school debate over nursing in LTC

racing-mom4, BSN, RN · Sep 30, 2008

Some people love LTC nursing while others despise it.

I do think the majority of the people think LTC nursing is easy, or not really nursing. What most people dont think of is LTC nursing is very independant nursing, they dont have a code team, or phlembotomy to draw thier labs, or an IV team,they dont have an ER doc that can come up and assess a pt or make a call.

Usually there is 1 or 2 RNs and maybe a few more LPNs for a huge amount of patients. LTC nurses really must provide not only full physical care and emotional care but also have to critically think.

I totally respect LTC nurses, it is one of the most difficult yet rewarding nursing jobs. I worked a few years as a CNA in LTC and let me tell you, I never worked so hard for such little money ever. But I do feel I did make a difference in some patients lives.

Hats of the the LTC staff.

Flames9_RN, BSN, RN, EMT-B · Sep 30, 2008

LTC easy, wow, never heard that! I'm only a student as well and have completed 1 rotation at a LTC, wasn't easy, lots to do!!

Advantages: Closer to your patients, as they are permanent residents, so you really get to know them, and many really appreciate you.

Disadvantages: They aren't getting any younger, so can be a bit depressing!!

linzz · Sep 30, 2008

I would say that you wear many hats in LTC. If you change shifts, in addition to passing meds, you will supervise staff, update care plans, reconcile medications and labs, contact doctors and admit patients. Because in Canada, we are very short of doctors, a ton of responsibility rests on the LTC nurse. When we send patients out to the hospital, it is either the LPN in charge or RN that decided on this, not the Dr.

TopazLover, BSN, RN · Sep 30, 2008

One of the greatest advantages I found was continuity of care. You see the same people over time so you recognize subtle changes that might indicate start of infections before they get too bad. You know how to handle a person with dementia by doing things the same way all the time.

Another is use of critical thinking skills as you don't have quick and easy assess to MDs. They learn to trust your judgment and accept your assessments. I have found most to be really open to questions as they know you are looking out for the residents, not just your lic.

It is easier to plan your day. You know what you have to do and have fewer interruptions except for emergencies.

One of the greatest down sides is the attachments you make with residents and their families when you lose one. Up side of this are those same attachments. You are there in the place of family members in many cases.

You learn medications and their side effects very well as even low doses of meds give more effect in elders.

You get creative in ways of getting PO fluids into people who don't feel thirst as easily as younger folks.

Hope these help. They have made my days on many occasions when I missed the hustle of more critical care settings. :specs:

TopazLover, BSN, RN · Sep 30, 2008

I just re-read your post. Disadvantages include lack of professional growth in keeping up with new technology.

Loss of skills for many advanced techniques.

Lack of immediate access to many support personnel.

biker nurse · Sep 30, 2008

15 years in LTC . LPN to RN. I know I can't hand a 13 y/o a baby. I know I can't take care of a child who has been abused and not strangle their parents. I know I can't watch a loved one freak in the Er(I've lived that one) I know I can hold the hand of an elderly lady and reassure god is waiting for her. I know I can give a lollipop to a man who wheels all over the building who can barley see or hear and see him smile and say thankyou.

I know I can tell the lady how beautiful she looks comming out of the beauty shop and she will smile like I gave her a million dollars. I know if I miss a day of work I will be missed. I know the little things in life are important and appreciated.

When I first became and LPN the nursing home was the only place hiring LPN's I swore I'd never do it. I swore I'd hate it.

Now can't see me doing anything else. Yes I have worked in other places THAT I hated!!

I could go on forever but other people may want to post. :nurse:

Ms.RN · Oct 1, 2008

i dont know if its just ltc but i work with doctors and other staffs with bad attitudes. many times they bad mouth each other or the residents and managers put up with this kind of behavior. my only experience in the hospital are when i did clinicals in nursing school and the staff and doctors seemed to be pretty nice. plus i have to put up with lot of biases from management, from don telling nurses that we have to call her before calling doctors when there is a change of condition, nurses are being blamed when patients falls when it is in fact a managers telling us we are suppose to be a restraint free facility.

right now i'm to the point of feeling like my job is not rewarding, its just a job to earn a check. i feel like i'm not learning anything because i'm doing the same kind of work everyday. many times i'm sitting down and wondering what i'm suppose to do?

southernbeegirl, BSN, RN · Oct 1, 2008

15 years in LTC . LPN to RN. I know I can't hand a 13 y/o a baby. I know I can't take care of a child who has been abused and not strangle their parents. I know I can't watch a loved one freak in the Er(I've lived that one) I know I can hold the hand of an elderly lady and reassure god is waiting for her. I know I can give a lollipop to a man who wheels all over the building who can barley see or hear and see him smile and say thankyou.
I know I can tell the lady how beautiful she looks comming out of the beauty shop and she will smile like I gave her a million dollars. I know if I miss a day of work I will be missed. I know the little things in life are important and appreciated.
When I first became and LPN the nursing home was the only place hiring LPN's I swore I'd never do it. I swore I'd hate it.
Now can't see me doing anything else. Yes I have worked in other places THAT I hated!!
I could go on forever but other people may want to post.

Thank you for saying everything I was thinking.

I won't BS you. LTC is hard work. I worked in the hospital and had at most 6 pts on the med surg floor. Those same 6 patients are also the same type in my LTC and my nurses have 15-20 patients a shift. It's hard work and more often than not you are not appreciated by the company who is just in it for money.

But the rewards....oh how many there are. :redbeathe

I truly believe it's like OB, you either love it or hate it. If you were to see my in an OB unit you might want to run,lol. but if you have a family member that has broken a hip, had a stroke, has dementia and needs a caring hand to hold, have a terminal family member that needs a smile and a shoulder when it hurts...then i'm your girl.

Like I said...it's hard work, long hours, staffing that makes you want to run out the door screaming...and i wouldnt trade it for the world! :nurse:

Dizneynurse · Oct 1, 2008

I work in LTC. We are 120 bed facility in Florida and we usually have 4 nurses in the entire building per shift (usually all LPN). We are only required to have one RN shift in the building in a 24 hour period. I love LTC because I really get to know my patients and their families. They come in and stay. I get to see them day to day and can recognize changes in their demeanor and condition because I really know them. It's not easy however. When you have 30 patients to yourself, doctor's writing orders, pharmacy coming in to do audits, the patient's hovering at your cart like ur giving away a prize, patients screaming r/t needing prn meds...it can get overwhelming. I got into nursing so I could know my patient's and LTC is the way to go. When I did clinical rotation in a hospital I found myself wondering what happened to the pt when they went home. You never see them again and never know how they made out. That's not the case in LTC. When I leave my pts in the capable hands of my coworkers, I come in the next day to a full report of what's going on with them. Good luck on your project!!

SunnyAndrsn · Oct 1, 2008

Advantages:

-relative consistancy

-developing relationships with residents

-ability to help someone leave this life with dignity and respect

-Fast paced (good if you like it)

Disadvantages:

-Most of your pts. will not leave until they die

-good percentage of pts. will have dementia--may be challenging to deal with.

-Many places are understaffed.

-One of the lower paid nursing positions.

Like any workplace, your co-workers can make or break the situation. I've had fabulous nights under otherwise trying circumstances because of the support of my co-workers. On the other hand, a few whiners or cat fights between CNAs can make for a very difficults night when everything else is going right.

I hate to admit, I did not have the best of opinion of LTC, despite being an LTC nurse. I have very supportive co-workers and management (overall) yet I did not see the importance of the work I was doing, or that this really was a SKILLED nursing facility (stress skilled--I felt like a pill passer for the most part.)

Then we hired an RN who had worked cardiac for the past two years. I had her with me for orientation one night. My goal was to introduce her to the pts., have the two of us do the med pass together to familiarize her with routine, and point out some of the common meds seen in LTC. She was dis-interested in the residents, and would have made a lot of med errors without me there. When it came time to show her our treatment book, she asked "when can I leave, the med pass is done, right?"

The realization hit that I'm not just a pill passer! I was like, wait! There is so much more...We make sure these people are cared for, we make sure their skin is healthy, they are getting turned, their eating/drinking, we watch for s/s of dehydration, we monitor weights, we do weekly summaries on their ADL's, meds, acute med. condition, etc...all to make sure we're providing the best care possible.

I then found myself mad at that new nurse for failing to see our residents as important, worthy of love and attention...I realized it's a skill to have a meaningful interaction with them and assess them quickly. I realized it's a skill to have my residents say "I'm going to miss you this weekend when your off", and you realize they are keeping track of your schedule because you mean something to them.

LTC is a not for the faint of heart!

-

In my transition to professional nursing class, we are having a debate over advantages & disadvantages of working in long term care. Does anyone have any input on advantages or disadvantages of working in long term care?
Much appreciaited!

SunnyAndrsn · Oct 1, 2008

I know I can tell the lady how beautiful she looks comming out of the beauty shop and she will smile like I gave her a million dollars. I know if I miss a day of work I will be missed. I know the little things in life are important and appreciated.
When I first became and LPN the nursing home was the only place hiring LPN's I swore I'd never do it. I swore I'd hate it.
Now can't see me doing anything else. Yes I have worked in other places THAT I hated!!
I could go on forever but other people may want to post.

Yup, I felt the same way...I still don't think I'll stay full time after my RN is finished, but I do think I'll stay on-call. I'd miss my people too much.

Oh, and today was our beauty shop day! I love it!