[brauchi]

Finally, I have found a place who might be interested in hiring me. But now I am getting nervous as I always thought that you should start your RN career in a hospital - rather than in a nursing home. I was offered a possible job in a sub-acute area of a longterm care facility where I would need to do IVs etc. So I assume that I would have to perform skills etc. But is this is a good choice? How about work conditions and/or pay? I really don't care much about pay but I would like to get at least what I would get in a hospital. How about ratios? Is it true that an RN in a LTC has a bigger ratio than in a hospital?

Thank you for your comments.

[cherilee]

Long term sub acute? I assume you will have pretty complicated patients.
I worked in a long term acute setting, for a short time, and the pts were sicker than the med surg floor I worked on. You will gain good experience there. You will be gaining skills needed for med surg, like IVs, giving insulin,
dsg changes, doc orders, etc.

I think Its a good opportunity. If you try it and it is not what you hoped, you can transition to a hospital as a new grad. Good luck

[Chaya]

I started out in "sub-acute" Rehab and it worked out really well for me as I could frequently care for the same patient on multiple days. This gave me multiple chances to do a complicated dressing, or Peritoneal Dialysis, or just spend extra time understanding some of my more medically complex patients. When I moved to an acute setting I felt very prepared in terms of doing a thorough assessment as well as most of the procedures I was called on to do.

[TheCommuter]

I worked on a subacute unit at a nursing home, but it was structured much like a free-standing rehabilitation hospital. I typically cared for 15 patients by myself. On this particular unit, we dealt with many central lines, IV antibiotics, CPM machines, feeding tubes, suture removal, surgical staple removal, complicated wound care, ostomy appliances, diabetic management, casts, braces, splints, cervical halos, and so forth.

Most of my patients had recently underwent surgical procedures such as laminectomies, knee and hip arthroplasties (joint replacements), kyphoplasties, CABGs, hysterectomies, limb amputations, colectomies, thromboembolectomies, and abdominal aortic aneurysm repairs.

The non-surgical patients were typically admitted to our unit for recovery from CVAs, acute MIs, debility, various cancers, fractures, status post pneumonia, deconditioned states, failure to thrive, status post falls, generalized weakness, and other afflictions.

Subacute nursing is a physical and emotional challenge, but I'm assured you will have the learning experience of your life!

[brauchi]

That sounds like a hard job waiting for me. But here is the question. How can one person be in charge of 15 patients when the ratio in hospitals is around 8 patients per RN? Am I missing something?

On the other hand I will be able to learn many skills so that I don't feel making a big mistake by not going into a hospital first. I just feel that the workload will be much higher than in a hospital. Or will I get more salary based on a higher workload? Can a new grad be able to get through a shift after only 6 weeks of training? I think I will have three weeks orientation and then 3 weeks with a mentor before I will be on my own.

I'm really looking forward to finally start to work as nurse - but the closer everything comes the more scared I get. Especially, after reading the last post.....

[cherilee]

You may have a tough jobat this place... but that is the best way to learn.

NO NEW nursing job is easy, though. The learning curve is steep. The first year is all new. So look at it this way, Get your year under your belt..
If you find it is not your niche, You can pursue other avenues.
BUT< you will have learned an immense amount and you will be very marketable to follow whatever makes you happiest. Good luck and keep us posted!

[brauchi]

I will have my real interview with the nurse manager on Tuesday. And at that point I will also see if they let me smell their place. It could be a good indicator about the place.

And then we will see. But the fact is that I don't have any options being an international nurse -- and I have to take whatever I can get. And if this place wants me -- then I want that place.

So I will just do my best and see that I won't fall too behind in schedule and then go from there.

[TheCommuter]

Originally Posted by brauchi

How can one person be in charge of 15 patients when the ratio in hospitals is around 8 patients per RN? Am I missing something?

Ratios in nursing homes, skilled nursing facilities, and other LTCFs generally tend to be higher than in the hospital setting. The rationale behing the staffing ratios is that subacute and rehab patients tend to be lower acuity than those found in the acute care hospitals.

These types of facilities do not have large budgets for lengthy preceptorships, training, or hiring more nurses. In addition, 3 weeks of orientation is unheard of in my area for nursing home subacute units. The average orientation period for a new grad in my city is 2 to 3 days at the most, and the nurse manager will laugh in your face if you dare to request more time. In other words, you are truly blessed if they are really going to give you a full 3 to 6 weeks of orientation.

[Chaya]

Originally Posted by TheCommuter

I worked on a subacute unit at a nursing home, but it was structured much like a free-standing rehabilitation hospital. I typically cared for 15 patients by myself. On this particular unit, we dealt with many central lines, IV antibiotics, CPM machines, feeding tubes, suture removal, surgical staple removal, complicated wound care, ostomy appliances, diabetic management, casts, braces, splints, cervical halos, and so forth.

Most of my patients had recently underwent surgical procedures such as laminectomies, knee and hip arthroplasties (joint replacements), kyphoplasties, CABGs, hysterectomies, limb amputations, colectomies, thromboembolectomies, and abdominal aortic aneurysm repairs.

The non-surgical patients were typically admitted to our unit for recovery from CVAs, acute MIs, debility, various cancers, fractures, status post pneumonia, deconditioned states, failure to thrive, status post falls, generalized weakness, and other afflictions.

Subacute nursing is a physical and emotional challenge, but I'm assured you will have the learning experience of your life!

Yow! Hope that was nite shift; you might get ratios up to these at our place on nite shift. Stll very busy but don't have a complete med pass for everyone, plus getting everyone up and dressed for PT/ OT, plus meetings, docs wwriting orders and admin in your hair. Plus, thank heaven, if we had a 1:15 ratio we would have another nurse and/or an aide.

[TheCommuter]

Originally Posted by Chaya

Yow! Hope that was nite shift; you might get ratios up to these at our place on nite shift. Stll very busy but don't have a complete med pass for everyone, plus getting everyone up and dressed for PT/ OT, plus meetings, docs wwriting orders and admin in your hair. Plus, thank heaven, if we had a 1:15 ratio we would have another nurse and/or an aide.

Nope, I cared for 15 patients during day shift. The night shift nurse took care of up to 34 patients when the unit's census was full, as this was a 34 bed unit. Nursing home subacute and rehab units do not staff in the same manner as the acute care hospitals.