As someone who's been a charge nurse in a nursing home for some time now (as first RN job) I must admit that I was wrong and many on here have been wrong as well.
The position is looked down upon but I can assure you there is a lot of critical thinking, decision making and responsibility in that position. As the lone RN in charge of 8-10 Aides, 3 LPN and 65-70 residents it is a huge task and responsibility. Not to mention when things go south for a resident, you might as well be a nurse in the rain forest or Kenya (as far as supplies are concerned). All you have is your critical thinking skills.
As someone who's been a charge nurse in a nursing home for some time now (as first RN job) I must admit that I was wrong and many on here have been wrong as well.
Just the first sentence gives me the heeby jeebies.
OP- congratulations on offending the very people you were actually praising.
It's an impressive skill I tend to exercise myself.
I started nursing at a SNF. I loved the work, found it stressful, but not overwhelming. It takes outstanding time management skills to be fully successful. From there, I went to an acute rehab hospital but as a liaison, and While the pay was excellent, I missed hands-on pt care. I went into home health nursing from there and tired of traveling, I've now transitioned to a LTACH. I've seen folks in each sect of the profession look down on each of the others.
I have seen more snootiness from EMS professionals (we can save lives without a direct doctor's order nana nana boo boo) and ER nurses who received SNF or HH pts when things went south and they had to go to the ER, than from fellow nurses.
Heck, I see a lot of "looking down" on each other between the day and night shifts where I am now. Seems like everybody thinks their job is the hardest and no other venue or shift has as difficult challenges to deal with as they do. Meh.
I think the stigma comes from not really knowing what's required in the different areas. Many of the folks I work with now had the misconception that a HH nurse is a glorified Dynamap. When I "educated" some of them on HH nursing (like limited supplies to care for pts, trying to complete sterile procedures while keeping the patient's cat out of the middle of it or keeping the roaches at bay, having a pt code out in the middle of nowhere & instead of being able to holler for help, you were own your own until EMS arrived, etc...) I think a few developed a respect for HH nursing.
Let's face it, each setting has its own set of challenges and no one setting is cushier than another. Most importantly, no one setting has a right to judge the worth of another setting's nurses. The end result we are all looking the achieve is the same- prolonging life, providing the highest quality of life possible.
I just saw this post featured on Facebook. I am SO FREAKNG ANGRY that OP's biases are being represented as held by the majority of nurses. I objected to this thread from the start and requested that moderators remove the objectionable title, to no avail.
Thanks for nothing, OP. Actually, worse than nothing. Thanks for casting a negative shade over us all.
I was just trying to start a conversation and admit I was in error. Man some of you people are touchy. No wonder people get so Offended on social media.
I hate to tell you but in my class of 70 RNs I'd argue that 95+% looked down on LTC nursing. The community I live in, I'd argue that statistic is the same. Like it or not, the vast majority DO look down on the job and don't feel it is "real" nursing.
Just the first sentence gives me the heeby jeebies.
That's exactly my feeling. Yet you'll see even on here many feel that starting out in a speciality is less likely than starting out in LTC. Which I find amusing. A new grad would be more likely to succeed in the ED, ICU, PACU, etc than LTC simply based off of the peer support they would have plus the adequate orientation vs the lack of support and lack of orientation in LTC facilities.
The community seems to follow the same mindset. It's a really hard first RN job (responsibility).
As a fairly rare direct care BSN in skilled care, with 18 years in, I find nothing wrong with this very short article. It reflects truth. I have worked in on a sub-critical unit in a moderate-sized hospital, and floated, precepted multiple students and new staff, and have traveled doing telemetry. There (all of them), I heard the thread of myths about nursing home nurses. First of all, to get into a hospital job years ago, I had to pay for my own ACLS course. I was hired into the outpatient rehab unit, now outdated and closed for "Acute Rehab." After I was in and served my 6 months, then, and only then could I transfer to acute care. Floor nurses FREQUENTLY shared stories of "ignorant" nursing home nurses they reported off to when transferring patients out. They had this weird idea that nursing homes sent residents to clean out for the holidays, or for convenience on the weekends. They had absolutely no concept that the opposite was true; that doctors clean out hospitals, and poor skilled facility nurses are bombarded with admissions; sometimes two to four of them within a 2-hour time frame on Thursday and Friday afternoons (every Thursday and Friday afternoon), which one, and only one nurse sometimes must complete all of, as well as pass pills to and care for 20-40 residents (yes, alone, on top of the admissions). New pills come at 2 in the morning from a pharmacy over 60 miles away, and everything has to be dropped to leave the floor and put the orders into the computer so the pharmacist will dispense them before the driver leaves at 7pm. That means many residents whose pills are in the cart do not get pills until midnight, because the nurse had to leave the floor. How quickly can you enter 30 orders? The admissions arrive between 5 and 6pm, if that early. Take a situation where a SNF nurse could not remember that metoprolol was a beta blocker. The snigger over the phone line is brief, but meaningful. But did the hospital nurse give pain medication before they sent that patient, because it might be 12 or more hours before I can get ahold of the doctor, get the orders in (for two new residents), plus pass pills, plus make multiple phone calls, and contact the pharmacy for an auth to pull narcotics from contingency (if we have what was ordered). But geez, that Metoprolol being a beta blocker was important, right? (The pain prescription is neglected maybe a generous 20% of the time, taking me off the floor at least 20-30 additional minutes). The resident is lucky if they have pain medication before midnight. How many hospital nurses neglect to give a person 3 days post-op a pain pill before leaving, and tell the patient, "Oh, they'll give you one when you get there?" That does not happen. Get it into your head. It does not happen. Both ongoing and recent changes in regulation of narcotics make it nigh impossible to give SNF residents pain medication on admission in a timely manner, and the good nurses check the liver enzymes and allergies, and slip them Tylenol on arrival, and retro-chart it to allay issues. In the past two years, it is the primary reason residents leave nursing homes AMA, or call EMS themselves to take the new resident back to the hospital. In multiple facilities, I have seen this go down over, and over. Office staff who might help go home at 4 or 5pm. We are on our own, with irate people in pain, and people who have not had their evening pills on time. But hey, metoprolol is a beta blocker, right?
The unfortunate truth is that SNF facilities do hire the nurses with little experience, and it can be a place for nurses who have difficulty finding a job elsewhere. Add all of the above to that, and you have a mess more often than should happen. If even I cannot get a Norco by 1am, can they? Should they be expected to? It often arrives, drop shipped, around 10 am the next day.
I love my hospital colleagues, but the reality is that skilled care facility nurses are indeed not respected. Going back to there from the hospital has been a trial in many ways, particularly as a BSN. Skilled facilities do not have the benefit of research advancements in care. We are on the tail end of the good parts of health care reform. We are at the tail end of changes, customer service initiatives, perks, including and especially educational ones, rewards for attitude and service, and we are overworked, and undervalued. The older management is not well educated in the JHACO initiatives enough to be pro-active from the skilled care perspective. There is no "scrub the hub" over-education. Nursing process gets thrown out the window for bandaid care. It was not this way in my first SNF job 18 years ago. It has become much harder work.
SNF nurses NEED acute care nurses to work with them, and to support them. The people at the center stage are the patients, and the residents, not us. We need experienced, educated managers and leaders, and a full staff. My biggest challenge in my career has been to keep a positive attitude, to be pro-active,; and to not complain, but to be assertive; to not be condescending, but to be inspirational in the most difficult situations, and within the worst morale of my career. I think I have missed the mark by a long shot. If you want to prove your snuff, work in a SNF. (You can steal that).
I hear a lot of that at work - a lot of my coworkers say the same things about floor nurses, too. I don't think that way, even when things really go bad for one of a LTC/floor nurse's patients that would have been preventable if caught sooner.
We get most of the rapid responses/codes so we get a lot of what people would call "neglect" or "horrible critical thinking skills," but the fact of the matter is that LTC nurses have ridiculous ratios and can't be looking at every single patient at the same time, so changes in status might just get missed. Same with unmonitored floor patients whose nurses have 6-8 patients. It's not that these nurses are bad nurses, it's that they're put in situations where missing something is going to happen. Looking down on them for something out of their control (ratios) is ridiculous.
Specializes in LTC,Hospice/palliative care,acute care.
This is why the good aides are so important.We have static assignments now and they are the first ones to notice someone "just doesn't look right".Sometimes our assessment reveals all is WNL's so we watch them and are ready when they tank later.
One of my dearest friends is a supervisor at a nursing home. She is one of the best RNs that I know. I hate that there is a stigma with this type of nursing.
Had another new grad come through orientation a week ago. She wants to get some experience and get out as fast as possible so that she can do some "real" nursing. Granted that this is only one of many new grads that have came through with this attitude, I don't think the stigma is going to go away.
I actually don't mind the stigma of being a nurse is a care home. If everyone else wants to work the harder jobs, it leaves the easy jobs for the ones that want it. I've seen recent threads and posts throughout my time here indicating that many acute care nurses are unhappy and overworked. Some of them indicate that they would still never choose to work in a nursing home despite the load that acute care places on them. Their loss, not mine
I actually don't mind the stigma of being a nurse is a care home. If everyone else wants to work the harder jobs, it leaves the easy jobs for the ones that want it. I've seen recent threads and posts throughout my time here indicating that many acute care nurses are unhappy and overworked. Some of them indicate that they would still never choose to work in a nursing home despite the load that acute care places on them. Their loss, not mine
In all fairness, we see a great deal of similar posts from nurses working LTC. Terrible ratios seem to be widespread throughout the industry.
Guest219794
2,453 Posts
Just the first sentence gives me the heeby jeebies.
OP- congratulations on offending the very people you were actually praising.
It's an impressive skill I tend to exercise myself.