This content origi­nally appeared in the Spring/​Summer 2020 issue (PDF) of The Washington Nurse magazine.

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Long-term care is a growing field in nursing, and the challenges are growing along­side the demand. Our original goal in this issue of The Washington Nurse Magazine was to examine the challenges facing long-term care, explore a vision for what it can be and celebrate the contri­bu­tions of the thousands of Washington nurses who are the backbone of the long-term care system.

Since Life Care Center in Kirkland became Ground Zero for coron­avirus in the United States, the pandemic has exposed many of the signif­i­cant, systemic challenges facing this critical system.

According to the New York Times, residents and staff at nursing homes and other long-term care facil­i­ties accounted for one-third of all coron­avirus deaths in the United States as of May 11, 2020. Across 7,700 facil­i­ties, tests have confirmed over 153,000 cases, with many more doubt­less uncon­firmed. Long-term care facil­i­ties are prime vectors for conta­gious disease, and the elderly and medically fragile patients in these settings are at extremely high risk.

The crisis poses another set of challenges for those providing in-home care and the families who rely on them. Families and nurses alike must balance the risk of infec­tion against the needs of patients in in-home care settings — a choice made all the more diffi­cult by the medically fragile nature of the patients in need and limited personal protec­tive equip­ment for caregivers.

The pandemic may cast a new light on the issue, but long-term care has been too-often overlooked by policy makers in the United States for years. Like our entire health care system, the demands created by a for-profit system put nurses in an impos­sible position all too often, and caregivers are consis­tently stretched thin and under-resourced as they care for those with long-term needs.

Meanwhile, nurses whose work is supported by public funding are often under-compen­sated, with few or no benefits and little insti­tu­tional support for their critical work.

When we have contained this pandemic, we must all continue the work to support and advocate for the nurses who work in long-term care to receive the support and resources to care for themselves and the patients they serve.

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Pamela Pasquale, MN, RN

Long-term care in Washington #

As of January 2020, the Washington State Depart­ment of Social and Health Services’ roster of licensed commu­ni­ties included 209 skilled nursing facil­i­ties, 540 assisted living facil­i­ties and 3,135 adult family homes. Together, they serve more than 67,000 people. Without skilled, profes­sional nurses, alter­na­tive care commu­nity options would not be successful. Read more…


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Albert Munanga, DrBH, MSN, RN

Busting myths about long-term care nursing #

Long-term care nursing is a specialty within commu­nity health nursing and provides health services, preven­tive care, inter­ven­tion and health educa­tion to commu­ni­ties or specific popula­tions. Duties often include optimizing activ­i­ties of daily living and the indepen­dence of patients with chronic illnesses or disabil­i­ties. In this article, we examine the myths and reali­ties of long-term care nursing practice. Read more…


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Kristin Knudson, BSN, RN

Profile: Kristin Knudson, private-duty pediatric nurse #

Kristin Knudson, BSN, RN is a private-duty pediatric nurse in Seattle. She is a graduate of the Univer­sity of Washington Bothell, and a member of Sigma Theta Tau. She has been working one case for more than seven years. There are growing numbers of children with medical complex­i­ties, those children with repeated and prolonged hospi­tal­iza­tions along with technology-depen­­dence and multiple organ system involve­ment. Read more…


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Ellen Rabideau, RN

Profile: Ellen Rabideau, assisted living #

Ellen Rabideau is Health Services Director of Prestige Senior Care of East Wenatchee, an assisted living commu­nity recently purchased by a company that owns several build­ings. In addition to the tradi­tional role of the RN to assess and manage medical issues, the role requires a good amount of social work and case manage­ment. Read more…


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Robert Butzerin, RN, BSN

Profile: Robert Butzerin, skilled nursing #

Robert Butzerin has a passion for the people he serves. He currently works as a manager in long-term care, super­vising two large nursing units with 37 staff members and 42 residents, with one of the lowest staff turnover rates in Provi­dence Home and Commu­nity Care. Read more…


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Reducing errors through electronic health records #

It is rare for anyone in the health care system not to have their medical infor­ma­tion in electronic form. Access to the patient’s electronic health record should be avail­able to those providing health care in appro­priate settings. There are examples of such systems in place in other areas of the world. Read more…


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Caring for aging patients: Liability risks for nurses working in long-term care settings #

Consider this scenario: A nurse working in a long-term care facility ignored the facility’s policies and proce­dures on medica­tion admin­is­tra­tion and gave a methadone injec­tion to the wrong patient, which caused fatal respi­ra­tory arrest. This case not only had a devas­tating outcome for the patient but also resulted in litiga­tion against the nurse. Read more…