Busting myths about long-term care nursing

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.

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.

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.