Long-term care nurses speak out: Midwest nurses speak freely about their likes and dislikes in long-term care - Feature Article

Nursing Homes, March, 2002 by Janet R. Buelow, M. H. A. F. Cruijssen

The healthcare industry is facing an international nursing shortage, and implications of this crisis are emerging for the long-term care (LTC) industry. With this crisis there is no question that services and care for elderly clients will suffer, but more alarming is that the survival of many small- and medium-sized facilities will be threatened. Fortunately, there are a few strategic forces LTC administrators can draw on which are not available to acute-care administrators. To develop this defense, however, LTC administrators need to listen and respond to the priorities and values of their nurses, as well as address their concerns and frustrations.

In an effort to better understand nurses who work with elderly clients, we interviewed 50 nurses about their typical days, satisfactions and dissatisfactions, and feelings about their coworkers and patients. Half of these nurses worked in nursing homes, five worked in assisted living facilities and 20 in home care agencies (see sidebar). They all had direct patient care responsibilities, primarily caring for the elderly. Each nurse's interview was scheduled for one hour and had open-ended questions so the nurse could decide what stories or feelings she wanted to share with the interviewer. All interviews were tape-recorded, transcribed and then analyzed, with all personal and facility names deleted from the transcripts. (Interviews were conducted by Dr. Buelow and two graduate students. Both authors analyzed transcripts.)

Most of the nurses seemed to enjoy their interviews and thanked us for our interest. Although we paid them for participating, many said they felt uncomfortable getting money for being able to have someone listen to them.

Typical Days

To describe nursing home work, one 30-year-old registered nurse succinctly stated, "Passing meds to 35 to 40 people, taking care of all the treatments, doctors' orders, charting, overseeing all the nurses aides and dealing with people that are in a crisis situation." A nurse in an assisted living facility stated she performed primarily the same duties that her counterparts in nursing homes did, only with less pressure. One assisted living nurse said, "I do things like setting up their medications, [getting them ready for] going to the doctor, getting their letters ready, doing all the quarterlies and assessments. If there are certain ones who don't have family around, I take them to the doctor's office.... [Also], I am the supervisor of the aides."

In comparing long-term care to hospital work, most nursing home and assisted living nurses emphasized that they took care of patients for an extended period of time, so they got to know patients and their families much more than hospital nurses do. One nursing home nurse stated, "In the hospital your basic agenda is life saving. In this facility, your basic thing is comfort and quality of care."

Satisfactions

In response to "What's the best thing about working here?" a common theme was heard from nurses in all three organizations: "The best part of our work is caring for our patients and doing worthwhile work." Many of the nurses working in nursing homes and assisted living facilities emphasized how emotionally close they felt to their residents because they had known them and their family members for such long periods of time. One nursing home nurse said, "I guess why I have chosen to stay in this type of setting is that I enjoy seeing the patients for a lot longer stay than in the hospital. It's nice to get to know the patients and their families." Another nursing home nurse said, "I like the feeling that you're doing something for the resident and making life just a little easier for them, being that they have to be here."

The assisted living facility nurses agreed, but said they also appreciated their less stressful atmosphere because of residents' relatively minimal care needs.

These intrinsic satisfactions, however, are only possible for nurses when the facility administrator is sensitive and receptive to nurses' dissatisfactions. To the extent this falls short, the LTC industry finds itself in the same nurse staffing crisis as its acute-care counterpart.

Dissatisfactions

To determine dissatisfactions, nurses were asked the question, "What is the worst thing about working here?" The nurses' initial response was often quick and off the cuff, as though they preferred to move on to a more client-centered dialogue. So, after we listened to the nurses describe their clients, their needs and typical requests, we asked, "What interferes with you giving clients this care that they desire?"

The nurses' answers moved into their areas of dissatisfaction and provided the details we sought. Surprisingly, not one nurse said that she felt her clients were truly satisfied and getting all the care they wanted. Some said they gave the best care possible under the circumstances, but knew there was more they could do--if only they had more resources. "You never have enough time to do all the things you'd like to do," was a response often heard.