Losing your skills in LTC

[Cubby]

I hear frequently on this BB, other BBs, Nursing magazines and other Nurse friends that "If you go into LTC you loose all of your skills" This is so untrue, it makes my blood boil.

I know that we do not HAVE to do alot of the procedures that Nurses in Acute care settings are asked to do, but there are alot of human skills that we have to have in abundance to succeed in LTC.

I did not go into Nursing to become a LTC Nurse. I did go into Nursing to help anyone and at every chance I could. Geriatrics gives me that opportunity. We don't just treat the ill, the infirmed. We have to see the big picture. My residents are not just sick and in the hospital. They are dying. And I take a great honor in being able to help them and their families prepare for this finality. I get to know these people as human, I know their children, their grandchildren, even their dogs/fish. The staff of a LTC facility are often the only family these forgotten souls have. I take great pride in being a LONG TERM CARE NURSE. And there is nothing lacking about my skills, there are different thats all.

[superbratnurse]

the only skills that i feel i have really lost are peds/ob experience....

i have post surgical patients, cvas, ivs, sometimes with lipids, or tpn, irrigate catheters, not to mention insert them....insert ivs, do various txs.... and we have better survival skills in ltc, i think, than any ol acute care nurse.... how many hospital nurses have ever talked an alzheimers patient off a fence, or for that matter, been hit, bit, spit at, scratched, kicked, urinated on (or at, if you are quick enuff) had feces thrown at them, been called every single thing but an earthling and not been able to do anything but try to redirect them first.... then, if not effective, medicate them in the slightest way that is effective.... in my area, all our residents invariably come back from the hospital, doped up, with restraints (if they are nonamb, or very confused) a foley cath, if incontinent, and almost always with at least one stage one (at the very least) pressure ulcer (the most i ever saw on one pt after an 8 day hospital stay was 27 stage is and 5 stage iis). now (at the risk of starting a riot) tell me who has lost their skills???????? :angryfire

~brat

[snowfreeze, BSN, RN]

I have 14 years of nursing, 8 of those in critical care and 5 in LTC. Now I am back to hospital nursing on a telemetry unit and my LTC skills paid off last evening. Dementia patient on heparin and cardizem IVs, pulling at everything, (first half hour took out both her IVs and looked like a drive-by shooting had happened in her blood drenched bed) trying to climb out of bed...all the typical sundowning stuff. Got out of the mitts and pulled out another IV in under 10 mins. I had 4 other patients and no sitter so she spent the evening in the hall with me in a gerichair. She folded washcloths, chatted with other staff, chatted with me a lot but didn't pull out anymore IVs, left her foley alone so by the end of the shift it had yellow instead of red drainage, didn't fall and only took herself off the monitor about 80 times. I didn't get a break but I took care of all my patients and her too.

It didn't take long for all my acute care skills to resurface after working LTC for 5 years. I think the sub-acute and rehab unit helped me to maintain a lot though. I started IV's put in midlines, placed and replaced foleys and G-tubes. Put a number of trachs back in too. I was always impressed by the cute smile of a vent-dependant patient handing me the trach they just removed.

[cindyjean]

I found that I have gained skills in LTC. At the hospital( where i worked 25 years) , we had a respiratory dept...at the home..I am the resp therapist at night doing as many as 15 treatments at times ( and there is much to know about this ), I am the physical therapist, continuing with gait training with RW , as patients ambulate to the BR at night.. and following up on PT recommendations. No where else but LLC does one have so much responsibility in assessments..and for the doctor to rely so much on your astute observations. In a hospital, the doctor and others watch the same patients day and night..but in LLC it is you alone and your CNAs until the next shift comes in...and it can happen in 8 hours. I am gaining skills in documentation I never had to have in the hospital setting to such a great degree. Nor do you see such attention given to skin assessments in the hospital for short term stays....which is obvious when the client reaches us.and there is so much more to add...no specialized units...you see it all in LTC and it is a very special person to learn the ways of communication...so add speech therapist and swollow evauation on top of that. ..lets see...how many hearuing aids have I changed batteries on, cleaned and put ionto a patients ears? yes..you are all skillful nurses!

[BrendaLeeRN]

I am a fairly new nurse, but chose and prefer sub-acute/LTC over working in a hospital. I did a research paper in school on a comparison study between ICU and LTC nurses. ICU's may be where the hi-tech skills are needed, but in LTC / Subacute you use your skills in psychiatric, pharmacology, documentation, extreme assessment and trouble shooting skills, pt. advocate, and IVs, blood draws, catheters, tube feeders, chest tubes, drains, CPMs, physical therapy, etc. In LTC, the doctors seem to be more willing to entertain the nurses suggestions. Most of the time when I call them, they say "What do you suggest?" I love my job, except the short staffing we all suffer!

[LoriAlabamaRN]

Cubby, I applaud you. I am also an RN in a management position at an LTC facility (night shift supervisor, the only RN in the facility at night, and 165 residents). I do not feel as if I have lost any skills at all, except for maternity or pediatric nursing. My assessment skills are top notch- they have to be. I have no doctor here at night, and my decisions have to be good. As for the IVs, foleys, blood drawing, wound care, etc I have more than my share. I adore working in LTC, and I feel as if I have made a difference every single night. I thrive on that, the feeling that I have made my residents happy and comfortable, and kept them safe. I doubt I will ever go back to an acute care setting- this work is just too fulfilling.

[lilyflower06]

LTC is increasingly sub acute & many medical wards are holding tanks for those waiting for LTC beds. There isn't a day that goes by in my LTC community that someone doesn't stroke or seizure or experience sudden SOB, chest pain, or fall. There are always urgent situations emerging that we handle on site do to the degree of intervention specified. There are plenty of oppertunities for use of skills & critical thinking. If nurses are self-directed & continue to seek learning experiences & fill their own learning gaps then LTC is a great place to practice.

[cindyjean]

I guess what I was trying to state is...that where I now work, I can utilize all I have learned over the past 30 years. I have always liked "problem solving" and finding solutions for the residents best care ...would rather be out on the wings than behind a desk. ...so now I can be...that is except when monthly summaries come around and other paper work starts to bog me down. Surely there is a better way to help the nurse stay out on the floor with the patients where she can continue to find solutions and give good care, esp in the more complicated cases. at one facility ( ventilator assisted clients) we used pocket computers (radix) at the bedside for a lot of the charting..and it was very useful to us.

[punkinjones]

Jennifer,

You put it so eloquently!

[momjacksonlpn]

As I was graduation PN school all of my classmates were getting excited abut working for the hospital or home health and here was lil ole me excited to go to the nursing home. I worked LTC as a CNA and now as an LPN for a total of 7 yrs LTC. In the beginning my main concern was my skills; I won't be using all that I learned in school.

However, what I do enjoy about LTC is that your residents prepare you even more for med/surg...if you really think about it every disease, ailment and most line of care is right there in the facility. Working LTC allows you to look at the full picture and if you go to MED/SURG you will know what to look for (its fresh in you skills)

I look at LTC as the root of MED/SURG just branching out into different areas of care....after all when residents come from the hosp back to the home the same care r/t hosp stay is our focus

IV therapy is usually the only skill (in this state) you won't use in LTC....I am currently working part/time for an agency for the hospital experience to widen my job opportunities

[mcdonaldgirl]

Remember, it is Long Term Care. We see people "Long Term". How CAN we loose skills? Esp. in assessing people....

MG

[Drysolong]

As a newly graduated LPN student, my opinion is that I don't like LTC and prefer working in a hospital. However, after reading some of the posts here, I have a better understanding and appreciation of nurses of work LTC. What I've learned is that it is up to the individual nurse to learn, use and practice skills in the LTC arena. This gives me a basis for developing a better and more professional attitude toward whatever position I secure after passing boards.

[Evening-gal]

I have worked in LTC since graduating. The facility I work in has suck a variety of patients from young to elderly, from trach pts. to hospice care. I have 38 residents of my own. I feel like I "know" my little people. I can walk the floor during shift report and look at them and assess that something is not right. When you work this closely with your patients you rely on your instinct as well as your assessment skills. We, in our facility, have the ability to make decisions whether or not to contact the MD or send someone out without getting permission first. And the MD's learn your skills quickly, and know whether they can trust your judgement. They know if I call and say "something just isn't right about so and so" that I am usually right. I love my residents, they feel more like family to me. I am honored to be a part of their lives. It is my goal in life to just make a difference if only it is to make someone smile.