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Tina M. Baxter, APRN, GNP-BC, has worked in both acute care and long-term care. A board certified gerontological nurse practitioner, she now teaches through HIS Solutions Health Care and works as a legal nurse consultant for Baxter Professional Services, assisting attorneys in nursing home litigation cases. Baxter took time to tell us what nurses can expect when working in long-term care.

Describe a typical day in the life of a long-term care nurse.

A typical day depends on your background. As an RN, you are responsible for the assessment and care plan for the resident. You may be responsible for staffing the unit and completing assessments in the hospital to determine if the resident is appropriate for admission to the facility. You may also function in the capacity below as is described for the LPN. As the director of nursing, you will be responsible for the day-to-day operations of the nursing unit by supervising other nurses, nursing assistants, and volunteers. You are responsible for making sure you stay within budget for care, approving the allocation of resources, and providing guidance to the staff.

As an LPN, you will begin with shift report, round on your residents, and morning med pass. After med pass, you usually begin your wound care treatments, breathing treatments, or other treatments needed. You also will begin your documentation of your assessment of the resident, field phone calls from the MD/NP for orders, review labs, fax pharmacy new orders or requests for refill medications. You then get ready for noon med pass, help monitor the dining room, and repeat the above. Afternoon med pass is anywhere between 2 p.m. and 5 p.m. You will document your assessments of the residents, attend to any resident urgent needs such as injuries, sick complaints like a headache or pain, and make additional phone calls as needed. Also, you will answer any family or resident question or concern that may come up during your shift.

As an advanced practice nurse and nurse practitioner, the NP will round on the residents similar to rounds in the hospital or for a primary care visit. The NP will assess the residents, address any medical or psychosocial concerns, document the findings, recommend treatment, and write orders for medications and treatments. The NP may meet with the staff, residents, and/or family to discuss the overall course of treatment, review any proposed changes to the plan of care, and discuss the best therapeutic options. The NP will also review and interpret laboratory and radiological testing and sign off on recommendations from other disciplines, such as dietary and physical therapy.

What kinds of nurses would do well in this role?

Nurses who love a challenge, can practice autonomously, and have a solid background in nursing across the lifespan. You have to be a generalist, as you will use your medical-surgical nursing, mental health nursing, community nursing, and nurse educator skills on a daily basis. You have to be comfortable with knowing that your resident may not ever become discharged from your facility until death.

What are the biggest challenges?

One of the biggest challenges is managing family and resident expectations. Often, residents come from the hospital and the ratio of patient to nurse is very different. Also, the expectation of the length of stay at the hospital is temporary. Residents come to long-term care (LTC) to live and therefore, they are in their “home.” The resident and family need to understand those changes in the dynamics. Sometimes, you have to have the difficult conversation of discussing curative versus palliative care. The goals of being in LTC is to keep the resident safe, provide for the best quality of life as possible, and to provide an enjoyable living environment.

What do you love most about what you do?

I love working with the residents and knowing that I can make someone’s day by just giving a listening ear, giving a cup of water, or explaining to a resident’s family a complicated procedure and having them appreciate the care that we give to the resident.

What do you wish more people knew about the job?

I wish more people knew that, while maybe not as glamorous as working in the critical care unit of a major hospital, LTC nurses are required to utilize a lot of the same skills as those in critical care. LTC facilities have come a long way and they are not the “sad prisons” for the elderly as they are portrayed in the movies and on television. There are many nurses and nursing assistants who work hard to care for the residents and do so with grace and dignity.

If a nurse is thinking about working in a long-term care facility, what kind of training should s/he have?

They should have some training in medical-surgical nursing and/or rehabilitation nursing.

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