Why are RNs underappreciated, underpaid in LTC?

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Can somebody please help me to understand why RNs are paid so poorly in LTC?

I love my job in a LTC/SNF. I started 2 1/2 years ago as a Nurse Tech, worked through school to LPN, and finished school in March, passed my boards and received a whopping $1.25/ hr raise from LPN2 to RN. What gives?

I finally have developed confidence and defined myself as a very good nurse (I feel) but I'm frustrated that pay is so poor, at least compared to the hospitals. There is very little incentive to stay. Please understand, it's not all about the money, but it's a little about the money! I haven't left to the hospital that will pay me $5.00 more an hour because I love my job and I love this population.

Any feedback would be appreciated!

Thanks!

Teresa

Specializes in LTC, Med-SURG,STICU.

Stanley-RN2b,

That would not work at my place of employment. There would be a massive uprising. However, I am glad someone values their RNs.

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Stanley-RN2b,

That would not work at my place of employment. There would be a massive uprising. However, I am glad someone values their RNs.

I didn't mention that we only have 7 RN's and they are all in supervisory positions. If we used them on the floor I doubt I would view them differently. I do try to jump through hoops for the LPNs and CNAs too but seeing as how they are on the units I find that I usually can't. It's a shame.

On an aside, as our pay rates are similar to a couple hospitals near us, I suggested our facility working out an employee sharing protocol with them where PRN staff could be utilized by both them and us. This would provide more work opportunities and give more latitude in time off as our PRN pool would grow tremendously but I don't see it happening. The hospital thought it was a good idea as our facility has a sterling reputation but our corporate overseers (non profit corporation) don't like it. :( Oh well.

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Specializes in Gerontology, Med surg, Home Health.

It's all about regulations and economics. LPN's can, at least in this state, do everything in LTC that RN's can do except pronouce someone dead. They can not be the ADNS or DNS. But they can be charge, do meds and treatments and the rest. So, if the facilities can get LPNs why would they hire a more expensive RN? I have some excellent LPNs and I wish I could pay them more than I do. I have a few RNs...same goes for them. Until what we do as NURSES in long term care is more valued by everyone and until the reimbursement rates for our clinically complex patients goes up, nothing will change and we will continue to be underpaid.

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Luckily for us we are 100% private pay. No medicare or medicaid whatsoever. In our state, LPNs could be ADONs (I am assuming that is the same as a ADNS), there are just some things they could not do.

I have found that medicare/medicaid nursing homes, while needed do not do as well as private pay homes. It gives us a way bigger budget and allows us more freedom in staffing.

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Specializes in Gerontology, Med surg, Home Health.

Not too many people can afford private pay and more and more of them are getting smart about hiding their money and having the state pay for them.

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Specializes in LTC.
As a staffing coordinator for a LTC I pretty much give RN's carte blanche. They all have custom schedules, get time off whenever they need and get to pull all the scheduling hijinks the wish too.

I love and appreciate my RN's. I would pay them more but tjat is not up to me. :D

They do get my overtime first though.

Don't get me wrong I like my LPNs too but hey I like my car but the scooter gets better gas mileage and therefore more love....

No offense, Stanley, but it's attitudes like that that causes LPN's to foster resentments against RN's. We are ALL nurses and all have responsibilities to our residents. We are held accountable for what we do, right or wrong. To be treated as 2nd class because we are "only" a LPN causes a lot of ill feelings, which will ultimately affect our performance. Have you asked your LPN's how they feel being treated that way? I'm sure they're less than pleased. I would not work for someone who treated one brand of nurse better than the other. Just my 2:twocents:

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Specializes in Gerontology, Med surg, Home Health.

I'm an RN and I was offended by what Stanley said....only an LPN.....puhleeeze....good nurses are good nurses no matter what the initials are after our names. And, again.....puhleeeeeze....I don't want to hear 'only' an LPN. You are a nurse...be proud of what you do.

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My initial comment wasn't meant a slight. But since you are soooo offended and proceeded to try to adjust my attitude please allow me to reply.

Treated differently? I can replace a LPN or CNA in a heartbeat. RN's not so much. It's labor and management. Officer and Enlisted. You can choose to be a RN or LPN or CNA or Doctor. You can't choose how people see things.

When my LPNs can call time of death and supervise I will woo them the same way I woo RN's.

It's simple.

BTW - Over 50% of our employees, including LPNs and CNAs have been there 10+ years. Our turnover is the lowest in the DC Metro area and our pay is not even the highest (Anymore). Just because some people feel 'left out' is not a problem I worry about. If you want to advance further, then advance yourself further.

While a LPN and a RN are both nurses the LPN is not and RN. Just like many of you established nurses insist MA's are not nurses. Everyone has their place and things work great when they stay in it. Even us lowly CNAs. The good thing about America is, you can change your place as you see fit.

Our LPNs don't complain because all of our RNs barring 2 WERE our LPNs. With the exception of people that won't or can't go to school, our facility is paying for everyone to go to school to advance themselves and their careers. Our staff educator is just about to get her Masters. Out of the 12 FT LPNs 8 are in LPN to RN school. An ungodly amount of our CNAs are in LPN and RN school.

None of the employees I staff have a problem with my attitude. Why do you?

My mother always said 'If you choose a place in life, don't be angry when people expect you to stay in it.' Best advice I was ever given...

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Specializes in LTC.

Please allow me to clarify, ye olde firing squad: CCM, when I said "only" a LPN, it was intended to be sarcastic, and I am perfectly comfortable in my station in life and career. Stanley: I'm NOT angry, and I aplogize for the tone of my post if it came across as such, but anger was not the motivating reason to post. In my facility, 2 LPN's can pronounce death, or 1 RN and 1 LPN. We have to have 2 nurses pronouce regardless of their title. We have quite a few LPN managers, while most of our RN's are floor nurses. Naturally the DON is a RN, as she should be. Our facility politics are obviously far different from yours. Also, in my facility, LPN's do the very same job as RN's, all the way down to careplanning. The ONLY difference is when we have a GIP pt, a RN must chart on them q shift. Otherwise, it's all the same, save the pay. And that's fine by me. RN's only make $2 more an hour than LPN's to start, so the pay difference is negligible. My point was, and I should have made that clearer, is that attitude you carry favoring RN's would not fly at my facility. There would be rioting, plain and simple. And why does your attitude cause a problem with me? Because I know many, many LPN's who are GREAT nurses and deserve respect because of their knowledge base and the great care they provide pts and families. Titles don't mean much in my little corner of the world. The care we give does.

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I have nothing but respect for LPNs. If my facility/BON or whoever decided would let LPNs do more things it would definitely make my life easier. A LPN is as good nursing wise as any RN in LTC, no doubt. I just really can't use them for the supervising and RNs seem to be hard to come by in LTC. Even with a stellar facility. Another problem is that we don't use new RN's we always tell them to get hospital experience first. So essentially I end up having to do way more to get and keep RNs.

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Specializes in LTC.

OK. THAT I understand. I don't know what area you are from, but in LTC in S. Indiana we can do a lot. In a hospital, however, we are used as techs at most. We can do little of nothing nursing wise there. Of course, we can't hang blood, do central line pushes, and a host of other things that RN's can do, (in a hospital), but we don't see that very often in my facility. A couple of PICC lines at most in the last 9 months. Again, I apologize if I came off...er...rhymes with "itchy". I truly didn't mean to.

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