Why do many nurses look down on LTC?

Specialties Geriatric


Specializes in hospice, ortho,clinical review.

Seriously, I just finished responding to a thread on general and a comment about it's a career killer just ticked me.:angryfire

Why isn't it viewed as just a viable career direction?

My DON is one of the nicest, down to earth, supportive, awesome people I have ever had the pleasure to meet, much less work for and she started in an ICU and hated it.

I really thought I would stay in the direction of critical care. I loved my rotation in the burn unit and that was my goal. However I've noticed that it seems to take a certain type that flourishes in the BTU, ICU, ER type environments. It seems they have to lose the compassion since it's a cold, clinical type atmosphere. No matter how much I would love to have the skills that critical would provide, it's in no way worth a trade off to work with those types of people.

I do not work with any backstabbers. All the nurses from all 3 floors will lunch together. It's a place that fosters respect and realizes that if you treat your employees with dignity and optimism, those people will in turn treat the residents and each other with dignity and cheerful attitudes.

So I guess unless I figure away to gain skills in a critical environment on a casual basis, it's just won't be meant to be. Because I'm not willing to lose a really important component of wanting to go to work and really enjoying those that I work with and for. vs getting some really great skills but being stressed out and not liking where I work.

I'm just sick of reading that LTC is a dead end or someplace to go when no one else is hiring. And it seems like there's an attitude that you're less of a nurse if you work LTC :rolleyes: I make a difference and I go home feeling good, I don't think that's a small thing or a less worthy career path.

Yes I unfortunately took this place off my radar when I first graduated b/c my school pushed the whole "gotta have hospital experience". Strange blessing for me that the economy tanked and my original plan of the exact place that I'm now working, came back into view. And timed as such that they were willing to hire me b/c of "me" as they're not one of those that has a constant demand for nurses. They retain who they hire.

I just wish the negativity towards LTC would stop. If you are seriously that miserable then look for another direction, Life is far to precious and short to be that unhappy and it's a choice to be unhappy.

Okay vent over, I'm just tired of reading the same thing...maybe I should stop reading!:D

It isn't so much that nurses look down on LTC as an employment option but that they are mirroring the opinions of employers. I have had employers comment in a derogatory manner about my LTC experience to which I learned to retort that my worth as an employee was just as visible to other employers as it was to the LTC employers who hired me. I kept to myself my opinion that I have more respect for the people who hired me than the people who turned up their noses at me.

Well shame on anyone that thinks that or says that and that goes double for employers. I can't think of anything more important than taking care of the most needy members of our society. I will point out that I have seen management hire people from nursing homes and it usually worked out well.

Specializes in Emergency Department.

Please explain what LTC stands for.

Thank you

long term care

I don't look down on ltc nursing, and in fact have always had a certain admiration. I hear stories about being short staffed, with patient overload, staying over and then having management on your back...

I don't know how you do it. I've seen long term care with 1 nurse and 2 aids with 20+ patients, and the aids give showers and get people dressed.... On my unit for 20 people we will have 5, probably 6 people. One of those may be an aid, or the all may be licensed. We also have the luxery of having incontinent or post op pts having foleys (little toileting), no dressing (gowns make for easier access), bed baths 95% of the time, with 50% of those people being able to do a majority of the bath themselves.

I couldn't imagine the stress with LTC.

Specializes in ICU, PICC Nurse, Nursing Supervisor.

i don't care what anyone says...i love my job in ltc:heartbeat... if other nurses look down on ltc so be it. i am more than willing to take care of the elderly, but also consider it a privilege ...a lot of these people have no one else but the staff ...they look up to us and a lot of the time trust us more than their own family....so what it not as skilled as icu or er...its a whole different animal with a whole different set of skills....i have worked with some amazing patients over the years in ltc that have taught me so much....i have cried with these patients, introduced them to my family , laughed with them comforted them....held their hand as they were dying....it is my choice to be a ltc nurse and there is no other place i would rather be.....

denise rn

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

LTC is mistakenly regarded as "bottom-of-the-barrel" nursing due to the patient population that is involved. Whether anyone wishes to admit it or not, the isolated elderly are generally devalued by society. We place extraordinarily high value on the lives of infants, children, teens, and younger adults, but the elderly get the short end of the stick in many measures.

In addition, nursing specialties seem to gain prestige and a greater degree of respect if more equipment and higher acuity levels are involved. The ICU nurse deals with high acuity patients and plenty of equipment and machines, whereas the LTC nurse deals with stable patients and a chronic lack of equipment and supplies. Guess who gets demonized for having less to work with in the first place?

Specializes in Legal, Ortho, Rehab.

Ah don't worry about them, they just can't hack it!

I am a new graduate and I agree with you completely! I love LTC and prefer to work in that area. Unfortunately I am not getting any interest from anyone but hospitals right now...ugh! Forget those other people who look down on your career! Taking care of the elderly is one of the most rewarding and amazing jobs on the planet! I dare any nurse to tell me differently!!

I think the attitude of some nurses is that any nursing position that doesn't involve direct patient care in an acute care hospital is subpar. I think that clinic nurses, mental health nurses, and nurses in case management etc experience some of the same biases. They are looked at as not doing "real" nursing care and some employers deem them unhirable because they think they are not using "real" nursing skills in non-acute settings.

Specializes in Flight, ER, Transport, ICU/Critical Care.

Seems that you have a wonderful situation - I'd think that working in a place like that would be so therapeutic. For everyone. I am openly envious! I am not sure that I would give up the level of satisfaction you have to work in an area of acute care that often does not leave you feeling very therapeutic ;) Thump away if you want, but some acute care nurses are way less than satisfied.

It does seem that there is a propensity of some acute nurses to "look down" on LTC, not sure why - but, I just accept that we live in different worlds and have different practice realities. I could never be a good LTC nurse - but, there are some (and my sister is one of 'em) that are amazing LTC nurses! God Bless all of you! :angel: :angel: :angel:

I think it is just a lack of understanding of the part of those that do acute care to really realize that how tough the job of a good LTC nurse is - good LTC nurses may not have highly developed technical skills (it is a numbers game - heck, anyone can get good at IV's and chest tubes! the main thing is knowing the why's and how's behind the actual skill and even some acute care nurses are not technically brilliant!) but they manage 20-50 "residents" (patients) and delegate practice and care. Both jobs are tough - just in different ways. Put me in charge of LTC and I may be able to be competent (with time) but, I'd never be good at it. Oh yeah - the very thought TERRIFIES me!

We just live in different worlds of nursing. Just remember that good organization and communication skills are always needed in any area of nursing and with motivation anyone can learn and change. I know I have done a lot of changing over the years.


Sad, story of my evil (now reformed) ways! - I'm very ashamed of it now - as a paramedic I answered a 911 care to a local LTC for a resident in a full code. The RN on duty had called for "a patient that is a full code needs to go to ER for a eval". (Pet Peeve: eval is NOT a word or a clinical condition - ever!)

Some how my dispatch (not surprisingly) took this request as a Code In Progress and the call went out!

--- everyone with me so far ---

There was 3+ inches of snow and more coming and the ED was 25+ miles of mountain roads away - there was 1 paramedic (me!) in the entire south end of the county (300+ square miles) and 1 4x4 ambulance. All of this was well known to all!

Still a true emergency had been called in! I was called from home, met the ambulance in the town intersection (actually, I slid to the intersection, driving and snow in sports cars do not mix!) the volunteer FD was summoned (that code thing, again!). We were good at what we did - and a request had been made, that could very well have been someone close to any of us - as we lived and worked in a very small town.

--- stay with me ---

We arrived at the LTC and 6+ of us went in, stretcher with backboard, monitor and 80 pounds of equipment - we were ready! Everyone seemed too busy to answer our questions (although there was eating and socializing clearly going on!) or direct us - "it must be on the other side" ***? So, we went to the other end of the building and someone said - "The patient is ready in XYZ room, here is your paperwork, his nurse is on break." Really? We got to the room and the "patient" was sitting up in bed having a soda. All of us were confused - what is going on here? do we have the right patient? Finally, tracked a nurse down and she offered that his nurse that called is on break - but, yep, the patient needs to go for eval - but, she didn't know much more than that. As I was finding it near impossible to be the wonderful, professional person I usually am - I asked that nurse to "Bring me the RN that called this in. Now. Please."

--- this is the bad part, you have been warned ---

Well the RN made her way to me. After we assured that this was the right patient and that there was NO EMERGENCY here or anywhere in the facility. She was young and seemed blissfully unaware of heap of crap we were standing in. I asked what she told our dispatch - "We have patient that is a full code and needs to go to the ED for eval". She recounted all this while she was chewing (and smacking!) her gum while her hand was firmly on her hip. I'm certain that I must have been some shade of crazy crimson with my mouth hanging open. What happened next would best be described as educational. I asked what the problem was - the RN told me that the patient "had a decreased rectal temp and it had been that way for a couple of days." I am not kidding. I asked if there was any problem or complaint - the RN replied, "no, he's eating fine, acts normal, denies any pain or anything, I just called the doctor again about the temp, actually the lack of one and we thought it best to just send him out for eval." THAT word again. She also told us that she had called the family to let them know that she was sending him to the ER and the paramedics were on there way - that poor family.

I admit I was invested and I was very direct with her - First, eval is not a word. Second, you are never to call my dispatch and mention a patients "code status" ever - all patients are full codes by the fact you have called for a paramedic and that is the law and it is even written in the front of every chart (the law is different now). Third, explain to me the entire thing from the start using logic or skill or the ability to critically think or heck, I'll take common sense - now that you have placed the patient in a certain-to-be-harrowing-trip at dark, in the snow by the only paramedic in the area to sit in an ER with no complaint other than a decreased rectal temperature (which as 97.9 as I recall). Well, I'm not sure what else was said but then she started crying - yep, crying. I don't think I was deliberately mean, but - to a nurse that was not skilled in acute care - I'm sure that the questions that might have followed that all important third point were unanswerable. Looking back - I might have been a bit more understanding and certainly now - I would never handle the situation the way I did - it was what it was and although she may have been new and showed very poor judgement, I was the one that really messed up here. :selfbonk: :selfbonk: :selfbonk:

I hope that my poor example will open someone's eyes. I do not have to make the mistake to learn from it. :bugeyes:

Anyway - I never look down at anyone. I know that I do not like being "looked down on" and made to feel less than..... We are all different and it is the really good ones that will take the time and gain the insight to let everyone see eye-to-eye. We are in this together. I see that now.

Practice SAFE!


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