Pros vs. Cons of Geriatrics?

suebird3 · Jun 10, 2006

Some older folk can be quite bitter. I have done LTC for much of my career, and have seen it all (at least I think so!) All you can do is treat them kindly, and realize some people just don't "age" well.

Suebird

mandaleigh · Jun 10, 2006

Hey Maryruth,

I think your reasons for wanting to work in geriatrics are valid reasons. You sound like you know yourself well. I, too, feel the way you do in how elders are treated a lot of the time. In the LTC facility I am in right now for clinicals, the CNAs say things like, "what did you go and make a mess like that for? you are stinking up the whole hall!"

I have heard it more than once and THAT breaks my heart.

There are lots of really good LTC places out there that care about the residents' needs, physical AND psychological, take your time and check some out. Good luck in your endeavors!!

NebbyLPN · Jun 10, 2006

i like working in ltc because i have the same patients every day. it does change, but not nearly as rapidly as the hospital. i like being able to get to know more about my patients and i can do that over days and weeks. when i know a patient's routine and the way they like to do things i feel a lot better about being able to help them. i can have their morning pills just at the time they would like them and i can do a little treatment for them before they go to their bingo game. many of these older people are forgetful and i can help them with their memory. despite what people might think, i really do spend a lot of time with my patients, but it's important quality time. i am very sad when we lose a patient. if their family can't be with them during their last moments of life, then i will be.

i suppose the cons of it would be when we are short staffed. everyone has to work a little harder then. occasionally, our don hires a cna who turns out to be a real jerk, but i don't blame the don. anyone can pull the wool over someone's eyes during an interview. we just have to do what has to be done to run these bad aides out of our work place.

indigo girl · Jun 10, 2006

Hey Maryruth,
I think your reasons for wanting to work in geriatrics are valid reasons. You sound like you know yourself well. I, too, feel the way you do in how elders are treated a lot of the time. In the LTC facility I am in right now for clinicals, the CNAs say things like, "what did you go and make a mess like that for? you are stinking up the whole hall!"
I have heard it more than once and THAT breaks my heart.
There are lots of really good LTC places out there that care about the residents' needs, physical AND psychological, take your time and check some out. Good luck in your endeavors!!

Talking to a resident in the manner you just described is considered abuse, and should be reported as such.

indigo girl · Jun 10, 2006

I am a nurse student right now. I am thinking about getting into geriactrics when I am out of school and I'd like to hear the pros and cons of geriactrics. All my family want me to go into it but lets face it what do they know...I want nurses who are actually working in geriactrics to give me the straight up truth about it.
Reason why I am thinking of geriatrics is kind of personal reasons. I saw how much my grandmother's last few years of her life was spent and it broke my heart. Nobody wants to "deal" with old people and I think they get alot of crap/abuse for it. But the other thing that scares me is how some can be extermly rude and mean too. I had both sets of grandparents...the very nice and the very cruel. Any info/opinions would be great thanks!

Hopefully, you will have clinical time in your program in a LTC facility, and experience what is like to practice there. Staffing ratios are a big issue. If you determine geriatrics is for you, I would suggest talking to as many people as possible to find the right place to work in as word of mouth is the best advertisment. Look at ads in the newspapers. If a facility is constantly advertising for nursing staff, it's a clue that there is a problem.

I think it is wonderful that you are interested in this type of nursing.

snowfreeze, BSN, RN · Jun 10, 2006

I have 15 years of nursing experience, mostly critical care. I did 5 years in geriatrics when a facility I worked at closed, I needed some time to decide where to work next. Now I am back in a hospital on a telemetry unit and am considered highly due to my geriatric experience. Geriatrics is bursting at the seams like peds and OB/gyn was when the baby boomers were being born.

maryruth · Jun 11, 2006

Thank you for all the replies. I am not to surprised to hear that there is alot of abuse to the elderly. It is one of the things I have to consider if I can handle jerky people who will do that. Do you think it is just because they are burned out or just bad people? Or way under staffed? I think that is another reason why I'd like to try Geriatrics is because I know there is a real need for it. If you do get burned out from it, is it easy to cross over into something else?

Someone mentioned they liked LTC because it gave them a chance to know their patients a little more and able to give them better care/attention than in a hospital. However, how much does it effect you more if a patient died there rather than in the hospital under your care? I guess what I am saying how do you cope with the grief? Is there a higher turn over for deaths there than in the hospital? Sorry for the silly questions.

Do you think its better in a hospital or at LTC? Which is more exciteing or rewarding?

indigo girl · Jun 11, 2006

Thank you for all the replies. I am not to surprised to hear that there is alot of abuse to the elderly. It is one of the things I have to consider if I can handle jerky people who will do that. Do you think it is just because they are burned out or just bad people? Or way under staffed? I think that is another reason why I'd like to try Geriatrics is because I know there is a real need for it. If you do get burned out from it, is it easy to cross over into something else?
Someone mentioned they liked LTC because it gave them a chance to know their patients a little more and able to give them better care/attention than in a hospital. However, how much does it effect you more if a patient died there rather than in the hospital under your care? I guess what I am saying how do you cope with the grief? Is there a higher turn over for deaths there than in the hospital? Sorry for the silly questions.
Do you think its better in a hospital or at LTC? Which is more exciteing or rewarding?

I would not say that there is a lot of abuse in LTC, but that there is a lot of attention to this problem. There are state mandated inservices held every year to educate staff about what constitutes abuse, how to report it, and the penalties involved for not reporting etc. Why does abuse occur? Ignorance usually, and not knowing how to manage personal frustration. Every facility has policies for teaching staff to identify this problem and deal with it.

Because staff take care of these patients usually over a prolonged period of time, there is a sense of loss when some of them pass on, and we all have our methods of coping with grief. Nurses in the hospital setting lose patients also, and can become attached to them. Patients in the hospital may be more acutely ill, that is why they are there, so it is possible that there is a higher death rate in hospital, I don't know really.

New nursing grads in my experience tend to want to work in the hospital first for experience in dealing with more acute and diverse problems. I have worked with many new grads who went into geriatrics first and regretted not having hospital experience. Some later switched to hospitals and did just fine so don't think you have to go there first. You don't.

Julie frm Dallas · Jun 19, 2006

Well, I commend anyone for wanting to help our elderly. But to be honest, working in a nursing home is no longer where I want to be. It's not because of the resident's, or so much the workload as it is the pure apathetic attitude of my higher-ups.

Frankly, it's all about the dollar do administration. As little staff as you can get by with, and they don't want to ruffle their feathers by correcting them when they know they are being neglectful/wrong. For example, I work double weekend shifts and Saturday night before I left, I placed one of my bedbound res. on her left side facing the door. I came back at 6:30 AM and immediately checked on her, sure enough, exactly like I left her. I asked if she'd been turned all night, her response was a sad "no". This res. is fully cognitive with a bottom that looks like ground beef now.

It doesn't even do any good to report this, noone really cares. I've left so many notes and made so many complaints to the CN, ADON, DON, and nothing ever changes. Patients left on wet sheets all night with only their incont. pad changed, leaving nasty dentures in all night long with a pound of food underneath, finding one gentleman in the SAME clothing I put on (I marked the depends with a sharpee) one week after I Showered and dressed him, full of old and new BM.

Who do you go to about these things when noone there cares? Nothing ever changes.

UM Review RN, ASN, RN · Jun 19, 2006

I really recommend getting some med-surg and possibly cardiac experience before you work LTC.

This is because more and more surgical interventions are being done on an increasingly elder population. They get their joints replaced, they have TPA for strokes, they have heart attacks, bypasses, GI bleeds, colon resections, chemo and radiation. These are interventions that even twenty years ago, were unheard of for certain age groups.

They're pretty routine now.

LTC staff generally do not have a lot of clinical hospital experience. As a result, the subtle symptoms that elders present with can be easily missed.

Some of those subtle symptoms include behavior changes like confusion, combativeness, malaise, anorexia, lethargy. The "cruelty" you mention could have been caused by pain, depression, Alzheimer's, or a host of other conditions--some of which may be treatable.

Believe me, there's nothing cooler than having a 98 yo confused patient perk right up, become alert & oriented X3, and go home after having an electrolyte imbalance restored.

Nowadays, elders who come to the nursing homes have so many comorbidities that it really does them a disservice to not have a good clinical background before working in LTC.

Just my :twocents:

santhony44, MSN, RN, NP · Jun 19, 2006

It doesn't even do any good to report this, noone really cares. I've left so many notes and made so many complaints to the CN, ADON, DON, and nothing ever changes. Patients left on wet sheets all night with only their incont. pad changed, leaving nasty dentures in all night long with a pound of food underneath, finding one gentleman in the SAME clothing I put on (I marked the depends with a sharpee) one week after I Showered and dressed him, full of old and new BM.
Who do you go to about these things when noone there cares? Nothing ever changes.

Julie: You do know, don't you, that you can call the state and they are obligated to come out and investigate? I believe that you can do this anonymously.

I don't think they have to give any warning ahead of time, just show up.

I have a friend who is a DON in a nursing home. She recently had state in due to allegations of abuse. In this case, one staff member was trying to get revenge on a couple of staff members she doesn't get along with. My friend absolutely does not tolerate abuse, and the resident in question is a very alert, verbal patient who would have spoken up, loudly, had anyone abused her.

Call state. Also, if you have not done so, keep a "paper trail" of everything you do. Every time you leave a note, etc, keep your own personal documentation of what you found, what you reported, and to whom. You never know when it will come in handy, particularly if management denies knowledge of things.