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!
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.
Well said. Post covers the salient points of the situation.
Specializes in Progressive Care, Sub-Acute, Hospice, Geriatrics.
On 9/25/2020 at 12:29 AM, Cheechwizard said:
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.
This. This is why I want to leave LTC. You summed up basically where I work at. It is really disheartening. It used to be 2 nurses on my short term care unit, but now they are changing my unit to long term care with 45 patients and 1 nurse, 2 CNAs at night. It was tolerable at first, but now it is crazy. For profit facilities will allocate the budget and even lower it just to cut down on expenses. I am overworked and doing a 2 nurses job with a salary of 1. I am looking for another job, but my area is too suburban. There aren't a lot of nursing jobs, 1 community hospital, the rest are case manager jobs.
This. This is why I want to leave LTC. You summed up basically where I work at. It is really disheartening. It used to be 2 nurses on my short term care unit, but now they are changing my unit to long term care with 45 patients and 1 nurse, 2 CNAs at night. It was tolerable at first, but now it is crazy. For profit facilities will allocate the budget and even lower it just to cut down on expenses. I am overworked and doing a 2 nurses job with a salary of 1. I am looking for another job, but my area is too suburban. There aren't a lot of nursing jobs, 1 community hospital, the rest are case manager jobs.
Nobody should have to look into what they don't want to do. What DESPERATELY needs to happen is that all of us, as an entire industry, stand up and make it clear that we are not OK with this. WE let this happen
Nobody should have to look into what they don't want to do. What DESPERATELY needs to happen is that all of us, as an entire industry, stand up and make it clear that we are not OK with this. WE let this happen
You are right. Nobody should HAVE TO look into what they don't want to do. But, I was making a suggestion, NOT informing him/her they HAVE TO look into case management. It was merely a bit of advice.
You are right. Nobody should HAVE TO look into what they don't want to do. But, I was making a suggestion, NOT informing him/her they HAVE TO look into case management. It was merely a bit of advice.
Dude, you got to relax. Good day!
The issue is that it doesn't solve the underlying problem. If it's not her it's another nurse who's going to replace her. Until we put an end to this, it's going to be an endless cycle.
Specializes in Progressive Care, Sub-Acute, Hospice, Geriatrics.
17 hours ago, TheDudeWithTheBigDog said:
The issue is that it doesn't solve the underlying problem. If it's not her it's another nurse who's going to replace her. Until we put an end to this, it's going to be an endless cycle.
This is what I have been telling my co-workers. It has become a norm because we (staff) let them (management) do so.. I tried to tell my co-workers that we all need to speak up because they will not listen to one voice, but apparently no one wants to speak up. We all want to leave, but we don't want to find another job that is going to be the same thing and we will have to start over again.
On 12/8/2020 at 6:06 AM, TheDudeWithTheBigDog said:
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.
At the same time, many hospital units treat the nurse as a glorified pill pusher as well. Read some posts on here about unsafe staffing ratios in the acute setting. At least in my area, the LTC nurses are paid much better than the hospital nurses. Not that either scenario is excusable
This is what I have been telling my co-workers. It has become a norm because we (staff) let them (management) do so.. I tried to tell my co-workers that we all need to speak up because they will not listen to one voice, but apparently no one wants to speak up. We all want to leave, but we don't want to find another job that is going to be the same thing and we will have to start over again.
Sadly, you can speak up, but management will replace you as well. In nursing, the squeaky wheel doesn’t get the grease. Usually it gets replaced...I've seen it many times. I've worked at 2 LTCs that walked all current staff out, having hired all new staff to replace. They did onboarding and orientation at another facility. Both times I was in the new group as DON or ADON. I didn't stay long, as a company that will do that, will have no qualms about running you ragged
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
10 hours ago, Hoosier_RN said:
Sadly, you can speak up, but management will replace you as well. In nursing, the squeaky wheel doesn’t get the grease. Usually it gets replaced...I've seen it many times. I've worked at 2 LTCs that walked all current staff out, having hired all new staff to replace. They did onboarding and orientation at another facility. Both times I was in the new group as DON or ADON. I didn't stay long, as a company that will do that, will have no qualms about running you ragged
Yep I have seen this. There were places where management deliberately ran experienced staff off and replaced them with cheaper staff, much less likely to protest dangerous conditions, either by lack of experience and knowledge or intimidation. Those are places no one who cares about their patients or license wants to work, whether LTC, a hospital or elsewhere.
Sadly, you can speak up, but management will replace you as well. In nursing, the squeaky wheel doesn’t get the grease. Usually it gets replaced...I've seen it many times. I've worked at 2 LTCs that walked all current staff out, having hired all new staff to replace. They did onboarding and orientation at another facility. Both times I was in the new group as DON or ADON. I didn't stay long, as a company that will do that, will have no qualms about running you ragged
So then you get revenge, you go public about the conditions you had to work under. Get a story out to the local news. Make the residents' families know about their mother having to lay in her own diarrhea because the only nurse was busy with 58 other patients and the CNA assigned to that room was busy with the call bells going off on his 29 other rooms assigned to him. Actually, do that anyway. Make the public know what their families are dealing with in these facilities. Make Medicare and the insurance companies know that they're basically paying for fraud, that all those RN hours that are reported to them are secretaries and office workers that do not require a nursing license.
The reason that a job would hire and train an entire staff at another facility and then replace their entire staff is because there aren't any consequences. And that's because of us. We allow our facilities to hide behind this illusion of an extensive amount of nursing care between the RNs and LPNs. We let them report the staff educator who handles new hire orientations as patient care hours. Me and a lot of other guys, let them make us do the heavy lifting, and the moving beds because we're men so we're stronger, that even if we're the strongest person in the facility, it's still technically sexual harassment since all the women are supposed to be held to the same expectation.
And with COVID, how many of our facilities are we watching expose non-covid-unit staff to the COVID unit, and then return to their long term floor, or work on the COVID unit, get exposed, and then work in long term the next day, becoming a ticking timebomb of exposing 30-60 residents. But you know who doesn't know about this? All the people thinking about sending their parents there. All the insurance companies and state agencies that have to cover the costs to the workers when they end up testing positive.
All it takes is one anonymous tip sent to a local news station.....
All it takes is one anonymous tip sent to a local news station.....
It's been done. What happened? A little of paper shuffling, then a lot of nothing. Indiana currently is "investigating" accusations of mishandling during this pandemic. Sadly, we all know nothing will happen.
Most states have minimum staffing ratios for LTCs. Most LTCs only supply the bare minimum. It sucks, but until someone makes a legislator TRULY care, nothing meaningful will get done
caliotter3
38,333 Posts
Well said. Post covers the salient points of the situation.