Thinking of switching from acute care to LTC

Long Term Care Columnist / Guide · Dec 16, 2007

Personally, I hated working in nursing homes---the residents' lives are too highly regimented, IMO, and the paperwork is horrendous. But I adore assisted living, which is where I've been working for the past two years and intend to stay with. The residents tend to be more alert and functional than those in LTC, although we do have dementia patients and a number who need a great deal of hands-on care. There is lots of paperwork in ALF too, but not as much as in the nursing home setting, and as a nurse you would have quite a bit of autonomy. Your acute-care skills will also serve you better than you might think in such a facility---you're the one who will recognize that subtle change in a resident that could signal an impending stroke or MI, and deal with the emergency if or when it occurs.

Being new still, you may want to get another year or two of experience before you make the leap, because you also have to learn to be a manager as well as a nurse. I will also say that the pay is not great when compared with hospital nursing, but the stress isn't half of what I experienced in my Med/Surg floor days.

JMHO.

SuesquatchRN, BSN, RN · Dec 16, 2007

Well, med/surg is largely geriatrics with an acute illness. You're well ahead.

I miss LTC. There are aspects I hate, such as insane regulations designed to protect residents that actually end up hurting them, and the inevitable inability to attract aides, but you also have a lot of autonomy, you have standard standing orders for your usual conditions - you don't need to notify the MD that you need a tylenol - and you devlop close relationships with your people. And you make a difference.

BarbaraNP · Dec 16, 2007

In another life, I worked 15 years in critical care. Never thought I'd want to leave. But I was getting burned out. So, I reduced my hours and started looking for something new. I found a job doing "staff development and infection control" in a small nursing home a few hours a week. They hired me to teach the nurses assessment skills along with doing the infection control. I loved it.

But I also learned about the lack of respect that LTC nurses get. One evening, I was called to help someone assess a pt who was not responding. Clearly, to this then ICU nurse, the pt was septic, and no advanced directive in place. We called the medics to transport her. The medics treated us like morons. So, imagine my great delight when the very next night the very same medics brought me a patient in the ICU. The look on their faces was priceless!

Seriously, LTC nurses need more skills and knowledge than hospital nurses as far as I am concerned - you are there essentially alone - none of the support and staff that you will find in the hospital. I found it both satisfying and heartbreaking. While I did not stay in it for years and years, it did change my life. While I was there, I was approached bout becoming an NP...that was 20 years ago.

I have a great deal of respect for good LTC nurses.

Long Term Care Columnist / Guide · Dec 16, 2007

Alas, it IS rather a surprise to hospital staff, EMTs, doctors etc. when they learn that the long-term care nurse has a brain..........

Daytonite, BSN, RN · Dec 16, 2007

you are going to find that a lot of the sick med/surg patients that seem to get discharged too early end up in ltc facilities. as an rn in ltc you are likely to get placed on their medicare wing, if they have one. that means you'll get those patients coming from the acute hospital that are sick and you will be very busy with them.

i've worked both ltc and acute hospital and i like both venues. in ltc you really need to be well organized and hone your leadership skills. you will be a charge nurse and will have to handle all kinds of problems and squabbles that come up with the cnas. this will be new to you as this kind of stuff doesn't necessarily go on in the acute hospitals. the work, for the most part, however, is fairly routine. but, you will be constantly busy. you will get to know your patients very well.

ltc is highly regulated and there are a lot of laws that they have to follow. you'll hear your other charge nurses mention this all the time. much of this regulation came about because of abuses going on many years ago when patients were literally dumped in these facilities and treated terribly. the states and federal government had to step in to clean it all up. the laws stayed. you can view them here:

http://www.cms.hhs.gov/certificationandcomplianc/12_nhs.asp the medicare conditions of participation (title 42, section 483 of the federal law) that apply to nursing home - to view the actual laws, click on the "42 cfr part 483" link at the bottom of this web page.

i never felt that ltc was in any way inferior to hospital nursing. it is just a different venue. there has, for many years, been an attitude that ltc nurses are second-class. i think that comes from the perception that old nurses that can no longer keep up with hospital nursing, or who "flunk" out of hospital nursing, go to nursing homes. while you might run across a few of these people, the "flunk outs" are the ones to be leery of because some of them are truly dangerous practitioners. i always kept my nursing ethics and standards high. all patients, whether they are in a nursing home or the acute hospital, deserve that.

*Pepper* · Dec 17, 2007

You might also consider hospice nursing. As a RN you could do independant Case Management as part of a service team, get to know the patient, family, and significant others.

actioncat · Dec 18, 2007

you are going to find that a lot of the sick med/surg patients that seem to get discharged too early end up in ltc facilities. as an rn in ltc you are likely to get placed on their medicare wing, if they have one. that means you'll get those patients coming from the acute hospital that are sick and you will be very busy with them.
i've worked both ltc and acute hospital and i like both venues. in ltc you really need to be well organized and hone your leadership skills. you will be a charge nurse and will have to handle all kinds of problems and squabbles that come up with the cnas. this will be new to you as this kind of stuff doesn't necessarily go on in the acute hospitals. the work, for the most part, however, is fairly routine. but, you will be constantly busy. you will get to know your patients very well.
ltc is highly regulated and there are a lot of laws that they have to follow. you'll hear your other charge nurses mention this all the time. much of this regulation came about because of abuses going on many years ago when patients were literally dumped in these facilities and treated terribly. the states and federal government had to step in to clean it all up. the laws stayed. you can view them here:
http://www.cms.hhs.gov/certificationandcomplianc/12_nhs.asp the medicare conditions of participation (title 42, section 483 of the federal law) that apply to nursing home - to view the actual laws, click on the "42 cfr part 483" link at the bottom of this web page.
i never felt that ltc was in any way inferior to hospital nursing. it is just a different venue. there has, for many years, been an attitude that ltc nurses are second-class. i think that comes from the perception that old nurses that can no longer keep up with hospital nursing, or who "flunk" out of hospital nursing, go to nursing homes. while you might run across a few of these people, the "flunk outs" are the ones to be leery of because some of them are truly dangerous practitioners. i always kept my nursing ethics and standards high. all patients, whether they are in a nursing home or the acute hospital, deserve that.

yes, what this poster said.