Why dont we get respect as LTC nurses?

[lvs2nrs3535]

Hi everyone,

I am hoping for some input to a questions that has been really burning my butt. I am a new nurse, and recently switched from med-surg at a local hospital (loved the job, hated the 12 hour shifts and the 45 minute commute), to a nursing home in my home town. I have spoken to numerous people about my new job, which I have, by the way, found to be very different but no less challenging than the work I was doing before. I am learning every day, and I truly do enjoy the job. I made the choice to change focus due to the fact that I have small children, 5 and 8, and the opportunity I had was a 7-3 shift, mon-thur. The money was less, but the savings in travel and not having to pay daycare made up for that.

Soooo, My big problem is, why is it that it truly seems that so very many nurses seem to look down their noses at long term care and geriatric nursing? I have even had one of my fellow graduates, (we both graduated May, passed the boards in June) actually say "I'm so sorry.":madface:

I couldnt believe my ears. And after I picked my jaw up off the floor, all the things I could/should have said came to me. Of course.

Has anyone else had this experience, or is it just me? And if you have, how do you deal with it? It is bad enough we undervalue and dont respect our elders, but now, I feel as if I have lost respect in the nursing community, (I am generalizing, I know, and I DO know that not every nurse feels this way, please dont feel that I think all nurses feel this way, cuz I do not).

I have been reading the nursing posts from so many of you on this specialty, and I can see that people who have worked in LTC understand. So sorry, I just needed to vent and get some understanding and hopefully advice from some of you more seasoned LTC geriatric nurses. During my med surg experience I felt more like a waitress than a nurse, it was kind of like 'turn em and burn em', without any time to connect with any patients, you were scrambling so hard just to meet their basic needs. I also realize that as a new nurse, I would have gotten better at the scrambling part, but still, after just two weeks at my new position, I already know almost all my 24 residents names, many of their likes and dislikes and have already been able to forge connections. So back to my question, how do you deal with it when you feel like other specialties look down on us?

I have also had ER nurses from the local hospital be VERY condesending to me when calling. Just twice, same nurse both times. And in case you are wondering, I am pretty thick skinned, I dont get my panties in a bunch over any little comment.

Any input would be sooo appreciated.

Thanks,

KristyBRNfortruenow

[Halinja, BSN, RN]

Only partially on topic, but relevant, I think. My parents are 77. They are beginning to experience serious health problems. I was a little annoyed at them because they'd have symptoms and not get proper treatment. I assumed they weren't telling the doctor everything.

Then last Christmas I was visiting them and went to a Dr.'s visit with my mother because I was curious as to what she was telling them. (she was experiencing serious shortness of breath, coughing, pain beneath left shoulder blade, dizziness). I was appalled at the Dr's response. She WAS telling him her symptoms. And his response, though I don't remember the exact words, was 'well, you're old, what do you expect?'. His manner was very condescending, as if speaking to a three year old child.

I begged her to go to a cardiologist, she did, turns out she had a mitral valve that was leaking on a 9.5 on a scale of 10 with 10 being absolute free flow, and 0 being a tight close. They operated on her and significantly improved her mitral valve function.

My point is, she had been complaining to the youngish GP for months, and every time he was patting her on the head, treating her like a whining child, and sending her home. My mother has a doctorate, she is neither undeducated, nor simple...but due to her age, she no longer gets respect. So how can the nurses who care for the aged get much respect?

If it helps anyone, I think someone who can care for the elderly, provide them with someone who cares when they have lost all others, give them a little dignity, deserve PROFOUND respect. Kudos!

[SydnieRN]

I have been wondering the same thing! I am a new grad and applied a few places in our local hospital. I had always wanted to work in OB but did not get hired. I am 7 months pg right now, and 6 months when I interviewed. This is my 3rd child and I understand why someone would not hire me. Partially out of desperation I took a job at a nursing home. One my grandparents were residents at. I love the people, the staff, the DON she keeps it running so well! She always knows what is going on and keeps the facility in great order. Starting pay is only 90 cents /hour less then the hospital. I am liking it very well so far, but when telling people where I work they say, "you have to start somewhere" or "I'm sorry" or "that will get your foot in the door" and I am just feeling terrible about that. I think I will start telling people what I do by saying, "I have the privelage of being able to take care of the elderly". What I have found, is we can have pts for years and they go to the hospital for a week or two and come back with the starts of or total decub. My father was in the hospital after a car accident and then a corrective surgery that went bad and left him a tetraplegic. After 1 month he had such a bad bed sore and had to have a flap replacement. Our residents at the nursing home do NOT get bed sores.

I also really like the 8 hour shifts instead of 12 hour shifts. I am so thankful to be hired being so close to the end of my pregnancy and I foundthat taking this different path is one I will love, I may not go to ob after a years experience here. Contrary to what the rest of the world thinks I should do!

So to you I say congrats on being able to have the honor of taking care of the aging and sometimes dying. It is very different from hospital care but I enjoy the pts!

[speckleddove]

it is a very simple explanation as to why they don't respect us.

because they have no clue as to all the duties and patient loads we are faced with daily.

yes, i too have had that experience.

i applied for a nusing position on a med/surg. floor in a local hospital.

they had my resume and believe me resumes are not my strong suit.

i detailed every duty and tiltle i held in ltc.

they called me in for an interview.

man was i insulted and angry, so angry i had to clench my jaws.

after all the detailed lisiting in my resume.

she asked if i had tube feeding experience, cather insertion, ng tube experience and i knew at that second, she had not even looked at my resume!

she made some snotty comment about making a ltc nurse a real nurse and chuckled.

and sneered her nose up and said in med / surg.or in any hospital setting, we need people with experience in these skills and that won't cry about a patient load of 8.

she said, just what do you ltc nurses do all day?

talk about blowing my top.

i firmly filled her in on the fact that every ltc nurses skills were equal to what hospital nurses do and then some.

i also made it very clear that i took offense to her having requested me to give long drawn out detailed job descriptions in a resume and her having not even bothering to read it.

i said if you want to cry about patient loads, how about giving them 50 + patient per nurse, every dang day for their entire shift!

man was i p off.

i rattled off all the duties we ltc nurses do every day.

and when i finally took a breath, i said i'm sorry but i just don't think your educated enough to interview ltc nurses or cnas and you need to change your attitude!

i left steaming for weeks over that.

i did not yell, scream or say nasty things to her but it still wasn't the best way to handle that.

my cousin also a ltc nurse was scheduled to interview with her the same day.

my cousin over heard her telling another woman she didn't think ltc staff could do their job.

so my cousin got up and left without even doing an interview.

after calming down.

i realized it is partly our nursing educators fault.

they place hospitals on this pedestal to nursing students and ignore ltc facilities.

i think everyone is left with the feeling that only the best nurses can work in a hospital and embed that into our psychy while were in nursing school.

so i think ltc nurses and ltc cnas need to create public awareness of just what it takes to fill these giant shoes we all fill.

we need to work to ensure we no longer go un-noticed and un-respected.

we need a ltc organization with local branches and hang out together and toot our own horns a little.

set up a little friendly competition between hospital and ltc nurses.

teach them that we are their equals.

but i hate the organizations that seem to only want money out of nurses!

they put on heirs yet do nothing for the nurses and usually begin turning their noses up when any nurse really needs some form of support or guidance.

it should be free and by donations only.

having a nursing license of any title should be welcomed and enough of a qualification to join.

if we want to do things or hand out phamplets, we should work together doing bake sales, arts n crafts, horse shoes, etc.

not asking each other to shell money we can't really afford.

god knows we shell out enough cash for our license, ceus and uniforms.

it should be casual dress, no acting as if your above anyone.

it should be just a group of nursing friends making new nursing friends.

sharing what we all have in common, health care.

not a group of some greedy, egomaniacs trying to impress the public.

if we cared as much about each other in nursing they way we care about our patients, we would have such a wonderful life working with each other.

we spend our lives with each other at work, we need to act like the family that we actually are.

no one seems to have a clue about what we do.

i spoke with friends and co-workers and strangers about what they thought ltc nurses did.

only one or two had even a slight idea of what we do.

and it seems that the general publics opinion of us, is far much more respecting of ltc nurses than our fellow nurses.

[speckleddove]

Now, after reading your words; I want to work with you.

That is exactly the way all of should feel and be proud of our skills.

[suebird3]

Thank you all for being so supportive of each other. :)

Suebird

[speckleddove]

My mother was done the same way.

I started going with her on every visit and started demanding certain tests, x-rays, etc. be done.

I had my fill of every new Dr. always wanting to playing with her prednisolone, just to see what happened.

She had Sarcoidosis.

She had been on steroids for years and every new Dr. wanted to see how and if lessions developed within her lungs as fast as they had heard about.

She couldn't breath at all without her prednisolone.

I put a stop to those games real fast.

I hate it when people disrespect the elders but for new Dr.s to play games at a patients expence, I turn into a you know what real fast.

Every older adult had something to do with how our own lives, pleasures,coping mechanisms and teachings came about.

We have reaped the rewards from everyone, even the mean ones teach us something, even if it is only teaching us how not to be.

More people need to remember that fact.

[speckleddove]

your soooo right you are, exactly my sentiments too.

[speckleddove]

that is an excellent point.

the only time you hear about us is on a tv special when a nightmare of a facility makes the news.

and then it's us nurses and cnas that take the blame, no one even thinks about the corporate individuals that created these places and conditions.

just once i'd like to see the media put them in the hot seat right along with the state agencies that do absolutely nothing to improve conditions nor protect patients.

public safety, my rear end; the state simply wants to save money for the politicians and hand out fines.

fines are monies that should be put toward hiring more staff, getting patient supplies, new equipment (like working beds) not some state agencies vaccation funds.

[Nascar nurse, ASN, RN]

Why can't we have adequate staffing, supplies etc and good nurses in LTC? Many facilites are already short staffed and underbudgeted that firing the "bad nurse that give us all a bad rep" ain't happening. I don't think its the nurses fault...its the large corps running the facilities.

I agree wholeheartedly with this. In my community anyway, nearly new hospital RN's are making $3-4/hr more than our highest paid experienced RN's. As an MDS nurse, I know what our medicare/medicaide rate is and am constantly pushed to get it as high as possible (and I'm Ok w/ that - it's the job I took). By regional comparisons of sister facilities I have one of the highest rates in northern half of the state. As a result of these efforts.. we have not received any increase in staffing, no additional equipment, no extra raise for me, etc. I am "pumping" out the money system - BUT WHERE DID IT ALL GO (coorporate - I know!) And yes, I agree, I have ran across some really bad and really scary nurses working in LTC and yep, they do give us a horrible reputation at times, but coorporate policy is "no rent a nurses" so who ya gonna get to cover all the shifts?

It's sad the the public has no idea what we are doing, but it gets real disheartening when other nurses want to label us as losers because we are LTC nurses. Lets walk a mile in each others shoes and then compare the blisters! (Said and meant in good spirits)

[hogan4736, BSN, RN]

...See, a lot of ER nurses will judge us by the residents we send out. That's not always fair. If someone has bedsores in this facility, 99% of the time they had them when they were initially sent here. The other times, it's virtually certain that the resident will not allow themself to be turned, which we chart diligently. If a call comes from the ER with questions and whoever answers the phone doesn't know, well, there are 165 residents here. If you get a different nurse than the one assigned to the particular patient, then chances are they are not going to know anything about them...

If the LTC would call report to the ED, we may not have to call the facility for questions

I was a w/e sup at a LTC (w/ a SNF)...When I sent a pt to the ED, I called report to the ED charge, and copied :

face sheet

labs

mars

H & P

nurses notes

treatment logs

and EVERYTHING else that was pertinent

I NEVER (in 2 years) received a call from an ED...

[hogan4736, BSN, RN]

let me follow up my above comments...

I worked ED for 6 years, right out of school...I HATED LTCs...We always received "train wrecks" from them (seemingly)

I got burned out in the ED, so I took a weekend supervisor job at a LTC/SNF...My eyes were opened indeed!

I gained instant respect for those that can pass meds AND do treatments for 30-40 patients (with only 4 aides...)

That being said, I am back in the hospital, working ED...I still notice two things:

1) report is rarely called to the ED, and there if often LESS than adequate paperwork sent

2) 911 is OVERUSED from these facilities

I was the only RN for 150 residents. I had 30 IV anibiotics to hang, do staffing, mop floors, etc...BUT I always called report to the ED, and sent (practically) the whole chart...

[TennNurse]

I will say this, I do not think for one second that I could handle working LTC. There is such a tremendous need for good nurses in this area, and my hat is off to the ones who've devoted themselves to caring for the elderly.

What I have learned over the last couple of years is that it is not LTC nurses that are the problem, it is many LTCs themselves. There is one here in town that is widely known as an absolute hellhole (my husband's men's group at church goes over there to hang out with the residents, and he has confirmed this assessment). Every ER pt I've had who came from there was an appalling mess. One poor old man I will always remember; he needed a Foley and it had been so long since he'd had basic hygeine done on his member that his foreskin was crusted shut and we had to get to his urethra with hemostats. This was painful for everyone.

On the other hand, when I was in nursing school, I worked for a lab that sent me to 3 LTC facilities at 0500 to get fasting labs on pts, one of which was a real high-dollar place where all the pts were just immaculate. This place obviously put money into hiring enough staff, and they apparently screened for the really good ones. Not having ever worked in an LTC facility, I can't say this with certainty, but it seems to me that what really makes the difference here is which facility the nurse in question works at. I have to assume that at this one horrible one here, either the staffing is so short that there is no way to meet even the most basic needs, or else this facility is willing to hire, um, less enthusiastic nurses, and certainly does not appear to hold the staff in general to any standard of quality of care.

LTC nurses are willing to take on a job that I don't think I could handle, along with hospice nurses and oncology nurses. So I am very thankful that you all are out there, and that you care so much about the elderly. I am very aware that my job would be a hundred times more difficult without you.