Why is LTC so hated

CapeCodMermaid, RN · Jun 18, 2011

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.

I would appreciate if you didn't insinuate I was a liar. I am the DNS at my facility. Giving a month of orientation not only makes for a better, happier nurse, it makes for a nurse who is comfortable on the job and therefore more likely to stay. At my last facility, we had a 6 week orientation for a new grad.

I had exactly ONE day of orientation when I worked at the hospital and it consisted of how to use an IV pump. Long term care facilities have far more regulations than hospitals. ONE day. That was all I had.

canigraduate · Jun 18, 2011

I worked in an ALF/LTC/Rehab for 8 months as a CNA. It had its pros and cons. The best part was spending time with the residents and patients. The worst part is that you only had time to do that on your day off.

At the facility I worked at, we were understaffed, overworked, and treated like dirt. The turnover rate was horrendous. We had two different administrators and three different DONs in that short amount of time.

So, that's why my old facility is avoided.

Nascar nurse, ASN, RN · Jun 18, 2011

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.

Oh boy! I can't even begin to respond to this as any response I give would likely get me banned from allnurses. Shame, shame, shame on you!!!!

Nascar nurse, ASN, RN · Jun 18, 2011

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.

My current facility and the facility I just left both gave 4-6 weeks of orientation for all the reasons outlined by CCM. In my last facility, as the ADON, I hired 3 brand new grads within a week and every Tuesday I personally spent an hour or two with them soley for the purpose of answering any questions they felt they weren't getting answered on the floor. We also went thru the proper admission procedures, emergency procedures, supervision of aides, etc. All 3 nurses were still at the facility (two years later) and thriving when I left.

Sorry you have obviously had a very bad experience in LTC but you are painting with an awfully broad brush. Check the attitude.

llbCCRN · Jun 18, 2011

I really can't agree entirely with "DNS" but you have to think of it this way: This is the viewpoint of MANY acute care employers, unit managers, supervisors and HR recruiters. So even if this information is NOT true, it is the word that has gotten around. An RN might have the most unbelievably amazing experience at an LTC facility, but if that stigma is stuck in your employer's head, it will hardly be considered worthy experience.

Just trying to keep things in perspective here, regardless of how varying LTC facilities may be...... :chair:

nurse2it · Jun 18, 2011

I found working in LTC to be depressing and overwhelming. Most facilities are primarily concerned with the bottom line, the only time there is an abundance of staff is when the state surveyors are due. It is backbreaking work, especially for the CNAs. Try changing a soiled brief with a demented resident who is cursing and swinging his fists. Please don't flame me, I am not heartless but the day to day realities of dealing with dementia pts who require total care is exhausting and soul draining, I lasted for 4 yrs and became severely depressed. Constant complaints from family members who demand you stop passing meds so they can vent for half an hour, etc. DONs who point out the 1 out of 10 things that did not get done on your shift, I could go on but I won't. It's really the CNAs who are the unsung heroes of LTC, IMO.

This is off topic, but the thing I hate about nursing is the neverending backstabbing culture...RN vs LPN, ICU vs the floor, BSN vs ADN, acute care vs LTC, why? Enough already, get over it!

casi, ASN, RN · Jun 18, 2011

LTC is the domain of Certified Nurses Aide who do most of the real work.
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.

Wow.... :eek: I really don't know what else to say other than wow.

NotFlo · Jun 19, 2011

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.

Well, whether you find it hard to believe or not, my facility will give a month and more to a nurse that really needs it. My last orientee was on orientation for 6 weeks (and still never "got it"...but wow, that's a whole nother can of worms). "Standard" orientation for a new grad is probably a month, an experienced nurse probably 2 weeks or so.

eriksoln, BSN, RN · Jun 19, 2011

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.

Oh boy! I can't even begin to respond to this as any response I give would likely get me banned from allnurses. Shame, shame, shame on you!!!!

Wow.... I really don't know what else to say other than wow.

I agree, the idea that LTC nurses have nothing to offer/teach nurses from acute settings is off base. But consider the source............and the source btw is not people like DNS. Its acute care setting administration.

Hospitals LOVE to sell and promote the idea that "real nursing" only occurs within their block of the city. Everything/everybody else is an offshot/mimic or incomplete. They promote this idea by refusing to hire those from other backgrounds, saying experience here does not translate to success there. Unfortunately, some people like DNS fall for it, all the while completely missing the point of what administration's goals are.

The benefits of promoting this sort of attitude are multiple:

1. It puts nurses in conflict with nurses. As a hospital administrator, I want the top grade nurses for minimal payout. Now, as an administrator, I'd feel more comfortable with my chances of getting this if the only group of nurses with whom I have to concern myself with are the ones under my own roof. Its one thing to know my most recent budget cuts will upset my workforce. Its a whole other thing to know they will upset the nurses in my workforce....................who also have the support of every single nursing home nurse within a 50 mile radius.

I'd be less likely to implement a staffing cut if I knew every patient and family member walking into said nursing homes would be aware of it within a few hours of their implementation.

2. In a "scratch your back, you scratch mine" sort of way, the nursing homes don't deny the perception that their nurses are "less able" because they benefit from it too. First, they get the same benefits the hospital does. Again, I'm much more confident about implementing cut backs that affect nurses/pt care if I know all the acute care setting nurses could care less about their peers. If for a second I thought all the nurses in the hospital were in league with the LTC nurses, I'd be too afraid of word of mouth advertisement of my cut backs.

3. By successfully splitting the nurses with a very definite line between Acute and LTC, I lower the public's perception of the nurses.

Acute care setting nurses come off as snide know it all types who will spit on their fellows in order to divulge in a moment of chest pounding. LTC nurses come off as undereducated or remedial. Much easier to convince the public that what is wrong with healthcare today has a lot to do with the nurses with these ideas already in the heads of the general public. Ever wonder why the public is so easily pacified by way of a nurse being thrown under the bus for a system flaw or another department's error?

I wonder how many LTC nurses who could do very well on other fields find themselves staying in LTC only because they have been convinced it is all they are qualified for. Thus, nursing homes are more capable of continuing with poor staffing and pt. care.

I wonder too, how many acute care setting nurses who are not cut out for their jobs are able to kid themselves and continue on while they tell themselves "I'm at least better than a nursing home nurse." Thus, said nurse fumbles through the day, barely meeting minimal standards, and believes there is no reason to improve. Again, the public's perception of us suffers as a result.

I'm not afraid to admit, a big part of the reason I won't do LTC is because I don't believe I could. I'd be the nurse who, while on pt. #15 of 40 I must pass meds to........is likely to be short tempered about someone demanding more time of me. I can handle ANYTHING that happens with my pt. load of 6 or 7, not so sure it'd be the same with 40.

LTC has its own distinctive skills and demands that can carry over into other fields of nursing. The ability not to panic under a heavy workload, being able to spend that three minutes completely focused on the person in front of you instead of going over your "to do list" while shoving pills out to people, prioritization.................it's all nursing.

I would, if I were in the shoes of some of the LTC nurses in here, take the opportunity to enforce this. Teach people like the ones you responded to that they are "moving their mouth" but it is the voice and words of business minded administration that they speak. Take the time to educate like minded nurses that LTC does indeed deserve its seat amongst their peers.

TheCommuter, BSN, RN · Jun 19, 2011

Pay is also a consideration, LTC always pays lower than hospital nursing.

This is not true in the large metro area where I live. The nursing homes and LTC facilities pay more than the major acute care hospitals in order to attract and retain staff. I was recently offered $26 hourly to work at a hospital and $33 to work at a nursing home. The $7 per hour difference is nothing to sneeze at.

The majority of nurses who work in LTC stay because they can not make it in real nursing.

Acute care hospital nursing is certainly not the only type of care that qualifies as 'real nursing.' In addition, hospital employment will continue to be on the decline as inpatient stays become shorter and more provision of care is pushed outside the hospital due to cost containment. Acute care is not the exalted diamond that everyone makes it out to be.

Nurses who work in LTC, psychiatric facilities, occupational health, clinics, doctors' offices, home health, hospice, public health, education, ambulatory surgery centers, rehab, assisted living, and other specialties based outside the acute care hospitals are very much real nurses who are providing 'real nursing care.'

joanna73, BSN, RN · Jun 19, 2011

DNS on the go, your reply is insulting and could not be further from the truth. Come and work LTC for even one day, and I guarantee you would change your opinion. We perform many of the same skills as acute care, and then some. You have a whole rainbow of psych issues to contend with, and hospice care on top of that.

I think many people fear LTC because of the value placed on youth. Working with seniors is precious, but it also forces you to reflect on your own mortality, and the fact that you will be one of them someday. Our seniors deserve love, respect, and compassion. LTC is the last stop for them. I say, if you don't want to work LTC...great, to each his own...please don't. The elderly need people who genuinely want to be with them.

And we are ALL real nurses. Furthermore, the elitist attitudes I notice among some nurses is shocking. One specialty is not better than another...they each have a different skill set.

nursejoed · Jun 19, 2011

"Come and work LTC for even one day, and I guarantee you would change your opinion. We perform many of the same skills as acute care, and then some. You have a whole rainbow of psych issues to contend with, and hospice care on top of that."

With 30:1 ratios, it's impossible to do any of this well. That's why LTC is so hated.