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!!!!!
Thanks Thornbird --- the demeaning attitudes of some nurses towards their professional colleagues who take up the challenge of nursing in LTC facilities can be incredibly offensive.
I was not trying to generalize all LTC nurses into a single category, I apologize if I made it seem that way. I was generalizing LTC as a place that doesn't promote new learning (there may be some that do). Maybe it's only my facility (working part-time while in school), but I see many nurses who simply don't understand pathophysiology and acute illness. My assessment as to why they don't understand is not that they are an unintelligent group of people but that they have not been pushed to learn more. Maybe my facility is a minority, that's a possibility, I get it. I think that with that increased autonomy mentioned above, a nurse in LTC needs solid experience because there is no doc making rounds, there is large workload, etc. etc., and it takes a knowledgeable nurse to pull that off. I've never heard of any LTC facility requiring a 6 month orientation with a preceptor or even 3 months for that matter. The nurses should already have that background knowledge because, IMO, an unexperienced nurse is not going to get it going directly into LTC. Now unless I am mistaken I did not say anything offensive about any group of nurses in this post, I only pointed out the fact LTC (in most cases) does not promote new learning.
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.
I invite you to work in my LTC for 2 days and then you come say this to me again, k?
I was not trying to generalize all LTC nurses into a single category, I apologize if I made it seem that way. I was generalizing LTC as a place that doesn't promote new learning (there may be some that do). Maybe it's only my facility (working part-time while in school), but I see many nurses who simply don't understand pathophysiology and acute illness. My assessment as to why they don't understand is not that they are an unintelligent group of people but that they have not been pushed to learn more. Maybe my facility is a minority, that's a possibility, I get it. I think that with that increased autonomy mentioned above, a nurse in LTC needs solid experience because there is no doc making rounds, there is large workload, etc. etc., and it takes a knowledgeable nurse to pull that off. I've never heard of any LTC facility requiring a 6 month orientation with a preceptor or even 3 months for that matter. The nurses should already have that background knowledge because, IMO, an unexperienced nurse is not going to get it going directly into LTC. Now unless I am mistaken I did not say anything offensive about any group of nurses in this post, I only pointed out the fact LTC (in most cases) does not promote new learning.
Specializes in A little of this & a little of that.
A CRNA is a Certified Registered Nurse Anesthetist. I believe that could mean a CRNA hopeful is an RN at this time.
Do not judge all LTC by any one. They vary tremedously in tye of patients, quality of care, staffing ratios and anything else you can think of. LTC's in urban areas are actually just as likely to have very complex, acute patients due to proximity to more medical centers. Most provide ongoing inservice at minimum to cover care of patients being admitted with "new" equipment or treatments.
Preceptorships are uncommon in LTC because they are cheap, profit-motivated corporate entities in most cases, not because they are not needed. Things have changed in that respect. When I moved from hospital to LTC, I received 6 weeks orientation and had an asigned preceptor for the first 3 months that I was on my own. It was an excellent facility and that amount of help at the beginning has made me forever a great LTC nurse. And that was over 20 years ago when there was a lot less to learn. These days a lot of hospitals don't provide that much preceptorship to a new grad. If you are not yet an RN, look into how much preceptorship new grads actually get in your area hospitals. You may get an unpleasant shock.
One problem with assessments in LTC are that many LTC nurses are LPN's. Because of the raging BS about "Assessment" as an RN only skill, there are LPN programs that are not properly teaching the basics of assessment that an LPN needs to practice. Then these unfortunate people get their licenses, get a job in LTC (the most common place to employ LPN's) get 3 days of orientation and thrown to the wolves. If they are lucky, a more experienced nurse will help them out. If not so lucky, they learn the hard way. Perhaps, you, CRNA hopeful, can advocate with your state for ensuring that new LPN's are trained in basic assessment because they certainly will be expected to assess their patients!!!!
One problem with assessments in LTC are that many LTC nurses are LPN's. Because of the raging BS about "Assessment" as an RN only skill, there are LPN programs that are not properly teaching the basics of assessment that an LPN needs to practice. Then these unfortunate people get their licenses, get a job in LTC (the most common place to employ LPN's) get 3 days of orientation and thrown to the wolves. If they are lucky, a more experienced nurse will help them out. If not so lucky, they learn the hard way. Perhaps, you, CRNA hopeful, can advocate with your state for ensuring that new LPN's are trained in basic assessment because they certainly will be expected to assess their patients!!!!
Thank you for your informative response. The last paragraph (the one quoted above) really describes my experience with LTC. I work in a mostly rural area and the LTC centers hire mostly LPN's, many of which are strait out of school. Then on top of that the residents who may become acutely ill are shipped out. So these nurses may never care for an acutely ill patient and may never be forced to think through disease processes like nurses in acute care, at least in my area. That is why I said LTC does not promote new learning. I can see from your post that this is not the case in all LTC facilities and that there are some that truly value critical thinking. Thanks again for staying objective and offering informative feedback
It is the individual nurse who will avail herself to new learning - through critical assessment and keeping up to date with best evidence when planning interventions.
I have come across nurses who get away with doing things the same old way and not taking time to effectively assess. The fact they get away with this - is related to poor quality systems. Elderly people and aged care is considered low in status..and coming from the top at a governmental level - there is a lack of desire to effectively promote ideals in care of the aged.
Your thoughts that nurses working in LTC don't get to critically assess - lack knowledge and don't have the opportunity for new learning, is simply another reflection of a sick health care system.
SKILLED assessment is not part of the realm of the LPN. They are not taught the critical thinking skills of the RN as part of their education. You cannot expect the same level of depth of learning, though they are often great nurses.
They are taught to recognize and report signs of illness or abnormalities, but their training programs or more based in the practice of nursing skills- hence the term practical nurse. That is why they generally function under an RN.
In the program I taught at, the RN and LPN students had the whole first year together, then the LPNS did peds, maternity, LTC in the summer and graduated. The RNs came back in the fall and did psych, LTC, maternity, peds, critical care, leadership/case management, home health. The RNs spent more in depth time in each of the specialties and had additional areas like critical care which develops many of the critical thinking skills about acute illness.
This is not to say RNs are better, but the education is different.
as yall can tell, this is such a sore subject for me. I have devoted all most my entire career to geriatrics. to have other nurses say I have no critical thinking skills or that i'm not as good as a hospital nurse just chaps my hide!
i worked in your precious hospital for 6 whole months. wanna know who my patients were on the med surg/telemetry floor??? they were my nursing home patients!! at the hospital, i had 6, maybe 8 patients at a time. had lab techs to draw the blood, iv teams to start the ivs...heck, in the hosptial theres a "team" for everything! the only thing i basically did was admin. meds and do an assessment on them. i was bored outta my mind! it cracked me upto hear the other nurses complain about having so many patients.
in LTC one nurse does it all. we draw the labs, make the appts, round with the doc, do the admits, do the d/c's, do the treatments, do the procedures...if our pt needs it, we do it. we have no "teams" to call. everything is done based on our assessment.
over the years, esp. the last 5 years, patients are being admitted to SNF units much sicker than before. IVs, CVLs, PICCs, ports, trachs, drains, wounds...you name it, we get it.
the only thing i did at the hospital that i dont do at my SNF is hang blood. when i worked in the hospital, i was constantly being complemented on my work and my skill knowledge. it cracked me up to see their faces when i told them my career history. it was nice to help break that ceiling about LTC nurses.
i dont think it makes a hill of beans difference WHERE you work these days. they are ALL sick.
ellen 12
79 Posts
What is a CRNA?
Thanks Thornbird --- the demeaning attitudes of some nurses towards their professional colleagues who take up the challenge of nursing in LTC facilities can be incredibly offensive.