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