Warning to New Grads

[Little_Mouse]

I just quit today after two weeks. I thought I was lucky enough to land a job at a SNF/subacute place nearby. After the first week, I was in for a rude awakening.

I had only 5 days of orientation in a 98 bed facility and was labeled charge nurse. Half the place is LTC, the other half subacute. 1st and 2nd shift have 3 nurses--usually 1RN and 3 LVN; 3rd shift usually has 2LVNs. Once I was on my own, passing meds to about 35 pts (in the LTC side) pretty much took me my entire shift. It was overwhelming and frustrating. On top of that, since I was an RN, I was responsible to hang IVs for all IV pts, no matter what side. I barely had time to document, and little to no time to assess the pts. As a friend had said, it felt like an assembly line--and that's how I felt I was treating the pts. There was no time to chat, no time to care, no time to critically think. Many of the staff members actually work on their OWN time (i.e. Not getting paid!) to chart, since many of them are afraid to get too much overtime since Administration will question them about it and may affect their performance review.

Many of my co workers were trying to convince me to stay, saying that it'll get better, that everything will become routine. But why is it that they are still taking more than their shift to do their work? It's simple: it's understaffed.

I brought all my issues up to the DON. All she said to me was, "I told you it's a lot of work and that it's a lot of patients. It wasn't going to be easy." Of course I didn't expect the work to be "easy", but I explained to her that there was no amount of training that could help me provide quality patient care if there is no time given to do that. She said she would like to hire more nurses, but Administration apparently doesn't want to hire anymore for any one shift. She just didn't seem to care too much.

I just had to vent and bring this up to all you new grads. I know I'm not the only that experienced this since I spoke and heard about a few people that experienced the same thing. I just want to give you some advice if you're looking into LTC or SNF. Some things I wish I had done before hand:

1) Research the facility.

Go to http://www.medicare.gov/Nursing/Overview.asp and do a nursing home comparison.

2) Tour the facility.

You may not see everything that goes on behind the scenes with this, but at least it's a good overview of the place. It's better than making any judgements based on how nice the building looks upfront or the nice painting and furniture in the reception area.

3) Ask the DON a lot of questions.

How many beds? As a new grad RN what are the job responsibilities? The job description? Expectations? Number of patients in your care? What is used for documentation/charting?

4)If you do commit, remember to buy some malpractice insurance (I guess that goes for any place you work at, but especially at a high liability job)

I hope this will be of some help to someone out there considering a job in a nursing home. I understand that many of us are still looking for a hospital job, but the pickings are few and far between. I haven't given up hope in finding that job, or even finding a job at another, better LTC facility in the mean time, but these are just some things to consider... Hopefully it'll save you from being burnt out or at least some tears.

[VegetasGRL03RN]

I know there are all these horror stories about being a new grad, but what field doesn't deal with this as a new graduate? I'm sure there is some that someone can rattle off, but even if you are "fresh off the presses", it's not like you have experience that other people can bargain with. I'm sure you'll find someone willing to take on an GN; you might just have to overturn some rocks you passed along the way to keep the bills paid and get your foot in the door. The flipside can work for those who have the desire not to compromise, but all this pessimism doesn't really get us nowhere. Not that I want a patronizing pat on the back, though.

[mmmc2]

Thank you so much for your post. If I hadn't seen it, I probably would have accepted a job that would have ended up being like the one you were at. I initially interviewed at a SNF for a staff nurse position. The position quickly changed to a charge nurse/house supervisor position. I only graduated in May, so I thought this seemed like too much for me to handle, but I was considering accepting the position because I need the money (student loans are coming due). The facility was a little too eager to get me, I thought. This should have sent up a red flag (and I also didn't get a tour of the facility when I interviewed.) But I felt fortunate to be offered a position at all....Then I saw your post.

Your post gave me the courage to decline the position. Then, a couple of days later, I was offered a great opportunity at a local hospital, which I did accept.

[nascentRN]

I'm not reading anymore of this. I'm a new grad with a fresh RN license. I need a damn job. I need to pay bills. Period. I'll take what I can get. I don't expect it to be a party nor a disco nor a CBGB's. I expect lifetime during wartime. (to reference the talking heads). But better than homelessness. Throw me into the inferno, now please, I am begging! I will stick it out for at least one year to get some experience, do the best I can and then move on!

[lvnjden4ever, R.N.]

Just accepted a job as 'Charge RN' in a subacute rehab facility. I have been working in aesthetics for 6 months now. I am kind of nervous to be supervising people that have way more experience than me. BUT everyone has to start somewhere. My mother worked in an SNF for the first 10 years of her nursing career. She handled 40 patients and she survived. So I am taking that as an indication that I will survive also. I am 100% sure that this will be a challenge, it's going to be hard, I may struggle at first...but I'll never know unless I try.

[fridayannelpn1974]

If it is any help, I work in a facility where I have resposibility for 52 long term care patients on the 11-7 shift. If you think long term care means there is never any drama - think again. Any given night one or more of them go "BAD", and I have to deal with falls and pts. who can't breathe etc. Fortunatly I have a great 3-11 crew who never leave me hanging out to dry by not taking care of the patients that are unstable on their shift. I only have to deal with problems that come up on my shift. There are too many nurses, in long term care, that ignore the changes in patients and just pass it off to the next nurse. NOT GOOD! I HATE LAZY NURSES! And there are many of them out there. When a nurse fails to act on a change of condition of a patient, the concequences can be deadly. Sure, they get away with it because they can always say," I didn't see any change in the patient". BS!

[NickiLaughs, ADN, BSN, RN]

The problem with long term care is that it is too many nurses to a patient. I was an LVN to 38 patients, which is a low load actually. 5 g-tubes, 10 diabetics. The med pass was long, if they were breathing, they were stable. I had two CNA's and had to help them turn the patients. Then the day nurse who was there to "help" and take care of orders and do wound care treatments would just refuse to do them. The patient who have the same dressing that I put on a WEEK ago (I had been off) I report it to the DON, she does nothing. The lazy staff makes it that much harder for the ones who care.

Any nurse who values their license would not put up with the conditions. The DON asked me why I was quitting. I said I couldn't handle risking my license and my patient's life on a daily basis because nursing homes are too cheap to adequately staff. She didn't seem surprised, most places have a big constant turn around. I had 2 days orientation at my job.

I would never work at one as an RN. And for the new nurses who are desperate for jobs, I understand your plight. But when you go to home exhausted and cry your eyes out because you have two med passes, charting, and no time to acknowledge your patients you may think different.

[Gizmo44]

The problem with long term care is that it is too many nurses to a patient. .

I think you meant too many patients to a nurse, at least I hope that's what you meant...I'm sure that is it based on the rest of your post.

I had a similar experience and couldn't deal with the risk it was putting on my license. I was a new nurse and I was "in charge", had 3 days orientation, and most of that was spent following the nurses around. Only one had an interest to observe my skills but we were so short staffed that day that we were lucky to get it all done. In the end I had to evaluate my own skills - no one really watched me do anything before I was set loose on the units. I figured they would want to "see" me do the basics to know for themselves that I could do them & did them to company/facility standards before I would be considered "Charge" nurse. I also observed long-term staff complain about the work load and lack of support. That alone should have sent me running for the door. Now these were nurses filled with compassion and struggled to do what was right for their residents but they worked at a high level of "overload" for so long that it led to burnout. Two come to mind here - one was very frustrated and the other was very bitter. Both had been at the facility for over 10 years and experienced a lot of changes - it wasn't the same place they started.

I kept hearing, "State won't allow us to have another _________ on the floor that shift" - fill in the blank depending on the situation whether it was a CNA or QMA or nurse but I think it had more to do with the facility and/or company and their bottom line and reimbursements. They often said, "fill out your paperwork right and maybe you'll get another person." This also led me to believe that it all had to do with their profit margin rather than giving the staff what they need to give the care that the residents deserved, and paid for. As new nurse I thought, well show me some examples so I do the assessments right. I think there was confusion as to how a resident should be assessed or rated when it came to mobility, needs, or self care assessments, etc. which, perhaps, led to them being underrated resulting in an inaccurate picture of their needs and in less reimbursements. I also suspected that people just copied the same information that the person before them entered.

Lets face it, people in hospitals are sicker, are discharged home sicker, or come to LTC facilities sicker than in the past. Sure advances in diagnostic, treatment, & medication has resulted in people living longer but that does NOT mean they are fully self-sufficient. LTC nurses & staff are expected to care for people with more complex needs than in the past and each one has more medications. Staffing models aren't keeping up with this need.

It is definitely time for a change...

[noc4senuf]

Not all LTC staffing and mentality is the same.

[fridayannelpn1974]

After 36yrs in this business, many of those years in LTC, if you have found a facility that staffs adequatly- Thank your lucky stars!! My guess is that at least 90% or more are seriously understaffed. Most of the time the thing that interfers with patient care is the enormous amount of documentation that we are required by the state AND the extra documentation that the facility requires. This extra documentation is directly preportional to the amount of B.S. law suits that have been filed by families in denial or with guilt issues. Thank goodness the "Kennedy Terminal Ulcer" (for example) has been identified. Many facilities and their staff in the past were subject to law suits r/t these ulcers -that are TOTALLY unpreventable. Where I work now, even though we are understaffed, at least as I said before, the shift before me cleans up their problems before I get there. The day shift doesn't afford them the same courtousy, so they are constantly cleaning up the day shifts messes. Fortunatly the 3-11 nurses are both strong nurses. One of the day shift nurses is a new grad and a tad bit lazy and the other nurse is just plain lazy or stupid. I haven't figured out which. Probably a combination of both.