[mama_bird]

I was offered a job at the SNF I wanted to work at (2 miles from home!) with the hours I wanted. This is strictly skilled care and custodial/personal care, no ventilators, etc. Some people may be on IV antibiotics. Most seemed to be in wheelchairs, very clean and in a very nice facility (all carpeted, new, etc). I was very honest about my situation (no bedside care other than family members for several years) and stated that I wanted to ease in with precepting and LPN duties (because I want to pass meds, etc), with the goal of being the charge RN 6 mos or so down the road. I told her I do not want to jeopardize the integrity of the patients or my unmarred license. They agreed to do it that way and my home care cases of three paralyzed clients will come in handy. Anyhow, this is the ratio:

Shifts are 7-3, 3-11, 11-7. They tried 12 hr. and said it was too much for most people.

60 patients to a floor, 2 floors, currently all beds full (good sign, the other place was down 30 beds). There are three distinct wings on each floor branching off of the central station. Each wing is 20 beds (private rooms on one side of the hall, semi-private on the other side)

One RN per shift in charge of the 60 patients. This is mainly a paperwork job and she said I would be at a desk all day once I feel comfortable taking this on evenings and or nights. There is a total of 6 RN's because there are 3 shifts and two floors. I would always have another RN on the other floor.

3 LPN's per shift, 20 patients each. Each LPN has one wing of 20 people and does the meds/etc. for just his/her 20 which the DON said is about all they do because it takes a long time to do 20 people.

6 CNA's per shift, 2 assigned to each wing. One CNA per ten people. DON said that they are the only ones who sometimes come and go.

The DON has been there for 14 years. The other RN's and LPN's have all been there close to or over 10 years. I asked about the turnover because if other people are unhappy and constantly leave, I don't want to find myself unhappy.

Monday I am going to orientation (general for all new hires). Tue and Wed I will work 7-3 to follow the LPN and RN and learn the ropes (since that shift has the most activity...they bring the doctor's to a room there instead of taking the patients out of the building because it can be stressful.) After that I should be going on my evenings/nights but not alone as charge until I feel ready. The last person I changed a dressing on was myself when I got bit by a spider last year and had three puncture holes and a staph infection on my stomach LOL.

I am not looking to leave after a year and go to a hospital. This place is near my house, 8 hr. shifts, beautiful facility, and I have a friend who was a CNA for there for four years and said it is a very nice place to work and few workers ever leave. I know once I am in charge I will be sitting doing paperwork (which is all computerized now) so I am not worried about stressing my body too much as I get older. The pay is excellent for this area, ($23/hr.$24/hr when in charge), good benefits, certainly more than the other interviews I went to. I realize it is A LOT of work to be an LPN with 20 patients or an RN with 60 patients and having to delegate to staff, but I have been building my stamina with a lot of physical activity all day from pretty much 7am to 10pm for weeks now.

I'm excited and I can't wait to get back in. Most of the people I volunteer with are elderly and I love talking to them about their decades of experience. I have been reading the threads here to learn the good, the bad and the ugly.

Can anyone recommend a good geriatric text? My books are ten years old and I have a good clinical companion for fundamentals but I would like another book.

I thank everyone for their help and input! If you have ANY advice, please give it.

[SisterJ392000]

Wow sounds too good to be true in LTC. But maybe it is what they say it is. I've worked in good LTC's and bad LTC's but and eventually got to the point that I said, No more LTC jobs for me. But if I could find one like that I might give them another shot. I love the elderly but most LTC's have so many problems it just kept me in a stressed filled state even when not working. The fact that the nurses have been there so long is a good sign, and hey there is no harm in giving it a go and seeing what happens. It's not prison lol, so If it doesn't work out for you then chalk it up to experience and move on, but honestly it sounds like a good job and the nurse patient ratios are comparable to most NH's (and even better than some). Good Luck

[barbyann]

The job sounds good and you appear to have a broad knowledge on what to look and ask for. Congratulations.

PS. I'm a bit jealous (2 mile commute)

[PsychRN03]

Originally Posted by mama_bird

I was offered a job at the SNF I wanted to work at (2 miles from home!) with the hours I wanted. This is strictly skilled care and custodial/personal care, no ventilators, etc. Some people may be on IV antibiotics. Most seemed to be in wheelchairs, very clean and in a very nice facility (all carpeted, new, etc). I was very honest about my situation (no bedside care other than family members for several years) and stated that I wanted to ease in with precepting and LPN duties (because I want to pass meds, etc), with the goal of being the charge RN 6 mos or so down the road. I told her I do not want to jeopardize the integrity of the patients or my unmarred license. They agreed to do it that way and my home care cases of three paralyzed clients will come in handy. Anyhow, this is the ratio:

Shifts are 7-3, 3-11, 11-7. They tried 12 hr. and said it was too much for most people.

60 patients to a floor, 2 floors, currently all beds full (good sign, the other place was down 30 beds). There are three distinct wings on each floor branching off of the central station. Each wing is 20 beds (private rooms on one side of the hall, semi-private on the other side)

One RN per shift in charge of the 60 patients. This is mainly a paperwork job and she said I would be at a desk all day once I feel comfortable taking this on evenings and or nights. There is a total of 6 RN's because there are 3 shifts and two floors. I would always have another RN on the other floor.

3 LPN's per shift, 20 patients each. Each LPN has one wing of 20 people and does the meds/etc. for just his/her 20 which the DON said is about all they do because it takes a long time to do 20 people.

6 CNA's per shift, 2 assigned to each wing. One CNA per ten people. DON said that they are the only ones who sometimes come and go.

The DON has been there for 14 years. The other RN's and LPN's have all been there close to or over 10 years. I asked about the turnover because if other people are unhappy and constantly leave, I don't want to find myself unhappy.

Monday I am going to orientation (general for all new hires). Tue and Wed I will work 7-3 to follow the LPN and RN and learn the ropes (since that shift has the most activity...they bring the doctor's to a room there instead of taking the patients out of the building because it can be stressful.) After that I should be going on my evenings/nights but not alone as charge until I feel ready. The last person I changed a dressing on was myself when I got bit by a spider last year and had three puncture holes and a staph infection on my stomach LOL.

I am not looking to leave after a year and go to a hospital. This place is near my house, 8 hr. shifts, beautiful facility, and I have a friend who was a CNA for there for four years and said it is a very nice place to work and few workers ever leave. I know once I am in charge I will be sitting doing paperwork (which is all computerized now) so I am not worried about stressing my body too much as I get older. The pay is excellent for this area, ($23/hr.$24/hr when in charge), good benefits, certainly more than the other interviews I went to. I realize it is A LOT of work to be an LPN with 20 patients or an RN with 60 patients and having to delegate to staff, but I have been building my stamina with a lot of physical activity all day from pretty much 7am to 10pm for weeks now.

I'm excited and I can't wait to get back in. Most of the people I volunteer with are elderly and I love talking to them about their decades of experience. I have been reading the threads here to learn the good, the bad and the ugly.

Can anyone recommend a good geriatric text? My books are ten years old and I have a good clinical companion for fundamentals but I would like another book.

I thank everyone for their help and input! If you have ANY advice, please give it.

the ratios should be criminal IMHO, but for LTC, I'd agree with others that they are reasonable for the LPN, relatively speaking

but I don't get it...what paperwork does an RN do? I mean there's no way an RN could assess, educate, intervene, etc. and chart on 60 patients, so what paperwork are they responsible for?

What happens with call-ins? If a RN calls in, do you work a double shift? If an LVN calls in, do the remaining LVNs split the missing LVN's patients? Or do they have a per diem pool?

[2006RNCS]

I am a supervisor in a LTC facility. I am an RN that was working 3rd shift for a while. I had to switch to weekend days and PRN, because night shift had so many call outs, and I was responsible for all 179 residents, and would have to work the med cart for up to 70 residents, plus being house supervisor. Not to mention that we work a skeleton crew on nights! There is no way to possibly do that safely. I was always afraid that I was going to lose my license. No amount of money is worth losing that hard earned license! Your LTC ratio sounds wonderful compared with what my facility offers. But, word of caution: If it sounds too good to be true, most likely it is.

Good luck to you. If you take the job, I hope it is your "dream job."

[PsychRN03]

btw...I am very jealous of your 2 mile commute

[michelle126]

but I don't get it...what paperwork does an RN do? I mean there's no way an RN could assess, educate, intervene, etc. and chart on 60 patients, so what paperwork are they responsible for?


Calling the docs, taking care of the labs, new orders, maybe the careplans or assessments?

This is a doable ratio. Do they have an RNAC, ADON , resorative or wound nurse? I'm just wondering...some of those duties could be put on the RN.

Take the job and give it a try.

[2006RNCS]

Originally Posted by michelle126

but I don't get it...what paperwork does an RN do? I mean there's no way an RN could assess, educate, intervene, etc. and chart on 60 patients, so what paperwork are they responsible for?


Calling the docs, taking care of the labs, new orders, maybe the careplans or assessments?

This is a doable ratio. Do they have an RNAC, ADON , resorative or wound nurse? I'm just wondering...some of those duties could be put on the RN.

Take the job and give it a try.

RN's are normally in a supervisory role in LTC. They are responsible for every licensed person, unlicensed people, and all residents in their care. At night, normally, this means ALL residents of a LTC facility.
There are rounds to be made every 2 hours to check on every pt, document and correct findings, shift and 24 hour reports to be made, fill in when someone calls in. Documentation of falls, incident reports, transfer paperwork of pts transferring out, etc... There is more paperwork than you can imagine, and an awesome amt. of responsibility on an RN's shoulders. RN's in LTC have to be wonderful time managers and possess excellent assessment skills. It takes more than what most seem to think.

[HannasMom]

Wow! Sounds like a great place! Congratulations! I just recently left a facilty where I passed meds to 48 patients on dayshift 7am to 7pm, besides that I did treatments, took doctors orders, charting, the daily log book, talked to family members, babysat the CNA's, etc.

Next week I start a new job as a MR/DD nurse and I'm very excited. Anyway good luck!