What exactly is so bad about LTC??

AMPneRN · Jul 25, 2012

RNS make way more than LPNS in LTC in my area. LTC also pays better than hospitals here as well.

AMPneRN · Jul 25, 2012

doing more with much, much less

Ruby Vee, BSN · Jul 25, 2012

i'll preface this by admitting that i have never worked in ltc. but ltc nurses are surely the heroes of health care. my mother has alzheimer's, and one of the things she decided while she still could decide was that she didn't want to ever leave "home", meaning the county where she was born and lived her whole life. she picked out two or three nursing homes where she'd prefer to be when the time came. the time came, and my sister and i moved her into an assisted living facility. the staff there were terrific. i cannot say enough good things about those people who cared so lovingly for my mother and were so good to me when i traveled across country four times a year to visit. they told me what restaurant had the best breakfast in town, shoveled my car out after a blizzard while i was so involved with mom that i didn't realize it had snowed, fed me breakfast one morning when i arrived before mom was awake, and always took the time to update me when i called. they worked very hard, and sometimes i don't know how they managed -- but they always had time for a kind smile and a quick hug.

mom's in a nursing home now -- different staff, but still just as kind and just as dedicated. they're knowledgeable about her slew of medications and how they work, interact and don't work. they can get mom cleaned and dressed even while she's throwing a fit about one thing or another, and can sit at a table and feed two residents at a time without gagging. (i've learned not to show up at mealtimes -- i don't know how those ladies do it!) mom loves the staff at her nursing home, and they give every indication of loving her right back, no matter how difficult she can be. they work very hard for very little appreciation.

thanks for the reminder. i'm going to send some chocolates to the staff of mom's nursing home along with a handwritten thank you note.

bubblejet50 · Jul 27, 2012

I had 2 completely different experiences in LTC. My first was in sub-acute facility that accepted young adults with brain injuries. Best nursing job I ever had (i was a cna at the time and would love to go.back but no openings in 2years). Ratio was 1 nurse and 2 aides for 10 residents plus 2 bath aides for the facility (30 residents). Most residents (all but 2) hoyer lifts so no strain. 19 had g-tubes. 6 had trachs. Nurses.were not stressed and helped aides all the time. Everyone worked as a team.

Now when I got my lpn license that facility had no nurse openings so I had to leave. I went to a snf with a daily census between 50 and 65. Worst job I ever had. The residents were a delight and I miss them but the administration left a bad taste in my mouth. I would either work the med cart or as charge nurse whatever was needed. On the med cart I would have between 35 and 50 residents to tend to while as a charge I would get between 30 and 35 with anywhere from 4-10 residents being medicare or abt tx. The ratio was such that I could not take care of the residents like I wanted to. We had 5-6aides on for all these residents with only 5 being independent. I did not like it because I went into nursing to take care of patients and make a difference not hand them pills while assessing them and having 5 min of interaction a day. My DON would yell at me for being "too" efficient and try to find mistakes. When sge couldnt find any she would change a rule randomly and yell at me while none of us nurses knew about this random change. Once I got my rn license I was gone. Im in home health now trying to get my year of rn experience and I like life more.

I think its more the management and staff that will make or break the ltc scenario. Both facilities I was at the staff worked well and the nurses very rarely tried to eat the young. Only if the new nurse was arrogant or condescending to the other nurses or couldnt complete their workload on time after about 3 months on a daily basis.

Vinniesguy · Jul 29, 2012

I enjoyed LTC when I worked in it but it was hard work. 33 elderly residents with challenging behaiour/dual diagnosis. Med rounds were a nightare especially the early morning one - an earlier poster mentioned some patients needing 15+ meds that need to be crushed, then mixed with something sweet, then fed to them - it could take up to 2 hours to do morning meds. Then if we had agency nurse aides on (which was often) I would try and do at least one or two showers for them otherwise they would end up getting way behind and missing their break. Mountains of paperwork.

The one thing that really annoyed me though was the amount of times the nurse before me had either run out of something and not re-ordered it, knowing I would need it in the morning or putting empty boxes back in the cupboard so when I did a stock check I assumed it was there!

Loved it though!

NC4RN · Aug 15, 2012

Adding, last week "State" was auditing our facility, I was off the day they came, one of the RCCs called me at home to come in and fill a couple holes in the MAR from the Monday prior, when I was the ONLY nurse (we had a med aide for 2 of the halls) to put in orders for 60+ residents, (coumadin, PT/INR, you know, Monday orders) then we had a meeting the last hour of the shift. So I had to rush through my EVERYTHING and jeez, didn't have time to go through the MAR and fill in the few holes. So I went, on MY time, and filled them in. Then, she called me again, the NEXT DAY, when I was off again, because I forgot one 72-hour paper charting on a resident who had fallen on a different shift. She wanted me to come in, again, on my day off, and falsify an assessment because state was there. She was there for the same shift, she's an RN, she could have easily just done the charting in the time it took to call me. I know these are my responsibilities, but when the work of 3 people is heaped on me, the odds are that I might forget to do 2 things. I love the residents where I work. But to manage through intimidation is, excuse my language, bullsh*t. Unless someone is dying and only I can save them, leave me alone on my day off. It'll keep until my next shift.

RAngersRN · Aug 21, 2012

Thank you all. I have really enjoyed this post. I kept nodding my head and (at times) felt someone had to read my personal thoughts and feelings. I am a new RN grad working towards my year of experience. Funny, I don't want to work at a hospital. I am trying to get experience as I finish my Masters degree to work as a FNP.

I agree with everything stated in previous posts. I want to add I feel LPNs run LTC...I'm just there because I have RN behind my name. It looks great on paper. LPNs do so many things that out of their scope of practice, I have to pick my mouth up off the floor. Some good, some bad, some necessary (no 3rd shift RN for almost 2 weeks). I have also experienced workplace bullying by LPNs at my first job. Until one day I decided I wasn't taking it anymore and stood my ground. Yes I'm a new nurse but I am an eager learner. Titles mean nothing to me. I think some of these LPNs felt I would be "high-class" and decided to attack me first. Either way it's sad. I'm there to provide quality nursing care to my residents. Be prepared to as a new grad to gain a backbone.

My frustration comes from the business of LTCs. When is it okay for one nurse to care for 30 post-acute residents?!?!? I often times fear losing my license. And often I share the joy of seeing a resident tell me "thank you" with tears in his eyes. I used to say I don't want to work med-surg (too many people with 1 nurse--sad nursing student thinking), but goodness juggling 8-10 patients looks better everyday. It breaks my heart to only spend 3-5mins per day with my residents. School (fairy tale) nursing days are gone. Reality stinks, but I do the very best I can do! Hang in there everyone.

nursetiffany. · Aug 21, 2012

I love LTC! :) Every work place has its downfalls. If you like routine (most days) and getting to know your patients...LTC is the way to go. :)

jcprn · Aug 21, 2012

sorry

jcprn · Aug 21, 2012

This is in response to CapeCodMermaid:

I work in a Massachusetts LTC/Rehab center and, unfortunately, I was told by the DON that "there is no difference between an RN and an LPN". I am a new ADN RN and this was very disheartening to hear. I went to school for five years (prereqs and waiting list...) and am "no different"? I could have been practicing three years ago if I got my LPN instead and owed a lot less money! I do not regret my RN decision, but I was put back by the comment - by the way, this DON is a BSN! I do know of a couple local nursing homes that are trying to get all RNs, but they are having difficulty - just wanted to share my experience.. :) Personally, I feel experience speaks louder than degrees and I take advice and learning experiences from the LPNs I work with very seriously and graciously :)

LTCNS, LPN · Sep 16, 2012

I disagree. In Massachusetts, LPNs go to school for 10 months. They are ill prepared to do anything. When I said I need RNs, I wasn't being disingenous and frankly I don't care how anything looks on paper. I care about the residents getting excellent care. Ten months...I think hair dressers have to have more practice time than nurses do. New grad RNs don't know how to hit the floor running,but they at least have more education.

I respect your opinion and agree wholeheartedly that LTCs are getting more acutely ill patients needing the extended education and skills of a RN, but as a LPN who has worked in LTC for 21 years, I have to say that I have had the fortune to learn and use skills that most LPNs never get to experience. I was a MDS nurse for 14 years, with 10 of those years working as Medicare/MDS Coordinator and am burned out to be honest. I am TB certified and am certified to replace G-Tubes. I have placed NG tubes and have extensive knowledge of wound care, although LPNs cannot stage wounds. I have taken care of new vent patients and have extensive knowledge of lab values and medications. That is just scratching the surface of what I am capable of and trained to do.

To say hairdressers have more practice than LPNs is hurtful. I have worked my butt off for 21 years and am very, very good at what I do. FWIW, LPN training is more than 10 months in MS. The course is extremely fast paced with everything crammed into 14 months. It is not easy by any means.

CapeCodMermaid, RN · Sep 16, 2012

I certainly didn't mean to offend, but you can't compare your education from 20 years ago and your 20+ years of experience with a newly graduated LPN. I only speak for the length of clinical/practice hours in Massachusetts and from years of hiring new and not so new grads.