Tips for Geriatric and LTC Nursing

I have worked in Geriatric/LTC nursing for over 20 years. The same scenario has played out hundreds of times in my career. It goes something like this: I meet a new person who asks me what I do for a living. I tell them I am a nurse. They are impressed and ask which hospital I work at. I tell them that I actually work at a nursing home. As I watch their face it is usually always the same. The expression changes from awe and wonder to disappointment and sometimes disgust. Nurses Announcements Archive Article

Tips for Geriatric and LTC Nursing

It is as if being a nurse is an admirable thing that one should be proud of unless you are a LTC nurse, in which case, you are not a "real nurse" because you don't work in a hospital. Many times, not knowing what to say, they will simply reply, "I could never do that." I have to bite my tongue at this point because I want to say to them that I agree, they probably could never do that.

Usually, this is the end of the conversation because many people have the belief that you are a nursing home nurse because you are not "smart enough" or "energetic enough" to work in a hospital. However, there are other times when this is not the end of the conversation and someone will ask you why you work in a nursing home. It took me asking myself that question and really thinking about it to come up with the answers that people needed to hear.

There is so much to learn in a nursing home! A lot of nursing homes are free standing and have to contract services. This means that the everyday services that the hospital nurses are calling upon ancillary staff to deal with, the nursing home nurses are having to learn and experience themselves.

When the diabetic patient needs dietary counseling and there is no dietitian in the facility, this responsibility falls upon the nurse. When a patient is newly diagnosed with gout, it is the nurse that will explain the need for the dietary restriction of protein. And when your patient has COPD and wants to know why he or she cannot have another pitcher of water, guess who gets to explain that? You guessed it, the nurse.

Another set of contracted services is physical, occupational, and speech therapies who work mainly Monday through Friday and for only a few hours a day if you are at a small facility. This means that for the rest of the day, the regular staff is working with the patients on these things. It is up to the nurse to know how to do a range of motion correctly, assist and instruct the patient in the proper ways of using their new occupational tools and silverware. It is also up to the nurse to train the CNAs on proper techniques for doing these things as well since the therapists have little time to do this training.

There is usually no lab contained in Long-Term Care Facilities like there are in hospitals. This means the nurses draw their own blood and start and maintain their own IV's.

Podiatrists? Maybe every 63 days since that's what Medicare allows. In between who has to deal with foot issues? That's right, nurses. There is no one to call to come to the floor to consult on a "bad toenail," or something that looks like fungus. The nurse learns what fungal characteristics look like and then make phone calls.

And then there are the phone calls. Character building phone calls at all hours of the day and night. Drs. very seldom make rounds in the LTC facility, therefore, the nurse is responsible for learning medical terminology that will describe a condition to perfection in order to obtain the proper interventions and orders.

Despite popular belief, LTCs and nursing homes are not places that people go to die. Therefore, not everyone is a "no code." For the nurse, this could mean running a code in the middle of the night with one other staff member in the building. There is no "code button" on the wall that you can push and a dozen available people come running. For staff in LTC, a code means calling 911 while you run down the hall on your way to retrieve an Ambu bag or AED machine and hope that there isn't a fire in town or you may have to wait a while for your volunteer EMTs to arrive for assistance.

I could go on and on but the bottom line is this: nowhere else do you obtain what you get working in geriatrics and long-term care. I have learned more and continue to learn more every day working as a charge nurse in a nursing home than I ever did in a hospital. So when I am looked down upon and asked why I work in a nursing home, my answer is because I CHOSE to get the education and experience that I cannot get anywhere else. And when they reply that "They could never do it" I secretly smile and think to myself, "nope, you probably couldn't!"

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yes you're right they probably dont understand how it is to be working in LTC. Nurses were trained to serve in ALL HEALTHCARE SETTING and Home care is one of those. Plus the qualifications that one must posses since you must rely on your own judgement when emergency situations arise.

Specializes in LTC.

Great essay! I, too, have seen expressions of disappointment and disgust r/t my employment in long term care. Many folks seem to have difficulty distinguishing between the bedside and the business office. We seem to have "profit" as a business motive. Shocking, isn't it? Apparently US taxpayers could save $81 billion dollars if health care professionals cared enough to improve our efficiency and safety by embracing the latest greatest fad or other type of social contagion. Nursing homes, historically, have been among the last to jump on the bandwagon. According to an economics prof, we have a vested interest in keeping people sick. He'd go visit his grandmother in her LTC facility, except he estate planned her out of her assets to maximize his inheritance and he can't look her in the eye, now. He's advocating for her, however, by proposing sweeping nursing home reforms. After all, we're supported by his taxpayer dollars.

amen to all!!!!! thanks!

Specializes in Addiction & Recovery, Community Health.

Excellent article. Thank you!

Bless you, I think the world of LTC nurses. That is all my brother who is also a nurse has ever done. I think if I ever heard anyone belittle him because of it I would get very angry.

This article set me straight. Years ago, I was one of those who wondered why or how someone could work in Long Term Care. Not because of thinking they weren't smart enough or anything like that, but I often wondered how someone could deal with having to watch someone die. I'm older now and have worked as a housekeeper in a hospital and have come to the realization "people die" in hospitals everyday. Big DUH, to myself. Anyway, the real question I used to have is how do you deal with the pain of the patients dying when you've done all you could do. I realize now, that is probably the hardest part of your job, but it can also be the most rewarding part. What I mean by that is KNOWING you did your best and gave the best care and being there for them. There is probably no greater feeling than knowing that your patients will always be a part of you no matter what. Your patients love you unconditionally because you take care of them, just like your kids love you unconditionally. There is no greater love and no greater feeling than that. I am not a nurse yet....don't even have my CNA certification yet...I have completed the class and have done my clinicals...just waiting to take my test...Anyway, when we did our clinicals, we only got to spend one full day in the Long Term Care facility. I was kinda dreading it at first, but I left that day very sad, because I wanted to spend more time there. That clinical and your article has helped me make up my mind in terms of what feild/place I want to nurse in....Thank you very much for your perspective on LTC.:D

very insightful! Hope you enjoy nursing!

In my years of convalescent care, I can not count on my hands, fingers, and toes (let alone every strand of hair on my body) that I have heard the same comments. As a geriatric nurse, you must think outside the box, and don't let the negative comments get you down! A gero nurse must be sharp, as the doctors only listen to what you have to tell them and make the diagnosis on the phone to prescribe the right treatments (all along knowing that is what you were asking for in the first place). I say hats off to Gero nurses!:yeah: and a GREAT :bowingpur as we don't have the team of staff to help us in our time of need.

Specializes in LTC, Nursing Management, WCC.

I greatly enjoy geriatrics and work in LTC. We certainly wear many hats as the nurse. Nice article!!

wow...this article really open my mind about giving care to the olders.. anyway, i am a student nurse..and u really inspires me a lot..thank you!!

Hats off to you:heartbeat for writing the LTC Nursing article. I am a LTC Nurse on a Dementia Unit and love it. Yes we do it all IVs. Lab work, assessing our residents, treatments, ect. Unlike critical care hospital nurses, we get to follow the disease and healing process of an individual for months and years on end. If a person is a new graduate nurse studing to take state boards, a LTC facility is a great place to work as there is a whole array of different diseases and cases to expericence first hand which you may not see in a hospital. Really I feel special being a LTC nurse and honored to share the lives of my Residents along with getting to know their families. Goals of mine is to make my Residents life be the best it can be by doing all that I can do to meet their present wishes.(Pet visits, Garden plants, Music, Sports on TV positive stories in the news, favorite foods ect). I have nothing but praise and honor for all LTC nurses. If I meet a hospital nurse that thinks I am less of a nurse because I donot work in a hospital, I view that nurse as ignorant in needs more education!!! Next January 09, I will be working on my Dementia unit 20 years. (12 years as an LPN and 8 years as an RN-BSN):wink2: