Long Term Care Stigma

Ruby Vee, BSN · Jul 21, 2017

Congratulations on your new job. You are right -- the elderly are an under-served group and they both need and deserve a compassionate, dedicated nurse who wants to work with that patient population.

I've heard LTC run down, and I've even done so myself, in the distant past. But it was more a case of "I could never do that" than "those nurses are inferior." I'm an ICU nurse and perhaps an adrenalin junky. I'm afraid I'd be hopelessly bored in LTC, and Rehab . . . well, let's just say I have difficulty sitting back and letting someone do it for themselves when I could do it for them so much faster. That works in ICU but defeats the purpose of rehab. I didn't understand back then how great the challenge are for a LTC nurse -- and when I did begin to understand, about the time my mother's dementia forced my family to consider an assisted living facility for her -- I knew without a doubt that I'm not up to the challenge. I am ever so grateful to the nurses who took such great care of my mother and actually enjoyed their jobs. Former classmates of mine work in LTC and ALF -- they discuss their jobs and their patients with so much love.

There are people who LOVE the NICU or Peds. I know that little people scare me, and I would never want those jobs. Some people are drawn to L & D or Nursery -- the times I floated there were some of the most awful, stressful shifts of my life. I wouldn't want those jobs for anything. Posters I respect love their Med/Surg jobs, and I'm happy for them that they found their niche. My niche is elsewhere.

I suspect a lot of what you're hearing is people who don't have any idea what LTC is all about, those who do know what it's all about and know that they couldn't rise to the challenge or those who are just negative people. Don't let them sour your good news.

cleback · Jul 21, 2017

I admire the heck out of nurses and aids who do LTC and enjoy it.

I'm not sure if I would/could. From working in a nursing home as a cna, I know there are a lot of difficult patient behaviors, and that management does not always back the nursing staff up trying to address them. I could not deal with that shift after shift. At least, in acute care, even if management does not back you up, the patient will not stay there forever.

Also wouldn't be good at it because you have to do a lot of things very quickly. I'm not slow, but I would drown trying to pass 30+ peoples meds in 1-2 hours. With that, I'very encountered some very burned out nurses in LTC... more so than in other areas it seems... not happy people... But I knoe they're just overworked with few resources.

Finally, I feel like the variety of roles and responsibilities isn't there as much as in acute care. I feel like you're either a staff nurse or the DON. Maybe you could train to be the wound care or infection control nurse, maybe... Generally, I like more options.

So yeah, that's kind of why I shy away from that specialty.

tyvin, BSN, RN · Jul 21, 2017

There is stigma but as far as being bored at a LTC job; that was my first biggest laugh of the day. Maybe on nights like any other place and it will definately depend on how many residents you're assigned. Don't think you'll get lots of training either. It's the impossible load of people you have to deal meds to (if that's what they have you do). Being charge is no different...I can remember I never took a break for lunch or went to the bathroom until the shift was over. So, it depends on your state and the place you work.

I remember this one time when no one could cath this poor 86 year old man (monthly cath change). I was charge and no one came and told me about it until they drew blood maybe an hour or more later attempting to put the foley in. The floor nurse finally comes and gets me, I go in the room and see this man who is profusely sweating has an abd extended like he is going to burst and looks into my eyes with pure desperation! I know this man; he's a slim guy with no belley and he can't even talk at that moment. I called 911 and had him transported to the ER stat (I got in trouble for it too, but I would do it again).

Later my friend from the ER was telling me how the ER RNs were putting us down and laughing as they admitted him; how we couldn't even cath an old man until they couldn't do it either.

It turns out the ER RNs had to get the doc and of course the doc figures out why no one can cath this guy. His prostate had grown so large that when the foley was introduced it would stop at the prostrate and just coil and coil around (I hadn't tried to cath him; it was far too out by hand by than). They have special foleys for these types: it's called a coude catheter designed for enlarged prostates. The catheter is stiff with a special point to get past the tight spot.

My friend said the doctor got 1800ml's out of the guy! After that I ordered coudes and had teaching done. We all can learn but that was over 20 years ago. Don't think you will be sitting around and don't be shocked when they give you 32 patients to care for at once (that includes giving meds, doing the wound care and charting). I never bothered with the CNAs taking vitals, I just did my own when the need arised when I had to go on the floor (they already have way too much to do). It's best IMO, to have your own equipment.

LTC places pay better or even with the hospitals to retain good staff but the turnover is great due to the hard work, low moral (sometimes) and overload in my state.

Location is important as well. Know the code status of your people and how they take their meds. Ask the CNAs; they know and it will save you a lot of running around looking for red velvet pudding (some resident's can be very picky and have a ton of meds to take). If you're a charge; it gets real complicated for awhile. Hopefully you got a good place where camaraderie flows.

It is imperative you establish a good relationship with the CNAs. That doesn't mean to let them walk all over you but have limits. Know your states regulations rules per your license for delegating tasks.

Hopefully you'll be a patient advocate as some of those LTC places aren't concerned with the population and cut corners that can be less than desireable for the resident (they call them residents, not patients, because the people live in the home). Look up some of the posts on this site about LTC; it will be an eyeful. Hopefullly you drew a good card...let us know how it works out. Good luck :)

Sour Lemon · Jul 21, 2017

LTC turns me off for one reason- I see the patients that we discharge there and know they won't be leaving anytime soon. A horrible patient in acute care will eventually move on (although we did have one stay for over a year and several stay for months). OK, two reasons ....it seems like paper and pen are more common in LTC as opposed to computer charting and medication administration.

Here.I.Stand, BSN, RN · Jul 22, 2017

My question is, why is there such a negative stigma when it comes to a nursing home or being a nurse in one?[/Quote]
Because some people are ignorant.

cardiacfreak, ADN · Jul 22, 2017

One thing I can say about good LTC nurses is that they have extrodinary time management skills.

I worked LTC as a CNA many many years ago and I loved it. I worked acute care for 18 years and now I am in hospice. I really miss my days in LTC , I was the residents family, I was there almost everyday and spent many holidays with them. I used to take my kids in and that always brightened their day. I laughed with them, listened to amazing stories of their younger years and held their hand when they passed on. LTC may not be for everyone but neither is Peds, ICU, L&D, ED, Hospice, etc....

Nurses who look down on other nursing specialties should realize that we all went to school and we all passed the NCLEX and for that alone, respect should be shown for ALL nursing specialities.

Scottishtape · Jul 22, 2017

Because some people are ignorant.

As always... this.

Penelope_Pitstop, BSN, RN · Jul 22, 2017

Nurses who look down on other nursing specialties should realize that we all went to school and we all passed the NCLEX and for that alone, respect should be shown for ALL nursing specialities.

That's the sad part - a lot of people don't see LTC, SNF, rehab, etc as specialties.

I went from ICU to LTC. It was terrifying not having monitors on my patients! Talk about the need for excellent assessment skills! Did I have more downtime in LTC? Yes, but a lot of that is because I worked midnights and most of my patients were truly long term care folks who actually slept at night. I never worked a day shift there - I have no idea how the day shift nurses did it!

kbrn2002, ADN, RN · Jul 22, 2017

I have always worked LTC by choice, never wanted to be anywhere else. So I don't have any hospital experience to compare it to. I'll never say one job is harder than the other but there are things you will need to get used to in this different world. First, there are not doctors in the building so if you need a consult it's most likely going to be by phone or fax and the MD is going to be writing orders based only on your assessment of the situation so you will develop excellent assessment skills working LTC. You will be all departments for your residents, if they need respiratory treatments it's you, not RT. If they need bloodwork chances are pretty good that it's going to you drawing them. Of course the elephant in the room is the massive med pass, more than 20 is typical and that number can be much higher depending on where you work.

I think maybe one of the reasons hospital nurses sometimes look down on LTC nurses is because we don't have the support of an MD in the building we occasionally need to send a resident to the ED for things that I am sure ED staff doesn't see as emergent but if the MD thinks they should be seen by a provider the ED is our only real choice.

rescueninja1987 · Jul 22, 2017

Forget them. Do what you enjoy and don't worry about it. Long term care can be very challenging and you depend heavily on your assessment skills. One of the reasons I like ICU is because with the monitor, recent labs and so on, I know the second my patient starts having a problem and usually can figure out what's wrong with them. Where LTC nurses rely solely on their assessment skills, including their ability to recognize subtle changes in their patient's mental status. If the nurses where you work look down on it, who cares, it doesn't concern them. Lots of people look down on blue collar jobs like plumbers and electricians even though some of them make six figure salaries and own their own businesses.

djh123 · Jul 22, 2017

We've recently had some long threads on this same topic. There is no shame in being a LTC nurse. I didn't choose it, but I've been one now for nearly 4.5 years, and I work my *** off every minute I'm there. And for the most part, my residents and their family members realize I'm doing the best I can for them. There's always someone you can't please, but at least for me, those are the rare ones.