I think NOT!!!! I have been so insanely busy with things at work, and it just makes me so mad when nurses say that I will lose my skills in LTC. today- PICC line, Central line,IV on 3 residents, TPN, trache care, G tubes, J tubes, not to mention all the neb tx, meds, eye gtts, nasal sprays, inhalers, families, doctors not returning calls, resident falls, another one in resp distress, dealing with paramedics who cant believe we gotta do CPR on someone 90. on and on and on!!!!! Here is a note to all the folks who dont or have never worked in LTC- we do not just write letters for sweet old ladies!!!!!! Thank you for letting me vent!!!!!
I work in a very rural LTC in N MN we don't have Lab to draw our lab work. we have only critical access hospitals. I have not lost any skills, I start IV's regularly, draw blood daily, we have trach's Pick Lines. Drains, you name it. I love LTC!
I was fixin to say, take several acute care nurses and mix them up and be sure that they wont know skills that the others do. It does not matter where you work, the skills are different for each. I think a ltc nurse that has 15-20 pts and gets all that work that goes with them done is awesome!
I think that when people say you'll loose your skills by working in LTC, they don't necessarily mean IV, enteral feeding, or wound treatment skills, those are easy to relearn. I think they mean more of your critical thinking and assessment skills will go down the drain. If you have to be responsible for 30 residents, there is not a ton of time to work on those skills and keep them polished. I'm an LPN, and I worked my first year in a step down rehab/vent unit in a hospital in a large city's downtown. I gained a lot of great skills and knowledge there and the nurses were very on top of things. I later moved to another city and began working in a LTC/rehab. I cannot believe some of the errors and detrimental things that I've seen since working in this LTC. A resident that had a well known history of MRSA infection of a rod in her femur stared having signs of reinfection. She stopped being able to ambulate for a few days after previously being able to ambulate independently with a walker for months. Her leg was piping hot, she was confused, and her BP was in the 80s systolically (this was a previously healthy, alert and oriented lady). This went on for three days without anyone spotting it and calling the doc. THREE DAYS! She ended up being septic, and barely lived. This type of thing happens all of the time there. It almost seems like the nurse's main objective of the day is to hand out all the pills to the 25 residents, sign for the meds and treatments, and do another med pass. There isn't very much assessment of the residents or looking into things that don't seem right. I do admit that it is hard to completely assess 25 people in LTC the same way you would assess 6 people on a med surg floor, but it seems as if a lot of the nurses dont even TOUCH the residents, they literally just hand the person a cup of pills and leave. When a resident has SOB, a lot of the RNs really don't know where to start when it comes to interventions even though following basic ABC protocol would get them out of this bad situation. I don't know if it is like this at other LTC facilities, but after I become an RN in a few months I am getting out of LTC and never looking back.
If I wanted to involve myself with the more technical tasks of nursing - I would choose to work in a surgical ward.
Long term care offers me the chance to work more within the "art" of nursing. Assessment skills and critical thinking skills are (too my mind) vital in a long term care for the aged ward. There is no doctor on the ward, the doctor visits just once a month or when I call on him with concerns. Long term care offers the chance to work within a more psychosocial role, I offer palliative care to the dying, often I am challenged with ethical dilemmas - the work is interesting and rewarding. Often older people have multiple diagnoses and they need care just as any other hospitalised patient needs care.
I enjoy contact with families and the nature of long term relationships I develop with patients.
There is the opportunity to update skills through ongoing education. Since qualifying 5 years I have continued with nursing education.
dtadeusz - why are you turning your back with no intention of looking back. I don't understand your point.
I could tell you horror stories about hospitals too. It has to do with the motivation of the staff. Good LTC nurses know their patients well enough to recognize when something is wrong, even when they have 25 patients. Some nurses just are not that motivated to watch for or address changes. It is no different anywhere else. They are the nurses wh leave things for the next nurse, or the next shift. Nurses who should have caught it when the patient was having trouble breathing, or diarrhea, or pain, but just brushed it off and moved on.
When you are not one of these types who avoid taking resposibility and who hide their heads in the sand when a patient shows signs of trouble, then you will always notice these nurses everywhere you go. Don't hope to free yourself from them by changing settings, it is not going to happen. They are everywhere. Instead, hope to encourage them to do better as you grow in experience and move into positions of more responsibility. Much of the time I think it is out of fear that they do only the bare minimum. That, and burnout.
I guess my point was that I just can't believe that the things that go on at this LTC facility actually happen. I do agree with you cxg174, these types of people are probably everywhere, LTC and hospitals too. Thank you for putting it into perspective for me :)
I just attended a seminar and one area of discussion was the notion that LTC/SNF nurses are just "nurses" without specialty which lead to defining who "we" are.....Gerontological Nurses. I LOVE that! It totally summaries what my background is coming into nursing and what I do now, by choise, not b/c it was the only job offered. A good gerontological nurse can have a positive and significant impact on someone's life, and what greater gift can we offer one another.
One more thing that I've been thinking about is that to be a really good LTC or gerontological nurse, you have to have an enormous heart. Having a ton of patience, compassion, and caring attitude are all attributes that good LTC nurses posess. I think that this is more valuble that knowing any technical skill because skills can be learned by anyone, but not everyone can learn to use warm compassion and caring in their nursing practice.
I would have to say that it is possible to lose your skills as far as critical thinking and assessment if you didn't have experience in the acute care setting already. After nursing school one really has just the minimum competency to be a nurse and requires lots of on-the-job training. If someone didn't have knowledge and assessment skills of the acutely ill patient then things will be missed and residents wont get the medical attention they need because nurses weren't knowledgable enough to help. Of course if a nurse had a strong acute care background that could be avoided but LTC, IMO, is not a place that encourages new learning and strong assessment skills.
Why would you think critical thinking and assessment only happens in an acute hospital?
I don't understand your rationale. I look after patients who have advanced heart disease, advanced cancer, dementia, advanced Chronic obstructive airway disease. I need to be able to assess and seek to treat symptoms related to these disease processes in order to provide comfort care.
I look after dying patients, I work within families - I need be able to determine best practice based on best evidence - I need to consider how to evaluate situations that create an ethical dilemma in order to promote practice that is ethically sound.
Too often I feel nurses who work in aged care are devalued and demoted in status - in the same way older people in society are devalued and demoted in status. One is a reflection of the other!
People who need to be in hospital all deserve the same level of assessment and care.
Specializes in A little of this & a little of that.
I would have to say that it is possible to lose your skills as far as critical thinking and assessment if you didn't have experience in the acute care setting already. After nursing school one really has just the minimum competency to be a nurse and requires lots of on-the-job training. If someone didn't have knowledge and assessment skills of the acutely ill patient then things will be missed and residents wont get the medical attention they need because nurses weren't knowledgable enough to help. Of course if a nurse had a strong acute care background that could be avoided but LTC, IMO, is not a place that encourages new learning and strong assessment skills.
Perhaps you have never worked in LTC? This is exactly the attitude that LTC nurses feel is demeaning. Many of the patients in LTC have complex medical problems and are discharged early from hospital because they will be going to a nursing facility. Even those who are just there for "custodial care" become acutely ill at times. They develop infections, have CVA's & MI's, CHF, aspirations, exacerbations of COPD, I could go on and on. The nurse must be able to recognize these s/sx because there is no physician making rounds daily on them. Yes, there are nurses in LTC who are lazy or incompetent (just as there are anywhere) so the challenge is that much greater for those who do their job right. When you have an emergency or an acute illness, you are dealing with it in a situation with minimal help and minimal equipment waiting for EMS to get there. Not all of these patients are DNR and not all DNR's are not to be hospitalized for emergencies. You have no phlebotomist, IV team or respiratory therapists to come do any part of the job for you. You call the pharmacy for a "stat" order and it may take 8 hours or more to get to you. It is a huge challenge to try to get meds and treatments and charting done for 20 to 40 patients on a unit and get decent assessments done. There are mountains of regulations that have to be followed that hospital nurses never have to worry about. It is very easy for a nurse to get caught up in trying to get everything done on time and end up skimping on the assessments. But, the fact is that strong assessment skills are essential. Learning has to be continual. There is nothing these days that is seen in med-surg that is not seen in LTC. The work can be overwhelming, the recognition non-existent and then to have other nurses (who should know better) demean it is the final straw. No wonder burnout is so high.
deleern
510 Posts
I work in a very rural LTC in N MN we don't have Lab to draw our lab work. we have only critical access hospitals. I have not lost any skills, I start IV's regularly, draw blood daily, we have trach's Pick Lines. Drains, you name it. I love LTC!