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Long Term Care Nursing is Lame

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purplegal purplegal (Member)

You are reading page 2 of Long Term Care Nursing is Lame. If you want to start from the beginning Go to First Page.

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine. Has 8 years experience.

OK, in LTAC I work right in between ICU and LTC, if one likes it to be put this way. I can honestly say that there are good, bad and ugly things done BOTH ways.

There are LTCs where patients are better cared for than in some ICUs - at least, I cannot imagine someone getting the whole hand first pale and pulseless, then purple and then almost black before it was finally noticed (a-line, thrombosis, no Allen done, AEA) in there. Moreover, there are group homes with one RN on duty for 60 clients, rest run by LPNs who never in their lives did anything "technical" and I doubt that any of them still remember anything about pathophysiology. While these nurses have no "acute" skills at all, I admire them because they know each of their patients literally inside out.

At the end, skills are just what they are. A monkey can be taught to insert any line in human body. But not many humans can suspect that something is very wrong by noticing that patient smells bad doesn't matter how much he is washed and has sudden difficulties to make his favorite puzzle. The LPN who noted it got doctors on in the middle of the night and insisted in sending patient in hospital. Ammonia 70+, acute liver injury due to averse effect of medication; if the LPN would wait till morning, the poor guy will probably die.

But you've impressed me, purplegal...

She's impressed me, too. Negatively.

Purplegal, if you want to make a change, do it. There is no need to put yourself down, along with many great LTC nurses - like ME!!!!! I'm a damn good nurse and I don't need you to tell me I'm not impressive. I have been there, done ICU and didn't really like it. I was not especially impressed with ICU. How about them apples?

Maybe you didn't mean to be insulting to those of us who work in what you might think of as a calmer setting, but we think we're doing good things for people, even if we don't ECMO and CPN and artline everybody. If you meant this in an insulting way, congrats, you made it. And if you meant it insultingly, go fly a kite.

Oh nooooo, Purplegal. Don't do this. Aren't you the one that posted a year ago about something similar and it took *forever* to get people to back off?

I work Geri psych/adult psych at our state hospital. We see patients come in from the ED, their homes, rehab, from LTC. And like another poster stated, we know when a patient came from a poor quality LTC. Not even just from pressure ulcers, but from their BMI, quality of communication (many times they are afraid to ask for help from staff, and you can often separate this from the s/s of the dx they came in with), and the cleanliness (among others).

I'm not in ICU or the ED. My husband is an ICU APRN, and I know in my heart that that's a job not for me. Despite its "exciting" challenges and opportunities ... meh. I wouldn't be good at it because my heart isn't in it. As for the ED, THAT's not all that's cracked up to be either; our particular hospital's ED is a miserable place to work (high turnover rate, high census, poor management, etc). One of my closest friends works there and while she loves the staff, she is pretty unhappy. Often times she reports, among the "exciting things," with most other complaints patients certainly don't need to go to the ED for.

I'm in a field people don't typically LOVE (psych). I'm the only one in my graduating class who did so. Who cares? I'm happy and enjoy what I do.

The grass isn't always greener.

Each of us has our niche And viva la difference. And that niche can change over time.

BSN16

Specializes in ICU, trauma.

I work in the level 1 trauma/neuro ICU and i think your understanding of what we do is unrealistically high.

Yes we do things like sedations, intubations, extubations, lines, machines....etc but these things just all become routine overtime, just like what you're describing. In fact there are many nights when my patients will have NONE of these things.

Also would like to point out all the things you described we do in the ICU as well. If you're hoping to get away from blood sugars, tube feedings, and wound changed this is not the place lol.

There will soon be a point in your ICU career where you walk in a room and aren't wow-ed by an ET tube or an art line. When i first learned CRRT I was SOOO pumped to do it, but now i'd rather just take regular patients than a crrt patient :yawn:

work is work wherever you go, but it's up to you whether or not to make it an enjoyable experience.

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory. Has 40 years experience.

When I worked psych I cared for a lady who had just had a baby, but she became wild and crazy and spent a night in restraints before she settled down. The next day she was calm and asked if she could see her baby. I had to give a lot of reassurance to the NICU nurse to be allowed to bring her up there.

While we were there and the patient was holding her baby, I commented to the NICU nurse that I found those tiny babies very intimidating. She said "That's how I feel about YOUR job!"

So to each his own. Hopefully we're not all in it to impress each other.

djh123

Specializes in LTC, Rehab. Has 5 years experience.

In a way, I get what you're saying re: skills required vs. some higher-acuity types of nursing. But the only things we can do are to do the best we can in whatever type of nursing we're currently in, and if we don't like it, move to another type.

Another commenter said 'well, you chose to do long-term care nursing' - I don't know if the OP did or not, but I didn't. After school, I had several interviews with a psych hospital, a hospital, a hospice facility, and a couple of specialty hospitals, and none of them took me, and I ended up at a LTC facility totally by accident. Another fallacy: one of the managers at work, lecturing nurses and CNA's in a little meeting, said 'You knew what you were getting into when you decided to work here'. Nope, that's not true either. I had little idea what I was getting into. :^)

This was clearly posted to get a rise out of people, but I'll bite. Ha.

The nurses at the long term care facility near me get slightly higher pay and better benefits than I'll be getting in acute care.

Not everyone wants to work in acute care.

I'm glad that not everyone wants to work in acute care, because patients/residents in long term care deserve a nurse who doesn't look at them as bottom-of-the-barrel patients.

cyc0sys

Specializes in EMS, LTC, Sub-acute Rehab. Has 6 years experience.

I'm going to assume you're just trolling. Anyone who has been a nurse at an LTC for day knows it's all about basic nursing skills and patient care. If you can't do those little things well, you sure can't do the high-speed, split second, life or death decisions some of these other specialties encounter everyday.

Personally, I've never seen an LTC that was properly staffed and budgeted with supplies. Which essentially means you're making chicken salad out of chicken ***** everyday while running the gauntlet. Because of this, LTC has made me more efficient and innovative. While wound care, cleaning butts, slinging pills, dealing with families of these frail and forgotten Geri's doesn't requires a lot of technical knowledge, it does require a helluva a lot of heart and compassion.

Maybe you should be focusing on how to better advocate and serve your patients instead of your own personal interests. If your not being challenged, look around for things you can do to challenge yourself. Fix the problem, not the blame.

I don't understand why someone with a BSN would work LTC unless it was a DON/ADON position. BTW, LTC nursing pay is low because of the value our society places on the elderly not the skill set involved with their care.

Edited by Silverdragon102
profanity changed to all *

pixierose, BSN, RN

Specializes in ED, psych. Has 4 years experience.

This was clearly posted to get a rise out of people, but I'll bite. Ha.

The nurses at the long term care facility near me get slightly higher pay and better benefits than I'll be getting in acute care.

Not everyone wants to work in acute care.

I'm glad that not everyone wants to work in acute care, because patients/residents in long term care deserve a nurse who doesn't look at them as bottom-of-the-barrel patients.

I truly like how you said this: "patients/residents in long term care deserve a nurse who doesn't look at them as bottom-of-the-barrel patients." Nicely stated.

I'm not so sure the post was meant to get a rise out of people. If I'm thinking back correctly, I think the OP made a similar post about a year ago; it took almost an entire year to go away, despite her taking back some of the things she had originally posted (correct me if I'm wrong, OP). It got pretty nasty if I'm remembering right.

Purple gal: I saw another post you made this AM about moving up to the world of ICU. If that is where your heart belongs, start trying to work your way there. However, I can see where this thread could be seen as inflammatory to those working in LTC as well and honestly, I'm not sure I see the point of it. Calling another speciality area as "lame," despite you working in said area, is pretty disrespectful to those working in it.

I couldn't do what my husband does (NICU); I'd be terrible at it, tearing up constantly. He couldn't do psych; he'd be too frustrated. I can't do peds, while my other friend in psych can't do adults and can ONLY do peds. I enjoy med surg, and would probably lose it in any ICU. God bless you all who do LTC; my time management skills are no way as good. School nursing? Nope nope nope, I'd probably get myself fired mouthing off to a parent, teacher (and I used to be one!), administration, or all of the above. I actually look at school nurses as angels with fiery swords, bless them.

If you're the poster I'm thinking of, be prepared for several more months of frustrated posters. And this time? You kinda deserve it.

djh123

Specializes in LTC, Rehab. Has 5 years experience.

I truly like how you said this: "patients/residents in long term care deserve a nurse who doesn't look at them as bottom-of-the-barrel patients." Nicely stated.

I like it too. My patients are MY PATIENTS - they're not better or worse than anyone else needing care. I'm not perfect by any means, but I do the best I can for them.

NightNerd, BSN, RN

Specializes in Med-surg/tele. Has 7 years experience.

Let's be honest: ALL of what we do is important. From the hospital to LTC to clinics to homes to everywhere in between. We are all doing something people need to thrive, whether we see it as glamorous or not. It can be hard sometimes to look at a job you've been in for a while and see its importance, I totally get that. But we are all meeting a need with what we do.

I can completely understand being disenchanted with the tasks that go into a particular job. It's okay to get bored and want to learn new skills, stretch your brain, and try something different. So do that! No need for public scorn of an entire area of nursing. :rolleyes:

calivianya, BSN, RN

Specializes in ICU.

Also echoing again everyone else about doing things that are "important" or whatever - I think what you do as a LTC nurse might just be way more important than what I do. Last week, I had several of my patients die on my shift. I willingly participated in tying them down and helping with invasive procedures where they got poked with scalpels, trocars, what the hell ever else, just so they could die anyway because they were too sick to have all of that stuff done to begin with - so I helped ensure their last few hours were absolutely jam packed with misery and suffering.

At least you're taking care of living people who might live a long time, and you're making their lives and health better. Half the dang time, I can't say the same. I literally just participate in torturing people right up until the moment they die, many of them against their wishes because their families rescind their DNRs when things start to go south. If you think participating in torture is glamorous, sure - come work with me. Most people don't last a year on my unit because of the moral distress that comes along with causing a lot of pain and suffering for some nebulous potential "good" that doesn't pan out in the end.

So, in light of the fact that at least half of my job is causing pain and suffering for old terminally ill people just to please some relative three states away that won't even come to see the patient... ICU nursing is lame.

I work in one of those super high acuity areas, and let me tell you... I could never do what you do. I would be ready to throw myself off a bridge having to take care of 20 patients. I hit almost basket case level when I have three. Props to you for succeeding where I would fail!

Well, to be fair, my first assignment alone was 8 patients, and then it's just gradually increased. I'm honestly not sure how I would have done if my initial load had been the 20+ patients I have now.

You're the one who picked to work long term care so I fail to see the point of you calling your own choice "lame". Be an adult and get another job if you don't like your current one instead of whining about how lame and dumb it is. Usually I find that those who do a lot of complaining are the ones who tend to be inadequate at performing the very job they're complaining about.

I didn't exactly pick long term care/rehab. I fell into it after my 3 month orientation on a cardiac surgery PCU was not successful and could not get placed anywhere else except in the ECG department.

I work in the level 1 trauma/neuro ICU and i think your understanding of what we do is unrealistically high.

Yes we do things like sedations, intubations, extubations, lines, machines....etc but these things just all become routine overtime, just like what you're describing. In fact there are many nights when my patients will have NONE of these things.

Also would like to point out all the things you described we do in the ICU as well. If you're hoping to get away from blood sugars, tube feedings, and wound changed this is not the place lol.

There will soon be a point in your ICU career where you walk in a room and aren't wow-ed by an ET tube or an art line. When i first learned CRRT I was SOOO pumped to do it, but now i'd rather just take regular patients than a crrt patient :yawn:

work is work wherever you go, but it's up to you whether or not to make it an enjoyable experience.

I'm not sure any of that would ever become routine for me because I'm just overwhelmed reading through the list of skills these units do. Whenever I perform an ECG on these patients, I'm amazed that these nurses are able to keep everything straight, making decisions while working with all of this equipment. Also, I'm not looking to avoid blood sugars, tube feedings and wounds at all...I'm just impressed with the vast amount of skills these nurses have. I'm a bit envious because technical skills like this aren't my strength at all.

The only thing lame about long term nursing, is the OP of this absurd post. Everything you listed you do, is also done in my part of the ER. Stop acting as if long term care is the lowest of the low in nursing. Frankly, if you are wanting to be wowed on the job, I don't think nursing is for you and I think you truly should reflect on what drivel you have written here. I am sure you admins would love to hear how you think that kind of nursing is lame, as well as the family of those you are tending to. If I were hiring in hospitals, I would refuse to hire you. There will be days that boring repetitive tasks are done....but they are vital for care. If you cannot see how important they are and want to be wowed, turn on the hospital dramas and get the heck out of nursing. Lame is not even the word for you!

I'm going to assume you're just trolling. Anyone who has been a nurse at an LTC for day knows it's all about basic nursing skills and patient care. If you can't do those little things well, you sure can't do the high-speed, split second, life or death decisions some of these other specialties encounter everyday.

Personally, I've never seen an LTC that was properly staffed and budgeted with supplies. Which essentially means you're making chicken salad out of chicken ***** everyday while running the gauntlet. Because of this, LTC has made me more efficient and innovative. While wound care, cleaning butts, slinging pills, dealing with families of these frail and forgotten Geri's doesn't requires a lot of technical knowledge, it does require a helluva a lot of heart and compassion.

Maybe you should be focusing on how to better advocate and serve your patients instead of your own personal interests. If your not being challenged, look around for things you can do to challenge yourself. Fix the problem, not the blame.

I don't understand why someone with a BSN would work LTC unless it was a DON/ADON position. BTW, LTC nursing pay is low because of the value our society places on the elderly not the skill set involved with their care.

You are right about having to be innovative. We, too, are often out of the specific supplies we're supposed to use, so we have to make do with what we have. And yes, you do have to be compassionate to work with these people, which is generally more of my strength than any technical skill. Also we're always getting patients with different needs that require learning new skills anyway, so there is the occasional challenge in that way, but definitely not everyday (which is probably why I do well there, I'm not being bombarded with tons of skills to learn).

As far as being a nurse with a BSN who is also working in LTC, I will say that getting my BSN did not improve my ability to be a nurse. My associate's degree was where I learned my nursing skills. For me, all my BSN degree indicates is that I went to school for an extra year and got extra exposure to public health and research; that is all. There are LPNs where I work that are better nurses than myself, so the degree really has nothing to do with it.

I truly like how you said this: "patients/residents in long term care deserve a nurse who doesn't look at them as bottom-of-the-barrel patients." Nicely stated.

I'm not so sure the post was meant to get a rise out of people. If I'm thinking back correctly, I think the OP made a similar post about a year ago; it took almost an entire year to go away, despite her taking back some of the things she had originally posted (correct me if I'm wrong, OP). It got pretty nasty if I'm remembering right.

Purple gal: I saw another post you made this AM about moving up to the world of ICU. If that is where your heart belongs, start trying to work your way there. However, I can see where this thread could be seen as inflammatory to those working in LTC as well and honestly, I'm not sure I see the point of it. Calling another speciality area as "lame," despite you working in said area, is pretty disrespectful to those working in it.

I couldn't do what my husband does (NICU); I'd be terrible at it, tearing up constantly. He couldn't do psych; he'd be too frustrated. I can't do peds, while my other friend in psych can't do adults and can ONLY do peds. I enjoy med surg, and would probably lose it in any ICU. God bless you all who do LTC; my time management skills are no way as good. School nursing? Nope nope nope, I'd probably get myself fired mouthing off to a parent, teacher (and I used to be one!), administration, or all of the above. I actually look at school nurses as angels with fiery swords, bless them.

If you're the poster I'm thinking of, be prepared for several more months of frustrated posters. And this time? You kinda deserve it.

Problem is, is where someone desires to work and where they can actually work and thrive are sometimes very different places. In my case, even though I would love to work in one of the ICUs, it's probably not going to be the best fit. I'm very intelligent and work well with patients, but I'm not technically inclined or manually inclined. Hands-on skills that require a lot of dexterity are not my strength. My personality is also not well suited for high acuity areas. While I'm very detail oriented at the job I have right now, I'm not anal enough when under pressure. I can handle emergent situations every once in awhile, but don't enjoy them day to day. So even though I would LOVE to call myself an ICU nurse, it doesn't appear to be in my nature. But if I were the right person, that's where I would go.