New Grad nurse @SNF...now on verge of quitting.

[iamNurse23]

Quitting while still in orientation: (After reading this, I hope I'm not alone regarding my experience and feelings with SNFs)

I've asked for advice. Friends have told me to hang for now, fellow RN friends/peers who have heard more of my experience in detail agree that its not worth the risk. Morally and ethically I'm against what I've witness and expect to witness in a SNFs

I am a new grad nurse and passed the boards in the early summer. I sent over a hundred applications for acute-care positions, but due to this difficult job market, I wasn't successful. So I went to my last resort which was applying to a SNF. The day after I applied,

I was called in for an interview and hired on the spot. A couple of my other friends were hired at different SNFs prior to me and told me how much they hated it and one even told me how he get nauseous before going to work because of the stress load, but I was really excited just to have a job and the salary $35/hr was much more than I was making. (The money is definitely not worth losing your license) Here are the problems I am experiencing

1) Two weeks into my orientation, It is safe to say I hate this job. The nurse to patient ration is from 1:15 to 1:25... average is over 20 patients per nurse. I don't know if its all nursing homes but it seems to be more emphasis on paper work than actually patient care. I am a very personable person and love talking and building a rapport with patients. However, with this patient load all nurses seem like all they can pass meds. The quality of care these patients are getting is pretty bad, the nurse I shadowed the other day asked why did I apply to a SNF, its not the place to be, and she worked in a hospital prior to moving to this state, and applying here was the worst decision she made, with 20 patients per nurse, an average of 10 medications (not including treatments) per patient and charting (tons of paper work) on each patient, she said she's lucky if she see's a patient for longer than 5mins in her 8 hour shift. One of the patients even made the comment "It seems like you are the dope dealer and I am the drug addict" And it sure feels that way, all we can do is say Hi and Bye.

2) Again, I'm not sure if all nursing homes are like this, but nurses take a TON of shortcuts and are pretty nasty individuals. I rarely see the nurses I shadow wash their hands, put on gloves, or verify the patient before administering medications. One of the other RN supervisors came and told my nurse "the state is coming soon to do surveys so we got to step it up, make sure we don gloves, wash hands every time, and ask the 2 patient identifier before giving meds" and my nurse said "what is the 2 patient identifier" .....i was in disbelief and I shook my head. Every nurse I shadowed has taken shortcuts and said that they have no choice and its so much for them to do, and they tell me "you didn't see me doing this or I didn't tell you this ok, ..but you'll see once you start working on your own".....I don't blame the nurses more than I blame the system itself, but at fault.

3) The DON pulled my supervisor to the side and was pretty stern about an incident. Long story short, the DON was upset that she didn't transcribe an order into the computer to be carried out, but the nurse reasoning was that she didn't receive an "ok" or Dr. signature approving her request. The DON said that the request for application of a certain ointment could of been carried out and transcribed without a signature. BUT! he said if the state comes..don't tell them I told you that, and tell them we always wait for a Dr.signature or "ok" in every situation. (My problem with that, it'll be just my luck that I apply that ointment without a Dr.sig (just approval from DON) and the patient have a major reaction to it)..ITS MY LICENSE AT RISK.

There is alot more things that I can go on & on about. BOTTOM line. This is definitely not safe, the patient load and responsiblities are insane and the stress level is high and mistakes are made daily. Its only a matter of time due to the high stress level. You just have to hope the mistake you make is not the BIG one. I didn't get into nursing to become a med passer, I don't enjoy this at all. I feel like me and the fellow nurses are only there to collect a check.

Lastly, my position is ON-CALL and I currently have less than a week of training before I'm out on my own. I'm definitely don't feel ready, and I have no interest nor passion for this. I pretty sure that my next day of orientation will be my last day. As crazy as it sounds, I would rather go to work making FAR less money doing something "i don't hate" than making more money, everyday risking my license. On the bright side of things. I have an interview for a RN position next week, and I have had 2 recent interviews that went really well and the managers told me the dates for the program (1 in Dec) and (1 in Jan) and they are just working on the exact dates. Nothing was officially signed, and I'm the "got to see to believe it" type of person.

[Peetz, BSN]

The SNF's get funding from medicare, so a licensed nurse must give medications. The patient load is very high and near impossible, yes something has to change. But please dont judge all SNF nurses, because most of us love our residents and do our best to care for them, so please dont say we are nasty people. Maybe the ones you work with are, but not most of us. How did acute care nurses obtain their nurse/patient ratio? They fought for it, so maybe its time for us LTC nurses to fight for one...

Not true. I work in a SNF and our meds are given out by a CMA. If anything is to change in SNF's and LTC facilities it will be due to our voices changing regulations and finding new ways for patients to fund the stay. Until then, it is what it is. We have to step up and give the best care we can with what we have.

One valuable lesson from working a SNF is organization and prioritization skills, you will learn them hard and fast and use them in every working environment you will have in the future. I say stay where you are until you obtain a job elsewhere.

Might I say 35$ is REALLY good. I have been working a SNF for over a year and only make 24$ with no raise is sight due to recent medicare cuts.

[MN-Nurse, ASN, RN]

Tough it out until you find a job you want. I worked in a horrible SNF as a CNA until I got into a hospital.

[RNmom2g1b]

I too am a new grad and just passed NCLEX in early summer. I was in a SNF from June 24th to sept 1st and had a very similar experience. I was full time days and really needed the hours but the load was heavy I had very little orientation and what little I did was with a traveling LPN, the list of horror goes on much of it has left me terrified. LOng story short as much as I needed the job I felt I needed my licence more so I left without having another job lined up. I am now working on a med surg floor In a small hospital on nights the last place I thought I would be, I LOVE IT!!! I got more orientation in 3 days than I did in 2 months at the previous job and the nurses I work with are not mean and nasty like they were at the SNF they are supportive and healpful!! My advice get out before you burn out, it is not worth staying somewhere you are not happy.

[iamNurse23]

The SNF's get funding from medicare, so a licensed nurse must give medications. The patient load is very high and near impossible, yes something has to change. But please dont judge all SNF nurses, because most of us love our residents and do our best to care for them, so please dont say we are nasty people. Maybe the ones you work with are, but not most of us. How did acute care nurses obtain their nurse/patient ratio? They fought for it, so maybe its time for us LTC nurses to fight for one...

Sorry. I didn't mean to call all SNFs nasty and I know nurses SNFs work very hard. But let me clarify my statement. I forgot to add ONE IMPORTANT part. I talked to 3 nursing recruiters from acute care facilities and told them I was considering working at a SNFs and I have heard both pos and neg things and I asked those recruiters for advice and how do acute care hospitals value SNF experience. Those recruiters told me pretty much the same thing. They said some hiring staff value SNFs because they are skilled and they have experience providing different skills. But the flipside to that, people also view the SNFs as nasty or nurses that take a lot of shortcuts. She said but it also depends on the hiring manager how they view SNFs but it seems that they would rather higher a recent new grad fresh out of school, than a SNF nurse with X experience because they don't have to try to fix those bad habits.

Lastly, I know that we love our residents and patients, if not, we wouldn't be nurses. Nursing is a career that you must love not only what you do, but also taking care of people. As I'm sure we all agree, everybody can't be nurses. But from what I've experienced so far, the nurses would like to provide better customer service and quality care, but the way the system is, it's very hard. You barely have enough time to chart and pass meds. But during med pass, we are running up and down halls trying to deliver meds on time, if any interruptions during that time its becomes even more hectic. But as you said, we do the best we can. I agree

[iamNurse23]

If this is the only job you were able to get after 100 applications ( not your fault I know ) then I would hang out. Quiting might just put you out of the nursing industry altogether. Even 3 months of on paper experience can make a big difference in your job opportunities.

The ratios in CA don't apply to nursing homes so they still have high ratios. I do have to agree for SNF 1:20 doesn't sound so bad. I think for LVN/LPN that ratio doesn't seem so bad since we train in that environment at for a few weeks. If all your clinical experience was at the acute level then eeek.

Regarding shortcuts. Just because your coworkers do it doesn't mean you have to. You can always take a few seconds to clean your hands glove etc. Now I don't work in a SNF but I can imagine that if your giving meds to Mrs Smith everyday for the last 2 years you might not want to verify her identity everytime.

I agree. When I heard the ratio was 1:20 I was like that's not to bad, especially when I know of others with a far worst ratio. However, it is quite a "challenge" coming from acute care facilities where I did my all of my clinical rotations.

Regarding shortcuts, I'm not blaming the nurses more than I do the system because like the person who trained me said, you know there's just not enough time, even by taking these short cuts, I'm sure I'll be here about 2 hrs overtime. I would be here an extra 6 if I did every thing by the book, overtime as you gain more experience and familiarity with this job, you'll learn your own short cuts.

[iamNurse23]

I am still working nursing homes per-diem just because my responsibility for child support, but one thing I have to tell you. If you make it in any nursing home, you'll be able to make it after in any other nursing environment. You can learn from any nursing job, but no other place would teach you time management and prioritizing like a work at nursing home. Always remember to put the patient first, even if its 20 or more of them (last time I had 29) and give them all you can in the time given. We are there for 8/12/16 hrs a day and that time should be dedicated to them: every single one of them!!! What others do shouldn't influence you in any way, you be the nurse just the same way you would like to be treated by one when you need her/him. Good Luck

I hear you. Thanks

[iamNurse23]

Wow sounds like where i work. when i'm out of rn school it is good bye to nursing homes, hopefully that is i can land a job somewhere else. in my facility i was told there are no 2 pt. identifiers. the pictures in the mar are not up to date and None of the residents have id bands because its 'there home'...we dont wear id bands when we're at home. this was said by the don & admin. dont get me started with doing things w/o a drs. order. please! everyday this goes on. they're starting someone on zpak for RI or straight cathing for a UA then its oh dr. so and so will approve it. really? it is so sickening i just cringe everytime i see this.

Hope all goes well for you. Good luck :hug:

Maybe we work at the same place! lol. Thanks

[DavidKarl]

No time to urinate? Hmm. A SNF nurse that never heard of Depends? This alarms me.

[TinaRN72]

This sounds exactly like my job. I've only been working there 2 weeks (in which 5 of those days was "orientation") and I'm back on the Job Search. I got hired in the spot also. and my trainers would also say "u didn't see me do that". All I have time for is to pass meds an do paperwork. Every other order gets ignored because there is simply no time. We have residents with horrible pressure ulcers because no one can keep up with skin checks. State came and gave us 15 tags right before I got hired and are going to be back anyday now so all I'm hearing is "when state comes we can't do this". Only different is I have 30 residents per nurse patient load. I got in trouble for staying too late after my shifts so I find myself doing more n more short cuts to finish on time. All this heavily weighing on my conscious. As a new grad this is not what I went to school to do. I'm getting out as soon as I can

[fairyluv]

sounds like where I work. I've been at my current job for 5 months now and I've been looking for another job since November. It seems the only place an LPN can find a job is in a Nursing Home (SNF) and from what i have read and heard, they are all pretty much the same. I feel that the nurse to resident ration is way to high. and some states don't use CMA's, would be nice if they did. I work 3-11 and I never get out on time and I'm always being asked "why does it take you so long to pass meds?" well I have 25-30 residents and they all get meds twice on my shift and I have to chart on half of these residents b/c they are either medicare or on ABT's of some sort and if I have someone with fever who doesn't have tylenol ordered, I have to call Dr and get order for tyl. If I have missing meds I have to find them or call pharmacy and fight with them to deliever meds. all this interrupts my med pass and by the time I get done with my med pass, it's time for my 2nd med pass (where often times my 1st med pass runs into my 2nd med pass) and I usually have to stay over atleast an hour to get all my charting/orders/labs ect done. And state will be in the facility in about a week. So if they decide to shadow me during my med pass then they are gonna be in it for atleast 2-3 hrs. To which I'm sure I will get wrote up or something for taking so long to pass my meds. I have seen/heard nurses take short cuts, some will only pass the prescribed meds and not the OTC meds, some won't give OTC eyedrops, and when charting some will only chart vs, and when I was orientating (4days) I was pretty much told "this is the way we do it and this is the way we do it when state is here" I am a new nurse and I have got to the point where I don't care how long it takes me to complete my med pass, I don't care if I'm there til 2am charting. I was there one night at midnight charting the admin called and I answered the phone and he asked what I was still doing there. I told him I was getting caught up on my charting. He then asked to talk to the night nurse. I feel like I'm damned if I do it the right way and damned if I don't. I will admit it's tempting to take those short cuts but then my conscience won't let me. There is one other nurse who often stays late as i do and the night nurses make fun of her, I figure they probably make fun of me to. But there med pass for the whole night consists of one med drawer. My med pass consists of the whole med cart. I doubt they could handle it on my shift passing meds.

best of luck to ya. Hope you find what you are looking for.

[SnowboardRN]

I couldn't find a job after graduating from school, so I eventually took a job at a SNF.

The first six months were very hard. I cried a lot, I got off hours later than I expected to, and I dreaded going to work.

Around the year mark, I was offered a position in a hospital on a busy tele unit. I was scared because I kept hearing how crazy busy it was.

After a couple of days of having patients all by myself I wondered How is this crazy busy?? Then I realized the SNF had helped me a ton with time management, and not in any short cut ways.

I still work every other weekend at the SNF because I have grown to adore the residents, and I am completely comfortable, and get things finished at least an hour before my shift ends.

So I don't regret sticking it out and experiencing that before my first acute care "busy" floor. I do love the hospital a tad bit more though

[scuba-girl, BSN]

even though this is an older thread. I've been working in a SNF since 2011. I have 30 patients, in my 8 hour shift. If I pickup a midnight shift I have 40. I believe BOTH of those number are the legal limit. Because the pt's r there long term I basically get through my medpass because I've memorized it. Since you still have to check it off in the computer as you go, you can see in advance if meds have changed. I was told a few weeks ago the same as the poster said, some governing people were coming and do like we are supposed to not like we actually do. Because I like my co-workers and get paid so much, I have stayed, however a nurse left the bathroom the other day, and I COULD SMELL that she had c diff. I point blank told her"you have c diff" She said what's the point of treatment I will just get it again. we often hang the isolation kits on the doors, but there are never gowns in them, and people don't use them anyway, and all the linens are mixed together. Since people are there long term, they roam around the building even if everyone knows they have c diff. it's almost like , what don't the higher ups know this can eat away at your bowels, people are taking this stuff home to our children! that is the last straw for me. I have started to update my resume and will look for work elsewhere. I will say on the goodside of working in long term care. It is NICE to know and see the same patients over many weeks as you get to see their progress, and BECAUSE of the high pt load all of us workers are close and work well together, (cuz we have to, like as if you were in a platoon in the War together!)