Stigma with LTC

Music in My Heart · Apr 24, 2011

What is the problem with Nurses wanting/having to work LTC?

For many nurses, the image of nursing that brought them into the field was that of a hospital specialist nurse (e.g. OR, ER, OB, ICU, etc) which is very, very different than SNF work. Many people find themselves very disappointed at being unable to secure the kind of employment that they were hoping for.

SNFs also present a very unique set of challenges.

Is it that much of a last resort as opposed to working hospitals?

For many people, yes.

If you're good at it and enjoy the work, what's the problem?

If you're good at it and enjoy it, there is no problem at all. The work is very important but it's most definitely not for everybody. Personally, I would hate it.

Is it the patient/nurse ratios?

That seems to be part of it. A lot of SNF nurses express frustration over the difficulty of providing decent care given the enormous numbers of residents for whom they're responsible. It can also be a real challenge to find decent CNAs to work in SNFs.

The overall atmosphere of the Nursing Home environment?

That's what it is for me. I would never, ever want to live in one for precisely the same reason. I know that there are excellent SNFs out there - so I'm told, anyway - but the ones that I've been in seem to be little more than warehouses for people and are depressing as all get out.

I don't get it.

Spend some time in a SNF and decide for yourself.

Some folks just love working there and are (presumably) very good at it. Other folks couldn't stand the thought of it.

Do what's right for you and don't worry what anybody else thinks.

caliotter3 · Apr 24, 2011

I suspect that lately there is less of a stigma attached to the paychecks coming from LTC facilities, as nurses find it more difficult to get those desired hospital jobs.

bsveillon · Apr 24, 2011

I guess for me, it's hard to see some of these patients get neglected by their families. I KNOW IT'S NOT ALL PATIENTS!!! I know that just because your family is in LTC it doesn't mean you've forsaken them. But it does happen. There's sad cases. There's people with no family left. There's very proud people left to depend on others and would rather die than do that. That's all over health care. But, going to work EVERYDAY with the same people. Seeing them come up and down, over the years, they become your family. Much like in a smaller hospital when the same patient makes frequent stays along their journey with cancer. The longer they go, the more often you see them.

I think we all know that that's a part of nursing and I think most of us can deal with that on a healthy level. I also think it's somewhat easier to be in an E.R. or L & D or places like that. You still see hard, heart-wrenching cases, but, I guess it's like they're not so attached as someone you've provided care for for a long time.

JulieCVICURN, BSN, RN · Apr 24, 2011

I think that is some circumstances it can be a very depressing job, because you're not really healing anyone, you're maintaining people who are never going to leave the facility by walking out the front door (most of them - some are there for rehab). Also, it's just a fact that doctors are often dismissive of LTC nurses. I have a friend who loves working with the elderly. She started her career as an LPN in LTC, and after 6 years in ICU has decided to return. She tells me there's a huge difference in the level of respect from the physicians, and these are the same physicians who know her former role as an ICU nurse.

Mind you, I'm not saying it's a job that's futile or not worthwhile at all. Eventually many of us will end up in an LTC, and I hope to God I have a nurse who knows her **** and cares about the residents when it's me or my mother or anyone else I love. I just think that it can seem pointless sometimes, because the majority of your patients aren't going to "get better" and leave.

On the flip side, though, the relationships you can build with these patients carry their own rewards.

Derek1975 · Apr 24, 2011

I think the situation varies by the home you're in. I've seen some facilities you could easily mistake for luxury hotels (mostly in the richer parts of town, as you'd think it would be) and some that were old, rundown and even had rat infestations that no one seemed to be in a hurry to get rid of. If I were to wind up in that particular area of nursing, I think I'd rather do home health, which makes sense since I'm a CNA in home health now. So yeah, in a way I do understand why, but until reading some of these threads, I didn't think the prevailing attitude was so widespread.

joanna73, BSN, RN · Apr 24, 2011

There is a stigma attached to aging in general, but someone has to care for seniors. I really enjoy LTC, which is actually a mix of acute, psych, and palliative care. Yes, they are going to die, but so are we all. We hope to make them comfortable and happy in their final days. I don't find LTC depressing. After all, how long do you want/ expect to live when you're over 90?

Furthermore, LTC provides a great means of developing time mgmt skills. It is a specialty just like emerg, ICU, peds. We need nurses in all of these areas.

JenniferSews · Apr 24, 2011

Part of the stigma isn't how those of us working in LTC or sub acute rehab feel. It's how we are perceived by the rest of the nursing world. Like we have no real skills or critical thinking ability, just there to push pills and go home while our patients lay in their own filth getting stage 4 bedsores from not being turned for days. But the population in LTC and SNF are becoming increasingly acute and it isn't like it was 30 years ago. Heck half the patients in our facility wouldn't have survived to make it to a LTC or SNF 30 years ago!

Hospitals in my city don't consider SNF as nursing experience.

iceprincess492 · Apr 25, 2011

I think alot of the attitude (especially on here) is from nurses who work in other areas of health care THINKING that nurses who work LTC are not as important/competent as hospital nurses, if they can't get a "real" job they go get one in LTC until they can get a real job. I have been in LTC for many years and for the most part the nurses that work there are there because they want to be not because they couldn't get hired in the hosp.

I LOVE LTC and wouldn't work anywhere else but I honestly get tired of defending it to people who don't know anything about which they are speaking. And yes I totally realize that there are bad nursing homes out there just as there are bad hospitals, dr offices, clinics etc..... One bad hospital does not make all hospitals bad or all employees of that hosp incapable of getting a real job.

In nursing just like all other professions what area you choose to work in should be just that...your personal preference. It's unfortunate that others in our profession try to make those who work in LTC feel bad about their choice

N.U.R.S.E. · Apr 25, 2011

What.s the big deal let me tell you this I just started a new job and I have to pray e3veryday because the workload is astronomical I have to give meds to@least 30 pts 7 of whom are tubefeeder I have to give accucks med @4@6@8 and @10 3different. Times for scheduled insulin chart on@12 people answer the phones doors family dr and accountable for can make sure everyone is fed monitor and record i&o. Body audits. And other duties I love what I do I just think that there ought to be a mandate for how many pts 1 nurse can have cnas have mandates why not nurses and heaven should forbid if falls or has to go out ou have to stop what u are doing 2 handle call all those who need 2 know I am only 1 person and this is the norm in nursing home instead of hiring more nurses ltc rather invest in lawyers. To save money they figure the payout maybe 3million rather spend 3.5 million on extra staff never mind the reputation in the community follow the money I went into nursing bcz I like taking good care of those in my charge almost next to impossible with such a high pt /nurse ratio

Hospice Nurse LPN, BSN, RN · Apr 25, 2011

There is a stigma attached to aging in general, but someone has to care for seniors. I really enjoy LTC, which is actually a mix of acute, psych, and palliative care. Yes, they are going to die, but so are we all. We hope to make them comfortable and happy in their final days. I don't find LTC depressing. After all, how long do you want/ expect to live when you're over 90?
Furthermore, LTC provides a great means of developing time mgmt skills. It is a specialty just like emerg, ICU, peds. We need nurses in all of these areas.

I really enjoy working w/ seasoned citizens! I'm a hospice nurse who sees pts in the LTC facilities. I LOVE getting to know my pts and their families. I know each one of them are going to die (some sooner than others) but I can make their last days comfortable and even happy @ times. I have also had the pleasure of knowing some of the residents who aren't my pts. There are always a couple of "Chatty Cathys" on each hall. I worked for a few years in LTC as the nurse. It's difficult to juggle 30 some residents even if you do have a couple of good CNAs. Between meds, tx, wound care, phone calls, charting, etc. it's hard to spend more than a couple of minutes/shift w/ each resident. I admire the nurses who do work there.

chlori · Apr 25, 2011

It goes back to what do you want to do with your nursing degree? I started off in long term care many years ago as an STNA, then an LPN, then an RN, and now 6 months out from my BSN....and still work in long term care, and by no means am I incompetent like that stigma out there portrays. I actually had an opportunity to take a position for an internship not too long ago at our city's only trauma hospital and I turned it down. I love long term care. Yes, I have worked the 40 to 1 ratio and I still loved it then because in the end you do build strong relationships with your residents and their families. Now, I do not work on the floor currently. I work on the finanical side of things, but I still love it, and I still love my residents. So it's all in what you want to do. This current position I have has actually changed my career path from wanting to obtain my NP degree to wanting to get an MBA because I love the business side of things as well, so my career path I have chosen was for a reason. So, if you should decide to remain in long term care, do not worry about what the general public has to say. Us long term care nurses are not incompetent by any means, and when those who put long term care down instead of trying to bring it up, will be glad when them or their loved ones show up at the front door and a nurse like me who knows her sh%t is there to care for them and their family.