Losing your skills if you start out in LTC?

[SouthernBelle85]

I have recently graduated from and got my Technical Diploma or Practical Nursing. During school. What I have been told is that it's not best to start off in LTC because they usually don't do IVs, Foleys, ect.

What I've noticed in the LTC is there isn't a lot of IVs, especially...most LTC facilities send them out to the hospital if they need that type of medical care. Which kind of scares me because, I really want to be able to be more confident in a lot of skill and don't want to lose technique if I chose LTC.

I actually saw a nurse at one of the hospitals I was at for clinicals and she was new there, most of her nursing career (been a nurse for 5 years) she has worked in LTC and clinics. She wasn't able to do IVs and I thought...crap that would be me.

I know that LTC pays the best but I think experience is more valuable. Did anybody start out in LTC? Did you feel you lost your skills or did they actually have IVs, blood draws, foleys, NG tubes, and whatever else.

I haven't even taken boards yet but I've been trying to kind of put in resumes.

[caliotter3]

It does not matter what specialty a person starts in, or at any time, works in, they will be using those skills that are needed in that area. Then when they move to another area of nursing, they may have to work on improving some other skills. You can't expect to be an expert in everything at all times. It is an unrealistic expectation. Better to keep flexibility and a willingness to learn at the top of your work habit list as you move through a career.

[Scottishtape]

It depends on the facility. When I first got my LPN, I went to a LTC facility and I did foleys, blood draws, and trach care constantly. IVs were a little more spread out. I had maybe 1 IV every few months. I never placed an NG tube in the LTC setting.

I've worked at other facilities that never did IVs. Sooo it all depends on the facility you get into.

Like the pp said, you will acquire the skills you need in the setting where you work. These will vary as you move through your career.

[Floor_Nurse]

It seems as though LPN nurses maintain their hands-on skills better than "desk-job" nurses. I see a lot of nurses who become RN's or BSN's and do admin. work for years as their daily routine.

Then, one day they have to actually work the floor. They crush meds that should not be crushed or make some med errors while getting behind in the vital signs. They can barely do a med pass at all!

Ladies, please don't take offense to my writing. I'm just stating what I have observed over the years.

[Neats, BSN]

I agree it depends on the facility. If you have a sub-acute facility then you will be doing IV's more, wound dressing changes and a lot of pain medication. There are some LTC facilities that just have chronic care needs so you will be passing medications more than likely your entire shift. Although a LVN/LPN does not really do an assessment you will be challenged and your skills will easily transfer.

I will get on my soapbox about LTC in that it does have a "bad" reputation. LTC history is not so great and until we get the proper reimbursement and staffing rations it will be less than desirable working in LTC....however as I write this times are changing. LTC should not be designated as a bad place to work...as only not good nurses work in LTC. We are a group of healthcare nurses who has a specialty, who acquire great skills just like another specialty.

[Hello_Pretty, RN]

One of the LTC I worked at had the med nurses, treatment nurse, and desk nurse. Desk nure was an RN during the week and LVN on the weekend. I worked every role they had as am LVN. You will pass tons of meds and will know them very well! As well as labs values. We never drew blood as we called a lab to do that (usually phlebs do it in the hospital too), I did many Foleys (if your or has a Foley, you will change it once every 3-4 weeks), in CA, LVNs don't do IV even if we are certified. I flushed IVs with NS and that was it (I couldn't touch PICC/Central lines tho).

In TX I was able to hang IV meds, etc (in TX it depends on the faciloty).

I've never seen an NG tube insertion either I LTD or acute care.

I did a lot of wound care and really enjoyed it, so now I plan to become a wound care nurse. To be WOCN certified I need my RN and 1 year experience before I start the program.

[InimitableRN2019]

I've done LTC pretty much my entire 15 years of being a LPN. I got my IV certification once it was available. I start IVs, do CAPD, taken care of vent patients, trachs, inserted more catheters than I can count, g tubes, started CPR, wound vacs, and more. Not too mention we are the docs eyes and they go off our assessments. It's a lot of critical thinking and thinking outside the box if you have confused residents. I love LTC.

[Cactus Nurse]

Like everyone is saying every facility is different.

Some long term care places have a sub acute, so vent pt will go there, but in the LTC side, you will still have foleys. I don't know why foley pt wouldn't be at ltc? It's actually great because it's better for their skin and more functional, than walking around with a giant bulky wet brief.

In my facility there are pts on iv meds because they are there for "rehab" post surgery. Lpns do blood samples and lab comes to pick them up.

My suggestion is look at job postings for ltcs and see what their scope is- what do they expect from a Nurse? That will tell you where to apply