LTC nurses: Can I hear from you, please?

[37changes]

Hello all ~ I am looking to hear from nurses who are currently working or have a lot of experience in LTC or AL.

I'd like to use this thread as a place to get to know you a little better & ask questions as I think of them. And maybe get your opinions on jobs down the road, etc... should I choose to head down this path.

I am beginning the last semester of my ADN program. People have been asking me what I'm going to do ~ and while telling them I'm still not sure, I'm also telling them I think my heart is in LTC.

I have felt this way since before I started school.

I had a great experience in clinicals at the nursing home. I know not all facilities are like this one -- I know that, for sure. But it was good. It was smaller. Homey. If my grandmother needed to go somewhere, I would have no qualms about this one.

I've been in touch with the ADON there, and she's offered to meet with me to discuss LTC vs hospital, as she has had experience in both.

I have an aunt who has worked her way up in LTC management over the years and is pretty high up, over many facilities. She is encouraging me to head this direction, as well, as I already have an associates in Business Administration. She says LTC needs people and I could move up quickly if I can do a good job and manage a team well.

I don't have a strong desire to work in a hospital. My local hospital does hire ADN nurses regularly, so it's not that I can't -- it's that I don't necessarily want to. I think I just prefer a different environment.

I will be almost 40 when I graduate, and I am not dead-set on pursuing my BSN. That would be required to be completed within 5 years at my local hospital. I'm not sure about others. But my kids will be starting college soon, and I'm just not sure if that is the direction I want to head.

I'm also looking for days. And I know, as a new grad, that is limiting. But I also don't need the benefits, I don't have to be full-time, and I'm cool with PRN days, if that is all I can find.

One thing I noticed while looking through the threads in this section is that people were saying LTC pays less than hospitals. I have heard the opposite here, from my aunt, as well as from one of my instructors who worked in LTC. My aunt said her company also pays $2/hr more for PRN employees. I'd love to hear thoughts on this. I wonder if it is area-specific.

Thanks to anyone who responds! I value your experience, for sure. As I currently have none. :)

[37changes, ASN, RN]

Thanks so much for all of the feedback so far. Of course I know there are those who are not cut out for it -- it's just not their thing at all -- but I also know that those people are out there who love it and CHOOSE it.

Interestingly, my oldest son has a new girlfriend & her mom called to introduce herself the other night. She told me she'd worked in LTC for many years as a healthcare facility administrator ... and we had such a great conversation. She knows a lot about the local facilities, who to talk to, etc.

It was pretty cool, since this is someone I did not know before and did not seek out in any way. She came to me. :)

[lumbarpain, ADN, RN]

Over 30 years of LTC experience..I am an RN .....tough job...have seen a lot of speciality nurses not be able to handle the dementia, confusion, demands and Irate family members you deal with.. but I am a Overly seasoned LTC nurse...you are young yet....my first suggestion to you is that if you don't have a lot of patience..and I mean a lot this isn't for you.....multi tasking also includes working as a CNA when they are short staffed...giving out po meds, doing Ivs, I&Os..wound care. colonostomy care, nephrostomy, urinary cath care, drawing blood, taking orders....all the regular stuff...plus if you stay long enough you may be voted in as the ONE WHO KNOWS ALL.....and then everyone comes to you to find things or do things for them cause they are new and don't know the ropes.....there is so much I could say here..but its worth a try...but like I said.....Patience is a BIGGEE in this job...not with only just patients and family....its your management and your coworkers also......Good luck to you...I hope you make the best decision for yourself.....

[Glycerine82, LPN]

My facility....we have close to 200 beds. We do all sorts of IVs, TPN, large bore chest tubes, trachs, IV push meds....you name it, we do it. Not much different than a med surg floor except you have more patients. I started years ago in the business. I went to a hospital based nursing school (I already had a bachelor's in something non nursing). I worked my way up to be the Director of Nursing. I'm now trying to back off because I was on call 24/7 for 13 years. There is always a need for smart nurses in LTC. Even the people on the so called long term floors need nurses with excellent assessment skills since the big focus is on keeping our residents in the facility and not sending them out. IM me if you have specific questions. I've been in the business for years and years and have done it all.

I'm not far from the Cape. You hiring? ;-)

[Glycerine82, LPN]

I too think I belong in a SNF. I'm two classes away from my RN and I don't plan on going anywhere. The work is harder and the credit is lesser than in a hospital setting, (IMHO) but I think it's what I am best at. I also think its where the largest need is. You will see how many nurses just don't care and how quick some are to say "not my problem". If you enjoy it, there is no reason you can't make it your life's work.

[37changes, ASN, RN]

My facility....we have close to 200 beds. We do all sorts of IVs, TPN, large bore chest tubes, trachs, IV push meds....you name it, we do it. Not much different than a med surg floor except you have more patients. I started years ago in the business. I went to a hospital based nursing school (I already had a bachelor's in something non nursing). I worked my way up to be the Director of Nursing. I'm now trying to back off because I was on call 24/7 for 13 years. There is always a need for smart nurses in LTC. Even the people on the so called long term floors need nurses with excellent assessment skills since the big focus is on keeping our residents in the facility and not sending them out. IM me if you have specific questions. I've been in the business for years and years and have done it all.

We have now had our first day in cardiac intensive care clinicals. I am becoming more and more aware of how much I don't know, and haven't done. Being there and seeing these things in real life is very different from reading about them in books and doing assignments (of course).

I've seen comments here about getting a lot less orientation in LTC, and that adds to my concern. Would you say that going directly into a SNF would be a bad move? I'm starting to feel like perhaps that year on a med surg unit in a hospital, as I see recommended so often, might be needed. What is your experience with new grads?

Thanks again for your responses!

[37changes, ASN, RN]

I am a LPN with 20 plus years experience most all of which has been working LTC /SNF.

I have learned a lot in this type of Nursing. I enjoy the Residents everywhere I have worked. Nursing has changed so much through the years. A lot of corporations own facilities . I have always been paid well in this field and for a LTC nurse. Presently I am working in Assisted living slightly different then LTC. I feel it's a great way for a Nurse to get a little experience under her belt . I would always recommend working in a hospital . See and do much more. Can always try LTC later on.

This is not easy work by any means . God bless the nursing assistants. Always treat them respectfully and help when ever you can . Mostly ,as LPN your a medication treatment nurse. RN the same or nurse manager on floor or staff . Can wear many hats. I love working LTC. Go for it.

Thanks!

Did you start out in a hospital... or LTC, SNF?

Now I'm trying to get a feel, from those who are happy with this choice, what their path looked like.

I wonder if people are more overwhelmed when they go into it without a lot of other experience. Or if the opposite is true ~ people get used to working in a hospital environment first, and then LTC is less desirable because of that.

[37changes, ASN, RN]

All of my experience working in LTC facilities convinced me that I could not go back to that environment. One works to support oneself and one's family. Becoming a sacrificial lamb or martyr to the culture that LTC corporate entities insist upon for their bottom line does not predict a long or healthy career in healthcare.

Thanks for your response ~ and I'm sorry it's taken me awhile to sit down at the computer and go through these and think about them in detail.

Your feedback is every bit as valuable to me as the positive experiences. Do you mind telling me whether you went straight into LTC, or did you have hospital experience first?

Do you feel like every single LTC facility is like this... or that some "good" ones can be found out there? Clearly there are reasons why my aunt says they need help so badly. I'd like to get to the bottom of what those reasons really are. It would be foolish to put on my rose-colored glasses, only to end up having them smashed on my face. :)

[37changes, ASN, RN]

I've been in LTC my entire career, by choice. For me the benefits far outweighed the negatives. In my region LTC does pay a little less then acute care, however there are many parts of the country where the opposite is true. Most LTC in my area do not offer charge pay or shift differentials, the few that do it's a pretty small amount. It's rare for LTC nurses to be unionized, so don't count on union support to secure raises. Benefits as far as insurance, 401k match, PTO or vacation/sick time are pretty comparable.

Opportunities for OT are readily available in both settings. Difference there is if you work for a LTC that utilizes mandating OT to fill a hole in the schedule you may end up with more OT than you want. Unlike a hospital you can't pull a nurse from another floor to fill a need. LTC staffing is a challenge almost everywhere. All the LTC facilities in my area do block scheduling. That's a major benefit for me, I really like that I don't ever need to rotate shifts and my schedule never changes.

The average nurse to pt ratio in LTC is astoundingly high, but it's usually doable with decent time management, a good support staff and management that doesn't micromanage. You will learn excellent time management skills in LTC. You will also gain amazing assessment skills. There is no full time MD in the building so outside of rounds the providers are writing orders strictly based on your assessment.

Many nurses that enter LTC do so reluctantly and leave as soon as they can land an acute care position. That's unfortunate as far as I'm concerned. The primarily geriatric population we care for is an amazing group of people. Even on the short term rehab end residents are typically there for weeks or months instead of the continual patient turnover you'd get in a hospital so the opportunity to really get to know your people and their families is a very rewarding part of the job. Of course the occasional downside of this is at least in a hospital you know you won't be dealing with the PITA patient or family too long, in LTC there is a real potential of months to years of dealing with a difficult personality.

I like the idea of getting to know my patients. I do understand that as an RN it will be very different than it was as a student... I could clearly see how busy they were. But when you are working "in their home" day to day, you will obviously know way more about them, what is normal vs. not, etc. than you would in a hospital setting where people come and go.

So you are in LTC by choice ~ your entire career ~ that's great. Can you tell me if your experience is more like SNF or more like rest home/AL ... as I have realized on this thread that when I say "LTC" there are many versions of that.

The experience I had at the local nursing home -- I believe I was directly told that they do not do IVs... that if they need an IV, they go to the hospital. So it was clearly a different level, perhaps a lower stress level with lower acuity? And that is the environment I was picturing when I started this discussion, because that is the LTC experience I've had so far. I know that might sound really naive... but we know what we know {shrug} and there is always room to expand and learn more.

[37changes, ASN, RN]

Over 30 years of LTC experience..I am an RN .....tough job...have seen a lot of speciality nurses not be able to handle the dementia, confusion, demands and Irate family members you deal with.. but I am a Overly seasoned LTC nurse...you are young yet....my first suggestion to you is that if you don't have a lot of patience..and I mean a lot this isn't for you.....multi tasking also includes working as a CNA when they are short staffed...giving out po meds, doing Ivs, I&Os..wound care. colonostomy care, nephrostomy, urinary cath care, drawing blood, taking orders....all the regular stuff...plus if you stay long enough you may be voted in as the ONE WHO KNOWS ALL.....and then everyone comes to you to find things or do things for them cause they are new and don't know the ropes.....there is so much I could say here..but its worth a try...but like I said.....Patience is a BIGGEE in this job...not with only just patients and family....its your management and your coworkers also......Good luck to you...I hope you make the best decision for yourself.....

Oh, how I'd love to be ONE WHO KNOWS ALL someday... or maybe not.

But seriously, thank you for your response.

I'm sitting here thinking about patience. Well, I homeschooled 3 boys at 3 different grade levels for seven years, and they are all in public school now and straight-A students from day one. I got a lot of "oh, I don't know how you can do that ... I don't have the patience". That did take a lot of patience, and perseverance. It was stressful at times. But I did it.

I'm not sure if that is a realistic comparison, though.

For one thing, they are my children, and I am deeply invested in how they turn out. There was no option to walk away and give up.

On the other hand ~ I got no real break from it. I felt a constant pressure to be doing more, learning more, improving. I feel that in nursing school, and I will be feeling that as a nurse (no matter where I end up) -- but the difference is that I CAN and DO take mental breaks from nursing. It's not 24/7/365 stress... there is time to recover.

Do you feel like people do better with LTC when they come as a new grad and it is all they've ever known? I see you say a lot of specialty nurses can't handle it. I know I'm repeating myself, but I wonder if it is best to go straight into LTC vs. having that hospital experience first.

[37changes, ASN, RN]

I too think I belong in a SNF. I'm two classes away from my RN and I don't plan on going anywhere. The work is harder and the credit is lesser than in a hospital setting, (IMHO) but I think it's what I am best at. I also think its where the largest need is. You will see how many nurses just don't care and how quick some are to say "not my problem". If you enjoy it, there is no reason you can't make it your life's work.

Thank you for this. Yes, there is a need... and I feel like LTC workers are underappreciated. I don't understand it.

I have felt all along that these are people who have lived a long life, they have contributed to society... they are tired and they are confused, they are lonely, and they are probably upset about no longer being able to do things for themselves. And I honestly can't think of a better way to use my education than to help care for them as they near the end of their lives. I don't care if they don't remember -- I don't care if they don't appreciate it. *I* remember and *I* appreciate what I'm doing.

My very first day in clinicals, which was at the nursing home ~ I was sent to take a woman from the dining room back to her room. Sounds easy enough, right? Except once we got there, I wasn't sure if I was supposed to just lock her wheels and leave her sitting there? Was I supposed to help her into her bed? I didn't know anything about this woman.

So I flagged down the CNA and she told me it was time for her to go to the bathroom. And she expected me to just jump in there and do it all -- again, not knowing anything about this woman whatsoever -- I didn't know how well she moved, what she could do on her own, etc.

So this grumpy old woman, as I am wiping her behind, told the CNA that we nursing students needed to go back to school because we're stupid. That was my first day ~ that was my first real experience. And it did not upset me in any way... I later told everyone, "she's right!" Because I did feel stupid. And I knew how much further I had to go. I mean, everyone has to wipe their first butt at some point, right?

I will never forget her. I remember her name, and I remember what she looks like. And I made sure to smile at her and greet her by name every time I saw her, for the rest of the semester. Her grumpiness did not make me grumpy... it made me want to do whatever I could do to help. It made me want to do better.

[CapeCodMermaid, RN]

lol...not on the Cape any more.

[caliotter3]

Thanks for your response ~ and I'm sorry it's taken me awhile to sit down at the computer and go through these and think about them in detail.

Your feedback is every bit as valuable to me as the positive experiences. Do you mind telling me whether you went straight into LTC, or did you have hospital experience first?

Do you feel like every single LTC facility is like this... or that some "good" ones can be found out there? Clearly there are reasons why my aunt says they need help so badly. I'd like to get to the bottom of what those reasons really are. It would be foolish to put on my rose-colored glasses, only to end up having them smashed on my face. :)

I worked as a CNA in LTC before I got my nursing license, then I worked as a licensed nurse there. My bad experiences all were because of workplace culture and behavior. It had nothing at all to do with the actual work or the resident demographics (dementia, etc.). Unfortunately, every facility I worked at, in more than one geographical location, was like this. Corporate entities figured out long ago how to keep costs for employee wages low so their facilities are imbued with that "save a buck at all expense" culture. It runs away people like me who can not figure out a way to duck and dodge the bullets forever. I would still be working in that area of nursing had it not been this way for me as an individual.