Long Term Care. Why you should care about it.

By January 10, 2016Nursing

I have heard all of the snotty remarks about the “Nursing Home Nurse” before.  It’s ok, we can take it.  I say WE because at one time, I did PRN in a LTC facility for about a year.  I can tell you that it is not all burritos and strippers, my friend.

Let’s bust the stereotypes together:

  • Long Term care nurses can’t make it in the hospital! LTC Nurses are extremely organized and compassionate people.  They love their elders, and they are passionate about patient safety.  Just because you can handle 8 patients on a med surg floor, don’t assume you can take care of 60 patients in a LTC facility.hands
  • Nobody would CHOOSE to work in a Nursing Home! Many people dream of working with elders in a LTC environment.  Not everyone has the ‘sexiness’ of the ER or ICU in mind.
  • LTC nurses can’t assess a patient.  A LTC nurse probably has as good or better assessment skills as a hospital nurse.  They have to be able to APD.  Assess per door or assess per dining room.  LTC Nurses must be able to catch symptoms early, and their patients are not on 24 hour telemetry. Is that increased confusion a UTI or is their baseline dementia getting worse? Ask a LTC nurse! She must take the time to know her patients at baseline. PF-nursing-home_1202162c
  • When was the last time you administered all meds, did all dressing changes, respiratory treatments and tube feedings on 40 people? Never? Ask a LTC Nurse.  The answer is probably ‘Yesterday’.
  • How many families have you spoken with today? Was one of them ‘that’ family? That family will be there for the next 6 years.  How will you improve your communications skills to deal with them for that long? Ask a LTC Nurse.  He is an EXPERT at this!

Why should you care, hospital nurse?

  • Because your Mother, Father, Favorite Aunt, Grandmother, and perhaps YOU are going there eventually.  
  • Because it is the right thing to do.  We warehouse our elderly in this country, in unsafe conditions, for years.  
  • New Graduate Nurses are going to this environment.  This is probably the worst idea on planet earth.  Often they go with no real orientation, no mentor, and no support.  We must help our new grads keep their licenses and not burn out.
  • CNA’s are treated as disposable, minimum wage employees.  Their spines are shot in 10 years from heavy lifting, and nobody is addressing this.  They rarely have enough people to safely lift a patient, and their lift equipment is often broken or does not exist, resulting in staff and patient injuries.  Seriously?
  • Health care employees in all environments deserve to have their licenses protected, the ability to do their jobs safely, and the reasonable assurance that their patients will not be hurt because of the staffing and equipment situation in the facility.


Let me know if you want to add anything.  Ask any admin on Show Me Your Stethoscope to invite you to SMYS for Change.






*** Thanks to Dawn Doccola for helping

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Author Janie Garner

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Join the discussion 10 Comments

  • Carla says:

    Thank you. I am a 40yr veteran RN w time in Peds, ICU, CCU, ER, MedSurg, Nsg mgmt, home health, psych outpt, corrections and LTC. LTC is by far the most rewarding n most challenging!

    • Samantha says:

      I chose to work LTC and it has been the most rewarding experience of my life, but it needs to change. Our elderly deserve the utmost respect and the best care possible. Staff to patient ratios must change. Right now on average there is 1 CNA for 12-14 residents. It isn’t humanly possible to give good care to all 14 within a 1.5 hour window. The care is getting worse and the expectations are getting higher.

  • Karen says:

    Thank you for addressing this issue, Janie! While I have worked ICU for the last 20ish years, I worked several years prior to that in LTC. In some ways, my heart is there with those elderly pts, but I just couldn’t deal with the insane demands of administrators, and the unsafe conditions I was often put in. I would go back in a hearbeat if the working conditions were better.

  • Traci Hart RNC MSN says:

    I worked LTAC nights for a year. At one time I had 74 pts with 2 CNAs. I was the 3rd. My assessment skills were honed in this environment. Although I enjoyed my CNAs & residents, it took a toll on my health. I ended up with HTN, increased migraines, severely exhausted & finally chest pain with a Cath. If you’re not organized, you can’t do this. This is not a place for new grads who don’t have skills yet. So thanks for writing this. LTAC nurses are dismissed & underappreciated.

  • Ellen Miller says:

    I agree staffing ratios HAVE to change. The elderly pt. deserves more than staff who are forced to split their attention between 20-40 people. Minimum staffing ratios are usually set by the state. Petition your state Representatives for positive change! The corporations that own most LTC facilities will be forced to comply.

  • jan says:

    I was Director of Nursing services of Skilled Long term care facility over 10 years ago. Assessment skills are extremely vital, IV’s, wound care, breathing treatments, medications are all given by our nurses that have maybe one other Licensed person, or just a medication tech to help. It is not just the facility does not want to hire personnel, CNA’s, LPN, RN’s. . It is just as big a problem that people do not always want to work, or do not show up to work. Our government has made it difficult to get people to work when they will lose benefits, etc. if they work. I frequently offered jobs to personnel, offered to pay for their training, and they would lose food stamps, etc, if they worked. What a mess we have made of our society, when not working is better than working, and being proud of ourselves and being useful to society. Mandating better staffing must come with increased payment to our Skilled Nursing Facilities, as well as having facilities for those persons who really do not need Skilled level of care. Some states do not provide care in assisted level of care, so we have people in Skilled care, that do not need that level of care.
    Older people have so much to give and have so much wisdom, we just need to enjoy then in what ever world they are in..

  • Bonnie Polster says:

    Wonderful article! I appreciate it greatly as a career long-term professional. It is so refreshing to see something positive about LTC. Thanks for the positive exposure!

  • Jeri says:

    The State sets the “minimum” requirements for staffing. They also regulate that the facility is required to provide staffing to keep the residents & staff safe. Unfortunately the facilities do not do this & they just go by the “minimum” to staff LTC units. I, personally, think we need to have the corporations who own the LTCs responsible to provide staffing that it safe for all involved. To many of these corps it is more important to monitor budgets & bottom line than safety. This is just my humble opinion.

  • Roberta Rheinschild says:

    I loved LTC and am still very passionate about it. I did some of my first critical care nursing there. Yes, I said it. Successfully treated seizures there and then was hideously late with afternoon meds for my other 19 patients. That was nearly twenty years ago, but it seems like yesterday. I think back wistfully about how well I knew my residents and their families and wish I could have that connection with each of my patients.

  • Hakuoki Aoi says:

    I work as a nurse in an assisted living facility. You’re the only nurse on duty besides the director of nursing (they’re usually in and out of meetings) and as much as you want to help families and your staff, you have to explain to them that we have to follow doctor’s orders and the staff who assist your mom/dad can only help them so much. I find that in our particular building, that marketing seems to oversell what out staff can do and the directs all complains to us which if you had told them what they can really expect, we may not have people move in and move back out within the same month.

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