Why is LTC so hated

[MadameFreckles]

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 . Can someone enlighten me? Can LTC nursing be enjoyable?

[CapeCodMermaid, RN]

Nursey stuff and cool wounds??? Yikes

[misstrinad]

I deal with the same problem in Ltc, I have been doing it for just over a year now. You just do the best you can. Everything that could/should be done is impossible to all get done. Lean on your manager to help and if you need to pass things on to the next shift, be clear why you need help and exactly what you need help with. It gets easier with time, especially once you get to know your residents very well and you have an established routine. Make a cheat sheet and have a system on your assignment sheet for knowing what pts meds are done. I put a slash through their name once their first meds of the shift are done and I color it in completely once their meds for the shift are done, so at a glance I can see who is left. Do the easy pts first in the morning and get them out of the way. I also always keep sticky notes on hand for my diabetic list and mom list and other little notes I don't want to get lost on my assignment sheet.

Honestly I have gotten a talking to about my incidental overtime and on paper I wrote down the amount of time I have each day minus breaks and divided it by the number of pts and found I had something like 15 min per pt per shift. I showed that to management and asked them to decide exactly what part of my job they didn't want me to complete in order to clock out on time...charting? Meds? Fall paperwork? Report? They had no answer except no you can't not do all those things. For a week I kept track of exactly what caused me to have incidental overtime each day it occured and shared it with my manager and he know understands and is always willing to back me up. I haven't gotten written up yet for it and it's been 9+ months.

Once you get the hang of things you will better be able to complete the work on time. But honestly some facilities it's just impossible.

[misstrinad]

If not answering questions to folks who are new to the field/not even actually in it yet I supposed I would have phrased it more like 'technical skills my schooling trained me to perform' and 'variety of different wounds requiring extensive treatment'. I guess speaking less technical to a non medical professional was shooting myself in the foot.

[JuneLeeRN]

Hey I got a month of orientation in LTC (20:1 pt/rn ration, mix of subacute and ltc floor) but as a new grad it's still tough. I'm learning to be an RN and familiarize myself with LTC- which I've no prior experience with. I found so overwhelmed with medpass and treatments, plus getting to know residents it took me 2 months just to be comfortable and get a routine down. I didn't get oriented on how to do orders (something we dont do as student nurses), communicate with physicians and interdisciplinary staff (pt & to)-of course now that I'm on my own in my thirds month I'm totally overwhelmed- and dread work everyday. I hardly have enough time to do everything I need to do- I stay 2 hrs over everyday to document. Plus it's a challenge balancing my demented pt with the actually sick people. The LPNs that work with me are awesome but just don't have time to teach or mentor and I'm afraid their patience with my questions and slow speed will eventually run thin. To DNS on the Go--nurses like you are why our profession is so devided- in the end it's all a shame because its the patients who suffer

[Esme12, ASN, BSN, RN]

Long term care is tough....it takes a special set of skills and they develop over months!!! The first year after graduation are the toughest. You need some good brain sheets.

Brain sheet here are a few....

mtpmedsurg.doc

1 patient float.doc‎

5 pt. shift.doc‎

finalgraduateshiftreport.doc‎

horshiftsheet.doc‎

report sheet.doc‎

day sheet 2 doc.doc

ICU report sheet.doc‎

[PeacockMaiden]

I got 5 days of orientation from nurses who really weren't interested in training me. To them, I was just a hindrance and slowing them down. Many of those nurses had really bad attitudes.

I was then put on NOC shift as a brand new nurse where it was me, one LVN, and 4-6 CNAs to provide care for 100 patients. Totally not safe at all. Who in their right mind would think this is safe?!

I loved caring for the elderly, but I hated not being able to provide the care that they deserved. My facility was also very punitive, and would look for any reason to write you up. And you could not pass on any work to the next shift, that was a sure way to make enemies and then have those nurses look for reasons to write you up.

It's a money game for corporations who own these facilities. All they do is give lip service about providing quality care, but they don't want to pay for it.

I would go home crying every day because the job was complete unmanageable and a liability to my license. I lasted there one year and I had to get out.

But I do think I learned quite a bit there. I worked with some very good and very skilled nurses. I learned all about IV management, trachs, vents, tube feedings, drains, catheters, ostomies, wound care, assessment, etc.

I learned how to prioritize what to do in situations when I was the only RN in the building of 100 patients and simultaneously had 3 actively dying patients, 3 patients desatting, one hypoglycemic patient, an IV infiltrating, and a fall all occurring at the same time. That was a crazy night, but I'm afraid to say this scenario was typical. Again, what genius manager thinks this is safe?

I now work an as RN at an inpatient psych facility. The population of mentally ill are as devalued as the elderly, and as such we are underpaid (they pay the same as the SNF where I was working- which is 1/3-1/2 the dollar amount a nurse in an acute care hospital makes), the management doesn't give us enough staff or supplies. Same scenario, different venue. But it is somehow more doable than the SNF that I was working in.

[sfcraigs]

I am in California and will keep my LTC anonymous, though it has a 5 stars rating. I am on my 5th day orienting and working on floor. 14 pts med pass, supervision of LVN with another 30 patients , 6 Cna's and a seasoned Rn for preceptor. Prior to these 5 days, I received 10 days of orientation. I will not be in charge of a floor for months. I will be considered an orientee for many months, training on different shifts and floors before being on my own.

I always wanted to work with geriatrics, LTC , Alzheimer's, dementia, and hospice patients. This is my first job, and I am paid for my orientation, supported in pursuing my education with great flexibility for school. I am one semester away from my BSN.

The LTC I work for is nonprofit as well as the hospice I volunteer.

I have to agree with many on this forum that the amount of work is daunting and don't know if I will ever manage to finish anything on time.

i chose this population and I don't regret it. Please, pursue what you like because it shows and affects everybody you work with.

Be well!

[SmilingBluEyes]

Having worked LTC, the main reason I can think of why it's "so hated" is because the nurse-resident ratios are ridiculous and unmanageable. LTCs are all for-profit businesses and they cut staffing to the bone every day they are open. There is also a lot of dysfunction in many LTC facilities. Such low morale from being worked to death is a root cause and people start sniping each other or spread rumors that are not true. I hope never to work LTC again. It was a job never-done and thankless as far as management went. The "good" thing I did like about LTC was the gratitude on the parts of many residents and families. But that was few and far between and frankly, I rarely spent more than a few minutes with each resident each shift. It was very dissatisfying and demoralizing for me.

[SmilingBluEyes]

One more thing: the pay was horrible. Worked harder and with so much heart to get 18.00 an hour, compared to 40.00 plus in the hospital. It's as if nurses/staff at LTC are not worth much, which is also demoralizing. They deserve every bit the amount nurses in a hospital make, but never get it. And most are not unionized, (or have useless, weak unions that do nothing more than collect dues)---- so there is no one organized to fight to improve the dismal conditions and pay LTC nurses endure. Don't get me wrong: I TOTALLY respect and revere LTC nurses. I really do! I just won't be one if I can help it, again.

[lifelearningrn, BSN, RN]

My SNF pays more than the hospitals for a new RN... I guess it depends on where you go.

[HeyNurse2014, ASN, RN]

I got 5 days of orientation from nurses who really weren't interested in training me. To them, I was just a hindrance and slowing them down. Many of those nurses had really bad attitudes.

Wow, I could have written this myself. One kept telling me how I was slowing her down and I better get a move on. I know it was bad of me but I couldn't help but responded with... "if I rush, it's more likely I'll make a mistake. Do you want to take responsibility for my mistake?" That shut her up.

Yikes... the more I read everyones comments, the more I feel I need to get out of LTC.

[ThursdayNight, CNA]

On 6/18/2011 at 3:35 AM, CapeCodMermaid said:

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.

I've seen these. I worked and am still working in SNF. Some patients or residents attempting to pull their parenteral tubes out.