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!!!!!
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Since I'm inherently lazy, I prefer a laid-back, unstimulating work environment. However, I have not found that in LTC.
I work at a nursing home (LTC/SNF combo). However, I work on a short-term rehabilitation unit where the typical patient is discharged home in 2 weeks.
I deal with mostly postsurgical patients who are too deconditioned to go home. These patients are CABGs, knee and hip arthroplasties, thromboembolectomies, hysterectomies, post CVAs, fractures, and so forth. One time I received a gentleman who was badly beaten and robbed, and needed reconditioning. Many of my patients are middle-aged, and wouldn't fit the description of the average nursing home patient.
I regularly give drugs via IVPB and IV push, especially antibiotics. I remove sutures and staples, dress complicated wounds, operate CPM (continuous positive motion) machines, iceman machines, oxygen tanks, concentrators, and PEG tubes. I had been employed on a traditional long term care unit for a year, and I had not been exposed to some of these skills.
There's always something to learn at my workplace. The opportunities might not be so obvious, so you have to be aggressive and seek them out.
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.
I am a registered nurse - and I work in long term care.
Some people will never learn to evaluate situations in critical manner - whatever their education.
Other people instinctively know how to evaluate and think along critical lines.
Critical thinking can develop through experience and learning in the work place. It is not simply the realm of RN's to be able to engage their minds in a critical manner.
I have not had a PICC, or IV ABX in several years, No TPN,Trachs or vents ever! We don't take those patients. So, I guess it all depends on where you work. I have lost my skills (my own fault) now I can't even find a med-surg job in a hospital. I guess I need to go to a more acute LTC huh?
I have worked in LTC now for over 14 yrs starting as a CNA and now am a LPN and I have to say we get alot of acute cases. We are attached to a hospital so the cases we get sometimes are pretty invovled. I feel everyone has their place in nursing and no one should be made to feel like they are not worthy of other nurses. We all have to support each.
ok someone please explain the wound vac..... i have never worked with one. i have been in long term care/assisted living as lpn for 10+ years and was cna before that. i have seen some pretty heavy duty skilled care in ltc. if ya need a nurse... call ltc... they probably can do anything with nothing. thier assessment skills are better than most hospital rn's. the assessment forms at our facility could be a nightmare. and all the care that they came from hospital with was unreal. always loved when dr. said oh your just a lpn in nursing home.... send them to hospital for eval..they cant be sick they way you decribe them...... then why do they admit them to icu? with exactly how you decribe the patient. and better yet.... why did i always have to send them on weekends and nights.?
Wound vac is a closed system that has a suction effect that pulls drainage away, stimulates circulation, and pulls wound edges closer together. it speeds healing and is used on difficult or large wounds. Works well on decubiti, large surgical wounds, non-healing wounds. There are a couple different brands. You put a foam type dressing in the wound, then there is a clear dressing like opsite over top with a tubing that hooks up to the wound vac. You change the dressing norrmally 3 x week. It is time consuming but works well.
I say bullfeathers. In the past month - IVs, stage IV decubs, brittle diabetics, COPDers with multiple nebs, O2, etc... I use everything but my OB and peds skill set at work, almost every day. Only IVs are somewhat out of the ordinary.
It sounds like you all work in some fairly high level LTC facilities. However my experience is quite different than most of yours. I am finishing up my ADN this semester (so yes I realize I have very little experience to comment) and working at a LTC center. I would have to say that nurses at my facility are probably way behind as far as acute care knowledge. We do no IV's so a PEG tube is about as invasive as it gets. It seems that in a situation like mine, if I were to go directly to LTC as a new grad RN (which would be unlikely for a "CRNA hopeful") that I would definately lose much of the knowledge of acute care nursing. My facility may be the minority but the headline of this thread caught my attention so I thought I would comment to further the discussion.
My facility is like this also, except we don't even have peg-tubs or indwelling caths. We don't even have any decubs(which is really a good thing). I have worked at a higher level nursing home where we were doing PICCs, IVs, peg-tubes, j-tubes, packing wounds, etc. which with close to thirty patients was very demanding, but I learned so much and actually miss the challenge. I work at a great facility and really shouldn't complain, but the nurses who have been there for awhile and have had no other exposure HAVE lost a lot of clinical skills and you can really see it, but they are really sharp in other areas.
Critical thinking can develop through experience and learning in the work place. It is not simply the realm of RN's to be able to engage their minds in a critical manner.
Critical thinking IS gained through experience. You can't just take a class. Critical thinking is not something only found in RN classes. It is a skill used widely in MANY industries and settings.
Heck, not everyone has to learn it. Some people can already think critically from the get go.
I live in norther WI also. We even take ventilator patients. Don't forget, we also pass meds to 25-30 residents during the day in addition to all the other stuff. If anything, your assessment skills need to be more accurate as changes can be subtle. Also, not every resident is a DNR anymore, nor are they all 90 plus years old. Those days are gone. Love LTC.
I am really glad I read this thread. I have been a Nurse for 20 years. I started out as an OB nurse then ortho neuro and as I had been a CNA for six years in LTC I tried It minus a couple breaks to return to ACUTE for about 3 years and the rest of the time I have been a LTC nurse. As for forgetting your skills that is baloney. To be A LTC nurse you need to be able to make decisions on your own and act fast because there is not always someone there to help you or guide you in what you should do. I do IV's Piccs CL's midlines groshongs wounds wound vacs i love wounds. I also have been an MDS nurse for about 8 years. Charge Nurse, Staff nurse, DON ADON. Currently I work in SubAcute in a Nsg facility we work 12s and i work nocs 6-6 I am the CN for the building so I have to be on the top of my game. No one to help me. Some acute nurses that work registry have came to our facility and are totally overwhemed. I have 22 skilled patients and 2 CNA's. Sometimes I just wonder what I am doing there and then something great will happen and it is all worthwhile. I have done a lot of different things in nursing but I dont think i would trade it for acute. Well thanks I just wanted to let you know i understand. People look down on LTC nurses. I say walk a mile in my shoes and most nocs that is how far i walk lol
TheCommuter, BSN, RN
102 Articles; 27,612 Posts
Since I'm inherently lazy, I prefer a laid-back, unstimulating work environment. However, I have not found that in LTC.
I work at a nursing home (LTC/SNF combo). However, I work on a short-term rehabilitation unit where the typical patient is discharged home in 2 weeks.
I deal with mostly postsurgical patients who are too deconditioned to go home. These patients are CABGs, knee and hip arthroplasties, thromboembolectomies, hysterectomies, post CVAs, fractures, and so forth. One time I received a gentleman who was badly beaten and robbed, and needed reconditioning. Many of my patients are middle-aged, and wouldn't fit the description of the average nursing home patient.
I regularly give drugs via IVPB and IV push, especially antibiotics. I remove sutures and staples, dress complicated wounds, operate CPM (continuous positive motion) machines, iceman machines, oxygen tanks, concentrators, and PEG tubes. I had been employed on a traditional long term care unit for a year, and I had not been exposed to some of these skills.
There's always something to learn at my workplace. The opportunities might not be so obvious, so you have to be aggressive and seek them out.