Long-Term Care Nursing: A Specialty In Its Own Right

Barbara, a nurse at a long-term care facility, says, "I've been working in this industry for 30 years." She adds, "I enjoy having the same residents day after day." The purpose of this article is to discuss long-term care nursing, which is a specialty in its own right. Specialties Geriatric Article


Long-Term Care Nursing: A Specialty In Its Own Right

Long-term care nursing is a specialty that involves helping patients who need extended care as they deal with chronic illnesses and disabilities. Long-term care nurses coordinate the care of patients, perform nursing skills, respond to changes in condition, and provide physical and psychosocial support to patients and their families. In most long-term care settings, patients are referred to as residents because the healthcare facility is also the place where they live.

In most long-term care facilities, the nurse collaborates with physicians, social workers, dieticians, speech language pathologists, physical therapists, occupational therapists, case managers, pharmacists, respiratory therapists, and other members of the interdisciplinary team. The interdisciplinary team is necessary in long-term care due to the elaborate complexity and extent of patient issues that now manifest in this setting.

Long-term care nurses care for patients across the life span with numerous afflictions and diagnoses, although the majority of the patients are elderly. Patients with chronic disease processes such as hypertension, coronary artery disease, hypothyroidism, diabetes mellitus, chronic kidney disease, osteoarthritis, and chronic obstructive pulmonary disease receive care from long-term care nurses. Patients who have been afflicted with progressive illnesses such as Alzheimer's disease, multiple sclerosis, Parkinson's disease, and AIDS wasting complex are also cared for by long-term care nursing staff.

Depending on the type of facility, long-term care nurses may perform skills such as vital sign checks, intravenous therapy, enteral tube feedings, wound care, range-of-motion exercises, indwelling urinary catheter care, respiratory therapy, cardiopulmonary rescuscitation (CPR), ostomy care, tracheostomy care, management of stable ventilators, and medication administration. Long-term care nursing staff members also assist patients with activities of daily living such as feeding, dressing, toileting and bathing. Moreover, long-term care nurses provide education, help apply adaptive equipment, and document all care that has been provided.

A person who wishes to become a long-term care nurse must have completed a nursing program and have attained licensure. Licensed practical nurses (LPN) and registered nurses (RN) may obtain employment as long-term care nurses. Long-term care nurses are employed at nursing homes, assisted living facilities, long term acute care (LTAC) hospitals, adult day care centers, skilled nursing facilities, and retirement communities. They function as bedside nurses, unit managers, staffing coordinators, case managers, directors of nursing services, house supervisors, wellness directors, infection control nurses, wound care nurses, minimum data set (MDS) coordinators, and nurse educators.

Certification in long-term care nursing is optional, but highly desired. Both registered nurses (RNs) and licensed practical nurses are eligible to attain professional certification. The National Association for Practical Nursing and Education Service (NAPNES) offers certifications for LPNs, while the American Association for Long Term Care Nursing (AALTCN) offers opportunities for RNs to become certified.

Long-term care nursing is a rewarding specialty that requires an extraordinary level of patience, knowledge of nursing interventions, analytical thinking, and compassion for helping people deal with chronic issues. The the long-term care nurse is a professional who experiences multiple joys and challenges during the course of a routine shift. Therefore, long-term care nursing is a specialty in its own right.

TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

176 Articles   27,610 Posts

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Double-Helix, BSN, RN

1 Article; 3,377 Posts

Specializes in PICU, Sedation/Radiology, PACU.

Thank you for writing a great article about the truth of LTC nursing. It truly is a specialty area that requires a unique skill set. Unfortunately, LTC has a very poor reputation as one of the least desirable places to work- a reputation that is undeserved. LTC nursing requires just as many skills as any other area of nursing and can be a very rewarding place to work.


21 Posts

Barbara-- You are right on-- that nursing in Long Term Care is a specialty of its own and requires special assessment skills and understanding. I worked in acute care for over 40 years before going to LTC. Hospital nurses do not understand the issues that revolve around LTC residents, their families and their rights . I remember working in an emergency dept and not realizing why the RN had sent someone from a LTC facility to emergency unil I worked in LTC myself. On several occasions in LTC I had to phone ER to explain why I was sending my resident and most of the time it was because the family requested this move. Education in this area would be very helpful for those working in acute care as I too remember wondering " What are they doing sending this resident to us in ER?"

Yes, -- a speciality of its own!!!!!


7,735 Posts

Specializes in retired LTC.

So nice to see a plain & simple, factual, unglossed and non-altruistic presentation of LTC. Too bad that soooo many new grads and acute care-to-LTC transferees view us as a disappointing second (or even third) choice, something they begrudgingly have to 'settle for' because their 'dream' opportunity in the acute care setting (NICU, PICU, ER, ICU, CCU, OR, OB, etc) didn't materialize. Or they have to wait for advanced practice and education. And then they post here to AN with their dissatisfaction. Their hearts just aren't in LTC so it's no wonder they complain and nit-pick and pooh-pooh and look for greener pastures.

Remember, nursing school separates us only as RN and LPN. Nobody goes to the 'XYZ University School for Hospital Nursing' or the 'ABC College for Nursing Home Nursing'. We are so much more than even the article described with our special skill sets and caring. But deep down we are all still NURSES.

It is just so hurtful and sad that we've been relegated to second-class status so frequently by so many (the general public, other professionals, the media, etc) but esp by our own.!!! I guess I''m acknowledging the 'elephant in the room among us' syndrome as this article triggered my feelings. I just hope it gets better soon! As the late Rodney King said, "can't we all just get along".

TheCommuter, BSN, RN

176 Articles; 27,610 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
It is just so hurtful and sad that we've been relegated to second-class status so frequently by so many (the general public, other professionals, the media, etc) but esp by our own.!!!

I agree with you. A definite, unspoken, unofficial hierarchy exists in nursing. Nurses who specialize in critical care and emergency nursing are elevated to the top of the pecking order. On the other hand, long-term care nurses have been placed toward the bottom of this invisible hierarchy. The situation is very unfortunate.

Specializes in LTC and School Health.

Thank you for this post. Long term care nurses are looked down upon so often. It is nice to educate nurses on what LTC nurses really do.

I'm now in ICU and I still miss taking care of my residents!

CT Pixie, BSN, RN

3,723 Posts

I'm a LTAC/LTC LPN and damn proud of it. Yes, when I answer the standard question of "what hospital do you work at" when someone finds out I'm a nurse with "I don't work at the hospital, I work at a LTC facility" more often than not, I am met with the look of disgust and the 'ohh, ok'. Just once I'd love for those people to shadow me at work for a week, hell, I'll take a day.

And maybe then they will see that I'm not 'wasting' my education or skills, I'm not JUST a boo-boo kisser and band-aid applier. My residents for the majority have very complex and sometimes more acute than chronic issues. My short-stay residents are those poor souls who have basically been kicked out of the hospital because the insurance company/TPTB or whomever decided that they can't stay any longer. Much too sick and unable to go home without 24/7 SKILLED nursing, they are shuttled off to me. Where I get to take care of the much too ill person with my limited resources and much too often to my own accord.

I/we do what we can with what we have. We don't have this specialist and that one to consult with or have our questions answered like the nurses in the hospitals. And yet we are thought of by the 'hierarchy' of the nursing totem pole as brainless nurses who probably work in LTC because we can't cut 'real nursing'. That patient you just had on your floor that required a lot of your time and nursing know how, the one who was discharged earlier..well I have them..and around 30 others just like them. I challange YOU to do my job for a day :)

Skips, MSN, RN

516 Posts

Specializes in L&D.

I applaud the LTC nurses!


62 Posts

I just finished my nursing assistant certification course (as a required part of my RN coursework) and had an incredible instructor who was so passionate about LTC nursing that she has inspired me to give it a try. I'm looking forward to my clinicals to see what it's really like, and see if I have what it takes.

I do know that the majority of students in my class do not want to work in LTC and had an attitude of "I'm too good for this". Some of these people came late, left early, cheated on tests, spent most of the class on Facebook and giggled incessantly at some very sensitive topics. Some have plans to work for a LTC facility for the minimum 90 days that is required to get reimbursed for the cost of their course. I feel really badly for the facilities that are going to hire and spend time training these people, reimburse them $1200 for their course and then have them quit right away I think this is really poor ethics but most don't see a problem with this and feel entitled to do so. I wouldn't want these people taking care of my elderly parents or grandparents anyway.

libran1984, ASN, RN

1 Article; 589 Posts

Specializes in Emergency Nursing.

For Real, bless those LTC nurses. It is a specialty that takes the right kind of person to do well.


366 Posts

Specializes in psych/dementia.

I may be in the minority, but I WANT to work in LTC. I was a physical therapist tech at a nursing home and there is nothing better than seeing a CVA come in who can hardly move and watch him literally walk out the door and shake your hand. He was SO PROUD of himself too! It's just INCREDIBLE!!!

I'm still taking pre-reqs right now, but my plan is to work in LTC.


54 Posts

I am a new CNA graduate with plans to get my LPN and possibly ny RN. When we did our clinicals, they were at LTC and Assisted Living Centers. I learned more at the LTC facility than the ALC in that I worked in the "mental" unit. Maybe it was the staff at the ALC that turned me off to ALC, I don't know. The staff at the LTC actually tested me as if I was taking my state boards. I found it very helpful to work with the RN's there and actually made me consider LTC for my employment after getting my license.

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