kfostercma

I was feeling self-conscious about starting my first med-surg job at the age of 38 when most of my coworkers became nurses in their early 20s. Then I happened across this inspiring post. Thank you so much for this! In short, no you are not too old. You have an illustrious thirty years of experience behind you, and when I was in the AD RN program, the LPN students seemed to do better with the content than those of us who were not yet nurses. Don't sell yourself short! Imagine all of the skill and knowledge you have gained during your career--and how much more you know than a new grad RN. Additionally, it is becoming more common for middle aged and older adults returning to college for various reasons. Different profession, I know but I took an abnormal psychology class with a gentleman in his mid 50s who was pursuing a doctorate in clinical psychology. He might be in his mid 60s before he gets to practice! I extend my condolences for your loss, and wish you good fortune as you pursue your RN. You can do it!

I have been working in a "Greenhouse Model" nursing home for 3.5 years. Here is what I have observed: Intent: and in addition to promoting independence like any traditional long term care setting, elders are encouraged to garden, help with preschool/daycare, and even meal preparation. Reality: out of 20 patients (a light workload compared to other LTC settings), only a handful, 2-3 at a time might be capable of these activities. In 3.5 years I have never witnessed an elder stepping foot into the kitchen, let alone assist with meals. Intent: Shahbazim (nursing assistants with extra training, singular: Shahbaz) have a smaller workload (5:1 ratio as opposed to 10:1), but are expected to take on housekeeping and maintenance roles. Reality: out "Greenhouse" facility still has housekeeping because even at a 5:1 staff ratio it is difficult for our Shahbazim to keep up. Intent: Shahbazim to prepare meals to order in a home-like kitchen Reality: Professional chefs cooking meals just like any other nursing home, except without the benefit of an industrial kitchen. The single biggest complaint about our "Greenhouse" facility is the food. Our elders were made to expect home style cooking every day and got something quite different. Additionally, even if a person is admitted to our facility with a level of functioning which allows them to participate in all of the tasks intended for the Greenhouse model, they inevitably decline and choose not to move when their acuity level changes. Often, since management is under pressure to keep rooms filled, many of our new admits are total care patients. A few things to mention as a positive: our elders are generally on fewer anxiety medications than traditional institutional style nursing homes. The hallways are shorter (ten elders to a floor); and the shorter distances are less intimidating for a person who is barely ambulatory. With one aide for five elders, I do a lot less wound care than I did at my first nursing home which had one for ten. Older post, I know but I hope that helps!

For clarification: I do not have a carefree attitude towards my work performance, I feel quite privileged to be actively using my education and I show gratitude for that by always looking for ways to improve. I listed my mistakes/need for coaching in some areas to emphasize the point that I am not as talented as my clients seem to think.

I have been a nurse for three years now, all of my time has been spent in LTC I am the only white male nurse on the payroll at my facility--which is not terribly surprising. Even ten years ago the female to male nurse ratio was something like 15 to 20:1 with male nurses preferring to take administrative or research positions. Most of my coworkers are minorities and over half speak English as a second language; every single elder on my unit is US born and white. At the risk of sounding pretentious, most of my elders and their families love having me as their nurse. I do my best and am always looking for ways to improve but I am honestly having trouble discerning genuine praise from the relief of seeing a person who has the same skin color and presumably same cultural background as them. My annual review on the other hand was a testament to mediocrity. I of course received high marks in customer service but my performance with daily operations needs improving. I frequently forget to chart my weekly skin body audits on the same day as the shower (I always look, but if there is no skin deficit I tend to forget about it); I also sometimes fall behind with MDS assessments. I don't always get to my accuchecks before my elders start to eat and more than once I had to be coached on using SBAR format when communicating with providers. And then there are medication and treatment errors; there was this one time I used an Enluxtra dressing in place of a Xeroform dressing and ripped this guy's fistula open. There was so much blood this guy's room smelled like a slaughterhouse (he wasn't harmed at least). When I reported this to my nurse manager he bellowed something like "Jesus Christ! Those don't even sound alike, why did you do that?!" Despite all of this, my elders (even the guy mentioned above) think I am doing well but that appraisal is in sharp contrast with my annual review. No this isn't a humblebrag and no I don't have any white guilt. I think it is pretty clear that my elders treat me differently than my colleagues, but what do I do knowing this? All I have thought of so far is to make an effort to say "good job" and "thank you" to my coworkers in front of as many of the elders as I can, and whenever an elder tells me that I am their favorite nurse I have a knee-jerk reply: "that is very kind of you to say, but I like to think of us as a team" or some variation of that. Have any of you noticed any preferential treatment given to white males in the geriatric setting?

Yes, I agree with notanumber about positive reinforcement. Leadership 101: praise is cheap! Always say please and thank you. It is better to ask an aide to perform a task for an elder than it is to order it. My aides often tell me I am their favorite nurse to work with. To explain that, I need to tell you a little about myself: I made the mistake of not becoming a CNA before I became an RN. I was once a CMA but that really isn't the same thing, and not a single thing I learned as a CMA helped me transition to the professional RN role. You can imagine how lost I felt when I started working at my first nursing home! My father raised me to believe that a supervisor (I like to consider myself a coworker of my aides, but my credential also requires me to supervise) should never ask a subordinate to perform a task that the supervisor cannot or will not do. I have always been upfront with my aides in that I tell them that I never worked as an aide, and not knowing any better, I tell them that their job is probably harder than mine. One of my first goals was to earn the respect of my aides. Here is how I did it: #1: If I am in a room with an elder and they need a fresh cup of water or a new brief or something, I will do it myself. I want my aides to know I am not above performing tasks that are normally delegated to them. One exception I will make is showers. I will not give showers because it is too time consuming, but I do want my aides to know that I am not above changing soiled briefs. #2: Answer call lights, and encourage all staff (not just nursing) to do so. The aides will feel less burdened by having to handle ALL of the call lights themselves and you might be surprised how often people accidentally press the call button, or need something simple like a glass of water, or to check the time. Of course you should not expect a receptionist or a HUC to change a dirty brief, but if the call light is at least answered the elder knows that they have been heard. That goes a long way. Strive to have every call button answered in sixty seconds or less. Have you ever had to wait sixty seconds for something? That time really drags on, doesn't it? Now imagine waiting sixty seconds with a full bladder....yeah..... #3: If an elder is complaining...at great length...about something that is beyond your control, hear them! Even if you have implemented the nursing process to the best of your ability and the elder still finds things to complain about, you can at least accept that you cannot change the behavior, but it might surprise you how far you can get with them by simply lending an ear. You may notice that my suggestions are more focused on the elders that you care for than your staff. That is because the morale of my coworkers and I are directly linked to the happiness of the elders for whom we care. Keeping the elders and their families happy is within our best interest. I hope this helps!

I'll confess that LTC wasn't my first choice (AD RN here, working on my BSN), and I will grant that it is predictable, it can be boring on some days, upward mobility is limited unless you want to be a manager (no thank you!) and I am constantly keeping my eyes open for a way out. But to say LTC is lame stings a little. Reading the comments on this thread, I am reminded of some of the dismissive attitude I have had to endure from acute care nurses when I sometimes have to send my elders to the ER--and as a male nurse, I am shielded from a lot of their condescension! If you are unhappy now but are limited on prospects, here is what I suggest: if you are so good at your job that you finish your med pass, MDS assessments and clear all of your alerts that your electronic chart flags for your elders, check your facility policy on how to destroy controlled substances. If you as an RN can destroy narcotics with a second nurse to cosign for you, imagine how much time you will save counting narcs! When I started at my current job, I ended up cleaning out almost half of the narcotics that we had on hand since they no longer had orders. Counting narcs at change of shift became a cinch! Ask yourself if you are implementing the nursing process to your elders' full advantage. A major part of our job as LTC nurses is to optimize our elders' quality of life. For instance do you have an elder who could benefit from a different sized wheelchair? I recently came back from a vacation and had a new admit on my unit who was using a loaner wheelchair from our TCU. It was a standard sized wheelchair, and this gentleman was at least 6'6" tall when standing, also he was on hospice. Poor guy was using that little wheelchair for about four days before I collaborated with hospice to get him a high back wheelchair. It isn't always about money. That is why we are nurses and not physicians, right? If you aren't feeling challenged at your current job, I invite you to look for opportunities to shine. Your coworkers and your patients will love you for it.

I am an AD RN and managed to find a 0.8 FTE job in long term care right away, but working in my favor is my gender. I have been frustrated trying to find something more specialized, hospitals in the Minneapolis, St Paul area where I live are unwilling to consider a nurse who hasn't completed a BSN, and I have yet to even land an interview at a clinic. 2 years is long enough for me to know I don't want to spend my career in LTC.

I'm a white male nurse with 2 years of experience kind of coasting by with my privilege. When it got to the point where I started to question whether I was really doing well at my job or if my white maleness is responsible for my accomplishments, I asked some of my friends (not nurses).who are minorities what I should do. Most of them said I should use my position to praise my coworkers at all times. I know it sounds silly, but some of the elders I care for have started to trust my non-white colleagues. Perhaps you can challenge your coworkers who are white to compliment good work when they see it.

When I was in my early 20s I originally wanted to teach high-school science. But after my first college speech class I found I couldn't speak in front of crowds. Ten years later, I graduate from nursing school and have 2 years experience...my confidence is much MUCH improved....but to take a pay cut? Maybe when I start to burn out.

When I was in my early 20s I originally wanted to teach high-school science. But after my first college speech class I found I couldn't speak in front of crowds. Ten years later, I graduate from nursing school and have 2 years experience...my confidence is much MUCH improved....but to take a pay cut? Maybe when I start to burn out.

She went off sliding scale for a time but she ept spiking into the 300s after breakfast and her a1c was 9ish so she went back on. I wanted to increase lantus but MD disagreed with my approach.

I average one double shift per week at my LTC facility and often it is the day before a regular shift. I work days so it goes 0630 to 2300 and back at 0630. I rely on public transit and won't get home until midnight....but the tradeoff is that the next day sure feels shorter! I started drinking coffee in the mornings to manage the sleeplessness, and I can't cancel myself.

I have been working in LTC for as long as I have been a RN--about 1.5 years. I have worked in two facilities, and I have run into the same problem with my sliding scale diabetics--actually all of my diabetic elders--in that no matter what aides I have working with me, they will bring my diabetics to meals without informing me so I lose my opportunity for a pre-meal accucheck. I have tried updating the care plans, verbally instructing my aides at the start of my shift, and even posting a sign reading "Elder must be seen by nurse BEFORE meals" but it is still a daily struggle. I do have a good routine down for the floor I work, but my sliding scale elder does not always eat at the same time every day. Often she will rise at the start of my shift while I am taking report on a different floor (I work two floors with ten elders each). Does anyone else have this problem or do I just suck at managing my diabetics?

NurseGirl has a good point too, the burnout rate for LTC is high and one nursing home administrator once told me that there is an expected worse than usual shortage projected for the next fifteen years. It gets frustrating fast; I threw my smartphone (breaking it) once because of staffing frustrations. Normally I try not to let my aides see me angry. Oh and speaking of aides, treat them like equals and they will take care of you! That isn't to say that you should delegate stuff outside of their scope of practice--don't do that--but demonstrate to them that you are not above doing some of the things that are normally delegated to them. I do pericare, toilet elders and get my own weights on some days and my aides love me for it!

Yes, everything ltcnurse4u said is correct.