Would love to know more about LTC

Forever Sunshine, ASN, RN · May 17, 2011

If you want to know what a LTC facility is like.. just walk into the zoo. Actually zoos are more docile lol

The LPN program I went to did not have a strong geriatric clinical. So I started knowing nothing about LTC.

It will depend on your facility what they have a charge nurse do. You might have a med-pass. The charge nurse is usually in charge of CNAs. This is where I struggled when I first started. A new nurse at my facility just did charge nurse during the day and said to me, "these CNA's and their assignments and issues are driving me up the damn wall.!" My advice to her was what another nurse said to me when I was in her shoes. "You are the charge nurse.. you make the decision.. this is what it is.. and this is what its going to be and there's going to be no questions asked." You will have good CNAs and bad CNAs. Treat them all with respect.

You might have a med pass, not sure if you are going to have LPNs on the floor too. LTC facilities these days have residents that require more care than people assume(I tell people I work in a nursing home and they think its just dementia patients that sleep all day and night(which is just the opposite). You'll see g-tubes, diabetics, respiratory issues, trachs, IVs, wounds, short-term rehab, etc

NamasteNurse, BSN, RN · May 17, 2011

Different facilities have different names for the positions. Where I worked, the LPN's were usually 'charge' and the RN's were supervisors. A charge nurse in LTC can do everything from general floor duties like patient care, and med pass to being the unit manager with more paperwork type duties.

Also most LTc's now have rehab, LTC and dementia units with different acuity pts on each floor. You should have gotten a job description so that you know which type of charge nurse you will be, actually on the floor or more managerial.

Some residents need a lot of care and others not as much. You can expect to do wound dressings on rehab pts and pressure ulcer care on others. They live there, so they eat there and go to PT/OT podiatry and the dentist. You'll make appointments, and speak with family members. You'll probably do care plans, assessments and a lot of fall reporting. You'll give a lot of hugs and try to understand how it feels to be old and left in a nursing home. Lots of sadness and depression.

You'll do a lot of finger sticks, and nebulizer treatments. Some IV's, and suctioning. Know the s/s of ketoacidosis, and hypoglycemia. Know that older people rarely have burning when they have a UTI and that bad behavior can mean illness. Get a good book on geriatrics and read it.

Lots of medications, brush up on those and their effects. Be very nice to your aides, but also be a leader. Jump in and help when they need you too. Break up arguments, problem solve and resolve conflicts. Order medications and supplies.

Wear really good shoes and bring an extra scrub top. Things get messy. Bring healthy food you can eat fast, forget about breaks. Drink a lot of water and coffee :) Have your own bp cuff, stethoscope and maybe even a thermometer, scissors etc with your name on them in indelible marker. Supplies are hard to find.

Bring a good attitude. There can be a lot of drama, try to stay out of it! VERY important. Be respectful to everyone from the housekeeping staff (they will find toilet paper and soap when you need it) to the floor washers, (lots of accidents in geriatrics). You will need favors! Be respectful to your fellow nurses they will make or break you. And did I say be extra nice (but firm) with the aides? Make your rules known and enforce them fairly. The aides will work for or against you depending on how they perceive your attitude towards them.

I definitely left a lot out. More people will answer. Best of luck! And BRING FOOD! (for yourself and treats for the workers)

taalyn_1, CNA · May 17, 2011

Your aides are your eyes and ears, be nice to them but don't let them run you over 9Im a CNA who is working towards my RN - graduate next may). Probably will have med pass for 20-30 pts. Will have a little of everything, from CHF, COPD, Dbl amputee, diabetics, to those who are just rehabing (fused backs, knee/hip replacements, fractures etc), there will be dementia pts and alzheimer pts, and little sweet ladies who become grandmas to you, old men who can be down right perverted but still cute and funny (lol), and then there will be a few grumpy guses (pts, aides, nurses, administrators).You will have favorite pts, then they will pass away, don't be ashamed if you cry, the LTC pts become like family. LTC runs the gamot, you will find everything and anything going on there. Take your time, learn to prioritize, learn time management, love your residents, remember that they need you to be strong and well prepared, have some humility (this is a must. In order to give them their dignity when doing pericare or whatever, a little humility on your part goes a long ways). Enjoy your first job as an RN, and always be willing to help others within the facility. Good Luck!!!

Columnist · May 17, 2011

Moved to LTC Nursing forum. Hopefully you get some good info here from some LTC nurses.

Congrats on the job!!!

hopefulwhoop · May 17, 2011

Good luck with that. I hated LTC and wouldn't wish that stress on anyone. It was pure hell. I took a major pay cut by going to a hospital to work M/S, but LTC was not worth it.

Missellie41 · May 17, 2011

I'm sorry you missed out on the wonderful things that go on in long term care! These residents can give so much love, and, oh, the stories they can tell!

DarcyLPN99 · May 17, 2011

I've been in LTC for 7 years now, and it has it's ups and downs. I've also been the weekend charge nurse where I work, too. I have 10 residents that I need to care for, as well as taking care of problems and concerns in the rest of the building. Some days it's absolutely crazy and other days it's not too bad. You take care of people with an endless array of disease processes and issues. One day is never like the next. The most important thing I can tell you is to get a routine down. No matter where you are or where you work, it can be a lifesaver. I typically work on the same unit (alzheimers) but will sometimes get moved. My routine is what keeps me moving for my 12 hours. Now mind you, sometimes things happen and NOTHING is going to help you turn it around....but for the most part I love it. Good luck with your new job!!!