LTC is Great

[ShaneTeam]

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.

[ShaneTeam]

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.

I do love the relationships I have with my residents. I have one that always has to say hi, and give me a handshake before I leave (Been that way since he found out I served in the Army, also). It is those moments that make my day.

[NurseBri78]

Hands down the best post I've ever read! As an LTC nurse for over 12 years I thank you.

[AspiringNurseMW]

Nursing student here. After my rotation at LTC, I left there with nothing but the utmost respect and amazement at LTC nurses! It truly takes a special and talented person to work LTC successfully!

[ShaneTeam]

Thanks everyone again for your kind words. It did make me feel better afterwards to write this, and hopefully, some people will better understand what a LTC nurse does. Our job never ends. Keep your heads up, and remember, no matter what happens, we have your back.

[quiltynurse56, LPN, LVN]

Thank you for this post. I, too, get frustrated with all the LTC is the worst type of post.

Along with caring, let's not forget that we also do a little of mental health therapy. I had a resident recently who was having trouble settling in for the night. She told me that she had received word that her son had an accident and her daughter was going out to see him. She was concerned and did not know what was happening. This was at the beginning of night shift and she had learned this several hours earlier, but I was the first nurse to learn this. I was able to talk with her a bit. Sadly, the next day he passed and at that point she was at peace to, because she knew more of what happened and she knew she had caring nurses to talk with if she needed to do so.

[ShaneTeam]

Sorry about the late reply. Thank you for being there to help her. Your story also touches one of the qualities for LTC, the desire to have a close relationship with our residents.

[VivaLasViejas, ASN, RN]

Thank you for this post, ShaneTeam. You put a finger right on the pulse of LTC nursing and reminded me of why I enjoyed it so much. It truly is a labor of love.:)

[BSN_to_ICU]

As an aspiring LTC nurse (currently a nursing student), thank you SO MUCH for this post. It is so hard to not get discouraged when everyone tends to cringe every time I mention my love for the elderly and LTC. Thank you for not only giving a newbie some hope, but for also being such a great nurse to your patients! :)

[BadwomanM]

I remember when I was teaching clinicals for a small ADN program in SW Missouri. One of the local Nursing homes was our first clinical assignment. So many of the same residents were there, year after year so every fall, I would see them again. What really impressed me was how clean everything was..and how well cared for the residents were. They were nearly all neat, tidy, and appeared well nourished. The bedfast patients were in good condition, not contracted, clean, hair was cared for, no decubs. One of the nurses told me that they almost never had pressure ulcers unless a resident had to be in the hospital for more than a few days, then they came back with them. There was a turn clock and an overhead announcement every 2 hours for the bedfast patients and they made good use of wedge pillows and the like.

I liked the relationships the staff had with the residents, too. You could really tell they cared. They were good with our students, too, although my first year of teaching we had a med faux pas and got off the blister pack schedule.

It really changed my preconceived notions about what nursing homes were like. This one may not have been typical, but it was still a pleasure to spend our time there.