The Cons of Working in Long Term Care

Based on my experiences as a floor nurse, charge nurse and supervisor in the long term care industry, I have compiled a list of cons associated with this type of nursing. Keep in mind that some facilities are managed far more effectively than others. Your mileage may vary. Specialties Geriatric Article


I worked as a floor nurse and supervisor in long term care (a.k.a. LTC, nursing homes, or aged care) on and off for six years. Last year I wrote two articles that placed a mostly positive spin on working in the LTC industry. This year I will attempt to balance the beam by discussing the drawbacks of working in nursing homes.

I have constructed a list of various cons associated with long term care nursing. Some facilities are staffed adequately, managed competently and stocked with abundant supplies while other nursing homes have neglected to rise to the occasion, so your mileage may vary.

1. The acuity level in LTC is rising.

The acuity level in LTC has increased greatly in recent years due to pressure to discharge patients out of the hospital faster. Some of the LTC facilities where I once worked often received patients who were only two days postoperative. I dealt with JP drains, surgical incisions, IV antibiotics Q4h, central lines, and other stuff that was once the within the strict realm of the acute care hospital.

2. High nurse/patient ratios are typical.

As a result of dwindling reimbursement rates from Medicaid, Medicare and other payor sources, the typical LTC nurse is responsible for providing care to a large number of residents (often 30+).

3. Shortages of supplies are typical.

Supplies such as tracheostomy cannulas, colostomy bags and indwelling urinary catheters might be unavailable or difficult to locate when the nurse needs them. Equipment such as feeding tube pumps and nebulizer machines might very well be unavailable, depending on the LTC facility.

4. The lack of staff is prevalent.

I've worked at multiple nursing homes. None of them have employed a unit clerk, a full time respiratory therapist, and so forth. Nurses and CNAs call off at the last minute, which causes staff to work short-handed. The LTC nurse must take off his or her own orders and do all admission paperwork because there's no unit secretary to do it. The LTC nurse must perform all respiratory treatments because, in many cases, no respiratory therapist will be on staff.

5. Incompetent employees can fly under the radar.

Incompetent employees can somewhat fly under the radar and still maintain employment at certain LTC facilities. You might have aides who sleep during the night shift. There will be the occasional nurse who continually ignores residents' concerns until relatively minor situations turn into code blues.

6. Society devalues the frail elderly.

Our society views the frail, isolated elderly with a certain degree of disdain. However, many people fail to realize that today's LTC population is actually a mixed bag of younger adults, middle-aged Baby Boomers who are sick due to hard living, and the frail elderly. For instance, my youngest resident was in her late 20s and stayed at the LTC for several weeks while receiving IV antibiotics every four hours for infective endocarditis that was caused by slamming heroin.

7. New employee orientation / training time is minimal.

The lack of orientation time is prevalent. Some fortunate nurses have posted that they received several weeks of orientation. Personally, I have never received more than a few days of orientation at any LTC facility.

Specializes in long trm care.

I cannot agree more LTC has always been hard but now it is a total disgrace the staffing levels are horrible. I have seen 1 nurse almost always an LPN with 60 pts! And acuity is ridiculous pts straight from ICU to a nursing home what the hell kind of crazy crap is this? Who the hell is supposed to care for these people? The LTC nurses donnot have resources or experience with these pts are that are forced on them by corporate greed. It literally is driving LTC to the brink of collapse it cannot continue to operate by pushing more work on remaining staff. And the idea of getting more nurses by bringing in higher acuity pts is so out of touch with reality it is laughable! Completely corporate greed!