Why is LTC Nursing have a bad reputation

TheCommuter, BSN, RN · Feb 2, 2014

Is there a lot of dirty work which is turning people off?

There's dirty work in almost all types of nursing: hospital, nursing home, home health, private duty, psychiatric, etc. Any nurse who works in an inpatient setting deals with blood, poop, pee, spit, and every other bodily fluid imaginable.

LTC has a poor reputation because the elderly are generally devalued in American society. The respectability of a nursing specialty is related to the patient population being served. Our society places a very high value on pregnant women (especially if they‘re middle or upper class), very rich people, infants, children, teenagers, healthy young adults, celebrities, thin people, politicians, and very good-looking people. On the other hand, our society places a low value on the elderly, the overweight, the obese, the poor, undereducated people, alcoholics, drug addicts, immigrant migrant workers, the mentally ill, the perpetually unemployed, the disabled, ex convicts, criminals, the developmentally disabled, and the chronically ill.

So if you are a nurse who works in LTC facilities / nursing homes, jails, prisons, psychiatric hospitals, group homes for the intellectually disabled, methadone clinics, addictions / drug treatment centers, migrant worker community health programs, chronic dialysis, or free clinics, people won't be terribly interested in what you do because you care for patients that are devalued. Even other healthcare professionals and nursing colleagues will view your specialty as a lesser type of nursing. Some will ask, “Why don‘t you want to do real nursing?” But if you are a nurse who works in a specialty where you encounter highly valued patient populations (labor & delivery, postpartum, pediatrics, NICU, PICU, reproductive medicine, aesthetic plastic surgery, trauma, sports medicine, the ER, etc.), members of the general public respond with a higher interest level, and your colleagues in the nursing community will view you more favorably.

CapeCodMermaid, RN · Feb 2, 2014

LTC is devalued because most people have no clue what nurses in LTC do. They remember the nursing homes of days gone by when 98% of the residents were alert and oriented and not in need of nursing care other than one or two medications a day. Fast forward to where we are now: 75% of the people in the facility have a chronic disease which requires monitoring. The other 25% are actually acute residents who could have a significant change in status from one minute to the next. Then throw in the demented/psychotic residents who get physically and chemically restrained if they are in the hospital. We have to jump through hoops to give them a smidge of much needed zyprexa. And let's not forget the workload....med-surg nurses complain bitterly if they have more than 4 residents a shift.

Working in LTC requires superior assessment and time management skills. The opionion of people who think we don't work hard, aren't 'real' nurses, or must work in LTC because we couldn't get a job elsewhere couldn't be farther from the truth.

THAT's why we're undervalued.

amoLucia · Feb 4, 2014

As per usual, Commuter & CCM, your answers are so spot-on. But as good as they are, I, too, think they are sadly lost on those who haven't a clue what we do in LTC and the other low-valued settings we work in. The general public, pre-nursing folk and even so many of our nsg peers (and some other health-care professionals) just don't know and I don't think they care to know because it really doesn't affect them. That is until they need us or have to walk in our shoes.

RNBearColumbus, BSN · Feb 5, 2014

I think some of the bad attitude about LTC nursing stems from the way nurses are educated. All nursing education assumes that the graduate nurse will be working in a hospital setting. There may be one clinical rotation done in a LTC / Rehab setting, but it's usually the first clinical rotation, and instructors often take the attitude that it's just "practice" for the real clinical in the hospital.

Even the LPN program I attended was taught with the assumption that we would be working in a hospital setting. (For example, LPN curriculum still includes an entire quarter / semester of OB/Pediatrics. Why? There should be more emphasis on geriatrics, since that's where most LPNs are going to end up working.)

Long term care facilities need to partner with nursing education providers to give students clinical experiences that demonstrate the LTC / geriatrics is a specialty (and a growing one at that) that can provide a rewarding career in nursing.

Hoosier_RN, MSN · Feb 6, 2014

I am a RN, BSN who works the floor (by choice) in LTC. I love it and wouldn't dream of having it any other way! Sure, my home health case management was more 'glamorous' and had better hours. But I love the residents. Before I lost my HH job, I had kept thinking how much I missed LTC......for any education level, it can be a great job.....you just need the right company and the right attitude

Here.I.Stand, BSN, RN · Feb 9, 2014

The Commuter and Cape Cod Mermaid...wish I could like your posts 100x!!! :up:

All specialties of nursing have dirty aspects, and all have stress. It's just different kinds.

Sam J. · Feb 9, 2014

LTC is devalued because most people have no clue what nurses in LTC do.

And many (read:most) of them wouldn't be able to handle the workload, anyway.

pinkiepinkPN · Feb 9, 2014

I think some of the bad attitude about LTC nursing stems from the way nurses are educated. All nursing education assumes that the graduate nurse will be working in a hospital setting. There may be one clinical rotation done in a LTC / Rehab setting but it's usually the first clinical rotation, and instructors often take the attitude that it's just "practice" for the real clinical in the hospital. Even the LPN program I attended was taught with the assumption that we would be working in a hospital setting. (For example, LPN curriculum still includes an entire quarter / semester of OB/Pediatrics. Why? There should be more emphasis on geriatrics, since that's where most LPNs are going to end up working.) Long term care facilities need to partner with nursing education providers to give students clinical experiences that demonstrate the LTC / geriatrics is a specialty (and a growing one at that) that can provide a rewarding career in nursing.[/quote']
This. All of this times a thousand.

CapeCodMermaid, RN · Feb 9, 2014

My facility is used as a training spot for 3 CNA programs, two LPN programs and now an RN program. We get first semester RN students. They are only there for a few days learning how to do patient interviews, but even after two days with us, they have a better understanding of what we do as nurses in LTC. I've been working with one of the instructors who is trying to help me convince the dean of the school to send me students who are farther along in the process so they coukd give meds, do treatments and see what it's like to be the team leader.

vintagemother, BSN, CNA, LVN, RN · Feb 9, 2014

I attended a vocational school and although we complained about the fact that 80-90% of our clinicals were in SNFs and a dementia units, that experience really helped get me ready for my new grad job in LTC. Even the patient care (CNA work) we complained about benefitted me immensely in this job.

LadyFree28, BSN, LPN, RN · Feb 9, 2014

As per usual Commuter & CCM, your answers are so spot-on. But as good as they are, I, too, think they are sadly lost on those who haven't a clue what we do in LTC and the other low-valued settings we work in. The general public, pre-nursing folk and even so many of our nsg peers (and some other health-care professionals) just don't know and I don't think they care to know because it really doesn't affect them. That is until they need us or have to walk in our shoes.[/quote']
Agree...LTC IS a specialty that requires a hybrid of several nursing specialties, good assessment skills, good teaching skills, and good time management skills.
With the changes in healthcare, I believe the tide will change on LTC; they will need a new ratio as well.