Why do RNs choose to work in nursing homes?

Nurses General Nursing

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I was originally under the impression nursing home RNs got paid A LOT more than hospital RNs. As a paramedic I would go to these facilities and there was usually 1 RN per "wing" of the nursing home. Caring for 20+? patients? So much medical hx to know and remember. Paper charting? I would assume the stress would be monumental. Everyone depending on you?

TL;DR: What is the allure of working as an RN in a nursing home? I hear they get paid less than hospital nurses and I see the amount of patients they are legally responsible for. Props to you guys, I can barely handle two as it is.

As someone who has worked "willingly" in a skilled nursing facility/LTC for over 2 years, this question is very offensive. People assume nurses resort to taking job in LTC because they are not able to get into hospitals right out of school, but there are many nurses like myself who enjoy working in sub-acute, rehab and mostly the older population. I am no less a nurse for working with this population and I use my nursing assessment skills and critical thinking many times during my work day. The best part of my job is forming relationships with my patients and hearing about their life stories.

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Another RN that chooses to work in LTC. Working as a LPN in LTC gave me the organizations skills to be successful in the hospital when I did finally receive my RN. Although I am grateful for the experience of being in the hospital and getting the acute experience I needed, I have no desire to return. I love LTC and the residents. LTC is not your typical "old people" type atmosphere anymore. I draw blood, start IVs, work with vents/trachs and basically deal with what most might cause subacute residents. It is not for the lazy or unorganized. I find in my area the pay is about the same as if I was back in the hospital in leadership. To dismiss LTC as something less than desirable may deter many that would actually love that type of care. Don't get me wrong its hard work and you never seem to have enough time, but its rewarding and you learn something new everyday.

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Specializes in Allergy and Immunology.
19 hours ago, Nursingstudent___ said:

I have always found it insulting when people ask why I want to work in long term care, as a CNA I've had people tell me to my face that only bad CNA's and nurses work in LTC and nurses and CNA's with "skills" work at hospitals. My nursing instructor told us this as well "We should work hard in school so we don't end up stuck working at a nursing home"

I like working in LTC though. Again I'm just a CNA but I love knowing my residents names and pretty much everything about them. I like that they tell me they look forward to me working. It may be selfish but my residents actually bring me a lot joy and happiness, it's very rewarding work.

We need better staffing ratios in LTC and it's a shame that the ANA in Mass. was against these ratios. We're in it for the long haul as the baby boomers get older and need more complex care, we need nurses, CNA's and doctors to care for these people. I hope as baby boomers get older nurses in the hospital, and new graduate nurses understand the growing need for LTC nurses. Working with the elderly is not as glorified as working in the ER, OB, or even med surg. but our elderly are the most vulnerable in society and deserve the best.

My nursing instructor told us this as well "We should work hard in school so we don't end up stuck working at a nursing home"

This quote is appalling! I can’t believe your nursing instructor said that to you...

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2 hours ago, Ella26 said:

My nursing instructor told us this as well "We should work hard in school so we don't end up stuck working at a nursing home"

This quote is appalling! I can’t believe your nursing instructor said that to you...

It was the hardest class to pass in my life, I just rolled my eyes all the time. She was pretty pompous and retired that year so I don't think she cared anymore.

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Specializes in corrections and LTC.

I absolutely love long-term care, that is where my passion is.

There is not a day that goes by that I don't laugh. There is not a day that goes by that I don't feel loved and appreciated.

Even on the worst days, there are always bright lights. Unfortunately, due to health issues I can no longer physically handle the demands of having that many patients. I now work with the developmentally disabled where I can have flexible hours. I love the patients and the nurse/patient ratio is very reasonable and I am not on my feet all day.

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I'm a retired LPN, and I've worked alot of LTC. I have no,idea where all you guys are located, but where I've worked in LTC, staffing was always short. The CNAs frequently had to,divide up another assignment due to call ins. Then as the nurse on the floor, I was expected to call someone in to cover. They answer the phone and hear it's the NH, and they day, "NO!" and slam the phone down . in the meantime, the clock is ticking and i need to get that med cart out on the floor. I had a heavy med pass. And there was no,way to get it done within state guidelines. It,was heavy. I had breathing treatments, G tubes, hosiery to,be put on, and they wouldn't allow the cnas put them,on, had to,be the med nurse, and just before patient,gets up. And just tons of other stuff to do. Med pass scheduled at 6. No way to get it done from 5 to 7. Had to,be started at 4 or 4:30 and went to almost 7. I was doing good if I was off the cart by 7, because day nurse coming in wanted the med cart for her to start on time.,

The Cnas were loaded down as well. Some patients were gotten up on night shift for their bath. And God forbid if you had an,emergency and someone needed to,be sent out to the hospital. It was an extremely difficult place to,work. I'm retired now, but I wouldn't go back there for love or money. It is not an easy peasy job. I loved the people but there was just too much to do. Sorry for the long post.

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I am a new RN grad, working in a LTC/SNF, and being three months in, I'm ready to quit. I went on numerous interviews, mostly for subacute facilities and was offered around the same amount of $, and it was non negotiable due to being a new grad. I then interviewed for a LTC facility, a company I've worked for, for 8+ years. They wanted to offer me $11 MORE than what the other facilities were paying. Some of my nursing friends took new grad residency positions at hospitals, and I'm making more money, so hospital nurses don't necessarily make more money, but it may just be my specific area/region. I would be stupid to turn that job down, right? Well now I'm regretting it. Money isn't everything!! Especially when it's your first nursing job. It's amazing pay for a new grad, but the amount of work it demands definitely gives you a run for your money. Nursing in general is demanding, but LTC is a whole different level. I work on a unit that usually has between 20-25 patients, but beds up to 30. Some are LTC, some are rehab patients who come and go. I am responsible for ALL of them. I do have an RN supervisor who will occasionally help me put in Dr's orders, but other than that, it's all me! Medications, treatments, putting in orders the doctors/NPs write into the computer, dealing with families, dealing with consults. It's very overwhelming. I received one month of training, and then was thrown to the wolves. It also doesn't help that I only have two CNAs (I work 3-11 shift). It makes it very difficult also, when you work with a lot of per diem nurses who just don't care, and they walk out the door without things being done, and it becomes your problem. Some of the residents I have are not easy! I have a lot that have psychiatric disorders, almost all of them have end stage Alzheimer's disease, numerous fall risks, combative residents, etc. In specific, I have one patient who requires A LOT of care. He has a tracheostomy, g-tube, and urinary catheter that requires a lot of my time. He has wound treatments on my shift, tracheostomy care needs to be provided. All in an 8 hour shift! I have to pass medications to all my residents (and it's not easy when they spit it out all over their clothes), provide treatments (a lot of my residents have wounds tx), and let's not forget the documentation! I rarely get out on time, and if I do, it's because I don't take my scheduled 30 minute break. Every time I walk out of that place, I sigh in relief. It's frustrating that I feel this way but I realized that's what LTC nursing is, and that it's just not for me. I'm starting to think money doesn't matter so much at the moment! I rather take the big pay cut for some sanity. It's to the point where I'm beginning to HATE nursing, but I tell myself I hate the JOB, not NURSING. lol.

I do have to say though, in the three months of working at a LTC facility, I have developed better time management skills, which I think will help me out in the long run, but it's a lot. I'm starting to think I need a job with better organization, and is more routine, even if it means taking a big pay cut.

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On 11/8/2019 at 2:47 PM, Nursingstudent___ said:

I have always found it insulting when people ask why I want to work in long term care, as a CNA I've had people tell me to my face that only bad CNA's and nurses work in LTC and nurses and CNA's with "skills" work at hospitals. My nursing instructor told us this as well "We should work hard in school so we don't end up stuck working at a nursing home"

I like working in LTC though. Again I'm just a CNA but I love knowing my residents names and pretty much everything about them. I like that they tell me they look forward to me working. It may be selfish but my residents actually bring me a lot joy and happiness, it's very rewarding work.

We need better staffing ratios in LTC and it's a shame that the ANA in Mass. was against these ratios. We're in it for the long haul as the baby boomers get older and need more complex care, we need nurses, CNA's and doctors to care for these people. I hope as baby boomers get older nurses in the hospital, and new graduate nurses understand the growing need for LTC nurses. Working with the elderly is not as glorified as working in the ER, OB, or even med surg. but our elderly are the most vulnerable in society and deserve the best.

What an excellent reply!

So many things I agreed with: "our elderly are the most vulnerable in society and deserve the best." Bingo. Take care of the most vulnerable. It's a sign of a society's/community's humanity.

As far as being "just" a CNA, let me share something. My father had a caregiver, and I'm here to say they are worth their weight in gold. She was not a registered/certified anything, but she was a genius in the field of care. Unparalleled intuition; presence (a woefully underappreciated quality); and common sense. Give me a good CNA/caregiver any day over a good cardiologist - for the elderly. Cardiologist calls me up and says, "listen, if your dad doesn't do x and y then z." Ok, thank you. How nice to actually talk to a cardiologist! Check with the caregiver, "Listen, your dad should do [fill in the blank]." I almost always went with the caregiver. They formed a relationship. This was so important to my dad, to our family and to her, the caregiver. She was there for him, knew what he needed and when, and if she couldn't handle him, no one could, and we'd all wait him out.

She always wanted to take him home with her, and we never understood that, but now I work with dementia patients from time to time, and I finally get it.

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Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF.

I started out in a SNF and ALF facility. It was my 2nd job as a nurse - I didn't like my 1st job as a new grad and ended up leaving that one after less than a year. Like others have pointed out here, nursing homes are often in high demand because they're so short staffed. I was able to interview and receive a job offer within one week, and then started the job just two weeks later. For someone who had been jobless for over a year because no one would hire me as a new grad, it was important that I start making $ sooner rather than later. LTC facilities tend to be more forgiving towards spotty work history, as long as you bring a good work ethic and interview well. I've been offered LTC jobs on the spot (although I wouldn't suggest working at those facilities, at all).

I can't speak for everywhere in the US, but in my area, I actually made more in LTC. Especially when I became a supervisor, my DON wouldn't bat an eye at overtime because it meant that we were staffed. For every hour of overtime, I was paid $35 per hour. My weekly pay checks were comparable with what I could potentially earn as a travel nurse, and sometimes much more. For a new grad that wants to get a ton of time management skills and enjoys working with the elderly, LTC is not a bad job. You can learn just as much about nursing in LTC as you can in a hospital. One could argue that there's more chances for promotion. Just stay away from the bad apples that tend to gravitate towards LTC.

I work in a hospital now. I get paid less, but I have regular pay raises, which is something my SNF/ALF facility didn't provide. I can also schedule time off, which was impossible to get at my SNF/ALF. I wouldn't trade those benefits for more money nowadays.

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Why do some choose med surg, ICU, ER, L&D, home care, Peds, OR, Pacu ???

Um...because!

Pay....RN's are well compensated in my area in LTC. I never thought I would choose LTC. 20+ years ago I graduated from a major teaching university that was in the top 10 for BSN students. At that time, jobs were scarce and the pay wasn't cutting it. I worked as a CNA to get experience in patient care that the nursing program lacked in teaching. I thought I would stay for a while, get some experience, earn some $$ and then go look for a job at one of the local hospitals when the time was right and pay was right. One thing led to another....I started moving up in the company, 1 baby became 5, I got comfortable with the short commute to work, no traffic, didn't have to pay for parking, etc and here I am 20+ years in LTC.

LTC residents have changed over the years. SNFs in our area offer skilled post-acute care. Complex wound care, TPN, wound vacs, ortho rehab, cardiac rehab are our biggies. We see a lot in my facility. We also have stable LTC residents and also do hospice. Our staffing is often at state minimum levels but more often that not it is higher. As an RN, you might be a supervisor or cart nurse. I've now taken on the role as a staff development coordinator/ infection control preventionalist/ adon. I don't work weekends!! If I wanted, I could pick up a ton of OT or work as little as I want to.

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On 11/9/2019 at 2:15 PM, ocean.baby said:

I absolutely love long-term care, that is where my passion is.

There is not a day that goes by that I don't laugh. There is not a day that goes by that I don't feel loved and appreciated.

Even on the worst days, there are always bright lights. Unfortunately, due to health issues I can no longer physically handle the demands of having that many patients. I now work with the developmentally disabled where I can have flexible hours. I love the patients and the nurse/patient ratio is very reasonable and I am not on my feet all day.

Forgive my ignorance. But isn't a LTC nurse still considered to be a Med Surg nurse?

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Why wouldn’t they? Many nurses enjoy LTC.

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