LTC is Great

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Specializes in MICU, ED, Med/Surg, SNF, LTC, DNS.

OK, so now it's time for MY rant.

I have worked in LTC off and on now for over 20 years. I also worked in hospitals for the same amount of time (usually, at the same time). I have noticed the bad rap LTC gets from others, and I am getting fed up with it. These people have no clue what it entails to be in LTC. Well, I plan to correct this NOW.

Let's start by comparing the job with something in the hospital that would be close - triage. Every time you look at the residents under your care, you are constantly doing triage, and like the triage nurse, you are going off what your eyes are telling you. And when you DO find that something that is just not right, you have decisions to make.

1) Does the resident have a PRN ordered for what is wrong?

2) Can what is wrong wait until morning, or do you need to call the Dr. now?

3) Is it serious enough to advocate to the Dr. to send the resident to the ED?

So, critical thinking is a must for LTC, since when it happens, it could be anything, not just what they were admitted for. The Dr. will expect you to tell him what is wrong, and how you want to fix it. He is not there, you are. He does not see the resident everyday, you do. So, you better know SBAR. Actually, in my experience, the nurses who come from the hospital to LTC that have the least amount of problems is ED nurses. I guess their mindset is similar.

Time management needs to be honed to a razor's edge. If it isn't, you will sink. It isn't a joke. My time management skills had to get better than what they were for Med/Surg, and the ratios at that time were 10:1 on Med/Surg. Also, prioritization skills have to be very good. Again, it is another killer (sometimes literally).

Another skill set you will use is thinking outside the box. I seriously believe the person who came up with the saying "necessity is the mother of invention" was a LTC nurse. You do not have the same ancillary staff that the hospital has. You have restoritive, PT, OT, ST, soc svcs, activities, and that's it. No pharmacy, RT, X-ray, ED, or hospitalist. And that is on day shift Monday through Friday. If you work noc's (like me), congrats! Those extras are part of your job, along with housekeeping, laundry, and dietary.

Let's not forget the hat of charge nurse. You are responsible to ensure your aides are doing their job, and for delegating extra duties as they arise. So, supervisory experience helps.

Oh, and caring, LOTS of caring for fellow humans. No, I am not insinuating that nurses in non-LTC positions don't care. What I am saying is that you are going to be taking care of these people for a VERY long time. I have several residents who have been at the facility for over 10 years. It is not like that in the hospital. It is the biggest reason LTC nurses love their job. Does an OR nurse care about their patients? As far as for their health and safety, absolutely. Do they care about their grandchildren? Or that their high school buddy is going to visit next month for their birthday? No, nor should they. But the LTC nurse does. Over the years, you will become like a granddaughter/grandson to your residents. You need to care. Don't buy the hype "don't get too close", it is impossible not to.

Let's not forget stress management. Actually, I know the nurses get stressed out, but all nurses do from time to time. I am meaning the resident's stress. Anyone who has worked in LTC knows what I mean.

Sorry, I am starting to wind down, I promise :)

Lastly, we all know what the nursing home's primary job is - to make the resident as comfortable as possible until their death, so end of life training is pretty important. If you haven't had any, ask your DON to have a local hospice provide this. This will help you to understand what the resident is going through, and why the comfort meds are so important at that time. If not, the resident will normally not get the meds when they need them, and might not be able to achieve a healthy death.

As you can see, it takes a lot to be a LTC nurse. And believe me, we ARE nurses.

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Specializes in LTC, Assisted Living, Surgical Clinic.

Great post, thank you! :)

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Specializes in MICU, ED, Med/Surg, SNF, LTC, DNS.

Thanks for reading :) After reading some of the other forums, I felt something needed to be said.

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Specializes in LTC.

You took the words right out of my mouth!!! Great post..thank you so much!!!

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[emoji106]🏻 good rant [emoji17]

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Specializes in MICU, ED, Med/Surg, SNF, LTC, DNS.

Thanks for reading all of it. I do tend to get wordy :)

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Thank you, LTC nurses, for all you do. Like taking care of my Dad.:(

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Specializes in OB.

My gramma recently got moved from an assisted living facility to a LTC. The ALF was large, newly renovated, had all kinds of programs for the residents...oh, and had absolutely terrible staffing and care. My gramma wandered off the campus, fell on the street, broke her shoulder, and was moved to a nearby LTC/rehab. She will stay there now until she dies. Luckily, though this new facility is old and no-frills in terms of decor, it is unbelievably clean (seriously, I've never been in a LTC that didn't have a weird smell the moment you walk in the door), well-staffed not just with warm bodies but people who are actually kind and compassionate and I really do trust. That is all that matters to me. I thank God that she was accepted there, has her own little room, and can live the rest of her life with this excellent level of care. The staff has already gotten to know her and try their best to make the place a real "home" for all the residents. I know that a lot of LTC nurses don't have the luxury of working in facilities like this one, and are swimming against the current with terrible staffing, no supplies, no support from management. Thank you ALL for all that you do to provide a comfortable and dignified end of life for people to the best of your abilities.

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Specializes in LTC,Hospice/palliative care,acute care.

Can't "like" this post enough.For all my whining and complaining g here I will admit I remain where I am because I shelve in our mission and we do a great job.I would leave if I was not proud to work there.

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Specializes in LTC.
OK, so now it's time for MY rant.

I have worked in LTC off and on now for over 20 years. I also worked in hospitals for the same amount of time (usually, at the same time). I have noticed the bad rap LTC gets from others, and I am getting fed up with it. These people have no clue what it entails to be in LTC. Well, I plan to correct this NOW.

Let's start by comparing the job with something in the hospital that would be close - triage. Every time you look at the residents under your care, you are constantly doing triage, and like the triage nurse, you are going off what your eyes are telling you. And when you DO find that something that is just not right, you have decisions to make.

1) Does the resident have a PRN ordered for what is wrong?

2) Can what is wrong wait until morning, or do you need to call the Dr. now?

3) Is it serious enough to advocate to the Dr. to send the resident to the ED?

So, critical thinking is a must for LTC, since when it happens, it could be anything, not just what they were admitted for. The Dr. will expect you to tell him what is wrong, and how you want to fix it. He is not there, you are. He does not see the resident everyday, you do. So, you better know SBAR. Actually, in my experience, the nurses who come from the hospital to LTC that have the least amount of problems is ED nurses. I guess their mindset is similar.

Time management needs to be honed to a razor's edge. If it isn't, you will sink. It isn't a joke. My time management skills had to get better than what they were for Med/Surg, and the ratios at that time were 10:1 on Med/Surg. Also, prioritization skills have to be very good. Again, it is another killer (sometimes literally).

Another skill set you will use is thinking outside the box. I seriously believe the person who came up with the saying "necessity is the mother of invention" was a LTC nurse. You do not have the same ancillary staff that the hospital has. You have restoritive, PT, OT, ST, soc svcs, activities, and that's it. No pharmacy, RT, X-ray, ED, or hospitalist. And that is on day shift Monday through Friday. If you work noc's (like me), congrats! Those extras are part of your job, along with housekeeping, laundry, and dietary.

Let's not forget the hat of charge nurse. You are responsible to ensure your aides are doing their job, and for delegating extra duties as they arise. So, supervisory experience helps.

Oh, and caring, LOTS of caring for fellow humans. No, I am not insinuating that nurses in non-LTC positions don't care. What I am saying is that you are going to be taking care of these people for a VERY long time. I have several residents who have been at the facility for over 10 years. It is not like that in the hospital. It is the biggest reason LTC nurses love their job. Does an OR nurse care about their patients? As far as for their health and safety, absolutely. Do they care about their grandchildren? Or that their high school buddy is going to visit next month for their birthday? No, nor should they. But the LTC nurse does. Over the years, you will become like a granddaughter/grandson to your residents. You need to care. Don't buy the hype "don't get too close", it is impossible not to.

Let's not forget stress management. Actually, I know the nurses get stressed out, but all nurses do from time to time. I am meaning the resident's stress. Anyone who has worked in LTC knows what I mean.

Sorry, I am starting to wind down, I promise :)

Lastly, we all know what the nursing home's primary job is - to make the resident as comfortable as possible until their death, so end of life training is pretty important. If you haven't had any, ask your DON to have a local hospice provide this. This will help you to understand what the resident is going through, and why the comfort meds are so important at that time. If not, the resident will normally not get the meds when they need them, and might not be able to achieve a healthy death.

As you can see, it takes a lot to be a LTC nurse. And believe me, we ARE nurses.

Thank you so much for this post. Much appreciated by this LTC nurse.

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Specializes in MICU, ED, Med/Surg, SNF, LTC, DNS.
My gramma recently got moved from an assisted living facility to a LTC. The ALF was large, newly renovated, had all kinds of programs for the residents...oh, and had absolutely terrible staffing and care. My gramma wandered off the campus, fell on the street, broke her shoulder, and was moved to a nearby LTC/rehab. She will stay there now until she dies. Luckily, though this new facility is old and no-frills in terms of decor, it is unbelievably clean (seriously, I've never been in a LTC that didn't have a weird smell the moment you walk in the door), well-staffed not just with warm bodies but people who are actually kind and compassionate and I really do trust. That is all that matters to me. I thank God that she was accepted there, has her own little room, and can live the rest of her life with this excellent level of care. The staff has already gotten to know her and try their best to make the place a real "home" for all the residents. I know that a lot of LTC nurses don't have the luxury of working in facilities like this one, and are swimming against the current with terrible staffing, no supplies, no support from management. Thank you ALL for all that you do to provide a comfortable and dignified end of life for people to the best of your abilities.

Thanks so much for sharing! There are actually quite a few facilities that are odor free now. I always tell friends to walk in the door, and take a whiff. If you smell something strange, go back in a couple of days. If the smell is still there, RUN.

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Specializes in psych and geriatric.

I too love the longevity of relationships within LTC. I never thought I'd want to do LTC d/t the frequent short-staffing and high stress of the job, and my first experience with working at a for-profit LTC nearly burnt me out of nursing altogether. However, I have just started at a new facility (new to me, the not-for-profit facility has been here for a very long time) and am able to love my job again. This is a beautiful profession that we are in and I am blessed to be able to share the lives of those I care for.

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