Caring for "Senior Set" Rewarding, Revealing

When Jean Morgan was considering a career switch to gerontological nursing after 37 years as an acute-care nurse with the Memorial Hermann Healthcare System, she admits she had reservations.

Eighteen months later, she took the plunge, made the switch, and is still marveling that she didn’t change paths sooner.

"I initially held the common misperception that this field of nursing consists of custodial care and is a no-brainer. Nothing could be further from the truth," says Morgan, who is now a long-term care nurse at University Place Nursing Center, part of a certified continuing- care retirement community owned and operated by Memorial Hermann. "Long-term care nursing is not feeding, turning and incontinence care. I’ve found there are many unique and rewarding aspects involved in the care of the elderly."

Morgan says the medical challenges of long-term care nursing are similar to those found in acute-care nursing, but without the same hourly stress.

"It is a slower pace, because much of what I do involves rehabilitation. While we deal with heart attacks, strokes and fractured hips, mostly we’re facing chronic problems, trying to help people function to the best of their abilities despite cognitive or physical limitations," she says. "The elderly exhibit tremendous diversity in terms of their health status. Most have chronic diseases that have a serious impact on quality of life. Their risk for complications is extremely high."

Staffing levels at University Place, Morgan says, allow her to fully address patients’ needs.

"I feel I have the time to talk with my patients, listen to their concerns and issues, act upon them and not feel like I’m standing with one foot out the door in leap mode," she says.

The greatest challenge, Morgan says, is dividing her time among healthy, independent residents who call University Place home, seniors in need of personal assisted-living services, and patients in the skilled nursing unit who require full-time medical attention.

"The advantage with each circumstance is that I can work with people over time, get to know so much about them and their families, anticipate their needs, and really appreciate their uniqueness," she says.

"In acute-care hospitals, patients are usually around for only a short time, but here, nurses become part of the extended family," says Marilyn Peoples, director of Health Services at University Place. "Nurses know the residents and their family members, and get to work through life issues with them. Seniors deal with a lot of losses. When they move into a retirement facility, they have just lost their home, they may have lost a spouse, belongings, their memory and some of their ability to function. Many are going through a grief process when they arrive, on top of facing chronic illnesses such as arthritis, diabetes, osteoporosis and heart problems."

Fortunately, many protocols can be implemented, Morgan says.

"The close physician collaboration and the multidisciplinary team effort is another big bonus of working in long-term care. We have weekly team conferences, focusing on the patient, and we involve family members a lot. We’re not only taking care of the resident – we’re nurturing family members as well."

Because many families are in denial about the severity of their loved one, Peoples adds, long-term care nursing requires people with strong interpersonal-relations skills. "One minute we’re loved, the next minute we’re hated for being the messenger of bad news. Sometimes, we’re telling a child that mom or dad isn’t doing well, perhaps reaching a level of progression closer to death that the child doesn’t want to face. Other times we’re telling a resident they’re being moved to a different level, which can be upsetting because, understandably, people want to hold onto their independence as long as possible. Once they are placed appropriately and once families adjust to the change, we’re loved again."

"When we take vacations in long-term care, we are really welcomed back, because not only is the staff glad to see us, but the residents are, too," she adds.

Morgan says as a long-term care nurse, she grieves more deeply when her patients die.

"It’s like losing a family member," she says. "But the rewarding part is we often have a number of years together and really get to bond during that time."

Morgan and Peoples agree that their careers in long-term care nursing continually provide them a strong sense of mission and satisfaction.

"I go home and spend a little more time with my own aging parents," Peoples says. "My job has taught me to have my own affairs in order, so that my children don’t inherit a situation with no durable power of attorney, living will or directions regarding personal belongings. My children now know that when the time comes when I can no longer make decisions, I want them to make them for me."

"At the end of the day," Morgan adds, "I know I have done my best and made a difference."

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©2006 Texas Medical Center

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