By Melissa Nguyen, Clinical Nurse Manager at Medical Solutions
While visiting my grandmother in a long-term care facility, I saw a handwritten sign on the employee lounge door that caught my attention. It read: “Our residents do not live in our workplace, we work in their home.”
This simple yet meaningful message really changed the way I looked at long-term care nursing — especially now that my grandmother was a resident. Most of her fellow residents were spending their final days, months, or years with healthcare professionals who were understaffed and underappreciated. Some residents never had visitors, some had family members regularly dissatisfied with their loved one’s care, and some wanted nothing more than for someone to just hold their hand. Each resident had a unique story and their nurses played an essential role in that story.
Prior to working as a Clinical Nurse Manager at Medical Solutions, I did not realize there were differences in the types of long-term care facilities. Now I know there are skilled nursing facilities (SNF), long-term care (LTC), long-term acute care (LTAC), and assisted living facilities (ALF).
So, how are these various long-term care facilities different? And what type of experience should a travel nurse or allied health traveler have to successfully work in each specific type of long-term care facility? Read the following examples to learn more about the variety in long-term care facilities and what skills you’d need to succeed in each setting.
Mrs. Smith’s Case
Mrs. Smith is a 76-year-old recently diagnosed with early-stage Alzheimer’s. Until recently, she’s been able to bathe and dress, make herself meals, and take all her prescribed medications as directed. Over the past few weeks, her daughter noticed Mrs. Smith forgetting to take her blood pressure medication and frequently skipping meals.
Assisted living facility (ALF)
Mrs. Smith qualifies for assisted living because she is unable to safely live alone but does not require heavy nursing needs (such as wound care or IV medications). Assisted living will help Mrs. Smith stay on track with her medications and provide meal services every day.
Travelers — whether RNs or allied health professionals — interested in working in an assisted living facility would need basic knowledge of medication administration, the ability to obtain vital signs, and the ability to obtain labs.
Skilled nursing facility (SNF)/long-term care (LTC)
Several months after moving to an assisted living facility, Mrs. Smith falls and breaks her leg. She goes to the hospital where she has surgery, however, she now needs assistance with dressing changes for her post-surgical site as well as rehabilitative services. She is discharged to a skilled nursing facility (SNF), where nursing staff will administer her medication and complete her dressing changes. She will also receive physical therapy and occupational therapy services. After several weeks, Mrs. Smith’s surgical wound has healed and she has completed her physical and occupational therapy, but she still requires assistance with mobility and taking medications. She is now transferred to the long-term care (LTC) side of the facility where nurses will help bathe and dress her, administer medications, and transfer her safely in and out of bed.
Travel nurses interested in working in SNF/LTC must have experience working in SNF/LTC with higher ratios than what is normally seen in acute care. It is not uncommon for an SNF/LTC RN to have a 1:20 ratio or higher. Nurses who have only worked acute care are generally not successful as they may struggle with higher ratios than what they are used to.
Mr. Jones’ Case
Mr. Jones is a 50-year-old man who was admitted to the hospital after a 1,000-pound tree fell and crushed him. He suffered multiple broken bones, a collapsed lung, and a bruised heart. After several days, he stabilized, but required a tracheostomy and remained on the ventilator.
Long-term acute care (LTAC) ICU
Mr. Jones’s injuries were healing, however, he needed to be weaned off the ventilator. He still needed intensive therapy to build strength and to learn how to breathe, talk, and walk again. He is transferred to a long-term acute care ICU where he begins the process of weaning off the ventilator.
Travel nurses interested in working in LTAC ICU must have experience working specifically in LTAC ICUs. Nurses who have only worked in an acute care hospital ICU are generally not successful as they struggle with the ratios in LTAC ICU (which often carry high acuity patient ratios of four or more). Nurses who have worked stepdown in an acute care facility may be considered if they have ventilator experience. Nurses who have only worked LTC would not be considered good candidates for this position as they do not have experience with acuity levels of LTAC patients.
Long-term acute care (LTAC) med-surg
Mr. Jones has been successfully weaned off the ventilator and moved to the LTAC med-surg floor. He still requires IV antibiotics and frequent dressing changes for his wounds. In addition, he will continue intensive therapy learning how to walk, talk, and eat on his own. Travel nurses interested in working LTAC med-surg must have either worked in an LTAC med-surg unit in the past or have worked stepdown/tele, med-surg or float pool in an acute care facility and have experience taking ratios of at least 1:5. Nurses who have only worked LTC would not be considered good candidates for this position as they do not have experience with acuity levels of LTAC patients.
As the United States population ages, there will be a higher demand for long-term care and long-term acute care nurses. It is a specialty that comes with its set of challenges, but that equally has its rewards. For many residents, it is their final journey in life and as nurses, we can make a lasting impact on how their final chapter ends. As Maya Angelou famously said, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”