Everything You Need to Know About Long-Term Care Nursing

Nurses are a truly special breed of healthcare professional. Ranked the “most trusted” profession for many years in a row, these men and women seem to connect with their patients in a unique way.

Nursing is a profoundly relational job. Caring for patients means listening to what they say and even sensing what they aren’t saying. It means helping them feel as comfortable as possible in some of the most frightening or worrisome moments of their lives. And it also means trying to gain their trust, in the hope that they adhere to their plans of care and heal as well as possible.

But for many nurses, the pace of the job and their workplace don’t give them enough time to develop the relationships they’d like with patients. When patients come in and out so quickly, the connections you make can only go so deep.

Long-term care nursing, however, is a completely different story.

“Working in long-term care (LTC), unlike so many other specialties within nursing, provides you with the time to get to know the residents, as well as their families,” says Joan Devine, RN and director of education at Pioneer Network. “It is truly a relationship-based model of nursing.”

If that sounds appealing to you, then read on and get the details of this truly fulfilling nursing career option.

What is long-term care?

For typically able and healthy people, healthcare is a short-term recourse for when something goes wrong. You get sick or hurt, receive care and head home. But many patients require an extended period of time to manage their illnesses or injuries. They might need years of care, or they might need care for the rest of their lives.

The nurses who help these patients heal are considered long-term care nurses.

Many people think of elderly populations when it comes to long-term care nursing. And while those patients aren’t the only ones in need of long-term care, they certainly make up a large group. According to the Bureau of Labor Statistics (BLS), the demand for long-term care nurses is expected to rise dramatically as the baby boomer generation ages.

What do long-term care nurses do?

“Working in long-term care is truly a specialty, and one not always seen as such,” Devine says. “Within nursing, there has always been this somewhat unspoken hierarchy with the ICU nurse at the top of the pyramid and the nurse working in LTC at the bottom.” This idea undercuts the engaged and often diagnostic work LTC nurses do.

Unlike a hospital environment, nurses in long-term care don’t have the constant support of a physician or other ancillary healthcare professionals, Devine says. This means LTC nurses need to provide clinical care for the residents, while leading a team of CNAs and others. “They are responsible for not only the quality of care for the residents, but also the quality of their lives.”

Working in long-term care with an older population means developing a specialized skill set in gerontology. “Most days, and in most situations, the nurse in LTC is not dealing with an acute illness that has been recognized with a treatment plan already put in place by the larger team,” Devine says. “These nurses have to know the residents so well that they are able to pick up on the subtleties of an impending exacerbation of an illness” to be proactive.

In this way, long-term care nurses need to always keep a diagnostic eye on their patients, while designing care plans that can give them the maximum level of daily functioning.

Where do long-term care nurses work?

Many LTC nurses work in nursing homes or assisted living facilities. Devine says assisted living facilities typically require residents to be able to perform activities of daily living with minimal support. Nursing homes offer minimal assistance as well as fully supported care. “Nursing homes definitely are designed to manage higher levels of care needed,” Devine says.

However, assisted living facilities are monitored at the state level, and the standards for resident ability can vary greatly. Devine says assisted living facilities are recently seeing higher levels of need on both the physical and cognitive level.

“Other options for LTC nursing employers include Adult Daycares, PACE programs and hospitals that have specific programs for geriatric patients,” Devine says. “I think someone with a background in LTC could be a great advocate for elders in the hospital setting.”

What skills do you need to be a long-term care nurse?

“LTC nurses have to have excellent observation and assessment skills,” Devine says. “They must be excellent communicators—in both giving and receiving information from team and residents.” Long-term care nurses are often the first line of defense for their patients and must be paying close attention to early warning signs of sickness or new health complications.

Nurses in long-term care also need to be able to see their patients as more than their needs. When interactions are short and limited, the way you view a patient might not have a significant impact on their experience. But when you interact with the same patients for months and even years, the way you see them makes a huge difference.

“It is not ‘the Alzheimer’s resident,’” Devine explains. “It is the resident living with Alzheimer’s (or any other sickness). Nurses in LTC need to see beyond the ailments of a resident and recognize their abilities to help them maintain meaning and purpose in life.”

How do you become a long-term care nurse?

To become a long-term care nurse, you must first become a licensed practical nurse (LPN) or a registered nurse (RN). After you’ve completed a program, passed the NCLEX and earned a license to practice in your state—you have the qualifications you need to begin your career in LTC.

But as you begin your education, Devine says there are plenty of ways to hone your knowledge in a long-term care direction. “Explore the newest trends and best practices in the field of LTC. If there is a gerontological nursing group in your area, then get involved.” Devine also recommends learning more about patient advocacy and even earning credentials as a gerontological nurse through the American Nurses Credentialing Center.

Above everything, Devine encourages students to hold onto the idealism they have about nursing and caring for people. No matter how technical your studies and your work get, at the end of the day—your job is about people. Don’t lose sight of the person in your plan of care.

Is long-term care nursing for you?

Long-term care nursing offers a unique opportunity to really make a difference in residents’ quality of life. “When you help someone engage in something that provides true meaning and purpose in their lives, that is such a great feeling,” Devine says.

“As strange as it seems, there is gratification in being a part of a resident’s final journey in life.”

Devine points out that the concept of “home” is important—and making each resident feel at home where they are makes a huge difference for people who need more care than a traditional home environment allows.

Does this sound like the kind of nursing specialty you’re drawn to? Can you see yourself really investing in long-term patients’ lives? If so, you’ll want to get started on the path to becoming an LPN. Start planning your next moves with our article, “ How to Become an LPN: 5 Steps to Earning Your Scrubs. ”