Why is LTC so hated

Art_Vandelay · Jun 18, 2011

The facility where I work has a skilled rehab side i.e. the resident normally stays 30 days or less and a LTC side, but I've also worked at facilities where they mix the two which never made sense to me. I can't speak much for the happiness of the nurses on the LTC side because I only supervise that side, but they do seem to be generally happier than the nurses(including me) on the skilled side. The LTC side doesn't have constant admits and discharges. Plus, sometimes on the skilled unit we get admits that we have to send right back to the hospital because they are too sick still. (Not that the LTC side doesn't have to send patients out too). I don't like working the skilled side though, because I only get 2-3 minutes with each patient if I want to ensure EVERYONE'S safety. I've actually been craving the opposite, ICU, where I would have very few patients, but I've never worked in ICU so I just don't know. So mabye it is the environment, maybe it is just not my "niche"... but I don't like it because I hardly have time to know 40 + patients and I have yet to work for an administration that truly cares about adequate staffing or patient care minus the phoney rhetoric, just the almighty $ and I can't seem to get past that. I've lost my fate in humanity somewhat. But maybe you will have better luck or just like it more than me! :)

KellyRPNinOntario · Jun 18, 2011

I love LTC...I have 32 amazingly individual residents that I have established trusting relationships with. Everyday there is a laugh and a cry. Im an Lpn and I love my job.

**NickiLaughs, ADN, BSN, RN** · Jun 18, 2011

I've worked LTC as an LVN and have been in ICU as an RN. I didn't hate LTC, I loved my patients, I hated that my facility understaffed so severely, I had no ability to bond or even have a conversation with my patients.

it was me and 38 patients on night shift, either 7p to 7a or 11p to 7a (we were so understaffed that I usually ended up working 4 to 5 12's a week). When I helped on days, it was beyond horrible, I know that when I came in at 7, usually the 5pm med pass wasn't done, so I would have to try to finish that on top of my 9 pm med pass, blood sugars for 14 residents, and then help the 2 CNAs with any baths or any other hygiene care that had to be done.

I then had charting, assessments to complete, and then the 38 MARS to check. I often had some sort of emergency whether it was a resident fall, or a really high blood sugar that required multiple physician calls. I then had a break sort of, that's the reason I worked nights. But then back to running around like a chicken with my head chopped off at 430 AM.

Now, I run like a maniac, but it's for 2 patients, and I feel like I sometimes have time to spend with the families, and the patients to give the care and attention they deserve/require.

If they instituted a ratio law, I think 1 nurse for 15 patients would enable me to give fair care they deserved, but at 38? no, any nurse will burn out, you can't provide quality with quantity.

50kn · Jun 18, 2011

I worked at both a skilled nursing facility (is LTC the same as a SNF?) and a hospital before. In my case, working at the skilled nursing facility was harder and busier than working at the hospital because of a number of patient's load. Some of the patients at the SNF were as acute as the patients in the hospital. I rarely had time to even go to a restroom when I worked at the SNF.

Art_Vandelay · Jun 18, 2011

I worked at both a skilled nursing facility (is LTC the same as a SNF?) and a hospital before. In my case, working at the skilled nursing facility was harder and busier than working at the hospital because of a number of patient’s load. Some of the patients at the SNF were as acute as the patients in the hospital. I rarely had time to even go to a restroom when I worked at the SNF.

LTC care is what the name implies: the patients are there to stay long term. However, technically, I believe it is still a skilled nursing facility as it requires skilled nursing care. However, I imagine you worked in the same type of skilled nursing facility I do where the patients are there to receive rehab for various reasons and then be discharged. Both require skilled nursing care, but the duration and acuity are different.

hope3456, ASN, RN · Jun 18, 2011

Some facilities are better than others. There are some that give the rest a bad name and rightfully so - but really the same goes for hospitals. The hospital in my community is horrible and the LTC's not so bad. I think it is unfortunate the number of RN's - many with extensive acute care experience - working in the LTC's b/c they got so fed up with the hospital.

Lahryn04 · Jun 18, 2011

One of my very first jobs out of high school was working in LTC as a CNA. I absolutely loved the residents, that was not the problem. However, I found it very difficult to do my job as it was to be done, due to lack of sufficient staff, supplies, and terrible management! I felt bad for the residents who I felt like received less than stellar care. I give props to those nurses and aides that work in environments such as this. It was very trying and emotionally draining at times. I'm sure not all LTC facilities are like the one I worked at but some are. Working in LTC is wonderful experience and can help you get your feet wet if you have no healthcare experience, but I would be picky about which one you choose to work at. Just my :twocents:

TonyaM73, ASN, RN · Jun 18, 2011

I started off in a LTC with rehab since none of the hospitals were hiring new grads at the time. I loved the pts, but there were just too many of them. You may have 20 pts on the rehab side. (which many of them are fresh post ops from the hospital only 2-3 days post op and 30 on the long term side.) When you have that many pts, you don't have enough time for each one to assess what is going on. If someone is showing early signs of something you won't know it unless you know that pt, are observant enough and are just plain lucky. I felt like I was drowning everyday that I worked with just the meds, so if you added in admissions or someone going bad, you were just done!

There are truely some very successful nurses working in LTC, but you have to have a good team to pull it off. If management dosen't support the nurse or if you have terrible CNAs or if your coworker nurses don't work together as a team, it is very hard to last doing that kind of work.

NurseLoveJoy88, ASN, RN · Jun 18, 2011

I could never hate longterm care. It gave me my start in nursing and I learned alot from it. Before I started nursing school I knew what specialty I wanted. LTC wasn't it but I did it to gain basic nursing skills and it helped me to build a good foundation.

CapeCodMermaid, RN · Jun 18, 2011

I think many people look down on nurses who work in skilled facilities because they still have in their little minds the picture of a nursing home from the 60's and 70's when the nurses basically did nothing all day but pass a colace or two.

Visit any skilled facility today and you won't see too many nurses sitting. The patients are sicker, admissions and discharges are common place, the skills you need are the same as on any med surg floor....oh wait, more so. The nurses at the local HOSPITAL won't take a trach patient on a med surg floor (and they only have 5 or 6 patients to deal with) ---they have to be in the ICU, but nurses at my skilled facility have to care for 20 patients including those with trachs. Let's not forget the PICC lines, TPN, wound vacs, drains, and everything else we deal with. Add to that the unbelievable number of regulations.

If you work in a hospital and the patient acts up...you give them Haldol and restrain them. We are supposed to be able to manage the SAME kind of patient without using restraints, chemical or physical.

So before anyone looks down on those of us who work in the business, I think all y'all should take a tour and see what we do every day.

nursejoed · Jun 18, 2011

It is impossible to give truly good care in LTC. The ratios v. expectations are obscene, and when push comes to shove, management is more concerned about the paperwork. That's probably one of the chief reasons why it's so widely hated.

netglow, ASN, RN · Jun 18, 2011

The big problem is the stigma for LTC nurses. It's awful hard to be considered for jobs outside of LTC. So many hospital recruiters as well as NMs absolutely will not even consider someone coming from LTC. Of course there are some that will, and they did when the economy was in a better place. Most jobs that are away from bedside, will, require you to have had some clinical experience. That experience is almost always required to be acute care experience.

I still hear people talk of if given a choice, they'd rather hire a NG without any hospital or any work experience at all, over, an experienced LTC nurse. This, makes no sense at all. Also, someone posted something that was really enlightening recently. About how so many nurses are similar to abused children in that they have been treated poorly so they look for some "thing" that they can hold above others to make them feel better. That "thing" is that they've never worked LTC. LTC is where the people work who are "lesser" than they, and they won't associate with "those" nurses from the wrong side of the tracks. This strikes me funny, as hospital jobs are just as sh**** as LTC these days. Heck!!