LTC NP

Are there any long term care NPs out there that can shed some light on a day in the life of a NP in longterm care/SNF?

I'm an ANP working in long term care, but I'm not a facility hired NP. I work for a company that contracts to the facility to provide NPs for residents who have a specific insurance plan. On an average day I handle everything from simple requests such as a dose of sorbitol for constipation to managing infections, COPD exacerbation, non-compliant diabetics, falls...well, the list goes on. I spend a good portion of my time interacting with staff and with families about how residents are doing and educating staff and families about disease trajectories. I also do a fair amount of advance care planning. I do end-of-life care. I deal with outside consults and usually spend an hour or two a week (sometimes more) on the phone with other providers. Some facilities take care of preauthorizations (a few I worked at did), but I do all of that, too, where I am at now. I function independently from the physician (no collaborating physician required) but I keep the physician updated about major issues. He pretty much doesn't change anything I've done and when he does (when he sees someone every 60 days) he'll let me know so I can track it. If whatever he does isn't working, I can change it.

I'm also the team float for my group of NPs, so I sometimes go to other buildings and do visits or help out. I cover another building when the NP there is on vacation. It's amazing the differences in the facilities, but each of them are also very similar in a lot of ways with the same issues for the most part I mentioned above. The best part for me is that I see my residents at least monthly, more often as needed, and I get to know them really well over time so dealing with an individual's chronic conditions, needs, and family gets easier over that same amount of time.

If someone tells you that LTC NPs have it easy, we don't. I deal with a lot of issues sometimes all at once. I have to manage multiple comorbidities, multiple personalities, multiple departments, and the administration of the building. People are sicker and have more complex issues than when I was an LPN in LTC even 13 years ago. I do a lot of sub-acute care and sometimes even acute care in the nursing home. I also have to balance orders with what the facility is capable of doing, including do they have the staff to do something one way or do I need to find a different time-frame or way to get something done. That's where a lot of the staff interaction comes in. I ask, we hash it out, I write orders. Sometimes it's just a time change, sometimes it's a "can we do it this way instead because we're better staffed in general here". Collaboration is key across the board. Geriatric medicine is different from general adult medicine because of the specialized needs of geriatric patients, the BEERS list, etc.

Love it, but it's not easy.