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LTC 101: What To Expect

Geriatric Article   (22,785 Views 29 Comments 990 Words)

VivaLasViejas has 20 years experience as a ASN, RN and works as a Retired/Disabled Nurse and Blogger.

346 Likes; 8 Followers; 141 Articles; 247,059 Visitors; 9,530 Posts

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Here is a brief guide for new LTC nurses as to what they can expect from their jobs. Included are the good, the bad, and the ugly aspects of working in this specialty. I hope it will be helpful to both new grads and nurses who are changing fields. Welcome to LTC! You are reading page 2 of LTC 101: What To Expect. If you want to start from the beginning Go to First Page.

VivaLasViejas has 20 years experience as a ASN, RN and works as a Retired/Disabled Nurse and Blogger.

346 Likes; 8 Followers; 141 Articles; 247,059 Visitors; 9,530 Posts

I hate to break it to you like this, but rehab/skilled nursing is MUCH more intense overall than LTC. In a skilled unit (SNF), you have a lot of really sick people who are basically sub-acute---fresh post-op CABGs, hip and knee surgeries, trachs/vents, people who need IVs, diabetic care and teaching, serious wounds, even some psych and a lot of dementia. You will never be bored if you go this route, but be aware that it's like the hospital, only with fewer staff and resources. It's not unusual for one nurse to be responsible for 30-35 SNF patients, and you might get 5 aides on day shift if you're lucky, plus a med/treatment nurse or med aide.

Personally, SNF is not the way I would choose to re-enter clinical nursing after so long away. If you do, though, just be prepared to be overwhelmed for awhile. I worked as a med nurse for a while and ran my rear end off, but I at least got breaks; the poor charge nurse never even sat down until the end of the shift, and that was only to chart and give report. I wouldn't have traded jobs with him for anything.

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misstrinad has 1+ years experience and works as a RN.

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Great post! I loved it.

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1 Like; 16,152 Visitors; 940 Posts

I hate to break it to you like this, but rehab/skilled nursing is MUCH more intense overall than LTC. In a skilled unit (SNF), you have a lot of really sick people who are basically sub-acute---fresh post-op CABGs, hip and knee surgeries, trachs/vents, people who need IVs, diabetic care and teaching, serious wounds, even some psych and a lot of dementia. You will never be bored if you go this route, but be aware that it's like the hospital, only with fewer staff and resources. It's not unusual for one nurse to be responsible for 30-35 SNF patients, and you might get 5 aides on day shift if you're lucky, plus a med/treatment nurse or med aide.

Personally, SNF is not the way I would choose to re-enter clinical nursing after so long away. If you do, though, just be prepared to be overwhelmed for awhile. I worked as a med nurse for a while and ran my rear end off, but I at least got breaks; the poor charge nurse never even sat down until the end of the shift, and that was only to chart and give report. I wouldn't have traded jobs with him for anything.

JoFlo - What OP said here is TRUE. Start back with LTC, not SNF.

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480 Visitors; 7 Posts

Ltc is no joke! The work is so hard both physically and mentally. I can't see myself doing it much longer. I refuse to break my body down because upper management refuse to hire more staff in order to save money, but want me to kill myself in the mean time. I will get as much experience as I can and then I am out! I really hate the fact that I can't give my resident's the care they deserve! Some of those folks hold a special place in my heart.

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LadyFree28 has 10+ years experience and works as a Clinical Nurse.

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LTC is a special place...thank goodness my area DOES look at the experience as a positive one!

Many co-works have moved on to hospitals after 1-2 years of working in LTC.

I have dabbled in LTC for many years; the personalities will get you, the time management and thinking outside of the box will be the best asset; you learn to look and people and assess appropriately without monitors-a DEFINITE plus!-and the icing on the cake is doing communication Olympics with some of the most difficult families and getting the gold when they feel as if you are the nurse they an trust-those mental health therapeutic communication is utilized here. ;)

To sum it up, LTC is a ton of specialties wrapped up into one; and with it being one the most expanding specialties, I believe one day nurses will say, "start off in LTC."

Mark my words. :yes:

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benegesserit works as a RN.

10,297 Visitors; 569 Posts

Yep, rehab tends to be more difficult. Where I work, it generally has 5-10 less patients than the LTC floors, but the acuity is higher, every single one of them needs a medicare assessment and charting daily, more need treatments (and often more complex treatments), there are constant time-consuming admits and discharges to deal with, and the patient population is constantly changing. If I'm gone for a few weeks for the rehab hall, it's nearly a totally new hall when I come back. If I'm gone for months from LTC, it's still largely the same when I return.

For those with LTC experience having a hard time breaking into acute care, I'd suggest finding a hospital-associated SNF to work in.

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greenerpastures has 5 years experience.

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Best McGyver moment in LTC - cutting the end off oxygen tubing to insert into a gtube that had a broken seam on the cap which would leak during feedings. Best funnel I've every seen!

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I worked LTC for over 20 years as a nurses aide and LPN. I have so many memories of the residents I cared for. Elderly people are one if the greatest populations to spend time with. I work acute care now and still love the little old ladies and men. They deserve the best care possible. It's too bad that the owners and administrators in LTC do not see that but the almighty dollar. God bless you for what you do! Great article.

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1,655 Visitors; 30 Posts

Excellent! Next Monday, I will celebrate my 3-year anniversary as a LTC nurse, and I have encountered every single situation except actually turning away an admission. Yes, that includes replacing a pulled-out g-tube with a foley...we don't even HAVE replacement kits. That gets done at the hospital. As far as family goes, I think I've known the spectrum: from those who are there every day and are actually helpful, to those I've met ONCE, and those who need the anti-psychotics they want us to give to their parent. I currently work in the dementia unit, and I swear some of their kids are certifiable! But I love my job and my residents, and have no plans to do anything else in the near future.

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momof2divas works as a Registered Nurse.

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This was an excellent article! I have only been a nurse for 2 years. When I graduated I wanted to do ICU but no one would call me back. I was eager to get a job and got a job at an LTAC facility. It was hard work but you know what? I learned so much in that first year. There is so much you see and you get to really practice your nursing skills. When I was asked," Where do you work?" and I responded," LTACH" I would get snide remarks from the other nurses working in the units.

I strongly believe that new grads could benefit working in Long term care. I feel that LTACH gave me the foundation for going into ICU. I miss it at times. I was told if you can work LTAC/LTC you really can work anywhere.

Also the whole attitude in nursing of ICU nurses are better than med surge, or LTACH nurses has to go. We all use Critical thinking skills. We are seeing patients with a myriad of complex issues in all areas which are requiring all nurses to stay abreast of information that will enhance our practice. We have got to stop bullying and attacking each other if we are to keep our profession strong. A house divided cannot stand.

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tyvin works as a RN Hospice Consierge Services.

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A SNF is nothing but med-surg over amplified. Instead of 4 or 7 patients you get 12, 15, 20, or maybe more, depending on the facility. When I worked SNF I had 20 patients and it's almost dangerous. In fact, in my opinion it was dangerous. There were CNAs on the floor but I rarely saw them and didn't have time to babysit them or chase after them.

Than I was a charge in a SNF :facepalm:... got out as soon as possible. I should have known better than to go back into a SNF but I needed a job and they dangled a huge carrot. It is a dead serious situation and must be entered into with eyes wide open depending upon how many patients you would be responsible for.

If you're highly motivated, and a fast study, SNF might work.

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jessicaRN32 works as a Registered Nurse.

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I have worked LTC for 29 years. A few times I have tried to get out of the LTC grind-house, by trying to get into Acute Care hospitals or Home Health. Each time you meet the same barrier - many do not see or accept the experience and years put in doing long term care. For a lot of the Nursing/Medical employment LTC is looked down upon.

A typical day/shift has the nurse coming into the building already *Drowning* lately. You either have work thrown on the next shift by the prior shift, or by the Nursing Managers, or simply because the day itself has been a mad house. Lately it is the 2nd shift ( 2-10pm or 3 -11pm) that can get hair pulling crazy. Yet - understand, this is only via my personal experience. On the evening shift you get Admissions which can come in any time during your shift - up to the time your shift ends, you have doctors/FNPs coming in during the evening and writing orders, you have family members underfoot. Then you also have the support leaving you after 5 -6pm ( ie; Managers, etc). Some will see their staff struggling and stay alittle longer to aid you if able. Sadly though many notice and just walk right out the door.

Toward family members many are actually very nice and caring toward the LTC staff. Still it is the one or two that come in, believing NOTHING you do is good enough, that can break the work day. And though you want to just tell them to take their family member home sometimes inside....you put on that warm caring smile, bite your tongue and again try to appease that family.

Then in the past several years you notice CNAs you are getting want the paycheck but try to do as little as possible, so you have to play Warden....having to chase them continually to get things done. Then you have Managers telling the nurse "You need to really stay on top of your aides," when you are already doing the best you can.

When you finally get done at the end of your shift, a day that was so busy you could not take a break, had to sign out for supper but had work through it to get done on time, you now have to wait on your relief nurse. It is now 30 minutes after your end time, no call or anything, and your relief saunters in late habitually. So you know the next day you will get called in to the office for working late because at your facility *There is NO excuse for working late accepted*.

And at least where I work LTC.....this is considered a GOOD day ( LOL).

I've been working at a LTC facility for 9 months, and you have VERY accurately explained my feelings/experience while working there. I thought it was just me!

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