slower paced nursing in long term care?

seizetheday · Oct 15, 2011

I haven't worked LTC but in my grandmother's LTC there are a number of later career nurses who have taken LTC jobs to get out of the hospital. I've talked to them and definitely the pace is different. They still look pretty tired at the end of the shift but there isn't the same running around. From what I've seen they walk with the med cart, do documentation while sitting, and go into resident rooms to provide nursing care as needed. They are often at the desk or on the computer (working). Just for reference in her LTC each nurse has 32 residents they are responsible for.

mazy · Oct 15, 2011

Sorry, but the pace in ltc is intense. Anywhere from 20-50 patients, less acuity, but also less staff, less resources, less support from management, more paperwork, an intensely heavy med pass, wound treatments, labs, orders.

Depending on where you work you may also have IVs, PEG care, colostomies, foleys, trachs, etc. etc. If you are an RN you will probably also have supervisory duties as well.

I run non-stop in ltc, and rarely have time for meal breaks, barely have time to go to the bathroom.

Have you thought about home health?

CT Pixie, BSN, RN · Oct 15, 2011

Slower pace and low stress..in a word..NO! Its just as fast paced, but for different reasons and the stress level is just as high in the LTC as in the hospitals

Albeit that in LTC we don't give blood or do procedures that are risky/invasive, the pace at an LTC is GO..GO..Go. And the stress level can get very high, depending on how far south the shift is going.

Huge med passes to an outrageous amount of people, treatments, charting, taking orders, calling docs, families etc, getting calls from those same people, getting new admits/readmits, shipping people out to the ER, consult appointments etc, keeping your residents VERTICAL (that alone will keep you running)...the list goes on and on. Being one of 2 nurses on a floor of 66 pts can be daunting.

But I love my LTC work. And honestly, with the acuity of our patients getting higher and higher, I've been exposed to many more procedures etc than one would think. Medicare wants these people out of the hospital but they are still to sick to be home..guess who gets them..yup the Short-term/LTC facility. I work on the LTC wing but frequently get patients who are short term who agree to take a bed on the LTC floor so they can get in, get their rehab etc. Even my LTC people are very sick..you aren't just seeing the typical 'old' people things anymore..its mixed in with a mishmosh of high acuity illness/diseases.

Nascar nurse, ASN, RN · Oct 15, 2011

ummm...with all due respect - just skip that upper post. Trying to "walk" that med cart around and give meds to 30 some people in a two hour time frame is NOT slow paced. While it may "look" easy there is nothing easy about it. I suppose you could find a place that services general long term care, stable residents but most places are skilled rehab settings that have IV's, trachs, wound vacs, Gtubes, complex wound care, etc.

If I were you I would look at assisted living facility or maybe a home health setting.

CT Pixie, BSN, RN · Oct 15, 2011

Ditto what Mazy said..."IVs, PEG care, colostomies, foleys, trachs, etc. etc. If you are an RN you will probably also have supervisory duties as well"

I had 4 of my 33 with IV's, more PEG;s than I care to talk about, 2 colostomies and one urostomy..added in with the 17 insulin dependent diabetics I have, oh almost forgot my 3 dialysis patients :)

Lucky724 · Oct 15, 2011

Have you thought about a doctors office? health department? home health? hospice? insurance company?

roser13, ASN, RN · Oct 15, 2011

I haven't worked LTC but in my grandmother's LTC there are a number of later career nurses who have taken LTC jobs to get out of the hospital. I've talked to them and definitely the pace is different. They still look pretty tired at the end of the shift but there isn't the same running around. From what I've seen they walk with the med cart, do documentation while sitting, and go into resident rooms to provide nursing care as needed. They are often at the desk or on the computer (working). Just for reference in her LTC each nurse has 32 residents they are responsible for.

LTC cannot by any stretch of the imagination be considered slow-paced. "Walking" with the med cart isn't quite as sedentary as this post implies.

mazy · Oct 15, 2011

I had 4 of my 33 with IV's, more PEG;s than I care to talk about, 2 colostomies and one urostomy..added in with the 17 insulin dependent diabetics I have, oh almost forgot my 3 dialysis patients :)

Oh wow yeah, the uncontrolled, non-compliant, QID insulin dependent diabetics, the narcotics -- twenty patients on scheduled and PRN narcotics at the same time,; all the patients going out for appointments that transportation always forgets; the unmanagemable dementia and combative psych patients, the falls, everyone falling...."keeping the patients vertical" will be my new mantra.

nola1202 · Oct 15, 2011

home health is fast paced in a different way. If you want to make money (and it will be much less than hospital nursing) you have to be organized and self disciplined. The admissions take a long time to complete, every 60 days your client will need to be recertified by medicare (not as bad as an admission)

When your pt goes to the hospital there will be a post-hospital visit with even more paperwork. The driving can be very stressful, then clients aren't home, visits are thrown off for the day. I used to start at 7 in the morning and finish at 6 at night, then spend evenings finishing paperwork. There's the labwork that has to be drawn and taken to the lab, out of the way and costing visit time. There's time spent at the office getting supplies for your clients. IV cases can go over an hour if the pt isn't teachable so can wound-vacs and dressing changes, family questions teaching. Oh yes and the deadlines for paperwork. Admission 24 hour turnover time, post-hospital 24 hour turnover. Recerts due in a 5 day window. (at least at my agency)

seizetheday · Oct 15, 2011

LTC cannot by any stretch of the imagination be considered slow-paced. "Walking" with the med cart isn't quite as sedentary as this post implies.

I don't think I implied that walking is sedentary or did I say LTC was slow-paced. Every LTC nurse will have their own experience. According to the ones I have spoken to and observed at my grandmother's LTC, they do state they prefer the pace of LTC to hospital and that is slower, although not slow. They chose to go to LTC in their later-careers for the change in pace. You may have had different experiences but that doesn't negate theirs. I was responding to the OPs question not telling you what your experience was. Perhaps in other places they do run non-stop and never sit down, however this isn't the case at the LTC I have experience with. The med cart has so much on top that if they ran with it, there would be trail of cups, straws and papers on the floor. They walk the med cart to one location and do meds for about 6 rooms then move the med cart and repeat. They stop and chat with residents, the evening nurse actually often sits and watches TV for 20-30 minutes with my grandmother each evening. What they mostly get stressed and upset about isn't the pace or the residents but the admin and the politics, frustrations with CNAs and staffing woes.

Forever Sunshine, ASN, RN · Oct 15, 2011

I don't think I implied that walking is sedentary or did I say LTC was slow-paced. Every LTC nurse will have their own experience. According to the ones I have spoken to and observed at my grandmother's LTC, they do state they prefer the pace of LTC to hospital and that is slower, although not slow. They chose to go to LTC in their later-careers for the change in pace. You may have had different experiences but that doesn't negate theirs. I was responding to the OPs question not telling you what your experience was. Perhaps in other places they do run non-stop and never sit down, however this isn't the case at the LTC I have experience with. The med cart has so much on top that if they ran with it, there would be trail of cups, straws and papers on the floor. They walk the med cart to one location and do meds for about 6 rooms then move the med cart and repeat. They stop and chat with residents, the evening nurse actually often sits and watches TV for 20-30 minutes with my grandmother each evening. What they mostly get stressed and upset about isn't the pace or the residents but the admin and the politics, frustrations with CNAs and staffing woes.

I'd love to sit and watch TV with my residents. But I don't have the time. That might be specific to where your grandmother is but where I work we fuss over the pace, resident acuity, politics, CNAs, and staffing every night. lol

When one thing hits the fan in LTC, everything else follows. Last night had 2 residents to send out to the hospital, thankfully they were both stable and not 911s, but that doesn't mean I can sit and play Angry Birds while getting everything ready for transport. I still had 25 patients who all get 4:30pm meds, fingersticks to be done before dinner which was rapidly approaching in 10 minutes, 5 of them wanted a pain pill, this one cant breathe, this one is going to throw up, this one has a bruise that wasn't there yesterday, this one is refusing care.

I've said this before in another post and I don't mean to be snotty but, 'Don't judge until you've walked in our shoes."