom said:

When I first started, I had classmates that would apologize to me when I told them where I worked, as if their hospital positions were what I really wanted, but just couldn't get.

I can identify, JBmom. Not only am I not a real nurse, I don't work at a real hospital:

However, I do have interesting situations to relay:

But I love my coworkers and the patients with whom I serve- what could be better?

Here's to those who bloomed where they were planted!

[YUKONrn]

It's not that I don't like LTC, I love it when I don't feel like I'm putting my license in jeopardy. Having a CMA who was diverting meds at one facility and a patient having a grand Mal seizure as a result is ultimately going to fall on my license, thank god that's the only bad thing that happened. And having 40 residents, 20 of whom are skilled and probably belong in an LTACH, for one nurse and 3 CNA's can be done, but not in 8 hours. Not when you have to knock 30 minutes of your shift for report, 1 hour off your shift to round with doctors, 1 hour off your shift to go to standup, and another 30 minutes off your shift to give report. Let's not forget your mandatory 30 minute lunch break which I clocked out for but never got to take. That gives you 5 hours to obtain 20 full sets of vital signs, perform 20 head to toe assessments AND document them in PCC, put orders in, call pharmacy 75 times about medications you are suppose to have but don't, do 10 fsbs and administer ss insulin, draw lab work from PICC lines so the pharmacy can adjust the TPN, spike and hang new bags of TPN, change 3 wound vac dressing, change 3 wet to dry dressings, put cream on literally everybody's rear because everybody would come from the hospital with at least a stage 2, administer 6 duonebs which takes 10 minutes apiece and you are NOT allowed to leave the room, administer meds to 3 different people with PEG tubes, bolus feed 1 of of the PEG tubes, spike and hang 2 new bags of tube feeding on your other PEG tubes, obtain urine and stool samples on multiple people. And that's just what I had to do for the 20 residents on the SNF hall. I had a LTC hall where people were on neuro checks, or they are c/o dysuria and need a ua, or they are going to the Dr and need an order summary printed. All while our fax machine and our printer did not work so we had to print clear across the building and then walk 1/4 mile to obtain it. It can be done but not in 5 hours. Most days I was there until 6 pm finishing my skilled notes. So I was working 12 hours a day 5 days a week.

[CJisRNBSN]

Thank you for posting this. I began my experience in nursing in a LTC facility and absolutely love it. I worked as a CNA and as an LVN at the same nursing home. I will be graduating with my RN BSN soon, and definitely will be happy to continue to work in LTC. I have also heard that this type of setting is a career ender. However, the skills that I have learned at the nursing home have (like you said), strengthened my assessment skills.

[YUKONrn]

Thank you for posting this. I began my experience in nursing in a LTC facility and absolutely love it. I worked as a CNA and as an LVN at the same nursing home. I will be graduating with my RN BSN soon, and definitely will be happy to continue to work in LTC. I have also heard that this type of setting is a career ender. However, the skills that I have learned at the nursing home have (like you said), strengthened my assessment skills.

You won't get your skills in LTC, hate to be the bearer of bad news. In fact it is downright dangerous to work LTC as a new grad. But hey it's your license.

[JBMmom, MSN, NP]

You won't get your skills in LTC, hate to be the bearer of bad news. In fact it is downright dangerous to work LTC as a new grad. But hey it's your license.

You're not the bearer of bad news, you're the presenter of misinformation. There are nurses all over the world that work in long term care facilities with skills equal to those of nurses in acute care environments. And a blanket statement that LTC is dangerous and could jeopardize your license is completely ignorant.

Edited to add that I just read your post about the ridiculousness of LTC, and I'm sincerely sorry that you've had a couple bad experiences, but that doesn't mean it's that way everywhere. Good luck to you.

[Crush]

Thank you for posting this. I began my experience in nursing in a LTC facility and absolutely love it. I worked as a CNA and as an LVN at the same nursing home. I will be graduating with my RN BSN soon, and definitely will be happy to continue to work in LTC. I have also heard that this type of setting is a career ender. However, the skills that I have learned at the nursing home have (like you said), strengthened my assessment skills.

I started out as a CNA and then when I got my LPN I moved on to the local hospital but stayed in the same LTC per diem. I feel like I got to use my nursing skills pretty well in both settings. I really enjoyed interacting and getting to know the residents (best part of LTC). After I got my RN-ADN I stayed on per diem for another year before I moved on. I have since worked with other nurses who started their careers in LTC before coming to acute care and they are certainly assets to our team. Even though I started in LTC, I have had no problems moving to other disciplines/areas of nursing.