LTC and loving it

bankssarn · Sep 14, 2012

You're definitely not alone in this thought. I worked LTC and loved it. I started off in LTC, however, I felt that I was putting my license on the line every day by having 35+ residents under my care. I couldn't give the care they needed, and it wasn't fair to them. If I could have a more manageable nurse to patient ratio, I'd go back.

artsmom, BSN, LPN · Sep 14, 2012

That is certaintly a lot of patients, but I think 5-7 acutely ill pt's while charge on the floor is a comparable number to be afraid of. I find it so overwhelming. I am returning as a supervisor and am excited to learn a new role.

itsnowornever, BSN, RN · Sep 14, 2012

While I have yet to find my first job, LTC holds some part in my heart. I LOVE the ER, that's also where I want to be, but why do I love the ER? Because of the old patients. They aren't entitled, they have something to offer the younger generation and they are amazing examples of what a person can over come in their life and how a person can soar! I really really hope to find an LTC that is rather small so I can have a relationship with them instead of just supervise.

balatro · Sep 14, 2012

LTCs have long had a bad reputation, primarily because before national and state reforms things were, well...nasty (generally). You know the saying, "It takes one sour apple to spoil the bunch?" It works for nursing homes. They had a reputation of poor care - residents going unshowered for weeks, sitting in their waste for hours at a time, staff that were more concerned about their paychecks and socializing with friends rather than putting themselves in the resident's shoes and wondering what their life might be like, etc.

Fortunately reforms have begun changing this, drastically. My mother worked in a LTC that was eventually shut down by the state for many (and more!) of the complaints I listed above. A lot of the nurses/CNAs I work with have horrible stories of facilities they worked in 15-30 years ago but have noted that, for the most part, these days are fading away and that by the next generation LTCs will have a better reputation.

I work at a LTC facility myself (CNA - current nursing student) - most of my residents are total dependence care (quite a few with severe emotional/psychological issues but our Memory Care unit is booked so we have to care for them and honestly, we're not able to do it but we try). A resident's son not too long ago asked how I was able to work in a LTC being so young and I must have looked confused b/c he followed it up with "People go to hospitals to get better. People come here to die." Which is true, and perhaps part of the bad reputation...we're a place of death; that unless someone moves, they'll be with us til their last day.

Anyway, my facility has CNAs caring for 8 residents on 1st, 10 on 2nd, and 10 or 15 on 3rd (depends on the unit). Which is very good but as I do work in one of the Skilled Nursing Units and most of my residents I have to be eyes-on the full 8 hour shift. 2 LPNs a shift, per unit, caring for 15 residents each. During the weekday there's 1 RN per unit (so 30 residents), on the weekend it's 2 RNs for 90 residents in Skilled Nursing and then available as needed in Assisted-Living (LPNs usually cover it fine over in AL - they call the RN for count or if a resident falls).

I love geriatric patients as well, but I don't see myself still being here a year from now but we'll see. I'm an A-Personality kind of guy that has often been told I thrive on adrenaline rushes and chaos, but remaining calm and unnerved, and honestly - I feel very un-stimulated working in a LTC. I'm also becoming rather cynical about the LTC environemnt here, I'm seeing a lot of CNAs and nurses that cut corners on resident care (nothing illegal, but still enough to raise an eyebrow) and being a higherend LTC (residents start out at the basic level of 3000/month - some are closer to 7; they're also divided by private pay and government assistance, and sadly the quality of care between the two is noticeable).

/rant off

mom_coach_nurse, LPN · Sep 14, 2012

This post excited me! I start school Tuesday (ack!) and this has always been my interest. People look at me, and often voice, that I am crazy. Anyway, thanks for the post. Good luck with your new position :)

nutty netty · Sep 14, 2012

I entirely agree with you artsmom. I too love the elderly. When speaking of nursing home stigma, it ****** me off to no end that when speaking of LTC to others, whether it be fellow nurses, [who do not work in this field] potential employers and general public, that they assume we have no "real nurse" experience. Little do they know how much we actually deal with. The residents they are admitting these days are getting quite technical, ie; wound vacs, TPN, to name a couple, as well as very acutely ill people that are being discharged from the hospitals too soon, being spread too thin by employers. Meaning having to take care of up to 25-30 residents at a time. This may include several medicare residents, hospice care, in addition to the ltc residents. I got a kick out of receiving a call from the hospital as one of our residents they admitted had a wound vac and they didnt know how to change it. Also the nurses who left the hospital setting to come to LTC because they were overwhelmed and thought it would be easier. Couldnt help but chuckle under my breath when they had that bewildered look on their face during orientation. People in general also do not realize that we do not have the luxury of having a lot of the support staff that the hospitals do. The responsibility in LTC is tremendous. LTC nurses are anything and everything from maintenance to dietary, respiratory to social services. I was struggling with burn out to begin with, but my last employer [a very large corp] was the last straw. I have never witnessed such chaos, lack of support, total disreguard for the residents wellbeing and failure to acknowledge the substandard of care that was occurring. Rather than address our issues of concern, blame was placed on us when state came to visit. And god forbid dont speak out to your employer about substandards as you'll pay for it one way or another. Needless to say I quit, was denied unemployment [lost appeal] Everyone seems to believe there is a lot of work out there, well not if your LPN with only LTC experience. I loved what I did, I miss those demented, cute old people, and yes even the harborview rejects we were excepting. In a sense I hate what the LTC employers have done to make an almighty buck, and what they have done to my livelihood as a nurse. I am reluctant to go back to this setting. I live in a rural community so resources for jobs are limited. OK I'm done venting now. If anybody has a solution to my current feelings please give me some input.

artsmom, BSN, LPN · Sep 14, 2012

nutty netty- do you have any family owned LTC's in your area? That's who I work for. We are an 86 bed facility and they do make sincere efforts to staff us well. The pay isn't the highest out there, but the overwhelming patient load isn't normally there.

I just hope other people and new grads realize that LTC is not the worst job in nursing. It is definitly not an ER pace, but even those who dream of being in the ER may find it is not for them, and I hate that it gets discounted before it is tried. I have amazing time management skills and I attribute that to working in LTC and my employers really like that skill.

CapeCodMermaid, RN · Sep 14, 2012

Reforms have begun??? Haven't you heard of OBRA (not Oprah)??? The reforms started in the '80s.

CT Pixie, BSN, RN · Sep 14, 2012

I'm a LTC gal myself and love, love, love it. Don't get me wrong there are days I want to pack up my things, walk to the supervisor and turn in my badge and nursing license and go home...they are far and few between. Most days I'm just generally happy to know Im going to a job I really do like. I have my burnt out periods, but nothing a weekend doesn't cure. :)

LPNnowRNhopefull · Sep 14, 2012

I too have worked exclusively in LTC at the same facility, on the same unit for 10 years now as an LPN. I have recently applied to nursing school for the sole purpose of becoming an RN and to feel a little more long-term security. My DON is aware of my intentions to retain my same position once finished with the RN program. I am not interested, at this point, in working in the hospital.

Patient loads can get challenging, and being shorted CNA staff is never easy, but I feel so important when I walk in to my job each day. I know the stigma attached to being a LTC nurse, but I have never bought into that feeling. I have never been a person to allow others the privelage of manipulating my self worth. I have also witnessed some hospital nurse's put down LTC nurse's in an ill attempt to boost their own moral.

But the truth is...we can't all be superhero's saving lives in the ED, or ICU/CCU. Fortunately, nursing is so multifaceted - that there is literally a job for every personality type. For me, there is no better feeling than making a connection with a patient who has a cognitive impairment. And it is truely an honor to hold the hand of patient or provide support to family at the time of demise. Even particularly meaningful when you have an established history with the patient/family.

pinkfish333 · Sep 15, 2012

I absolutely love long term care as well, and my story is much like yours. I dont care what other nurses or people think about LTC being the bottom of the barrel job, I hope to stay in it for my entire career. It is so rewarding, and I love the role nurses have in our setting. Most of all I love the long term relationship (relatively long compared to perhaps other settings) that we have the privilege to build - with residents and their families. Everyday I have goosebumps when I am there, because of the connection I am making with residents and their families, by trying to do my best to be there for them. Good luck to you! Love to all our old folks!