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“LTC Isn’t ‘Real’ Nursing”

September 15th, 2010 by – Marijke Durning

How many times have nurses heard or said that long-term care nursing (LTC) isn’t “real” nursing? If those words aren’t used, there are other comments, such as

- If you can’t find work anywhere else, you can go work in LTC

- If you can’t handle acute care, you can always to work in LTC

- If you don’t like to work hard, you can always go work in LTC

But is this true? Quite frankly, no, it’s not.

Registered nurses (RNs) and licensed practical nurses (LPNs) – or licensed vocational nurses (LVNs) – who work in LTC facilities work just as hard as nurses who work in acute care – the difference lies in the intensity and the approach to nursing care, not the quality of care.

Without a doubt, nurses who work in high acuity environments, such as intensive care and med/surg, need to keep up to date with the latest developments in patient care, but so do LTC nurses. Patients in LTC facilities need good quality nursing care every bit as much as those who are in a hospital.

Nurses in LTC rely heavily on their assessment skills, as do nurses in acute care. In acute care, changes in some patients can be detected quickly, while changes in a patient in LTC can be much more subtle. An elderly patient who is normally alert and oriented all around who suddenly becomes confused needs to be assessed. Why did this confusion occur all of a sudden?

Does the patient have an underlying dementia that hasn’t shown before now or is there a problem that is reversible, like a urinary tract infection? Urinary tract infections can easily lead to something much more serious, such as sepsis, causing death. But if a nurse picks up on the possibility of a UTI and assesses the patient for it, most UTIs can be reversed successfully, returning the patient to his previous level of health.

Nurses in LTC need to be aware of how medications interact with one another. Patients in LTC settings often take numerous medications, all of which have potentially very harmful side effects. LTC nurses are often left to be quite independent. Doctors may not be readily available or easily accessible, leaving decisions, using facility protocols, up to the nurse in charge.

Nursing in LTC may also be emotionally draining. While in acute care, patients come and go, LTC patients stick around, making it easy for nurses to develop relationships with them. If the patient is not to be resuscitated and is comfort care in his last days, this can be tough on the care givers who remember laughing and talking with him in better times. It’s easy to get attached.

Are nurses who work in acute care and LTC different? No, they’re not. A nurse is a nurse. But a nurse who works in LTC is more experienced and likely more knowledgeable about seniors and chronic illnesses than is an acute care nurse, while an acute care nurse knows more about other issues.

It’s not a competition. Nurses give care, wherever they work.

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Posted in Work-Life Balance

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