Why is LTC so hated

Specialties Geriatric

Published

I hope I am not offending anyone with this question. I have been on allnurses for a while now, trying to find out as much as I can about the nursing career before getting started. One thing I have noticed is that LTC seems to be thought of as the last resort for nurses who can't get jobs elsewhere. I've seen many posts with people saying, "getting a hospital job seems hopeless, I guess I'll go to LTC." I don't get it, why is LTC worse than working at a hospital? I was thinking of volunteering at an LTC or hospice and getting a CNA position there later so I can hopefully be hired as an RN upon graduation. I am also interested in Hospice but that seems to be hard to get into for new grads. From some of the posts I've read though, it sounds like working LTC is the tenth circle of hell :confused:. Can someone enlighten me? Can LTC nursing be enjoyable?

I worked LTC and really liked it. I did staff nursing, DON, ADON, Skilled Unit Manager, and MDS. I enjoyed being a staff nurse the most and primarily worked on the Medicare Skilled/Subacute Wing. Many of my residents were short-term admissions and were discharged - believe it or not. One of the main problems was having enough talented and dependable CNA's....the pay for CNA's is horrible. I left LTC primarily because of all the duplicate and triplicate documentation. But I've learned recently, some facilities have gone to electronic documentation like hospitals.

When I hear someone dogging nurses that work in LTC, I just tell them that unless they've ever worked there, they don't know how hard those nurses work. After all, they have to be the eyes and the ears of the physician when they have to call a doctor about an ill resident. The nurses and the cna's know those residents like a family member that lives in their home. It is the "subtle" changes in a resident's behavior that gives the nurse a "clue" that they're getting sick.

I have a lot of respect for those that work in LTC. It's a specialty in and of itself! :heartbeat

Rhonda :)

As an LTC CNA on a dementia unit, I SO appreciate your words... Sometimes it is hard to get an answer on what is the problem...When you work w/ patients and you see a change, it is SO helpful to have a nurse that adknowleges your observations! LTC is a different kind of animal!

A good friend of mine just left med surg to come work at the nursing home. Her reply was "Wow it is just like med surg only harder" lol and she is orienting on our floor with the lowest acuity residents :)

I do love ltc. I love my residents and most of the staff. I don't like the way ltc is handled in this country and I am an avid supporter of the green house project. The facility I am at is not a green house home but they have adopted many of the Eden alternative ideas.

Specializes in LTC, Disease Management, smoking Cessati.

I think LTC is looked down upon because people don't know what is involved. You use your skills, if you are in a skilled unit you get those patients fresh from the hospital and believe me they come out a lot sooner than they used to. People who frown upon it need to go find out what it is and not be so negative. I chose to work LTC and have worked in other places. I like the population and never felt my skills were lost.

Specializes in Gerontology, Med surg, Home Health.
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.

Just so you know, the residents in MY facility get excellent care and I am management. The staff is supported and respected for the work they do. When push comes to shove, the other managers and I are out there on the units helping the nurses and the CNAs.

I worked LTC once for 2 months, and will never do so again. Not enough staff, no supplies, med passes on 35 patients plus all treatments. I didn't have time to get my work done and I am good at time management.

I work in a hospital now where I can never have more than 7 patients on night shift, many nights are just 6 patients and most nights the patients are not high acuity. In two years I have stayed overtime about 40 minutes and that was due to others being late, not the inability to have enough time to get my work done.

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Specializes in Telemetry, OB, NICU.

I wouldn't like to work at LTC. Because, first, they don't give you enough orientation even if you are a new grad and just throw you out there to take care of 25-35 residents. At least the ones I know of don't have enough staffing and so very good care.

Specializes in Geriatrics, Dialysis.

Long Term Care, or Skilled Nursing Facilities can indeed be very rewarding places to work As mentioned in another post there are many facilities that have higher level of acuity patients on a short term rehab unit, frequently in my experience this unit is used as a post-surgical step down. There should be plenty of opportunity to practice skills, and maybe even learn some. So don't assume that LTC is "the 10th circle of hell." But, like anything else there is good and bad, and some facilities are great to new grads and inexperienced nurses while some are horrible [i imagine hospitals are the same story - some good, some bad]. If you are interested, do some research and find places you might be welcomed and given proper training. A decision to start at one of the poor facilities could sour you from nursing altogether [no joke!] There is also the consideration that the field just isn't for everyone. You would be working with a predominantly elderly population, and that just isn't some people's cup of tea. I happen to love it, but then for me the thought OB/GYN or PEDS is horrifying ! There are almost always staffing issues in LTC, the patient to nurse ratio can be quite high, and that is often overwhelming to inexperienced nurses. Pay is also a consideration, LTC always pays lower than hospital nursing. This is not a slight to the nursing staff, just an economic reality. The majority of hospitals receive higher payments from patients than LTC, most of the income in LTC derives from Medicare/Medicaid and state funded programs which pay the facilities less so they in turn pay their staff less. There is definitely a bias against LTC nurses, questioning our skills is common so if you decide to join us be prepared to let that bias just roll off your back. I do occasionally give in to my urge to defend my chosen field, especially here when I am in a lousy mood and decide to take somebodies rant or ignorant post personally [and if I've done that to anybody reading this, sorry...maybe]. After all this, and sorry if I rambled on a bit, if you want to try LTC, go for it! You may decide you love it, and if you don't nothing says you have stay there forever!

Good Luck!

I am one of those people who used to say "I would retire before I worked in a nursing home." I still feel that way, despite my interviewing with a LTC facility when I wanted off night shift.

My reason: Nothing to do with LTC nurses not having the same skills to practice, compensation or thinking acute care is any more valuable. Simply put, I resent that Medical Care in the U.S. has become more like working in a warehouse and less like.........well, medical care. IMO, LTC exemplifies this flaw more than any other field. Pt. ratios are worse in LTC than anywhere else, holistic/personable care is sacrificed in the name of making a bonus or two for admin. and "just keeping people alive for the shift" is acceptable more so in LTC than anywhere else.

Mind you, hospitals are closing the gap on a daily basis and are guilty of the same, just not to the same extreme. That is why I have no desire to work LTC, it is the field that has, more than any other practice, lost its way and completely forsaken the patient.

This completely sums up all my frustrations with LTC. It is a business run by business entities with no health care knowledge or interest (other than a well-paid staff of litigation attorneys always hard at work handling one malpractice suit after another) who are in the business just to suck the Medicare system dry.

Minimum revenue out, maximum revenue in. Means that LTC facilities are short staffed, have no supplies, do not want to pay or attract experienced nurses, throw inexperienced nurses on the floor with no orientation, resources, support, etc., etc. etc. Sometimes I feel like I constantly have to remind administration that just because a patient is a DNR, that doesn't mean we can actually kill them.

I work in the non-profit sector now so I don't have to deal with those issues -- pay is less, but I don't cry myself to sleep every night. So it's worth it and I really love doing what I'm doing. Working with the elderly can be very rewarding if you are in a place where you have the resources to do it well.

After being stuck with LTC for more than 2 years, all I could say is that i really do hate it!

When I first started, I was oriented for about 5 days and then was put on the floor right after to fend for myself. The first month was absolutely horrible. I was struggling with identifying all the patients, getting their meds together and making sure the MAR is complete, doing Medicare documentation, reporting changes in patient conditions, writing incident reports, doing admissions, attending to resident/family complaints, answering phone calls, finding replacements for CNAs calling in sick for the following day...complete chaos. Even after the initial "getting used to it" stage I still struggled to do my job effectively.

The medpass...probably the most hated aspect of LTC for me. One half of my typical shift is all med passing. And then you get the non-stop phone calls and incidents that come every so often, further cutting into your med pass time. Then you go rushing trying to finish passing your meds and blood sugars before mealtime. Then suddenly, a demented patient is reported to have fallen trying to go to the bathroom. There goes your whole day. Some GT patients in our facility have bolus feedings 4 times a day, so thats more time consumed.

Admissions is another story. Sometimes we get admissions from hospitals 7:00 in the evening! Now you have to somehow sacrifice precious med pass time to do your admission and skin assessments, calling the doctor to verify orders and medications, transcribing the orders and meds to the MAR and TAR, complete pages and pages of admission papers, and you still wont have enough time in your shift to finish everything! And with management minimizing overtime, we have to work through our breaks and work past our shift unpaid just to finish everything.

How can it be lawful to allow LTCs to have nurses have 30 patients under their care? I understand that the acuity is much lower in LTC, but the accountability and responsibility is the same nonetheless, but even more heavier since you have so many people to take care of! If something wrong happens to one of them, welcome lawsuit, bye bye license. There is simply no way to provide quality and safe care with this patient load. You're always in a hurry trying to make every second of your shift count. How can I establish a good working relationship with a patient if I can't even spend a bit more time with them to address their concerns? I am so sick of this kind of work. I love the elderly, but LTC does not allow me to provide the care and be the nurse I want to be. Coupled with the fact that hospitals wont even look at my resume because my experience isn't considered "acute care" just adds more salt to my wounds.

Specializes in Gerontology, Med surg, Home Health.

My facility gives new grads at least a month of orientation. When I worked in the hospital, I got ONE day of orientation and then was put in charge of a floor despite the fact that I was a brand new grad because I was the only RN.

LTC is a business-most LTC facilities are for profit. The mentality of the administration is geared towards cost containment which manifests itself in poor staffing, poor benefits, lack of supplies and lack of resources to do the job. Add to this the lack of training other then the few mandatory in-services and a management team who are seriously lacking in professional skills and education helps to create an environment that has historically had a very high turnover among nurses. Nurses see what it is and run quickly. LTC is the domain of Certified Nurses Aide who do most of the real work.

I have worked in several LTC facilities as staff, as agency and as an MDS coordinator and DON. Regardless of the role, the buildings are different but the goals are the same-making money for the owner.

In a hospital, the facility must provide you with real education so that you can function in your job. The staffing in hospitals may not be ideal but the hospital management must appease the patients and their doctors so the staffing usually does not get too tight.

Having worked in both arenas-LTC and Hospital -in both staff and management roles, my 2 cents is to avoid LTC if possible. You will not learn or grow professionally...it is just a pay check. Even if you work on the sub acute or skilled unit your learning and professional development is very very limited.

Remember, LTC is not about you or the residents/patients but about the owner making money.

As a DON I have been told by the administrator of the facility, " it is their business and we are to do as we are told".

Additionally, nurses who work in LTC are not nurses from whom you can learn. LTC and other post acute care providers are staffed by nurses who for the most part are not up to snuff. The majority of nurses who work in LTC stay because they can not make it in real nursing. This is sad and I know it will cause many to attack this reply but it is the reality of the situation.

In summary if you need the check and have no other choice or it is close to home or fits your life at the time- LTC is acceptable but if you want to learn, develop as a nurse and have a nursing career with some options, acute care is the place to be. LTC offers very few options and the "clinical experience" you have is limited.

Most hospitals will not even count your LTC experience in determining years of experience differential.

To those who say they love LTC...good for you- love it- but to new nurses or nurses who do not know about the nursing sector jobs...be aware about what LTC is really about.

Dear Capecod Mermaid,

I find it very hard to believe that any LTC facility would give you a month orientation to a new or any nurse. One month of unproductive time??? Additionally, no hospital will give 1 day orientation except for an experienced agency nurse. Hospitals are regulated by the Joint commission and the JC has numerous new employee regulations.

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