Why is LTC so hated

joanna73, BSN, RN · Jun 19, 2011

It's challenging for sure, and certainly not always ideal, but you learn to make the best of it, and become very efficient. It's not impossible, because you don't have 30 people requiring hospice care all at one time, for example. Their needs vary.

kbrn2002, ADN, 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.
Well that is extremely insulting. I don't know what your current area of practice is, but I would never presume to make broad, sweeping statements that because you work in that environment that you can't make it in real nursing! I'm sorry you apparently had such a horrible experience in long term care, but don't take that out on us!

As for you comments about poor orientation, simply not true! Where I work new hires get a minimum of 4 weeks of orientation, regardless of their experience level. Some of the more experienced nurses ask to come off orientation sooner because they are bored with it, while newer nurses can request, and receive, even longer orientation id they feel they need it. Bottom line, nobody is put on the floor alone unprepared!
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.

OK, I will give you this one. I know it's true because two nurses I work with are wanting to make a move to hospital nursing and have been told that their LTC experience doesn't count. Sad, but true!

Forever Sunshine, ASN, RN · Jun 19, 2011

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.
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.
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.

Your post just baffles me and I am quite insulted by it. I shortened it to the things I want to share my opinion on. The other stuff I just don't have any comment on.

CNAs work their asses off but so do the nurses. We are there over our 8 hour shift working and .. not getting paid for it. But we have to stay and finish because.. we will get written up for the work that wasn't done. So don't say we don't do real work.

I've been working as a nurse for almost a year and a half. I've learned so much about this profession and its a work in progress. I have a lot to go but I give my residents the best care I can and find a way to make it happen even if we have limited resources. Its not just a pay check. Have you been on a sub-acute or rehab unit recently? Have you seen the acuity or the nursing skills required to care for those residents? The only thing different from med-surg is that we have 3x the amount of patients. THAT takes skill. and we are up to "snuff" even though to you.. we are just pill pushers who can't make it in the hospital.

I have loads to teach new nurses. I've trained a new nurse who is turning out to be fabulous already. I and the other nurses where I work are continuing our education. Our facility encourages education and professional growth.

Even if hospitals do not think LTC nursing is experience. I strongly suggest they rethink that and walk a couple shifts in our shoes. We are excellent nurses.

reeveslpn · 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.

When I started out as a brand new LPN 9 years ago, I also recieved 1 month of orientation. The DON wouldnt have it any other way, even if you had experience she wanted you to have two full weeks of orientation. She was the best they don't make them like that anymore.

joanna73, BSN, RN · Jun 19, 2011

And by the way, DNS, I came to LTC from an inner city 80 bed Acute Care unit. The skills I learned on that unit are invaluable to me working LTC. I left because I was tired of the lack of resources and crappy crappy staffing, not because I couldn't cut it. I have news for you...to everyone that thinks LTC staffing is bad, well these days nurses are exploited everywhere. Furthermore, because I received 4 years of training in various med surg units, I can honestly say that in LTC its the SAME WORK. Actually, no...because instead of 5-6 patients, you have 30 or more.

mazy · 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.

LTC is also regulated by JCAHO.

As to your comments about LTC nurses, I don't even know where to begin. Not even worth the effort. Yeesh. :down:

CapeCodMermaid, RN · Jun 19, 2011

I'm done with this issue. Obviously DNS On the Go...should go away. Far far away. I'm all for spirited discussion, but the woman called me a liar, and I will not tolerate that. We who work in the field know what we do. We don't need someone who is clueless to cause us any more trouble. And we certainly don't need anyone to validate what we do.

Nascar nurse, ASN, RN · Jun 19, 2011

We who work in the field know what we do. We don't need someone who is clueless to cause us any more trouble. And we certainly don't need anyone to validate what we do.

Agreed.

But I have to say, I find a couple of things disturbing about the thread:

1. How many people actually gave DNS on the go's post kudos. (Really...you all believe LTC nurses are idiots? Really?)

2. That DNS on the go made such an inflammatory post and this disappeared from the thread.

3. Apparently the OP got the answer to the question.

I am a nurse and I am a DA** good nurse. And I AM PROUD to be a LTC nurse!

kbrn2002, ADN, RN · Jun 21, 2011

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.

That's really interesting! There is nowhere near me, including a large metro area 150 miles away that pays better in LTC than the hospital. I know here I live it's explained [by employers at least] that Medicare/Medicaid payments to LTC are lower so the wages are lower. Maybe I should take that with a grain of salt, because it's also true that all our hospitals are union, and to my knowledge none of the local SNF are. Makes me think a little!

Bbo.W · Jun 21, 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!

I am a CNA at a LTC facility. Recently I was changing a brief on a patient with severe dementia. This patient punched me in the nose, causing s nosebleed. My nurse's advice to me? "Don't get so close to the residents when you are providing care." REALLY!!!!!!!!!!!!!!! How exactly am I supposed to change someone's brief from across the room? I cried all the way home. :-(

Mobiusrain · Jun 22, 2011

Agreed.
But I have to say, I find a couple of things disturbing about the thread:
1. How many people actually gave DNS on the go's post kudos. (Really...you all believe LTC nurses are idiots? Really?)

I'm one of the posters who gave kudos to DNS on the go's post. I was so immersed with many of the points made and how much of them held true to my situation and how I felt. I must have overlooked the derogatory statements about LTC nurses not up to snuff. While I agree with everything else, I have utmost respect for LTC nurses, having been one myself. LTC is real nursing, but in very harsh and unsafe conditions IMHO. Having to handle such a large number of patients at a time is very daunting. Regardless of acuity, the medpass will still take so much of your time that you can't afford to slow down for other things or else you'll be way behind. Not to mention the piles and piles of paperwork you have to do as well. How other LTC nurses can endure such working conditions is beyond me, but I commend them for being able to persevere.

Skills-wise, LTC requires its own set of skills, but accept it or not, hospital employers look down at LTC nurses. They won't hire me despite having nursing experience. Apparently it's not "acute" enough for them.

Nascar nurse, ASN, RN · Jun 22, 2011

I'm one of the posters who gave kudos to DNS on the go's post. I was so immersed with many of the points made and how much of them held true to my situation and how I felt. I must have overlooked the derogatory statements about LTC nurses not up to snuff. While I agree with everything else, I have utmost respect for LTC nurses, having been one myself. LTC is real nursing, but in very harsh and unsafe conditions IMHO. Having to handle such a large number of patients at a time is very daunting. Regardless of acuity, the medpass will still take so much of your time that you can't afford to slow down for other things or else you'll be way behind. Not to mention the piles and piles of paperwork you have to do as well. How other LTC nurses can endure such working conditions is beyond me, but I commend them for being able to persevere.
Skills-wise, LTC requires its own set of skills, but accept it or not, hospital employers look down at LTC nurses. They won't hire me despite having nursing experience. Apparently it's not "acute" enough for them.

Thank You! I appreciate your clarification. :)