What's it like working in ltc nursing?

Angeljho, MSN, NP · Dec 14, 2009

I am a new grad and was meaning to post something similar. To add, do nursing homes support the "12 hrs/3 days" schedule or is that solely for hospitals??

TheCommuter, BSN, RN · Dec 14, 2009

I have been working in nursing homes for the past 4 years as an LVN/LPN. I cannot fully encapsulate what it is like for an RN to work in a nursing home since I do not yet have an RN license.

I work the weekend double shift, which consists of two 16 hour shifts every Saturday and Sunday from 6am to 10pm. The shift sometimes progresses in a stressful manner because I've got 30+ residents with their different requests and demands that I must address. "I need a breathing treatment!" "Give me a pain pill!" "My ears are aching!" "Rub some cream on my bottom!" "Where's my shot of Phenergan?" "I hate my roommate!" "When's my next doctors' appointment?" "This room is too cold!" "I can't have a fifth cup of coffee?" "I think I'm having a heart attack!" "I'm seven months pregnant!"

Demented residents can become potentially violent and explosive if stimulated too much. Some residents are as sweet as pie, while others are bitter and terribly manipulative. Also, the nursing home population in my city is getting younger and younger. Some of my residents are in their late 20s and early 30s due to hard living, drug abuse, and noncompliance.

TheCommuter, BSN, RN · Dec 14, 2009

I have a few more details to add. . .

In my city of residence, the vast majority of the nursing homes staff with 8 hour shifts, and the employee turnover rates are sky high. Some of the CNAs will be insubordinate and outright disappear during the course of a shift. Many facilities in my area now utilize medication aides that pass oral meds to the residents, which cuts down on the nurse's physical workload. Most of the facilities in my area have skilled Medicare rehab units that admit very sick postsurgical patients who are not yet stable enough to go home. The family members of the residents often have misplaced anger and sometimes behave obnoxiously toward staff.

hotnurse84 · Dec 14, 2009

i've heard a lot of the above from residents also. sometimes it is comparable to a psych ward. however, I liked it but when it was short staffed I didn't like it. I didn't like how it would make me act. I felt like I had no time for any patient and I sometimes would get snippy with people cause I was so stressed out. also, family members could be a big headache or a big help. just depends. why don't you become a cna and work in a nursing home first or shadow a nurse in ltc. also, if you become an Rn you could be the DON or ADON and would have different experiences than the floor nurses.

studentenurse · Dec 14, 2009

Thanks for the info. I have alot to consider. I have been reading posts on other websites about how much others have come to hate nursing altogether. I would like to help people, but I am not sure that's enough to go on.

wyogypsy, RN · Dec 14, 2009

I have worked many different areas of nursing, and absolutely love LTC. My least favorite patients are those that are younger and there because they have MS, have ruined themselves with drugs/alcohol and are no longer able to function on their own, etc. My favorite? The patients with Alzheimers and dementia. Some of them are violent, but most of them are wonderful! There is not a day that goes by that one of them does not make me laugh or feel appreciated. Yes there are rough days....but overall it is very fulfilling. Most LTC facilities that I know of, in several states, offer both 8 hour shifts and 12 hour shifts; and some do offer 16 hour shifts. I believe someone suggested becoming a CNA? I agree - become a CNA and work in a LTC facility for a few months. You will love it or hate it - but better to find out before going to school. You will find out first hand the answers to all of your questions and many that you don't think to ask. Good luck!

litbitblack, ASN, RN · Dec 14, 2009

Long term care is not all about nursing homes either. There is assisted living, cert. alz ltc and it also depends on if its private pay or medicare. MY first long term care was/is certified dementia center that is private pay. I love it. I get to know my residents and family and develop a relationship with them. To me its the most rewarding. and i was in the hospital for 10 yrs....so....i say go check them out. don't let the few clinicals that you do dictate whether you like it or not. My mom is an older nurse and she always used to tell me that going from hospital to nursing home is devastating to your career but...i am here to testify that you learn different skills. How to redirect a alz resident, patience, patience patience, you can get certified in wound care. There are always things to get involved in.

dragonflydani · Dec 14, 2009

I have worked in long term care as a CNA for 5 years. It is probably the most rewarding, and the most stressful job you will ever have. I really love old people. I think that they are amazing and caring and have a lot of knowledge to give, but working tireless hours trying to give 20 people the care they need in 20 seconds can really wear you down. But there needs to be patient, reliable, caring people that can work in this field, and I think that if you have any inkling at all to do it, then definitely shadow someone for a day or two and check it out. Talk to the patients. Most nursing homes have activity departments that accept volunteers and I think that would be a great way to get into the facility and meet the patient type and go from there. Good luck!

Lovely_RN, MSN · Dec 14, 2009

It depends on the facility. The one where I have worked at for almost two years has a little bit of just about everything. We have the demented, psych, MS, TBI, rehab, hospice, vented and the list goes on and on. We deal with just about anyone who no longer needs acute care but can't be cared for at home. We also have a lot of homeless residents with conditions like diabetes, COPD, Cirrosis, ESRD etc. A lot of them have mental health issues and were alcohol or chemically dependent when they were out in the streets.

There is never a dull moment at that job.

It can be extremely stressful at times but, and I know this may be hard to believe, there are days when it's not so bad and even some fun days. Getting cursed out by a schizophrenic is sometimes funny (as long as they aren't swinging) and then I have my sweet little old ladies and men. I actually had one who refused to leave the nurse's station until I danced with him so I did!

LTC can be good and bad but no matter where you work you will gain valuable experience, I promise you that much.

amjowens · Dec 14, 2009

I love working long-term care. It's where I'm able to be the kind of nurse I want to be...I want to maintain the holistic whole-person care I thought nursing offered. I see hospitals as so task-oriented and business-like. I'm an LPN in my 3rd semester of RN school and plan to continue on to become a nurse practitioner. I don't ever want to leave the place where I work, but may have to work part-time or contingent down the road to allow for experience in a hospital, though I dread that thought! I don't even want to get into all the unhappy nurses I've encountered in the hospital setting; very sad. I say, better at least be a happy nurse where I love to work rather than a burned-out nurse who quits and doesn't end up using all those hospital skills anyway.

Orca, ADN, ASN, RN · Dec 14, 2009

The long term care facility I worked in killed any desire I had to do any more LTC. I was the only RN on a 120-bed unit on swing shift, and for half of my time there I was also covering meds for over 40 patients because an LPN quit. I handled all the doctor contacts and family contacts, plus I had to issue supplies every shift to the CNAs, and I had to physically go into the room every time they went in (the facility was a bit paranoid about theft). For all this, the pay was about $4 per hour less than the local average. I couldn't get out fast enough.