Why the disdain for LTC?

[klone]

I'm reading the "New Grad perfect job thread" and I keep seeing the NGs say that LTC is a "deal breaker - no way I'm going to apply to an LTC job".

Why? If I were a NG having difficulty finding a job, I certainly wouldn't have that attitude. LTC is a WONDERFUL way to learn time management and multi-tasking skills. Hell, I have almost six years of nursing experience, and if someone offered me a job in LTC working 8-5, I'd take it in a heartbeat. LTC is a great way of opening up for administrative/management opportunities as well (lots of ADON and DON positions around).

I'm confused about the attitude, and wondering if someone could explain it to me, because surely there must be something I'm missing.

[Nurse SMS, MSN, RN]

I said I would look at LTC as a last resort, but for the most part I see a much heavier weight of unhappy nurses in LTC than in other specialties. And believe it or not, we are listening when nurses talk about such things.

I would not turn my nose up at LTC if it were the only means I wind up with for getting a job. But I am also not eager to work in one. I love the geriatric population. I just don't love the idea of poor staffing, dangerous conditions, hostile environments and unhappy and/or toxic coworkers. Those can happen anywhere obviously, but there is a great proportion of complaints about these things from those who work LTC.

[xtxrn, ASN, RN]

While LTC is a good place to get experience, I think it's the bad route to getting that experience - i.e. being overworked to the point that you HAVE to learn time-management or you will sink.

There is very little orientation, very little worthwhile continuing education, and very little backup when things go wrong. This is not the case in ALL LTC's, but it is the case in the larger majority that I have been exposed to.

Having said that, if LTC was the only job offer I had as a new grad, I would take it. When I graduated LPN school, my first job was in LTC. But, let me tell you, it's a SCARY place to learn!

Contrasted against a large hospital system that is going to give you a 3-month minimum orientation (often with a dedicated preceptor), mandatory classes for ACLS/PALS/CPI/EKG/whatever alphabet soup is appropriate for your unit, plenty of help if something goes wrong with your patient -- you can't beat a good hospital job as a new grad.

The bottom line is that LTC facilities in general do not have the resources to adequately educate a new grad. Yes, you will learn skills. Oh, how you will learn skills. But you're so overworked and spread so thin that it's hard to truly learn and comprehend what you're doing.

As an RN now, with 5 years' experience as an LPN (2 of which were LTC) and another year as an RN, I hope and pray that I never have to go back to LTC. It's just too much. It's too crazy. And this is coming from an ER nurse!

^^^ This. Absolutely this.

I've worked in LTC/SNFs that had speakers, or sent nurses to conferences a lot. It was nothing for someone to say, "Oh- I'll be out next week at the >>> conference"......

Not all LTCs are the same. :)

For those who have no other job, is it worse than no nursing job at all? How much experience do you get doing dishes? :) I agree, the residents of LTCs deserve people who don't think they're not worth working with.... but the sentiment that LTC is second rate is sad....

[ionatan]

I'll just throw this out there and all you hospital nurses can b**ch me out for saying this, but I don't think that working in a hospital will necessarily give you more skills or make you a better nurse. You learn plenty in a nursing home. It's a different type of nursing, for sure. However, on a recent visit to the ER at Cleveland Clinic with my mother (an RN), the young RN "taking care" of my mother was terrible. It was obvious she did not want to touch her patients, she contaminated a syringe and still tried to use it to give my mother an IV push, and she would not take a manual BP when asked to on my mother whose systolic reading was almost 200 (my guess is she didn't know how to do one). You're only as good of a nurse as you want to be in my opinion.

[SNIXRN]

Mostly because we had bad experiences in nursing school. We went my first semester of nursing school and all we were allowed to do was bathe, help go to the bathroom, oh, and of course help feed... It didn't seem to be the ideal nursing path, for me at least.

Obviousy that's not what LTC RNs do, but it left a terrible impression on me.

[33762FL]

"Lower pay is not always true. Many large corporations have excellent benefits, including great tuition reimbursement. " I didn't say it was always true, just often true.

"These comments are based on not knowing about LTC- OR maybe just not liking old folks.... " Most patient's I've had in acute care are older (except for L&D and Peds, obviously) so my not wanting LTC as a new grad certainly has nothing to do with any dislike of older people. I was an extern on an acute care geriatric floor.

"You get a lot of skills even more than acute care nurses- and your assessment skills have to be good- LTC nurses know their residents and can tell is something is not right....

". Maybe LTC is different in your area than in mine, but in mine the LTC facilities where we had clinicals were more passing meds, paperwork & some assessment, plus hygiene. There were no IV's, cardiac monitors, blood xfusions, etc. Yes, you need excellent assessment skills in LTC but that is another reason why I don't think it is the ideal specialty for me as a new grad.

I personally feel that LTC is probably better mid-career rather than as a new grad, but I can only speak for my own preferences in job-searching.

[cheyoda]

I saw a new grad nurse make several med errors in one day at an LTC after being trained for three days. It was scary. The LTC tried to cover for her, but it made me nervous that she was dangerous to her already frail patients. I have nothing against LTC, in fact I loved my clinical experience. I would go to a LTC in a heart beat if they would train me for three months. For the safety of the patients though it is important to be trained properly.

[Maggie09]

I have the utmost respect for nurses in LTC. You guys and gals are absolutely amazing! I work in a busy, city ER which can be tough in its own right...but I know full well I couldn't handle LTC. The nurse/patient ratios and lack of support would have me freaked out from day one. The idea of having to deal with 25-50 patients...good grief, there's absolutely no way I could function. Too much responsibility and not enough security. Ok, that's my rant Regarding new grads, I think it would be a very, very tough place to start just on the basis of time management. It's hard enough to get used to taking care of 4+ patients in an acute care setting where there's always some form of support in the way of other nurses and doctors...to have double digit numbers of patients and all of the responsibility would likely overwhelm most new grads. Heck, it would overwhelm me and I've been a nurse for a little while now. But to each his/her own, and kudos to those who can do it!

[NurseSnarky]

[/b]

Lower pay is not always true. Many large corporations have excellent benefits, including great tuition reimbursement.

These comments are based on not knowing about LTC- OR maybe just not liking old folks....

You get a lot of skills even more than acute care nurses- and your assessment skills have to be good- LTC nurses know their residents and can tell is something is not right....

Sad that the prejudice about LTC is so deep, and with any prejudice, not based on fact.

Sorry but a lot of it is fact. Where I live, it's VERY low pay, high patient to nurse ratio and it's VERY rare for tuition reimbursement to be offered. Benefits are expensive and with low pay...forget it. There is a LTC facility that has such a high turnover they run regular ads on Craigslist. In states where medicaid reimbursement is super low, it's much much worse. It's not to say that there are not good LTC facilities out there, but most have private pay residents...VERY strict hiring standards (no new grads)...and turnover is freakin' low.

I would just like to see mandatory orientation periods of at least two months. I think our aging population deserves to have someone taking care of them that has the right training period. Any population does, but for some reason the elderly get the shaft. Probably because they can't for whatever reason speak up for themselves. There's a revolving door reputation at LTC for staff and somehow that's "okay"??? If nurses and cnas are well trained, have preceptors, support maybe LTC wouldn't have such a reputation.

[trauma_lama, BSN]

agree! i personally don't want to work at an LTC because i prefer a faster pace and a more "critical" (think adrenaline) environment. HOWEVER, i'm not going to get on AN and complain to anyone who will listen about how the market is saturated with RNs and how i can't get a job until i have thoroughly persued ALL avenues of employment in an RN capacity. you can hate on LTCs, and you can complain about not being able to get a job (esp as a NG), but PLEASE don't do them simultaneously.

[JenniferSews]

There are always bad facilities. Orientation isn't the greatest in most cases. It takes an extremely strong grad to start in LTC IMO. I work with mostly newer nurses (1-2 years in general) and at this point most of us are stuck. Hospitals would rather hire a new grad than a LTC nurse because the stigma is so bad, so you are limited to LTC until the economy changes. On the other hand one of us did recently get a GREAT job offer. But that nurse decided the $6/hr pay cut wasn't worth it.

[Nascar nurse, ASN, RN]

It always cracks me up to here someone say if they go to LTC they will lose their license. I've been in LTC for 25+ years now and have never known (or heard of) a single nurse lose a license because of working in LTC. Have heard of just a couple lose it just because of drug diversion type stuff (two of which were acute care nurses).

I can't completely deny that the environment wouldn't be better with more staff or longer orientation but it's just not going to happen. In fact I fear it will get worse with the upcoming cuts but someone has to give a damn about these folks and I've just accepted that this is where I'm going to be my whole career. Someday it may be me in that bed and hopefully I will have influenced enough of the younger generation to take good care of me and value me for the person I once was. (as all elderly deserve).

[joanna73, BSN, RN]

It depends on where you work. I've worked in Acute Care and I'm now in LTC. LTC nurses use the same skills as you would in medicine or acute, and then some. That's the reality.