Pain management nurse in LTC- an unreasonable goal?

[misstoast]

Hi all:

I'm going to be graduating in May and I'm confident I will remain in LTC. I have been a CNA for 6 years and I'm sure I will be fine with the duties, but I'd still like to have my bachelor's. The application process to the University of Kentucky's RN - BSN program involves a statement of professional and academic goals. Any college beyond the BSN would be to specialize in pain management. Other than that I have no real desire to do anything other than bedside nursing.

I know chronic and complex pain tends to be a massive problem in nursing homes. I personally believe that every LTC facility should have a pain management team just as they are required to have a dietitian, social services and soforth. That's just me though. But when it comes to the possibility of working as a pain management nurse, so far the responses seem to be rather cynical- "there's no market for it" and "that's silly". Am I being unreasonable? Would continuing on to a DNP in pain management be impractical? Will my boss laugh me out of the room if I ask about it?

[VivaLasViejas, ASN, RN]

Sorry to be the bearer of bad news, but you'd have a better chance of jumping over the moon than of creating a new position in LTC these days. There simply isn't the funding for new programs, let alone the people to staff them.

However, your idea is fabulous, and if I were in charge of these things, I'd love to develop a pain management program, teach LTC nurses the theory and applications, and mandate each LTC facility to have at least one specially trained pain-management person on staff. I've long believed that if we managed pain adequately in the long-term care setting, we'd get rid of 75% of the anxiety and behavior issues we see in our residents.

Unfortunately, elder care is one of the most overlooked (and under-funded) types of health services in this country. I can't advise you one way or the other on continuing your education, but I'm sorry to say you'll have a very difficult time selling anything that costs a facility money, even if the initial outlay would pay for itself over and over again in reduced treatment costs, fewer doctor visits and drugs for behavior problems, and so on. Sorry.

[JenniferSews]

I pretty much have to agree. If medicare or medicaid isn't going to pay for it (in a way that is profitable to the facility) it isn't going to happen.

OTOH, I can't think of a single LTC or hospice patient in my facility with pain issues. Between the nurses as strong advocates and the willing to listen docs, I have LTC pts on heavy duty scheduled narcotics. Personally I'd rather give someone pain meds at the end years of their lives than have them exhibiting behaviors because they were in pain and unable to communicate it effectively. Maybe your goal should be to either change the culture of your facility or find one that believes in your goals like ours does.

If pain management is your passion, I remember that the hospitals I did clinicals at often had pain specialists. It's a worthy career to pursue if that's your interest.

[misstoast]

Thank you both for the fast and straightforward replies. I too suspect that many of the behavior and anxiety issues are in fact pain issues. My facility isn't too bad regarding pain management (as a facility), but I've worked in others to know that it is a big problem. Pain and pain management is the only subject which I find fascinating in its entirety; etiology, pathophysiology, pharmacology, chemistry and all.

I think I'll continue to look into pain management despite the low probability of doing such in LTC. Though it's not ideal, perhaps through a pain clinic I could act as a facility consultant or something of the sort? Thanks again for the input.

[systoly]

A few weeks late, but anyway, while I don't foresee such a position either, I believe there's potential for (and certainly much needed) teaching and inservicing, especially for CMAs (med techs). I have worked with numerous CMAs who were not properly trained in understanding the correlation between routine and BTP management and therefore would undermedicate. On the licensed staff side, I've seen a great need for more training in understanding equivalencies and how to properly medicate for BTP given the routine regimen. I would love to see a pain management specialist give inservices in LTCs.