Nursing: Long-term care

Last semester began with a short assignment in a long term care facility. It was my first clinical experience as a nursing student. I had high expectations, and my general impression was not one of disgust or even disappointment, but I was not pleased. I'm looking back on it now because I am about to begin three new clinical assignments. Each one will involve a different population and a different set of nursing skills than my previous clinicals. I intend to have these notes with which to compare them all at the end of the program and the beginning of my job selection.

I was assigned to a small but well-endowed nursing home on the upper west side called Jewish Home and Hospital. Overall, it seemed like a decent long-term care facility. The halls were clean and bright, the rooms were spacious, and the meals looked appetizing. Yet somehow the whole place frustrated and saddened me.

When it comes to the long-term care system in the U.S., I see a basic paradox: advancements in medicine have lengthened the lifespan of the aging adult, but have done nothing to improve the quality of life at this juncture or to otherwise accommodate the needs of the elderly. Viewing this problem from the standpoint of a future nurse makes it even more difficult.

In a long-term care facility, nurses have the most important role in the patients’ health care. Unlike physicians or sometimes even family members, nurses see the patients daily, which also means they have the most opportunity to help improve their quality of life. As I worked with my patient, AS, I realized that what she needed most was the attention and deference she got before she came to the nursing home. Although she told me how thankful she was to be alive after her stroke, the things AS appreciated most were not that her medicine was dispensed on time or that her blood was drawn painlessly. AS wanted to be a functional, fulfilled human being, and for the most part she now had to look outside of her home to find that. It is no wonder why: with only one RN or LPN per unit and 24 residents to divide their time and tasks between, no single nurse could possibly provide the kind of care to meet all the needs of every patient.

AS had family and friends who would visit her or take her outside of the facility, but many of the other patients did not have a daily visit to look forward to, or someone outside of the home that they could count on. Sure, it was depressing, but by the end of the assignment I was dealing with another conflict. I came away feeling sort of empowered because I witnessed the importance of my future job in so many people’s lives, but at the same time I felt dejected at the prospect of all the nurses who are stretched too thin and forced to go to work knowing that as long as they worked in a nursing home, they would never be able to provide enough care in one shift to satisfy all their patients' needs. It's a problem, and it's the reason why I wont be doing this kind of nursing.