When I started my nursing career many years ago I never thought I would work in a long term care facility. But after many years in different nursing roles in various settings, I am now a nurse manager on a skilled nursing unit in a continuing care residential community (CCRC) and loving it. Here are some of the reasons I work in long term care and why you might consider a nursing position in this setting:
Focus on relationships
In the last year of nursing school I worked in a New York City Coronary Care Unit (CCU). It was not unusual to have as many as five codes in one shift. I didn’t mind the fast pace. What I didn’t like was the amount of time I worked with machines rather than with patients. Because most of my patients were comatose, interaction with them was nil or minimal. In the years to come I found myself seeking out positions where I could develop relationships with patients. In a long term care setting, patients (residents) stay for years, longer than any other nursing setting. I have the opportunity to focus on developing relationships with patients and their families and less on the technical aspects of nursing.
You’d think that with most residents staying a long time, there would be little change in a long term care facility. Monotony would set in. I used to think that, too. However, I was wrong. Our residents’ conditions change frequently. It is up to us nurses to perform thorough assessments to catch those changes and take the appropriate actions. When there are no acute changes or emergencies, we have residents with multiple chronic illnesses we have to deal with such as heart and lung problems, diabetes, Parkinsonism, skin issues and dementia. Because of these conditions our residents take multiple medications with many interactions and side effects. Our residents are not just there to die. It is our responsibility to help them stay as independent as possible for as long as possible. It isn’t how long they have left that counts.
If you work in a small facility, like I do, you may be able to do multiple jobs. Initially, I had trouble wearing so many hats. Now, 13 years later, I enjoy the variety. I am not just a nurse manager. I am the MDS coordinator. I am on the nursing unit often assessing residents and teaching nurses assessment and management skills. I work with an interdisciplinary team. I teach formal in-services. I make emergency calls in our independent community and enhanced assisted living unit. I sub for the director of nursing when she is not there.
There is a reason long term care facilities are called, “nursing” homes. They are run by nurses. The focus is on nursing care. I like that. Doctors visit infrequently. We care for the residents and contact doctors/nurse practitioners when we need them. We are free to focus on what we do best: Assist residents to have as high quality life as possible for as long as possible, do rehabilitation after surgery or a hospitalization and ensure residents die with dignity and in comfort.
I know some nurses worry about losing their “skills” if they don’t work in a hospital. I believe they are referring to the technical skills of inserting IVs, catheters, etc. What I have found is that when you take a job in a specialty you have never worked in before, you will master whatever skills you need. If you, like me, want to develop your nurse/patient relationship skills, like challenges, variety and independence, consider a job in long term care. You will become skillful in nursing assessment to catch critical changes, rehabilitation, dementia care and end of life care.