Why do RN's avoid LTC positions?

[amyca]

What are the pros and cons of working as an RN at a LTC facility? It seems as though many RN's avoid LTC positions.

Is it the nature of the job (LTC duties)? Lack of variety? Do hospitals look view LTC experience as unfavorable experience?

I'm pretty new to the nursing world, but am learning that hospital jobs are highly sought after, while LTC facility jobs the ones to avoid. (Not necessarily my opinion, merely an observation.) Just looking for some insight/opinions!

[Chronicallychanging]

Hello NocturneNrse, I am 56 and finishing my ADN degree in May. Everyone in my class are looking to go to the hospitals to work upon graduation. Some of them have already secured a position. I was thinking of looking at LTC for my first position, but am afraid to mention it to my peers. Right now we are also in a class that is discussing the correct job match, and hospital work does not look lke the correct match for me. I would like to make a difference in someones life and having a caring nurse who wants to be there is for the elderly client is needed regardless of the type of facility. I was encouraged to hear your words and will probably start on my job search at LTC soon.

[bryanleo9]

Chronicallychanging said:

Hello NocturneNrse, I am 56 and finishing my ADN degree in May. Everyone in my class are looking to go to the hospitals to work upon graduation. Some of them have already secured a position. I was thinking of looking at LTC for my first position, but am afraid to mention it to my peers. Right now we are also in a class that is discussing the correct job match, and hospital work does not look lke the correct match for me. I would like to make a difference in someones life and having a caring nurse who wants to be there is for the elderly client is needed regardless of the type of facility. I was encouraged to hear your words and will probably start on my job search at LTC soon.

Follow your heart. LTC definitely needs nurses that want to be there.

[Oldmahubbard]

I am an NP consultant in numerous LTC facilities.The largest issue by far from my perspective is the for-profit motive, and the fact that state fines for poor patient care are seen as no big deal, merely the cost of doing business, as long as the place is not actually shut down.

The place develops a poor reputation, and it is hard to attract decent employees who consistently come to work. The benefits are poor, and there is no clinical ladder. The nurses who are there are repeatedly mandated extra shifts, which many can't do. They have families, they aren't young anymore, or they just want to have a life outside of work.

Totally incompetent employees? Can't fire 'em because we have nobody to replace them.

I have seen nurse fired for patient care issues, and re-hired less than a year later.

It is the employment of last resort. Apparently.

I hate when I come back from vacation, and several of the decent nurses have left, or been walked out. But this is becoming commonplace.

There was a time 20 or 30 years ago, where being an RN in a nursing home was a long-term, respected, if unglamorous job. Now it seems not to be.

Sad.

[Davyd0322, ASN, BSN, MSN, CNA, LPN, RN]

From my personal experience of working in long-term care it seems to now be becoming a dumping ground for all sorts of patients. The nursing home where I work I normally have between 26-32 patients depending on census, and for these patients its me and 1.5 cna's on a good night. Some nights its just me and 1 cna. Out of my patients I have several tube feedings, everyone is now vital signs q 6 hours and respiratory assessments q 6 hours since covid started. Also there are times that I have to help my cna transfer or move patients. Oh did I mention the 11 diabetics I currently have 3 of which are very fragile, and the 88 narcotic cards I'm responsible for. And now we are being told that administration no longer has time to help us with admissions and it is our responsibility. Long-term care is very demanding and the burn out happens quickly if you are in a bad place, I have done this 10 years and have worked at good places, sadly most places eventually turn bad, when there is a shift in leadership. My best advice is to give it a try, but be aware even on night shift you will work your butt off unless you luck up and get a gravy supervisor job.

[Queen Tiye, RN]

I know this post is old, but I want to add to it in 2020. Some reasons RNs run from LTC facilities:

1) every rule that the BON sets forth is broken over and over again

2) the nurses are tasked with impossible assignments but have to chart that they did it all

3) nurses have to purchase their own VSs equipment

4) in many facilities, there is no training in clinical care or proper charting for new nurses or competency checks leading to unbelievable incompetence; not working toward a common mission; poor team ethic

5) LTCs are largely run by LVNs who didn’t receive formal training in leadership and who have limited clinical knowledge based on courses taken (save for the smart veterans). (By the way, LVNs are expected to function like RNs, are not compensated for it and aren’t as respected.)

6) many experienced LVNs resent new RNs and revel when you don’t know something or make a mistake, and will disempower you at every opportunity

7) the limited education and lower socioeconomic background of many staff members leads to excessive gossiping, maliciousness, and unprofessionalism — especially in facilities that lack staff diversity

8 ) working with lazy/ disenchanted colleagues becomes frustrating

9) facilities full of new nurses and no staff development is dangerous

10) you fear for your license because something gets missed in providing care or charting

11) leaders with poor leadership skills

12) not getting your meds and having to chart that you don’t have them

13) poor communication

14) egomania on steroids

15) Nurse Leaders with limited clinical experience/ knowledge can become frustrating

LTC as a field is wonderful, but how they are allowed to operate should be a crime and will be some day. I wish we could collectively refuse to work there. Quit in droves. If we could manage to do that, things would change overnight.

[lumbarpain, ADN, RN]

37 years I struggled with LTC...after the first 4, I wanted out...Life happened and set me back and although my biggest dream was to become an Holistic nurse......it fell out of the boat...….I swam to find my NOOK in nursing...but finances brought me to a dead stop...moving from state to state...etc.(finding myself again and where do I go now was my biggest challenge.) all of which never worked out....and I wholeheartedly agree with most of the posts here...you have to force yourself to assimilate....(much like being a BORG )

Its the system itself...….I knew it from the get go...poor everything except the poor patients themselves....who most didn't want to be in a nursing home either......sad...…...a lose, lose situation for all involved. we all get old....and if anything, Nursing homes need to be totally revamped up a thousand notches.

[ComeTogether, LPN]

Its really, really hard work and RNs have a much better selection of which to choose from. 

[TheDudeWithTheBigDog, ADN, RN]

On 6/12/2020 at 9:34 PM, Queen Tiye said:

2) the nurses are tasked with impossible assignments but have to chart that they did it all

I'm going to go with this is 100% the reason so many RNs avoid LTC, and so many those of us that end up in it only treat it as a temporary job while we're constantly looking to get into a hospital.  You can have 6 patients in acute care that keep you busy your entire shift, or you can have 15 patients in LTC and be expected to give the same exact quality of care as the 6 in acute care.

There is absolutely 0 reasons why a nursing home can't be staffed the way a hospital is for patient ratios, especially now that so many of them are corporate owned.  But instead of hiring just a couple more nurses to be able to give better care, which would cause medicare to refuse less payment, ultimately making the nursing home more money, they focus more on hiring on the administrative side.  Why do nursing homes need schedulers?  Doesn't every other manager in every other nursing setting handle that easily on their own?  Do they really need an entire department dedicated to bringing snacks to the patients, an entire job that can be taken away by just supplying snacks to the floors to give to the patients/residents?  Oh, and we all know they definitely need to have a management position in charge of being a middle man between the patient and the entire rest of the nursing home, instead of just having a realistic patient ratio so that the nurses have time to just handle that themselves, like they do in hospitals.

But yeah, let's all keep pretending that the problem is that RNs don't want to take care of the same old people they'd take care of in hospitals instead of the fact that the second you clock in to work at a nursing home, your license is at risk.

[Cheechwizard, BSN, RN]

On 6/12/2020 at 8:34 PM, Queen Tiye said:

I know this post is old, but I want to add to it in 2020. Some reasons RNs run from LTC facilities:

1) every rule that the BON sets forth is broken over and over again

2) the nurses are tasked with impossible assignments but have to chart that they did it all

3) nurses have to purchase their own VSs equipment

4) in many facilities, there is no training in clinical care or proper charting for new nurses or competency checks leading to unbelievable incompetence; not working toward a common mission; poor team ethic

5) LTCs are largely run by LVNs who didn’t receive formal training in leadership and who have limited clinical knowledge based on courses taken (save for the smart veterans). (By the way, LVNs are expected to function like RNs, are not compensated for it and aren’t as respected.)

6) many experienced LVNs resent new RNs and revel when you don’t know something or make a mistake, and will disempower you at every opportunity

7) the limited education and lower socioeconomic background of many staff members leads to excessive gossiping, maliciousness, and unprofessionalism — especially in facilities that lack staff diversity

8 ) working with lazy/ disenchanted colleagues becomes frustrating

9) facilities full of new nurses and no staff development is dangerous

10) you fear for your license because something gets missed in providing care or charting

11) leaders with poor leadership skills

12) not getting your meds and having to chart that you don’t have them

13) poor communication

14) egomania on steroids

15) Nurse Leaders with limited clinical experience/ knowledge can become frustrating

LTC as a field is wonderful, but how they are allowed to operate should be a crime and will be some day. I wish we could collectively refuse to work there. Quit in droves. If we could manage to do that, things would change overnight.

This sums it up.

 

I made the mistake of taking a LTC job and just quit tonight. 

 

I'm the only RN working the unit, the other RN is the DON. I was doing night shift 10-6.

 

Normally I'd have 2 units, 36 residents. Tonight they tried to pile me with 55, and they wouldn't budge. So I quit. 

As an RN I have to worry about my license first. It's how I make money. These facilities, mind you I worked in one that is considered the best of the best in the state of Texas, are understaffed. They rely on LVNs to do the nursing care, but it's pure task work. An LVN with 30+ years experience will spend 4.5 hours dropping meds and taking vitals on an 8 hour shift. The thing is they take shortcuts everywhere that will cause state to throw a fit, give you a ring on your license or worse. 

 

It's all unsafe shortcuts.

 

Now with covid-19 it's an additional hassle. And these facilities absolutely do not abuse by state guidelines. Rather because there are no firm mandates these places do what they want.

 

Patient gets covid-19, they won't move the patients belongings to their isolation room. They don't clean the patients room even though the individual has a roommate. Staff goes in and out of the room and so it spreads. Staff gets covid-19 and they don't clean the facility or the break room. And so it spreads.

Gloves? What are those? Rare to find even the oldest LVN wearing gloves much less handwash. Remember, this is a top home here in Texas.

Patients will sometimes have cameras in their rooms so the family can watch and complaining from home.

 

Equipment is ancient. Ancient oxygen concentrators, tube feed pumps that must be over 30 years old. They're usually broken and not maintained properly. 

No pyxis, rather medications are checked out by hand and paper records document taking of narcotics. It's all honor system.

Part of my training, all 2 days of it, included learning to steal medications from one patient to administer to another if they were out of a particular drug. 

Drug rights? Nope. Just line up cups, drop pills of varying types, and hope you remember who gets what. The only patient identifier was a photo on the EHR. As a bonus the software they used was incomplete, and you'd have to look in a mar and a "nmar", literally two different mars just to make sure you're getting all their medications because their software was unable to reconcile them.

Paper charting at random.

As for computer charting, every patient has tasks listed in triplicate. Charting on 35 people takes a while.

It's just nonstop. And then there is the guilt. As an RN I felt horrible that I wasn't able to provide the sort of care I got into nursing for. You have zero time to visit with residents. You have zero time to come back and assess them. 24 minutes per patient is what Texas says, but that would take us 13.5 hours. We're given 8 hours.

It's not an environment for proper nursing. It's a shame. People complain about nursing homes and LTC facilities, but why do we not have legal standards in place? Why do people not press our government? They run off low paying medicare. I get it. But why do folks need to suffer?

 

I would rather die at home or in a gutter than have to be admitted to any LTC care. It's so low quality, it's just awful. Waiting to die in filth. And if you're an RN you cannot work in such an environment within feeling awful. Like you're doing something unethical, because more than likely if you're not reporting where you work to the state, you are unethical.

 

 

[TAKOO01, BSN]

On 1/1/2012 at 9:47 AM, NocturneNrse said:

 

BUT.. as an RN you are in demand in LTC and can try out different facilites to find the best one.

This is a very accurate and positive statement. 

I worked LTC for a few brief days and hope never to return. I found it to be dangerously understaffed, with lax med protocols and a scary lingering feeling that I would lose my license. I didn't mind the patients or the poo, but I minded the insane workload and lack of support. I'm sure that those cons can be found in any specialty at some point, but it felt so pronounced in the LTC setting in my eyes. I too have the utmost respect for those who love this specialty. 

[whatintheworld]

I still think you should do a couple years medsurg first. Long term care is mostly for RNs who want management positions.

 

[TheDudeWithTheBigDog, ADN, RN]

16 hours ago, whatintheworld said:

I still think you should do a couple years medsurg first. Long term care is mostly for RNs who want management positions.

 

Trust us, if there were available jobs in our area, you can be really sure that we would not be working in LTC.  Unless we do want to be in a management role, 0 of us are OK with the risk we have to take to our license and career to clock in at these places.  And the sad part is there's subacute units in these places that would give us the medsurg experience, if we were staffed right.  But unfortunately, with 30 patients, you're a glorified pill dispenser and nothing more.  You are not a nurse in a LTC / subacute facility.  You're just a title for compliance with the state laws.  We'd rather be in a hospital and work as the actual nurse that we spent all that time and money to become, while not having to fear that we're going to lose our license or have it suspended before we can move on to a real nursing job, but unfortunately life isn't that perfect and some of us are stuck with this because our landlord doesn't care what we think about our job, it's either pay the rent that we need this job to cover or be homeless and die on the street.