Long Term Care Nursing is Lame

Specialties Geriatric

Published

Having worked in a long term/short-term rehab facility combination for a year now, I have to say that in comparison to other areas of nursing, it's pretty lame.

Yes, we work hard. We have 20 or more patients on our own who require medications. Sometimes they'll have tube feedings, ostomies, JP drains, etc. There are many wounds, blood sugars, bladder scans and emergent situations aren't as rare as you would think. No one is denying people at these facilities work hard.

At the same time, when looking at other areas of nursing, including ICU and ER, it's safe to say we don't really do as much for these patients as these incredible nurses do. For example, I am highly impressed with a cardiovascular surgical ICU in my town, one of the best in the nation. These nurses see and do EVERYTHING. Skills include Skills include TPM, PPM, Chest reopening, chest tubes, trach, PEG, JP, NG/OG, pigtail cat, extubation, sedation, CT/MRI, Bronchoscopy, line placement, cortrac, IR, specimen collection, medications including inotrops, vasoactive, blood administration, insulin, heparin, CPN/lipids, paraltyics, and lines such as arterial lines, Cordis/STCVC, pAC, TDC, TPM wires, PICC, non-VAT blood draws, CRRT, Flexiseal, and pumps including PCA, Medication and Tube Feeding. They have LVADs, ECMO machines and take care of ALL ages from the newborn to the elderly. The MICU is also quite an impressive area, as are all the other ICUS. Plus, you can't beat the top notch nurses in the ER.

Sorry everyone but it's true...there's a reason why long term care nurses/rehab nurses are paid less than others.

Just because you didn't fit in well in the one PCU you tried, doesn't mean you won't thrive in a different one.

If you are really so unhappy in LTC, try to get into another PCU, spend a few years there to get your skill level up, and then move into ICU.

Its a process. Insulting a crap ton of LTC nurses and not seeing the value of what you currently do will not get you to where you want to be.

It almost seems like you dont actually care about the job or patients itself, moreso, you care about image. Re: "I'd love to call myself an ICU nurse".

Maybe some reevaluation would go a long way for you.

Specializes in ICU, LTACH, Internal Medicine.

Purplegal, I seriously invite you to try long term acute if you have one such place close enough. You'll NOT need too many technical things there to begin with (there always will be some needle-and-tube happy one like myself nearby, I assure you :)) and we teach you the rest. If you are tele tech, you already know a good chunk of mandatory stuff. A couple years there will give you base for anything from burns to HD, including lower-key ICU, and you will have time to decide what you like most.

Good luck with whatever you deside!

I've worked LTC for almost 10 years. I wouldnt consider it lame at all. I love what I do. I take care of 15-20 patients on dayshift and on the weekend I have 30+ patients. I feel like make a real difference. It is my calling and my passion. LTC needs good nurses. We may not do all the acute care stuff but that doesn't make it lame at all. I start IV's, I can flush ports, do wound care and hold the hand of a dying patient, coordinate care, and do preventative measures for each patients risk factors. Don't put off something as lame just because you don't like it. That's just rude.

Specializes in ICU + Infection Prevention.

I bet your patients are impressed and don't think LTC nursing is lame... but if it doesn't fulfill you, move on!

I bet your patients are impressed and don't think LTC nursing is lame... but if it doesn't fulfill you, move on!

Right. They do not care that I'm not an ICU nurse.

Specializes in Crit Care; EOL; Pain/Symptom; Gero.
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.

Wow, just wow. There is way more to LTC than the tasks you've described when taking care of "frail and forgotten Geri's"!?

I am a COB, an old ICU nurse from the trenches. I became a Gero NP in my late 40s, and I use all of my finely tuned assessment and management skills from years in the ICU to discern symptoms of stroke, HF, resp failure, "dwindles" or failure to thrive, exacerbation of MS and an assortment of other neuro maladies, ortho problems, arthritis, allergy, falls and fractures, skin issues, pain and symptom management, and EOL care. And more.

I work as a team member with CNAs, LPNs, RNs, a part-time medical director, community attendings, consultants, pharmacists, nutritionists, social workers, and one other NP.

My workplace is a 188-bed continuing care community with 5 separate residential units ranging from transitional (subacute rehab) to a locked memory care unit, with a few hospice beds scattered throughout.

I am on the run from 0630 to 1630 daily, (high speed, split second) with admission workups, ensuring safe discharges to home, small booboos, big catastrophes, insulin orders, antibiotics, antihypertensives, antiarrhythmics, side effects of these meds, interpreting 12-leads, making decisions when to send residents out - considering the functional decline that takes place when older individuals are hospitalized, or putting together a workable plan to keep the resident within our community to the extent that we can handle, related to IV hydration, IV morphine etc.

Although your advice to OP started out well, it turned a tad murky toward the end as you question why a BSN would work as a staff nurse in LTC. Why not a BSN, if that's the niche and comfort zone.

My sense is that even though OP stated that LTC nursing is "lame", her listing of her skills demonstrates just the opposite. Seeking reassurance and reaffirmation is fine. And sometimes necessary.

Anyone who works in adult acute care knows that Gero is where it's at, baby. And it's going to stay that way into the 2060s, when the last of us Baby Boomers shuffle off this mortal coil.

As nurses, we value individuals from the cell to the spirit.

Love ya, mean it.

Specializes in LTC, Rehab.
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.

Wow! I was given 32 initially, w/no experience, and what-a-joke-are-you-kidding-me amount of 'training'.

Specializes in NICU, ER, OR.

I agree, and I'll never work in such a setting, ever.

Specializes in Critical Care; Cardiac; Professional Development.

I don't really like passive aggressive and that is what this sounds like to me. You would rather do a different kind of nursing and you feel like those are the cool kids and you aren't cool enough to be one of the cool kids so you will post here about how not cool you are in hopes that people will jump up and tell you no no no, you really ARE cool...or at least, that is how it reads to me.

Your skill set is both needed and valuable. If you want to do a different kind of nursing, go for it. LTC is not "lame" and nobody in nursing deserves a poor paycheck. Geriatric care is a wonderful specialty full of really REALLY special people. If you don't want to take pride in what you do, we can't help that, but I can tell you, tons of nurses in LTC DO take pride in what they do and rightly so. Don't insult them in your attempt at validation for yourself. They don't deserve that.

Specializes in Peds/outpatient FP,derm,allergy/private duty.

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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.

If not for this reality I would've chosen to work in LTC. In my mind's eye I pictured the ideal, enough staff, enough money. . .it was the grandmas in my life who caused me to see a spark. But I know my own limits related to a finite number of things I can handle coming at me at once

purplegal, I can't tell if your comments are very dry or serious, though unfortunately I agree the specialty has a public perception problem.

Specializes in Med-Surg, NICU.

Hmmm...where to start.

1. LTC (and home health) nurses are the wave of the future. Baby Boomers are getting older and within the next 20 or so years, we will be seeing a surge of people needing to live in LTC facilities. LTC nurses are DESPERATELY needed and are HIGHLY valuable. Get a few years in an unimpressive LTC and soon, you will be able to write your ticket to better facilities with better pay and working conditions.

2. I work in both med/surg and neonatal ICU. To be honest, I find my work in med/surg (which is often looked down about in similar fashion) FAR harder and more impressive than my oftentimes "cushy" NICU job...and yet, I receive far more appreciation in the NICU. When people find out that I "still" work in med/surg, their noses wrinkle and their eyes bulge out of their sockets in complete shock. "I could never work in med/surg." Yeah..they couldn't. Not with that attitude, at least.

You tell future NMs that you are able to juggle the care of 20+ patients and watch their reactions. Don't say anything....just observe.

3. ER and ICU nurses aren't constantly doing life-saving or adrenaline-rushing stuff. Oftentimes, our days are long and uneventful with a sprinkle of action here and there. Many ER nurses feel burnt out d/t lack of actual emergencies and seeing abuse of the ER system. ICU nurses aren't always coding patients, but monitoring, assessing and keeping the MDs/NPs up-to-date on patient status. It isn't all action.

I have more to add, but I have got to go. I do find starting this thread to be very tasteless and attention-seeking.

Wow! I was given 32 initially, w/no experience, and what-a-joke-are-you-kidding-me amount of 'training'.

Honestly, I think the only reason I had only 8 was because we were a pretty new facility at the time. They have no problem giving large assignments to the new nurses who start now. One nurse left after 3 nights of orientation with the full load. My training was minimal as well, considering I was on my own on day 3 of 5 of "orientation."

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