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A Small Deed is a Big Deed to the Residents in Long-Term Care

I’ve been a nurse for 34 years and have been in long-term care for 19 years. In acute-care, I was a staff nurse and started on the night shift. I eventually went to the day shift and was recognized for my teaching skills. From there, I became a preceptor to new staff. I was then recruited into the education department, where I became a staff development educator and eventually the director of the education department. Soon enough, I was the coordinator for continuing education for the whole medical center. I have a master’s degree in adult health and nursing education and currently was just accepted into a PhD program. My background has been primarily in education.

There was a lot of transition going on in the acute-care facility I was working in. I was employed in a multi-hospital facility, which was downsizing and restructuring. Fortunately at the time, I had a good coworker and mentor who sparked my interest in gerontological nursing. She was a clinical nurse specialist in gerontology, and we worked on several continuing education programs together. It was her background and expertise that got me interested in the older population. So when I saw that acute-care was going through a lot of restructuring, I thought maybe it was the right time to seek a different care setting. It was then that I went into long-term care, first as an educator, which eventually brought me into different roles.

When I first came into long-term care, I was a staff development manager. Over the years, I worked in various other staff development and infection control positions in multiple facilities, became an assistant director, and following that took on the responsibility of risk management. I also dabbled in some human resources and went into a director of nursing role for a short time. Finally, I came to my current position, which is the assistant director of nursing at the Maria Regenia Residence, which is owned and operated by a group of sisters. The mission, the vision, and the value statement are very apparent in everything that we do here, which is, “To bring Christ’s healing, comfort, and power to all in the spirit of hope, health, and hospitality.” We are a five-star facility.

I think the best part about working in long-term care for me is rising to the challenge and making a difference. Working with the dementia residents and the staff, I always say I know I’ve had a good day if I’ve made a difference in one person’s life. The request can be something so small, like the person who rings the call bell and asks, “Can you pick something up for me?” If I’m there and I can do that for them because they can’t, then I believe I made a difference in their life that day. Seeing the residents smile, seeing the staff take the time to sit at the bedside holding a resident’s hand because the resident may be alone, doesn’t have family, is frightened, or is anxious – that is so meaningful and really captures our mission. For me, to witness the mission in action, that’s a job well done.

For anyone considering long-term care as their field, you have to have heart. You have to have passion. You have to realize that you are dealing with a population that may not be verbally responsive to you, and you may get the wackiest answers. You have to have patience and don’t expect too much at one time. Take the small milestones, like a smile, as wins. Any little things the resident can do, celebrate them. And say to yourself, “I have been a part of this.” The fact that someone in a dementia phase made contact with you, that you put a smile on their face, that you were able to do a small deed – that is the incredible part of this job and can be very gratifying. A small deed to you is a big deed to them.

These are the residents who are the most dependent, who just need a smile, the holding of their hand, and the lending of an ear when you can. Be willing to give of yourself, be patient with yourself, and be patient with the residents and the families, who can sometimes be demanding and challenging.

However, knowing you are providing service to some family who is unable to do it is also very rewarding. You want the family to be able to rest their head on a pillow at night and sleep, knowing that their family member is in a good place.

Having good clinical skills is also very important, because there aren’t always physicians in the building to call. Good assessment skills are necessary, and you can learn them. This is a great population to learn from.

I think the future of long-term care is going to be interesting, because as SNFs become more and more acute and admit fewer people to the hospital, we are going to become the hospitals of yesterday. We are going to see a different clientele. Part of our goal in long-term care is to avoid rehospitalizations, and in order to do that your clinical skills really need to be astute. If we can treat them here in the facility, we are going to treat them here.

However, that’s a whole mind-shift from what long-term care has been before. It’s not the little mom and pop home like before. We are now more acute, or more sub-acute, and we are going to have tougher and more challenging patients to take care of with the goal of maybe even getting them home instead of them staying long-term. So I think that’s the challenge of the future, and I’m up for it! I would love to get my hands back into an acute-care phase, even in long-term care. But you have to have the clinical expertise, and we are currently limited by ourselves for what kind of residents we can accept into our facility. We should work toward opening our minds up, expanding our skills, and offering those services. I want to be able to say one day, “We can take care of this patient. We can do this! We can!” We have to think differently. We have to take on new challenges. That’s the long-term care mindset of the future.

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