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Busting myths about long-term care nursing


This story appears in Long-term care.


This content origi­nally appeared in the Spring/​Summer 2020 issue (PDF) of The Washington Nurse magazine. See the full set of stories on long-term care.

Teaser busting myths

Long-term care nursing is a specialty within commu­nity health nursing and provides health services, preven­tive care, inter­ven­tion and health educa­tion to commu­ni­ties or specific popula­tions. Duties often include optimizing activ­i­ties of daily living and the indepen­dence of patients with chronic illnesses or disabil­i­ties. Long-term care nurses work in a variety of commu­nity settings, such as skilled nursing facil­i­ties, assisted living commu­ni­ties, rehabil­i­ta­tion centers, schools, home health and hospice.

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Albert Munanga, DrBH, MSN, RN

The long-term care setting is a rich and valuable learning environ­ment to hardwire assess­ment skills, to gain first­hand experi­ence with complex health problems and to learn to work as inter­dis­ci­pli­nary team members. It is inter­esting to contem­plate the various perspec­tives of long-term care nursing.

In this article, we examine the myths and reali­ties of long-term care nursing practice.

Myth 1: Long-term care requires less critical thinking #

The thought that long-term care nurses are expected to think less clini­cally or criti­cally than other nurses couldn’t be further from the truth. Long-term care nurses must possess strong analyt­ical and critical thinking skills and the ability to carefully examine clinical situa­tions using the nursing process. These skills provide a crucial perspec­tive that can make an immediate differ­ence in the lives of their patients.

Consider the following example: A patient with a chronic cough had multiple diagnostic studies conducted to deter­mine the under­lying cause of the cough. The patient’s care team could not find an answer. The assisted living regis­tered nurse proposed that the poten­tial cause of the chronic cough was a side effect of a blood pressure medica­tion, Lisino­pril. The regis­tered nurse was correct, and the puzzle was solved. This example demon­strates strong critical thinking assess­ment skills that helped address a complex and costly problem. Nurses in the long-term care setting must maintain profi­cient medica­tion knowl­edge, including drug dose calcu­la­tions, drug manage­ment and pharma­cology. Contin­uing profes­sional educa­tion and training supports ongoing competency.

Myth 2: Long-term care nursing is for older nurses #

Asserting that long-term care nursing is for older nurses who can’t keep up with a fast pace is misguided and false. Some people further suggest that long-term care nursing is the last stop before retire­ment. In fact, long-term care nurses often carry a signif­i­cant case load while caring for patients of all ages, in different care settings, with multiple comorbidities.

For example, a long-term care nurse is often assigned to care for residents with a variety of stable and unstable comor­bidi­ties, such as conges­tive heart failure, dehydra­tion, dysphasia, severe rheuma­toid arthritis, irritable bowel syndrome and diabetes. While addressing patient needs and changes in condi­tion, the regis­tered nurse may also be sched­uled to conduct an admis­sion assess­ment for a patient coming from the hospital. To be able to effec­tively manage this workload, a long-term care nurse must be physi­cally and intel­lec­tu­ally fit and capable of multi­tasking and collab­o­rating with stake­holders expeditiously.

Myth 3: Long-term care is boring and less glamorous than other types of nursing #

To provide a histor­ical backdrop, in the United States at the start of the 20th century, long-term care housing was referred to as poorhouses” or poorfarms.” These terms create a dark image of places that often provided shelter to the indigent, mentally ill and criminals.

Nursing is a calling of the heart and must be appre­ci­ated as a unique and impor­tant special­iza­tion. The elderly and chron­i­cally ill desper­ately need the care and skills of regis­tered nurses and deserve respect and compas­sion along with grati­tude from the commu­nity for the life and liberty they have given to us.

For example, a typical retire­ment commu­nity today offers an abundance of living options, services and quality ameni­ties along with engaging activ­i­ties designed to make each resident’s long-term care living a new adven­ture. Residents who may other­wise be at risk for social isola­tion, poor access to nutri­tion or health care, or are at risk of becoming homebound suddenly have newfound indepen­dence, choices and a full, vibrant life thanks to the support from their long-term care team.

Myth 4: Long-term care nurses work independently and not as part of a team #

Long-term care nurses are miracles of versa­tility. They educate patients, nursing assis­tants, families and staff on matters such as infec­tion control, medica­tions, disease manage­ment and more. They coordi­nate care with hospi­tals, home health agencies, pharma­cies and durable medical equip­ment compa­nies, to name a few, while skill­fully orches­trating care plans within an inter­dis­ci­pli­nary frame­work. The long-term care nurse supports nursing assis­tant team members and collab­o­rates with other clinical and non-clinical personnel, serving as vital leaders and team members.

For example, upon assessing a patient’s need for therapy (perhaps after multiple patient falls), a long-term care nurse will contact the patient’s primary care physi­cian to recom­mend therapy. The physi­cian often agrees and places a written order, which the nurse provides to the patient’s preferred home health agency. The nurse then commu­ni­cates the plan with the patient, family and other care stake­holders while remaining engaged with the patient’s care and therapy.

Serving as a coordi­nator, the nurse updates the patient’s family and provider as appro­priate, collab­o­rates with the home health agency, arranges for durable medical equip­ment and follows up on recommendations.

Myth 5: Long-term care offers fewer opportunities for specialization #

Long-term care nurses have the oppor­tu­nity to specialize in areas such as educa­tion, IV therapy, wound care, diabetes manage­ment, leader­ship, regula­tory compliance/​policy and expert witnesses. Other areas of special­iza­tion include case manage­ment, infec­tion control and chronic pain management.

A nurse can specialize in dementia care, for example, and may also choose to obtain additional training and certi­fi­ca­tions, along with ongoing contin­uing educa­tion, in additional areas of interest. This provides patients with access to nurses with multiple areas of exper­tise who are core members of a care team that provides a broad range of clinical and critical thinking support.

Myth 6: Long-term care is only for LPNs, or for RNs with ADNs #

Long-term care nursing welcomes those with various educa­tional levels. It is common to find nurses with a broad spectrum of educa­tion, from licensed practical nurses to those with master’s and doctoral degrees.

For example, my organi­za­tion has several nurses with bachelor’s degrees and master’s degrees in nursing. In addition, there are many licensed practical and associate’s degree nurses. Each nurse offers a different perspec­tive that benefits patients and other members of their team.

Myth 7: There are fewer opportunities for growth in long-term care #

Long-term care nursing offers many oppor­tu­ni­ties for profes­sional growth. With the aging popula­tion, the need for long-term care nurses with various special­ties drives a hungry job market that seeks and rewards nurses who continue to grow their skills, educa­tion and specialties.

For example, a nurse might choose to become a general manager of a long-term care facility, such as a skilled nursing facility or assisted living commu­nity. His/​her exper­tise and training serve as a valuable comple­ment to the business and manage­ment skills neces­sary for such a role.

Whatever the choice of practice setting, the role of a long-term care nurse calls for careful atten­tion to princi­ples of health and strict adher­ence to prescribed plans of care. As a repre­sen­ta­tive of the most trusted profes­sion, nothing big or small is taken for granted, and a commit­ment to provide expert and compas­sionate care to all those who seek our service is required.

The American Nurses Associ­a­tion encap­su­lates what long-term care nurses do in the care of older adults, saying that care is focused on wellness, health promo­tion, preven­tion of illness and injury, as well as keeping older adults physi­cally and mentally healthy, functional, as indepen­dent as possible, and with optimal quality of life.” This can only be achieved by ensuring that nursing and other members of the care team are appro­pri­ately educated and deployed to care for this aging popula­tion. Nurses who serve in long-term care commu­ni­ties are committed to upholding these princi­ples daily.

Recommendations #

  • Long-term care nurses must tell their own story, bring impor­tant work to the forefront and demon­strate and elevate the value of this specialty.
  • Offer complete orien­ta­tion and residency programs; provide mentor­ship in the long-term care setting to allow new gradu­ates and other inter­ested parties to have a first­hand experience.
  • Address the dispar­i­ties in salaries and benefits; provide compet­i­tive compen­sa­tion packages to attract highly skilled and quali­fied nurses.
  • Long-term care nurses associ­a­tions should continue to advocate for better reimburse­ment rates to improve the finan­cial health of long-term care facilities.
  • Nursing associ­a­tions should mount media campaigns to counter negative any media outlook on long-term care nursing.
  • Long-term care nurses should continue offering high-quality care leading to positive outcomes and increased positive percep­tions among consumer populations

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Profile: Robert Butzerin, skilled nursing

Robert Butzerin has a passion for the people he serves. He currently works as a manager in long-term care, supervising two large nursing units with 37 staff members and 42 residents, with one of the lowest staff turnover rates in Providence Home and Community Care.

Profile: Ellen Rabideau, assisted living

Ellen is guided by the holistic care model and endeavors to meet every person’s goal of living happy, healthy and well. She addresses their physical, mental and spiritual/emotional needs in close personal relationships