Stigma with LTC

Rabid Response · Apr 25, 2011

While I don't think less of RNs who work in LTC, I personally would not want to be a nurse if that was the only job I would ever have. Passing meds and supervising unlicensed personnel are two of my least favorite aspects of nursing, so a job that consisted mainly of those activities does not appeal to me in the least. I do know some nurses who have worked acute care but prefer LTC. It's just a matter of preference. Anyway, my organizational skills and ability to delegate are so bad that I wouldn't last one day in a SNF.

Juwon · 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.

I love it, she made an excellent poing of LTC nursing

JenniferSews · Apr 25, 2011

I would like to also point out a lot of people posting "I wouldn't be happy in LTC because I don't like x,y,z" obviously don't work in LTC and don't seem to have tried. I'm not argueing that they should, or that they might be happy if they tried. But to post that they would not be happy when they have no experience just feeds into the idea that LTC is somehow settling or less than other specialties. Yes, the med pass sucks, but that's not ALL we do and therefore if you don't like passing meds you should be grateful not to be in LTC. Those types of comments just perpetuate the issue.

joanna73, BSN, RN · Apr 25, 2011

I can also add that I've worked med surg and acute. Quite honestly, it isn't all that different on those floors than it is working LTC, where I am now. I'm not really sure why some people feel that LTC is so different. We have meds, IVs, suctioning, wound care, etc...just as you do in acute. The difference for LTC is that you have 30 patients instead of 6, and they live there.

hope3456, ASN, RN · Apr 25, 2011

I live in a rural community where there is a really crappy hospital and a really nice LTC. The LTC is fullly staffed with RNs when they really only have to hire LPNs. Many of these RNs have alot of acute care even critical care experience but the ratios and working conditions are so bad in the hospital so nurses who want to stay in the area have few other choices for employment.

The hospital, on the other hand, is hurting for help mainly b/c they just cant retain their staff. Kinda sad.

milwerica, MSN, APRN · Apr 25, 2011

I work in a skilled nursing facility... that is what I say and it tends to not have that stigma. I am in the acute setting type rehab... lots of dressing changes, trachs, wound vacs, peg tubes, picc lines, therapy, therapy, therapy, MD appointments and critical thinking because I do not have an MD on site 24 hours a day to call when someone goes unresponsive or when someone is confused out of the ordinary or if their wound is goeyier than normal.. I honestly critically think more in SNF than I did as a nurse in the hospital... I assess every time I see a resident... and I have 25 of them, all with acute care needs... and I LOVE IT!!! Never would I apply to a hospital now because I am using my nursing skills every second! All should rethink what they think long term care is because it is an evolving field with much more acute care patients there for rehab to go home...

shouldabeenabarista · Apr 26, 2011

I believe the stigma comes from many lazy people who are drawn to LTC because they THINK it's an easy job or at least easier to slack off at. If those people are at a place they bring down the entire reputation of the facility.

Meanwhile, the hardworking nurses at the facility are asked by well-intentioned people "oh you're such a good nurse, why don't you work at the hospital?"

Come on, I know you all have heard that one! :flamesonb

gentlegiver, ASN, LPN, RN · Apr 26, 2011

LTC is a very demanding job. On any give day you are overworked, short staffed, lacking supplies and support from the higher ups. The position calls for you to be Nurse, caretaker, emotional & physical support for elderly who can no longer do for themselves and who often have no family to help them. It is at the same time overwhelming and underwhelming. It takes a special type of person to care for a confused/demented/Alz. pt, to give the best care you can while the pt is pushing you away from fear/pain, to recognize thier current condition and act on what you see. All the while you may have between 20 and 30 pts all NEEDING the same quality care and time.

You deal with families who are just as confused by what is happening to thier family member, perhaps they feel guilty because they cannot take care of the person who always took care of them, or because they are burnt out from trying. And they strike out at the Nursing staff because they want the very best care, but can't recognise that the overworked CNA and Nurse can't toilet everyone, put everyone to bed, be in all the rooms, answer all the callbells at the same time. To them, thier family member IS the most important person on the floor and therefore the other patients can wait while you get water, pain med, snacks, another warm blanket. Unfortunately, the family members of the other patients feel the same way.

And while you are running around trying to take care of everyone, you still have meds to pass, treatments to do, assessments,admissions, discharges, keeping all pts safe from falls, dehydration, failure to thrive, help answering callbells, and the phone, making judgements based on assessment findings, answer Dr's calls and record/initiate the orders that go along with them. Then there is the ever present paperwork, LTC is highly regulated which means constant charting on every aspect of care given, current physical and mental health, how much they ate, drank, pooped, peed, VS, abnormal labs and again call the Dr, any new orders, did they walk, self propell in w/c, cooperate with staff, how they got along with roommates and other residents.

In order to do this job you must have the patience of a Saint, be as firm as a rock, as tender as a new born chick, and have all the superpowers ever thought of, you must be able to run like a leopard from one room to another while keeping an eye on those still in the hallway/bathroom/TV room, be able to give report/answer questions about on every person in your charge to Dr's and proxies on demand.

No it's not for everyone, but for those of us who can walk away at the end of a shift and feel like we just might have suceeded in helping someone feel better,be free of pain, caught something before it became a major problem, it is soooo worth it! I personally don't care that hospital Nurses look at my job and think I'm not doing real Nursing, I KNOW that I am!

tewdles, RN · Apr 26, 2011

Personally I think the stigma results from ignorant and uninformed comments from nursing professionals who have not and do not work in that environment.

jlynn2303 · Apr 30, 2011

Wow, have I noticed this. I am a new grad RN and started looking for hospital work, when that didn't pan out, started applying to LTC and got a job right away. I had heard in school and on these boards that it is best, no matter what you do later, to get a year's medsurg experience before doing anything else. I have also heard that "while looking for a hospital job" to get an ltc job for the experience. I have also heard that once you do ltc you will not be hired in a hospital. Wow. So far, I like it, but I am still in orientation, and, like any job, it takes awhile to find out what things are really like. Right now I spend a lot of time looking for things! One of the things I have found most unpleasant is the ranking/tension amongst the staff. It is mostly STNA's and LPN's with a couple of RN's. Nursing is second career for me, and I got my BSN because it was actually faster than an ADN where I live. Boy, the competition? Eating of young? between different types of nurses is brutal here. The STNA's who are in nursing school all say that as soon as they get their ADN's they are out the door and into a hospital because who would work in ltc once they are a nurse? The LPN's who are studying for ADN's all say the same thing and look at me like - why are you working here? It's crazy. There's resentment out the wazoo. I just want to take my name badge off and say - can't we just work together?! I didn't do anything wrong by getting a BSN! (I noticed this tension in the hospitals during clinicals as well.) The pay isn't that different, and while there are a lot more patients, and I am not used to being in management (i.e. having to oversee stna's) there is certainly a lot to learn. I sure could do without the competition, though.