Why do RN's avoid LTC positions?

RNperdiem, RN · Jan 1, 2012

I can't tell you the pros and cons of LTC having only done clinicals there, but there is the matter of status.

The status of our jobs is related to the kinds of patients we look after. In this society, the frail elderly, the disabled, the poor, the addictied, mentally ill and the chronically ill are devalued.

So if you work in the prisons, the state psych facilities and LTC, you are unfortunately looked down on. This is unfair, since LTC patients are most dependent on good nursing care for their quality of life.

Or you could assist in cosmetic surgery for the young, rich celebrities. (sarcasm)

AZO49008 · Jan 1, 2012

I would rather eat glass shards then work in LTC. When we did clinicals in LTC I literally felt like running out the door at the end of the shift - couldn't get out of there quick enough. Mass chaos, mis-management, under-staffing, all sorts of bed alarms going off, incontinence, pureed food. Nope. I will always sing the praises of people who can work these positions, but I cannot. Will not. It's not a "I'm better than that" sort of thing. I think the whole LTC industry is criminally mismanaged and I would be frustrated in a job where my best efforts would still feel like one step forward, five steps back.

NocturneNrse · Jan 1, 2012

I started right on Med/Surg/Tele after nursing school because that's what everyone in school advised me to do. "Go to Med/Surg, get good experience, learn all you can there.." blah blah blah.

Well, I tell ya what I got from Med/Surg.. alot of chaos, running around, feeling like I was not providing safe care, not having a SECOND to learn about a medication or procedure, etc.. Backstabbing which sucked out most of my energy and spirit, just plain OVERWHELMED.

I was hesitant to try LTC because everyone talked down a"bout it. Basically gave the impression that the nurses who worked LTC weren't "real" nurses.

I am in LTC now RN Supervising. I WISH I had started in LTC. I have time to really get to known the patient, learn and absorb all I can about their conditions (which are plentiful!), the medications, learning how to interact w/families/MDs/other nurses/Labs etc.. Learning about procedures/protocols. Where I work, we also have post surgical pt's.. so we get total knees/total hips/ etc etc you name it,, just a few more days past their surgeries than you'd get on Med/Surg.

I have heard that LTC management is horrible. Where I work now.. it's pretty dang good. Where I'd previously worked, it stunk. BUT.. as an RN you are in demand in LTC and can try out different facilites to find the best one. THEN.. after a yr in LTC..if you still feel that need for hospital work.. I personally would hire a nurse from LTC BEFORE I hired one straight out of school...and I have heard other nurse recruiters would also. You will enter the hospital with FAR more knowledge and working skills that will have you all set to learn what Med/Surg has to offer... without feeling so overwhelmed.

That's how I wish I'd done it. = )

FLmomof5 · Jan 1, 2012

I started in LTC. Unlike the poster above me, it was horrible!

First, you got only 5 days orientation. 30 pts with no name bands and old pics on a 5 inch thick MAR. The MAR had the common name of the drug, but the boxed in the cart had the generic in itty bitty print. Of the 30, nearly 1/2 were diabetic so you had to do the accuchecks on them. Four of the 30 were g-tube fed. It was an 8 hour race to pass the meds. You were on your feet for the full 8 hours and I was exhausted and my feet hurt (wore sketchers).

If you were lucky, you got the last hour to do your documentation. Your shift was ruined when you had an admit or if one or more of your pts went south and needed to be sent to the hospital. Then there were the falls!

For the first month, I was constantly there until 1 AM (I worked 3 - 11). I got chewed out for that. Geez. Finally, I got to the point where I could be out by 11, but when those 'special' events occurred, there was no way to be out on time. Then the nurses were threatened with criminal charges if we weren't clocked out on time, but were reminded that for OUR protection, we couldn't leave anything undone. Verbally told to work off the clock. Of course, if a resident went postal and we were there off the clock, we weren't protected.

The residents who got the best attention were AOx3 or if a fam member was there constantly. They were the ones who could complain.

I was so stressed out that my hubby told me that I should just quit. He hated seeing me so miserable. I couldn't do anything on my off days, but sleep.

I did quit. It took me 2 months to find a Med/Surg job. I love it where I am now!!!!

God bless the nurses who do LTC, I couldn't do it ever again.

TheCommuter, BSN, RN · Jan 1, 2012

I have worked in LTC on and off for the past six years, so I will comprise a list of what I believe are the cons of this type of nursing.

Cons:

1. The acuity level in LTC is rising due to pressure to get patients out of the hospital faster. The LTC facility where I am employed often gets patients who are only 2 days postop. We deal with JP drains, surgical incisions, IV antibiotics Q4h, central lines, and other stuff that you'd typically see on a med/surg floor.

2. Due to low reimbursement rates from Medicaid and Medicare, the typical LTC nurse is responsible for providing care to a large number of residents (often 30+).

3. Supplies are often nonexistent. For example, we currently have a comatose trach patient with orders to change his inner cannula every shift. However, the facility does not always keep the correct size inner cannula in stock because it is too 'expensive.' We cannot find colostomy bags when we need them. Equipment such as feeding tube pumps and nebulizer machines can be hard to locate.

4. The lack of staff is prevalent. I've worked at multiple nursing homes. None of them have employed a unit clerk, a full time respiratory therapist, and so forth. You must take off your own orders and do your own admission paperwork because there's no unit secretary to do it for you. You must perform all respiratory treatments because there will likely be no respiratory therapist to do it.

5. Incompetent employees can somewhat fly under the radar and still maintain employment at certain LTC facilities. You might have aides who sleep during the night shift. There will be the occasional nurse who ignores patient concerns to the point that it turns into a code situation.

6. Society tends to view the frail, isolated elderly with much disdain. However, many people fail to realize that the LTC population is actually a mixed bag of younger adults, middle-aged Baby Boomers who are sick due to hard living, and the elderly. My youngest resident was in her late 20s and stayed at the LTC while receiving IV antibiotics Q4h for infective endocarditis after slamming heroin.

7. The lack of orientation time is prevalent. Some fortunate nurses have posted that they received several weeks of orientation. Personally, I have never received more than a couple of days of orientation.

Marshall1 · Jan 1, 2012

I have tried twice to work LTC in the area I live...and I can't do it. Like others have posted, lots of chaos, employees who are either decent or not, management does understand, at least at this facility, the nursing/medical part of it, I could go on...the shifts for RN's are 8.5 hrs w/a mandatory 30 min taken out of your time whether you break or not - if you clock out to leave the premises for the 30 min. an additional 30 min. is taken out by the administrator because she does not think someone can break as they should if they clock out - oookkkk.......this particular facility stays full and makes $$ yet everything is very, very dated, the supplies stay at a minimal, there will be no changing things until this administrator - who literally yells, cusses and insults most of the staff, is gone - she has been there since 1986 - yes, that's 1986. The pay is lousy - even for RN's - and to supervise - which is what RN's (there is 1 on staff a day for 8 hours other than the DON - there is no RN on evenings, nights and no ADON) - is basically going room to room to make sure the aides have done what they are suppose to do and standing in the dining area while residents are fed etc. Orientation consisted VHS tapes from 1979 and 1988 (no kidding) that were geared toward watching out for "pot heads" and "hippies"for the drug video and one about steel worker factory safety. The RN position was boring but stressful if that makes sense...everyday, like another poster, I could not wait to get the #$%% out of there - my head would pound, it was noisy, too bright lights, too much....I think a lot of how LTC works for an RN is the facility itself and the value that is placed on the staff and residents by those in charge. Never again for me though..

DragonPurr · Jan 1, 2012

I have no experience with LTC, however, my perception of why I would never work at such a facility is simply that of work environment. The stories I have heard about patient med passess, and being the only RN in a facility for an astronomical number of human beings who are dependent on my ability to care for them, scares me to death. Being at the mercy of employeers who care more about money than their patients also is very unattractive. So for me it's not a status thing but more of self preservation.

Ruby Vee, BSN · Jan 1, 2012

It depends on what you'd like to do; where you'd like your career to go. If you're interested in either management or geriatrics, long term care is a good place to start. I have friends who started out in ltc and within a couple of years were don of their facility. From there, they could transition into management in acute care settings. I'm not commenting that I think it's appropriate to hire a ltc manager to manage an intensive care unit . . . But it happens. And it happens often enough to make me believe that it's seen as a legitimate career path.

My step-daughter's mother started out in ltc and was don of a facility most of the time s/d was growing up. She had fairly regular hours compared to mine and dh's (both of us working in critical care.) now she's a geriatric nurse practitioner . . . Still with fairly regular hours.

I've never worked in ltc. I love critical care and firmly believe that I don't have the patience for long term care. I visit my mother and my mother-in-law in their respective dementia units and stand in awe of the nurses who work there. I know I couldn't do it -- wouldn't want to even try. But one of mom's nurses tells me she's worked ltc for 35 years, loves it, and would never dream of changing jobs.

SuesquatchRN, BSN, RN · Jan 1, 2012

I like LTC. Don't love it but like it. I hated being a floor nurse there but then, I hated that in the hospital, too. I am now doing hospice, visiting, and love it. Lots of freedom, lots of autonomy, and no MDs changing orders every 30 seconds.

It depends to a degree on your state. I started in NY and LTC was very tightly watched by the gov't so the corner-cutting I see here in TX, where they have actually outsourced a lot of survey, wasn't possible. But it's hard, wherever you are.

leslie :-D · Jan 1, 2012

If you're going to work ltc, it's very helpful if you truly enjoy the elderly population.

Lots of people don't, whether it's r/t the overall devaluing of elderly, whether it's r/t fear of aging and its ultimate reality (for many), whether it's r/t just the overall depressing environment one can get when working with 'diapers and baby food'.

When I graduated (from a diploma program), I was offered a job at the sister hospital - a very exclusive, elite, good-paying job.

I wanted to work with elderly.

I interviewed at different facilities and automatically rejected those where I observed drooling, overly sedated pts strapped in their wcs...Watching cartoons in the day room.

Then I interviewed with a don and adon, whose evident pride for facility, just gushed throughout interview.

I later checked state survey scores (deficiency-free facility) and accepted job offer.

Immediately I was given med pass for the 40 residents on the floor, and they gave me 3 months before I assumed the cn role, for which I was hired.Not only did I fall in love with these residents, I learned a lot about prioritizing, time mgmt, polypharmacy with all of its potential interactions (esp with renal/hepatic impairment), and developed key assessment skills...

Since elderly just do not present w/any textbook s/s.

As a ltc nurse, it is the subtleties that you pick up on, when someone is ill.

We had plenty of iv's, wounds, drains, tubes, acute morbidities...And the best part of all?

Very little turnover, dedicated nurses (who also adored elderly) with high standards of care, and plenty of team work.

If you work in a poorly run facility, that sucks for you the nurse, and even more so for the pts.

But if you happen to work in a facility that is well run, everyone benefits, including new grads who learn a lot.

Only reason I left was to take inpt position at hospice facility.

Even when I took that position, I remain part time at ltc facility, until it became too much.

This was a wonderful job for me as a new grad...

And would go back to it, if it was a reputable facility.

Don't listen to naysayers.

They have likely worked for a shabby facility, or had bad experience r/t personal reasons.

But you really gotta like the elderly if you're going to work there.

Otherwise, good chance you just won't appreciate all the implications that go along with being elderly and debilitated.

Good luck!

Leslie

MN-Nurse, ASN, RN · Jan 1, 2012

"What are the pros and cons of working as an RN at a ltc facility?"

Pros: it's a job with RN in your title.

Cons:comparatively little training and often barbaric working conditions. One classmate of mine's first RN job was at our old ltc on the long term floor - night shift. One RN:50 patients. This facility has a habit of putting a lot of residents with acute issues on the "Long term" floor.

"It seems as though many RN's avoid ltc positions."

See the cons above.

Is it the nature of the job (ltc duties)?

Actually, no.

Lack of variety?

Nope. There is tons of variety. From memory care to long term placement, to short term rehab. You deal with residents with psych issues, diabetes, cardiovascular disease, ortho, renal, urology, spine, pain, wounds, feeding tubes, traumatic brain injury, family issues, social issues and much more....Basically everything.

"Do hospitals look view ltc experience as unfavorable experience?"

Not in my experience. I have a lot of coworkers who started in ltc. I did too - as an aide.