Becoming a Long-Term Care Nurse: What You Need to Know

More than five million Americans currently live in, or will be admitted to, long-term care facilities (LTCFs) this year. These facilities include:

• Nursing homes
• Skilled nursing facilities
• Adult daycare centers
• Assisted living facilities

While most long-term care is provided in the home by family and friends (not by trained professionals), long-term medical facilities serve patients who need more specialized and ongoing attention than home care can provide. There are now more than 16,000 long-term care facilities in the US. The LTC industry is the third-largest employer of healthcare providers in the country.

In this guide on how to become a long-term care nurse we’ll explore the role in more detail, covering:

• What does a long-term care nurse do?
• Steps to becoming a long-term care nurse
• Education requirements for long-term care nurses
• Reasons for becoming a long-term care nurse

What does a long-term care nurse do?

Alongside other medical providers and therapists, nurses in long-term care facilities help manage patients’ conditions and monitor vital signs and symptoms. Depending on your education level, your daily tasks may include:

• Taking patient histories, tracking patients’ progress, and maintaining medical records
• Performing tests and assessments
• Administering medicines, intravenous feedings, and tube feedings
• Dressing wounds
• Bathing, grooming, and clothing patients
• Assisting with rehabilitation and physical therapy
• Creating treatment plans alongside other professionals
• Assisting doctors during exams
• Educating patients and their family and friends about medical conditions and care

What is it like to be a long-term care nurse?

Simply put, your job description will depend on what kind of care nurse you are, and the rules of the facility itself. The roles nurses assume in long-term care facilities are described below:

Licensed practical nurses (LPNs)

These professionals—also called licensed vocational nurses (LVN) in some states—usually have the least amount of education and do most of the day-to-day work. Their roles include:

• Taking vital signs
• Administering medicine
• Cleaning and dressing patients

In some instances, LPNs can have a supervisory role if the facility lacks qualified registered nurses (RN).

Registered nurse:

These nurses generally supervise LPNs and other staff. They are also in charge of:

• The overall quality of the facility
• Creating care plans
• Assessment

By law, the director of nursing, who oversees the staff and acts in a management role, must be a registered nurse.

Nurse practitioner (NP)

NPs are RNs with a graduate degree and a lot more responsibility. NPs can prescribe medication and have even more autonomy than RNs. There are 78,500 NPs in the US, but only around 2,000 work in nursing homes. In states where they are permitted to do so, they can serve as primary-care providers.

What is the average annual income of a long-term care nurse?

According to the job website Salary, LPNs working in long-term care earn an average annual income between $42,411 and $54,566. Their average wage is between $20 and $26 per hour.

Without accounting for benefits, staff nurses working in long-term care earn an average salary of $71,827 per year. For context, all RNs earn an average of $63,393.

Nurses who become long-term care nursing directors earn around $83,582 per year. Nursing directors must hold a master’s degree.

Job outlook for long-term care nurses

The US is facing a nursing shortage even as the Bureau of Labor Statistics reports that nursing jobs should grow by 12 percent between 2018 and 2028. In addition, an aging population means both that older nurses are retiring—creating vacancies for younger nurses—and more elderly patients are entering long-term care. All this adds up to opportunity.

The problem in long-term care is particularly acute. “The long-term care workforce crisis is well-documented,” says a LeadingAge report. “Large numbers of vacancies in professional and direct-care positions create significant obstacles for providers and workers committed to delivering high-quality care. Adding fuel to an already-raging fire is the difficulty of attracting new talent to long-term care and retaining employees once they are hired.”

The report claims that contributing factors include:

• Demography
• High turnover
• Negative public perception of long-term care
• Insufficient wages
• Poor work environments
• Inadequate education and training

Educational requirements for long-term care nurses

There’s no reason to wait until graduating from high school to start exploring a career in long-term care nursing. Some facilities may allow you to volunteer in a nursing home or other long-term medical care center, so you can gain experience and see what daily life for patients and employees is like. It will also give you a chance to experience the negatives of long-term care facilities listed above. If you can’t abide the challenges of working in this field, best to know that as early as possible.

What is the highest level of education required to become a long-term care nurse?

This depends on what type of nursing you want to practice. Entry-level long term care nurses, LPNs, usually hold an associate’s degree in nursing (ADN) and must pass the National Council Licensure Examination-Practical Nurse (NCLEX-PN). It generally takes two years to meet these requirements, though there are one-year nursing certificate programs available through:

• Community colleges
• Trade schools
• Vocational schools

Most RNs earn a Bachelor of Science in Nursing (BSN) from a four-year college, though it is possible to become an RN with just an ADN. Regardless of your education, all RNs must complete these certification requirements:

• Graduate from an accredited nursing program
• Pass NCLEX-RN exam
• Complete additional steps, such as passing a background check and meeting other state-specific requirements

Nurse practitioners in long-term care

For those who want more autonomy in their job, becoming a nurse practitioner is a smart move. It requires completing a Master of Science in Nursing (MSN), which usually takes two additional years. MSN programs often require a BSN to qualify for entry, but there are accelerated programs, such as this one at Saint John Fisher College that allow students to complete an MSN in a shorter time frame.

What should you look for in a long-term care nursing program?

For nurses who want to specialize in gerontological care, there are nurse practitioner programs at the master’s and doctor of nursing level. According to US News & World Report rankings, the top adult primary care nurse practitioner programs include:

• Duke University
• University of Pennsylvania
• Columbia University
• Vanderbilt University
• Johns Hopkins University

Having an MSN can help you earn more money and advance your nursing career.

Nursing programs at every level of education are widely available online. Be particularly careful with online associate degree programs, which can be significantly more expensive than earning the same degree from your local community college. If you already have your associate’s degree and want to complete an additional degree, consider RN to BSN programs or RN to MSN programs, which can save you time and money.

Steps to becoming a long-term care nurse

Beyond passing the necessary licensing exams, there is no certification requirement to become a long-term care nurse. If you want to advance in the field by becoming a director of nursing or another managerial role, you will likely be required to obtain a certification, such as:

• Gerontological nursing certification (RN-BC) from the American Nurses Credentialing Center.
• Director of Nursing Services–Certified (DNS-CT) from the American Association of Directors of Nursing Services (AADNS)

To be eligible for the RN-BC credential, you must have:

• A current, valid RN license
• Two years of experience as a practicing RN
• Completed 2,000 hours of clinical practice in a specialty area of gerontological nursing within the past 3 years
• Completed 30 hours of continuing education in gerontological nursing within the past 3 years

The RN-BC certification can help improve:

• Knowledge of pain management
• Discharge planning
• Care for physiological and psychological aging changes
• Job confidence

Applicants for the DNS-CT must:

• Be a registered nurse
• Have two years of full-time experience (or an equivalent amount) in the field
• Have one year of leadership experience (preferably as a DNS)
• Pass DNS-CT courses with a score of at least 80 percent

What fieldwork is required to become certified as a long-term care nurse?

Unless you decide to pursue a specialty certification, there is no fieldwork requirement for becoming a long-term care nurse.

Reasons for becoming a long-term care nurse

Many nurses choose long-term care because they want to forge relationships with patients. Others gain satisfaction from caring for those who cannot help themselves, and doing it in a way that patients feel heard, valued, respected, and shown the dignity they deserve.

As a long-term care nurse, you can expect a working environment in which you’ll have:

• Hands-on interactions with patients
• Independence
• Varied, complex, and essential responsibilities

What types of people are best suited to long-term care nursing?

In an interview with DailyNurse, Tina M. Baxter, a long-term care nurse, said that the most qualified nurses for the position are:

• Generalists, who can draw on well-rounded nursing experiences to address mental health concerns, educate patients, and assist with medical and surgical tasks
• Comfortable with developing relationships with patients for possibly the remainder of their lives

Above all else, “Nurses who love a challenge, can practice autonomously, and have a solid background in nursing across the lifespan” will do well in the role, says Baxter. If that sounds like you, perhaps a career in long-term care nursing is in your future.

(Last Updated on February 26, 2024)

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