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.
You did not get the experience I did- please do not speak for the generic 'anyone' :)
Some places are ECFs- that makes a difference. SNFs are where the acute patients end up when they can't stay in the hospital, and there are no LTACs around. In the late 80s, the facility I started out at began taking vents- and are still considered an LTC, not a LTAC.....
Experience and work are what you make it- and many are 'nice new, clean' places...they're not all pits. Some are- sure....but did anybody see the report about Walter Reed in DC???? That's where the people who need medical help who served this country were sent, and the exterminator should have been the first person in the door every day (it's going to close soon- but not before being a major pit).
I don't know what ECF and SNFs are cos I'm down in Oz - what are these places?
And I'm certainly not telling you what to think - you are entitled to ur opinion on here as much as anyone.
And was it you who said you did all the double shifts with all those duties as well? (I could be getting mixed up with another poster). How on earth could residents get excellent, one on one care with all those duties to be performed and all those patients you had? You must have very good time management.
Well, all I can say is, when ur an RN and an agency sends you to a LTC facility where u have to do meds, treatments, etc for 65 residents, they CANNOT possibly get one on one, excellent care. I had one carer helping me some meds (not all of them, carer couldn't do PEGS/pumps etc), and the EEN was off sick. There was NO WAY I could give those people the proper care they deserved, plus deal with unhappy relatives and who also wanted to chat re Mum or Dad's condition. I barely had time to do all the meds and I was still late for handover. I felt disgusted when I got home cos I just could not spend anytime with those patients - and as someone else said on here, our elderly deserve better. NOBODY should be accepting a 1:65 patient ratio and argue that that is safe!
LTCs - in my experience - have poor staffing, staff (in Oz anyway) who are from overseas and who don't understand Ozzie culture and speak extremely poor English, doctors who don't give a hoot - even when u stand and argue with them - nil orientation or a very quick orientation, and NUMs who say call me if you need help - then don't ever answer their phone. If you are a new grad YOU ARE IT. And it is not a good learning environment - I found it to have the same dull, negative, repetitive duties everyday, but it's also not where my interest lies (I like psych and more of an adrenaline rush).
I remember going into one elderly lady's room when I was a carer. I inspected her fingernails cos they looked dirty. She had dried faeces under her lovely long nails, on her bed, on her shoes, in her hair, in her dentures - no-one had bothered to clean it off and I knew the family was coming to visit that day, so I spent time I didn't really have cleaning it all. Nobody could have cared less when I told them - they just said we haven't had time. Pretty gross if that was ur mother. And those faeces were NOT new; they were at least 2-3 days old I reckon - the staff were trying to tell me she recently smeared it all over herself, the bed, etc. It was all BS and pure laziness; something I've seen a lot of in LTCs - but yes you also get it in hospitals too, to a certain extent.
I hope there are better facilities out there, but the ones I've seen, you won't get good clinical skills - new grads need to try and get a med/surg placement but it all depends on their choices, money paid, travelling time, etc. LTC suits some people's personalities.
And what is this Walter Reed in DC? Have u got a link for that?
Being an agency nurse in LTC is the pits- completely agree with that :) Especially if you end up with the 'regular' staff being snotty and not giving any help about where things are, and the CNAs don't help with who people are (the admission photos can look like mug shots from 1856:D).
ECF- extended care facility- don't have major medical needs, but can't take care of things by themselves...not great for learning experiences, but not horrible. I found them rather dull as a CNA- only worked SNFs as a nurse.
SNF- skilled nursing facility- have post-hospital rehab, tube feedings (though I don't consider that all that skilled), some have vents; need some type of professional care that can't be done by a family member or CNA alone.
I did a lot of doubles when I first got out of school (and for a few years out). I did have good time management, and CNAs. I was the only RN for 30 on evenings and 60 on nights. Did the resp treatments, trach care, other treatments (though not so many pressure sores at that place), etc. I was young- it was expected to get done, and I did it. Were some nights crazy- oh, yeah :) But it still got done.
Another plus was visiting hours back in the mid to late 80s....families hit the road by 9 pm (unless someone was dying- and family needed to be there). And, CNAs were career CNAs more often then- and really took pride in their residents and the care they gave- it made a huge difference.
I'll look for the Walter Reed link- I'm sure there are several, since it's been a supposed great place for years, then some journalist got photos of the pit it is.... be back in a jif :)
It's pathetic....and unfortunately, US healthcare - while technologically excellent- is sadly unavailable for many....even those who fight for the country. There are some great VA (Veterans' Administration) facilities. And then there was this.
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.
Prior to becoming an RN, I was an STNA for approximately 7 years in LTC. Why did I chose acute care over LTC after graduation? Certainly no disdain for LTC. My choice was mainly r/t technical skills in nursing. I wanted to build on skills that I basically only glimpsed in nursing school: starting IVs, IV drips and titration, blood and blood component administration, ABGs, blood draws, etc. The new grad in LTC is not afforded this opportunity. I did not want to lose new skills that I had never gained.
Some people genuinely dislike LTC due to personal experiences, however there are many nurses that believe if you're not taking care of someone on half a dozen different drips, working code after code, handing IV's and A-lines out like their lollipops, and continually impressing the physicians with your vast array of clinical expertise and witty observations then obviously you and your specialty are irrelevant.
Let's face it new grads (and a larger number of more experienced nurses than we'd like to give credit for) have a lot of negative and inaccurate portraits and stereotypes for different specialties:
1) LTC/Geriatric nurse = nursing reject or ex con who "couldn't find a job doing anything else"
2) Psychiatric nurse = a nurse who is probably "crazy" anyway and doesn't have ANY skills because let's face it what kind of skills can you possibly develop from taking care of people with severe psychiatric disorders.
3) Clinic/Outpatient nurse = "Like oh my god, that is soooo easy!"
Sorry for the sarcasm, and new grads I'm not picking on you because these types of attitudes are seen in veteran nurses as well, it really gets old. It seems like some nurses simply want that Swedish massage for their egos so they feel smarter, more special, and more important so they mouth off long enough about something out of ignorance or a personal experience/story that is biased and SHAZAAM stereotypes are born.
Frankly, I enjoy acute care and I enjoy LTC just as much only in different ways, I work full time in acute and part time in LTC right now, and who knows that may change one day.
SO it was about you- not the LTC residents...? Did you find you learned anything in LTC that acute care nurses don't get exposed to?
I've also worked both... and found myself going back to LTC when I wanted a different pace. I worked the floor, and MDS/mgmt...so not always on the floor.... did treatments for all 120 beds at one place and LOVED that job.
Isn't it all...really? A nurse is an employee and not a matyr:)
Good management, good working environment; bad management, bad working environment.
I would not presume to knock any facility at all.
If there is a general disdain for LTC- they earned it. Work is neccessary to remove the foul odor attached to LTC.
Most nursing homes are very badly staffed, unsafe, but the nurse will be held liable for negligence etc. It wasn't that long ago that NY DA put camera's in nursing home and proved care was not being provided, who was arrested, the nurses, even if it was the aids that were falsifying records.
I wouldn't want to put myself in a unsafe situation legally and ethically. Also I have a hard enough time getting the PCA's where I work to do their job. It is very frustrating many of the night shift PCA's do the bare minimum on my floor, you have to beg them, remind them or take them by the hand to get things done. The agency PCA's are actually very hardworking and do a better job than regular staff.
I've read problems with bullying and threats from PCA's in nursing homes and even the criminal element, though that should no longer be an issue thanks to federal guidelines.
Lastly, I just can't deal with all the confused, dementia, and psyche patients that are living in nursing homes. You can't restrain them, you can't sedate them, the alarms will be going off non-stop. That is a nightmare for me, at least in the hospital we can give out haldol or ativan and restrain as a last resort or get a sitter if your lucky!
Specializes in Med nurse in med-surg., float, HH, and PDN.
Most nursing homes are very badly staffed, unsafe, but the nurse will be held liable for negligence etc. It wasn't that long ago that NY DA put camera's in nursing home and proved care was not being provided, who was arrested, the nurses, even if it was the aids that were falsifying records.
I wouldn't want to put myself in a unsafe situation legally and ethically. Also I have a hard enough time getting the PCA's where I work to do their job. It is very frustrating many of the night shift PCA's do the bare minimum on my floor, you have to beg them, remind them or take them by the hand to get things done. The agency PCA's are actually very hardworking and do a better job than regular staff.
I've read problems with bullying and threats from PCA's in nursing homes and even the criminal element, though that should no longer be an issue thanks to federal guidelines.
Lastly, I just can't deal with all the confused, dementia, and psyche patients that are living in nursing homes. You can't restrain them, you can't sedate them, the alarms will be going off non-stop. That is a nightmare for me, at least in the hospital we can give out haldol or ativan and restrain as a last resort or get a sitter if your lucky!
Oh, there are orders for Haldol and Ativan, but if you give them--all according to the orders, perfectly legal and doctor approved, mind you-- there are those who will say you're just trying to keep the patient quiet.
Specializes in Nurse Leader specializing in Labor & Delivery.
Hey OP, why don't you work at LTC? Don't tell because they don't have a 8-5 shifts; no place has it pretty much.
If it is that beneficial as you feel, why not give it a try for your own nursing development? I bet you would get hired in a heartbeat.
Meanwhile, I don't think you are being honest with your LTC opinions; or you'd try it yourself first. sorry.
Yes, a lot of places have 8-5 shifts. Home health case management, primary care clinic nursing, infusion clinics. I'm sorry you don't feel like I'm being honest. Don't really know what to say in response to that.
If I could find a LTC facility that offered me M-F 8-5ish (I'm looking for something with no nights, no or very few weekends), that could pay me what I need and offer good benefits, I'd take it in a heartbeat. You don't know me, and you make assumptions about me that have no basis.
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.
I thoroughly agree with this poster. Nursing hmes (now caled LTC) are not what they used to b e. They get much more acutely ill patients than they used to 10 to 15 years ago. Hospitals discharge patients long before they are ready and send the patients to nursing homes or rehab. Nurses in these environments have to on the ball. I think it's easier being a new nurse in a hospital than at a nursing home or sub acute facility. (please don't flame me for that!) JMHO.
xtxrn, ASN, RN
4,267 Posts
Amen !! The job is what you make it! If someone goes in thinking they're not going to learn anything, they definitely won't...