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.
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.
there are good nursing homes with the appropriate staffing for the level of care...
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.
legal and ethical issues are not limited to ltc. if the pcas aren't working they need disciplinary action- not for ltc to be globally lumped into a "bad place to work" category :)
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.
you've read this- have you experienced it? you can find articles to support anything....princess di isn't really dead, elvis is eating donuts in las vegas....:) i worked in ltcs for about 6 years total, including floor, supervisory, and management. i don't' recall any criminals being on the payroll . we did background checks, which are required. i don't even remember any juicy stories about the "ones who got away"
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!
ahhhh - ok... you don't like ltc. you don't like confused, demented patients (the actual psych patients with overriding psych diagnoses who can't be managed in a regular ltc are sent to psych faciities for the elderly- if someone poses a risk to others, state health departments mandate removing them from the regular ltc). it's good you don't want to work there, if you think restraints and chemical restraints are the way to treat confused individuals- it makes them worse . hospitals see way different behaviors from these people because it's not familiar to them. that's not the overall way they behave. ltcs have a routine they are used to, and it makes a huge difference. if you simply don't like ltc- great.....but why trash an entire part of nursing because of your feelings- this isn't about ltc :) not liking something isn't the same as it being "bad".. :)
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.
Well, DUH!
Abuses of chemical restraints are a problem. If there is a documented need for the meds, they are permitted. Haldol is not been an approved med for the elderly since it was created- it's for longterm schizophrenics and psychotics...that's not the same as dementia. :) Ativan makes them more dangerous to themselves, because of the fall risk. DOCTORS are the worst with dealing with the elderly in the hospital- most have NO clue about appropriate meds for the demented elderly (and temporary confusion in a hospital is not necessarily dementia- ever seen a 40 year old after a couple of weeks in ICU??? They get a bit loopy as well. It's all about convenience for the staff (w/the doc) , and to be sure he doesn't get calls in the middle of the night...NOT to keep the patient safe. Keeping them quiet is all about the staff- not the patient. Do they get wound up, and need a lot of care in the hospital- absolutely. They take up a lot of time. And that's not how they always are- hospitals are lousy for them as it screws up their regular routine, and that makes them more confused. It's not their fault :) A medicated dementia patient is a lawsuit waiting to happen because of falls.
If the elderly are such a point of contention among so many, who do you think makes up a good chunk of the hospital population? It's not just LTC- the elderly are what keeps the hospitals open :)
Specializes in Nurse Leader specializing in Labor & Delivery.
FWIW, when I was in nursing school, I did one semester in the VA's longterm care wing, and part of that was in the dementia wing. I actually loved it, especially the dementia wing.
Specializes in Med nurse in med-surg., float, HH, and PDN.
xtxrn,
I see your point, and I did not know that about the Haldol and Ativan--they are so widely in use. And I LOVE old people; their confusion is not a problem for me. It"s the Alzheimer's patients who seem to snap and become physical that scare me; and it's probably worse for them. But it shoots adrenaline right through me when they go off. So, I shouldn't work with a large population with severe dementia, and I don't. I can handle the ones in early stages, but three times in my life I have been "attacked" and I would assume that's what colors my view. I suppose when the preliminary agitation starts ramping up, I AM interested in calming them down before it gets any worse, and yes, that addresses my comfort level , I can see that. But without sufficient support staff I can't take care of their needs, keep them from "getting into it" with other patients, and do the job I was hired for without my frustration eventually conquering me. I would rather, in that situation, just be doing the patient care instead of dealing with all the pills,paperwork,phonecalls,etc,etc. It's the combination of both together that I find daunting, especially in an understaffed situation where I can't locate the aides when I need them.
I see your point, and I did not know that about the Haldol and Ativan--they are so widely in use. And I LOVE old people; their confusion is not a problem for me. It"s the Alzheimer's patients who seem to snap and become physical that scare me; and it's probably worse for them. But it shoots adrenaline right through me when they go off. So, I shouldn't work with a large population with severe dementia, and I don't. I can handle the ones in early stages, but three times in my life I have been "attacked" and I would assume that's what colors my view. I suppose when the preliminary agitation starts ramping up, I AM interested in calming them down before it gets any worse, and yes, that addresses my comfort level , I can see that. But without sufficient support staff I can't take care of their needs, keep them from "getting into it" with other patients, and do the job I was hired for without my frustration eventually conquering me. I would rather, in that situation, just be doing the patient care instead of dealing with all the pills,paperwork,phonecalls,etc,etc. It's the combination of both together that I find daunting, especially in an understaffed situation where I can't locate the aides when I need them.
Yep- most nurses don't know that about psychoactive meds and the elderly. :)
The Alzheimers patients are generally reacting almost reflexively- it's scary to deal with, for sure. And with bad experiences, it would be worse :heartbeat
I'm sorry you've had such lousy experiences w/dementia patients. I have had some lousy ones, but when I was a CNA- and the other CNAs would band together to take care of the ones who attacked when getting their beds changes (major contortions going on!).
There are places I didn't like to work as well- and didn't. I'm all FOR people not working where they don't want to work- but for the reasons that they KNOW about (like your bad experience)- not assumptions
I am a new grad and was thrilled to get an offer from a LTC/SNF(acute, sub-acute) facility. I trained on one "hall" and that was to be my hall. After a week of orientation, they asked me if I was ready to go it alone. Yes, sort of. (I could do the med pass, but throw in an admission and there would be challenges because I was not trained for that since they had no admissions during my orientation.)
I show up for my first day alone and sure enough they assigned me to a different hall! A more challenging hall! I got an admission, a fall incident and a resident that had to be sent out. I was there until 2 am and that still wasn't good enough because I 'forgot' things on the admissions (for which I wasn't trained). They put me back on orientation (I was grateful) because the new hall was going to be my hall in the future after all.
Then I was told that to pass meds according to the clock and MAR was not possible so there were "ways" around it to get it done. (License on line stuff)
After being there more than a month.....here is what I see....
1.) They hired RNs not LPNs because they want to focus on the acute/sub-acute side.
2.) On the LTC side, they cut back on CNAs, so we have 1 RN for 30 residents and 2.5 CNAs.
3.) If the CNA doesn't do their assigned task, then the RN is responsible.
4.) It takes the FULL 8 hr shift to do med pass. Forget the "customer service" and spending time with the resident.
5.) They take care of the AOx3 and those with participating family members first (they are the ones who can complain) and leave the demented for last.
6.) CNAs have been known to make up vitals and are now (in our new computer system) reporting BMs where they didn't occur.
7.) The Nurse is expected to do all Accuchecks - 50% of the load and twice a shift. There is "no time" for a 2 nurse check for insulin.
8.) We are now being told that we MUST clock out at the end of our shift or get written up. (Corporate policy states that you cannot work off the clock.) IMHO, this is their way to force nurses to work off the clock and then later claim that the nurse did it against corporate policy.
9.) Documentation is still 80% paper and very duplicative.
10.) Some of our doctors are one step before being residents....... (just as old and maneuver just as well)
I could go on. I have learned time-management skills, but this is overload. I worked full time while attending nursing school full time. In fact, I often worked OT at my job 5 days a week, went to class at night and did 12 hr clinical shifts on the weekend.....and it wasn't as stressful and hard as just working 3 - 11 in an LTC.
Our nursing school had NO LTC clinicals.
I thought it would be great to take care of our neglected geriatric population....and then learned that most are demented....some sundowners....some as old as God but are full code....young MVA victim whose right brain was damaged and fights us in helping her....one legalized drug addict that acts like the queen of the nile. The screamers that yell "HEEELLLLLOOOOOOO!!!!!" or "Helllllppppppp!!!!!" as soon as the CNA and/or nurse walk out of their room (keeping the OTHER residents awake)....the seriously obese patient who is confused and telling tales (false) about their care.....4 of my 30 are on G-tubes, 15 of 30 are diabetics (along with a host of other issues), we have 6 - 10 residents who get parked at the NS because they are fall risks.....but there is never anyone at the NS because we are out passing meds and the CNAs have their hands more than full!
And the delightful 90 yo whose body no longer works, but her mind does....the few that come to the cart for their meds (on schedule!)...the married couple who are both Alzheimers - who have a great relationship during the day, where the wife thinks our facility is the Hotel California (you can check our any time you like but you can never leave!) who both have to have separate rooms on separate halls because she sundowns and gets violent with her spouse....the sweet 100 yo who is with us after breaking her other femur (OMG!)...
I am a hard core Republican, conservative, but I can now see why many nurses are Democrats. I would say to them that the vast majority of "professional" positions in this country are not treated like the slaves of LTC. We have caring and supportive management with an inflexible owner. Sad.
Our residents have MANY medical issues. I have had multiple residents that were fine one day, started to decline the next during day shift...they fought to stabilize the resident only to have them begin to crash during 3 - 11....and since they were full code....a call to 911 to get said resident, only to find they expired in the ER. We do have residents on IV on occasion, many G-tubes, cardiac issues, COPD (who go to the smoking area to have their fix!), those with pacemakers, those whose PT/INRs are unstable forcing us to watch their daily labs to decide whether or not to give coumadin, OCD'ers with Alzheimers (what a combo!)....and MOBILE residents - none of whom wear ID bracelets (we are to rely on an old picture to ID them!) and hunt them down as they roll the corridors...those who can't swallow (crush meds into applesauce) - those that know what is in the applesauce and don't want it (but we can hide in food or medpass), non-compliant diabetics, non-compliant with their diet (ie: pureed meals and thickened drinks) who demand a regular diet...most residents are incontinent...need to be fed by the CNAs, on and on.
I think anyone who believes that LTC is easier that acute needs to spend time in my facility. Honestly, I can't wait for my golden year to get into acute (most that I know who have left said that acute care was EASY after the LTC experience!!!)
I have been there ~6 weeks. The girl who started the same day I did, lasted 2 days. They hired another that lasted 4 days. My fellow classmates hired by this facility have either left are actively seeking to leave. This place pays MORE than the local hospitals, gives full benefits and pays educational reimbursement!
I love most of the residents. The workload is more than can be humanly done in the time allotted if you follow the NPA. This is NOT what I thought about when I thought about geriatric care.
God bless the nurses who do this long term (no pun intended)!!!!
Hang in there :) You will get your own rhythm down, and time will become easier to deal with. The ratios are a bit off from what i was used to recently (back in the 1980s, what you describe was GOOD !! ).
And bless you for caring :) I know it's hard- you know your residents as individuals and that is huge- whether they remember it for more than five minutes or not.
You're right- LTC is no piece of cake (neither is acute)....but the residents can really be wonderful to work with :)
Call it what you want but I like being able to provide all of the nursing care I document. Explain to me how this is possible when you have 40-60 pts? Management will give you the song and dance about managing your time but the truth is that there is no way to get everything done. So the nurse is forced to chose between lying and keeping their job. No one cares until the you know what hits the fan and then it all falls on the nurse. In my state more than a few nurses have been arrested, charged, and convicted of neglect and fraud. When you read into the situations most of the time it was really just a nurse cutting corners or not checking to see if the CNAs were doing their work because of the insane ratios at their facilities. The nurses had become complacent and turned a blind eye to what was going on with the residents because they just wanted to make it through their shifts. If a nurse can handle 40+ patients then good for her. In LTC I don't want more than 20. That's the number that I feel I can manage safely and there are not to many facilities with those ratios where I live.
Did I learn anything working in LTC? Sure I did. I gained some good assessment skills and I know how to make due with little in the way of supplies and staff. When I went to work in the hospital it was mostly about IV skills, blood draws, and working with a computer since everything was still paper at the LTC. I did more wound care in LTC and I'm really on point with medication since I endured the gigantic med pass. I also am very good with geriatric patients. So there is something of value to be gained from working LTC. I don't look down on ANY nurse regardless of what setting they work in. We all work hard. I'm just not into the slavery ratios and abuse that LTC nurses have to put up with.
I have to add this. It was also about wanting to see what happens next. After a while I got good as assessing my patients. I knew when they were de-compensating and I knew when to send them out. What I didn't know was what happened next. People get transferred to the hospital because they are sicker and I wanted to learn about what happens next. Now I'm curious about learning how to take care of even sicker patients. I know I eventually want to transfer to a step-down or CCU. What's wrong with wanting to move on? These days there is no shortage of nurses willing to take just about any position. So why care of worry about the nurse who wants to move on from an area or never work there at all?
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.
Florida: you sound like me a decade ago. I lasted in LTC/Geri for three years before I went to Acute Care. The manager that hired me told me to my face that "LTC for three years demonstrates that you KNOW how to manage your time and work hard".
The bulk of LTC in my country is government funded. It used to be a really good place to work. Conservative governments in my province are trying to privatize healthcare as much as possible. Nursing home patients are becoming Assisted Daily Living Candidates.
You start with the intention of treating every patient the same, nursing as the Ivory Tower in College told you, you should. By the end of the first week alone, you are wondering what in hades you've done.
I left because I couldn't deal with the families anymore. Guilt and revenge are prime motivators for some children. In all my years, I've only met one honest family member. She told me to stop calling her about her Father. He (in her words) had favoured her brothers for years treating them like princes and expecting her to take care of all the "dirty" stuff. I was to call the Princes to deal with their Father because she was done.
LTC nurses have a special corner of heaven reserved for them and they deserve it.
i don't know how common it is anywhere else, but around where i am, a lot of the LTC positions open actually ask for at least a couple years' experience in an acute setting before they'll hire a person.
that being said, LTC needs nurses, badly, but i think it's unfortunate that it has such a bad reputation among newer and graduating nurses. :/
xtxrn, ASN, RN
4,267 Posts
ahhhh - ok... you don't like ltc. you don't like confused, demented patients (the actual psych patients with overriding psych diagnoses who can't be managed in a regular ltc are sent to psych faciities for the elderly- if someone poses a risk to others, state health departments mandate removing them from the regular ltc). it's good you don't want to work there, if you think restraints and chemical restraints are the way to treat confused individuals- it makes them worse . hospitals see way different behaviors from these people because it's not familiar to them. that's not the overall way they behave. ltcs have a routine they are used to, and it makes a huge difference. if you simply don't like ltc- great.....but why trash an entire part of nursing because of your feelings- this isn't about ltc :) not liking something isn't the same as it being "bad".. :)