Changing Careers

  1. 0
    I have been a LPN for 3 years in Indiana. I have over 2 years experience in LTC/Rehab and Alz. I am also a junior in college for my BSN.
    I started a new job about 5 weeks ago. I work weekend options (two 16 hour shifts) so I can complete my school work/clinical during the week.
    I really need some feedback as I am deciding if nursing is really “for me”. I have read a lot of posts on here that confirm some of my thoughts, but would like to present my issues for replies.
    Our typical ratio is 15-25 patients for 1 nurse and 1-2 CNAs depending on staffing. The units are typically a mix of LTC and rehab (mostly rehab). Acuity is very staggered. The nurse is responsible for all meds, charting (including Medicare daily charting), helping with toileting/call lights/ADLs, assisting with meals (room trays and dining room), wound care and assessments, admissions, vitals, accuchecks, INRs, etc. Basically everything.
    I have already had some issues every weekend I have worked. I met with my DON last week (5 days ago) and discussed many of my concerns with supplies, organization and staffing. I also called the director on Friday before my weekend shifts to express concern about staffing and the requirements of my position that are not typical “nurse” responsibilities (believe me I am all about helping, but this place is a little more than I have ever seen with spreading the responsibilities). During meals all of the CNAs are usually in the dining room to serve, transport, feed, etc. The nurses are then responsible for all room trays, answering call lights, answering phones, etc.
    Anyway, my biggest question is this: Should I change careers? I feel that I am constantly working at facilities where I spread too thin. I made a mistake yesterday on my shift and did not complete a wound treatment on a patient. He had developed another skin issue that I was concentrating on. I had read and flagged his treatments and then had other things happen that I could not complete the treatment and did not inform the next shift. Our treatments are “mixed” in a MAR (we do not have a separate TAR) and many times the treatment supplies are missing or mixed in the med cart (against state regulations for meds to be with creams, etc.). This was one of the concerns I discussed with my DON. I specifically told her I was afraid of mistakes that could be made with the need to “hunt” for the orders and supplies and that wound care should have a separate TAR/cart. I called my DON this morning and admitted to the mistake and expressed understanding if I get a write up (it will be my first write up ever).
    I feel like I am being a wimp. I just want to have time to truly take care of my patients. With 15 patients it is difficult to ensure that I can complete all med passes accurately, treatments, acute care PRN, check labs, contact doctor/families. I believe if I had a better ratio or if acuity was considered more, I would feel more confident that my patients and license were “safe”.
    I just do not think this will get better with my BSN. I see posts from RNs and other nursing fields that express the same thing. I am so worried about all of this that I am losing sleep and I am almost brought to tears more times than I can count.
    Is there any hope? How can I be a better nurse? Am I just not good at my job?
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  3. 11 Comments so far...

  4. 0
    no, i do not think you should change careers unless you have some experience or training in a different field. otherwise, i think you should graduate with your bsn and get a nursing job away from bedside if possible. gl!
  5. 1
    Hate to see you let go of all that valuable education and experience. May consider getting out of LTC
    Otessa likes this.
  6. 1
    LTC sucks and is notoriously understaffed. Not that hospital's are that much better, but. . .
    Otessa likes this.
  7. 0
    Try changing jobs...

    LTC made me think about my career choice as well. I used to work LTC Psych. had to deal with lots of BS from dealing with lazy staff to being short staffed and doing 2 peoples jobs etc.... I would always stress about work even on my days off. it was horrible. i would even get calles on my days off to deal with work situations. i finally decided to look for another job and applied at a clinic.

    I was an LVN at an OBGYN clinic. I loved it! the stress was still there, but when it was time to go home.... i left work at WORK. made me see nusing in a whole different light.

    I really recommend lookng for a new job. Maybe a differnt LTC facility or even a different specialty.

    good luck to you. Keep going for your BSN
  8. 1
    Your job sounds really though and I'm sure other nurses would agree. You seem to be a great nurse and I would advise you to persist with nursing, due to the following:
    - you are trying your best to do your best
    - you have not quit yet
    - you have consulted your supervisor
    - you are seeking advise here
    My first job in the medical field was as a CNA at a nursing home, I quit after 3 months and reconsidered nursing. Later on, I got a job as an LPN at a different nursing home, quit after 2 months. I have worked in different settings and I have had wonderful jobs. It sounds like you just need to find something different.
    dance4life likes this.
  9. 0
    If I were you, I would get out of LTC. It sounds like autonomy is important to you. I have always found this easier to achieve while working in critical care. You will have 2 patients (usually) to focus your care and attention on. I imagine it to be much more rewarding and satisfying than LTC. Can't imagine having that many patients. I definitely understand your concerns about safety and liability.
  10. 0
    Thank you for all of the responses so far. I agree with all of them. As a LPN I am really limited to LTC (thanks to JACO). I hate that all LPNs abilities have been compared to the that of a MA or over-educated QMA (no offense intended). I have former classmates that have already completed their ASN following their LPN and they agree that LPNs should and can still do many hospital positions.
    This attitude has spread to families of the LTC patients I have. I had a family member that had never met me before come to me and demand that a RN replace me to care for her husband first thing in the morning. She rolled her eyes when she saw my badge and asked for a "real" nurse.
    As a BSN student, I am committed to never treat LPNs in my future this way.
    Anyway, I think I am going to try home health care. I applied at a few agencies today. I really want hospice and that is why I decided to get my BSN instead of continuing the ASN program I was admitted to.
    I am amazed that the patients I have are often discharged from facilities/hospitals where they were one of 3-5 patients for a nurse and where CNA ratio is not much higher than that.
    I often wonder why the nurse that assessed them decided that "we" could handle them with the ratios we have (I know-money!!). They are on their call lights constantly (and usually for valid reasons, but we cannot handle 5-7 lights at a time when there are just 2-3 of us) and we provide substandard care compared to a hospital with lower ratios and more nurse time per patient. Many are only a few days post-op, critical diabetics, on isolation, etc.
    Even our facility Dr. has discussed the decrease in care since he started there a year ago when the facility opened. He agrees with my frustration (the conversation was initiated by him, not me). He believes they are just putting "bodies in beds" for a check and does not like the acuity of the patients we are admitting.
    In home health I may take a pay cut, but it is worth the autonomy and increase in my ability to do my job properly. Keep the replies coming!!!
  11. 0
    Some of this sounds like the same routine from my old days romping in LTC. Except for the higher acuity. Very true though, hospitals are under pressure to discharge patients and those patients enter rehab/LTC in not the best of health.

    Other than supplies/organization (you can be the solution in those cases) and staffing (not within your control), would you ever stay? At least 2 of those issues are easily correctable.
  12. 0
    Quote from novairene
    Thank you for all of the responses so far. I agree with all of them. As a LPN I am really limited to LTC (thanks to JACO). I hate that all LPNs abilities have been compared to the that of a MA or over-educated QMA (no offense intended). I have former classmates that have already completed their ASN following their LPN and they agree that LPNs should and can still do many hospital positions.
    This attitude has spread to families of the LTC patients I have. I had a family member that had never met me before come to me and demand that a RN replace me to care for her husband first thing in the morning. She rolled her eyes when she saw my badge and asked for a "real" nurse.
    As a BSN student, I am committed to never treat LPNs in my future this way.
    Anyway, I think I am going to try home health care. I applied at a few agencies today. I really want hospice and that is why I decided to get my BSN instead of continuing the ASN program I was admitted to.
    I am amazed that the patients I have are often discharged from facilities/hospitals where they were one of 3-5 patients for a nurse and where CNA ratio is not much higher than that.
    I often wonder why the nurse that assessed them decided that "we" could handle them with the ratios we have (I know-money!!). They are on their call lights constantly (and usually for valid reasons, but we cannot handle 5-7 lights at a time when there are just 2-3 of us) and we provide substandard care compared to a hospital with lower ratios and more nurse time per patient. Many are only a few days post-op, critical diabetics, on isolation, etc.
    Even our facility Dr. has discussed the decrease in care since he started there a year ago when the facility opened. He agrees with my frustration (the conversation was initiated by him, not me). He believes they are just putting "bodies in beds" for a check and does not like the acuity of the patients we are admitting.
    In home health I may take a pay cut, but it is worth the autonomy and increase in my ability to do my job properly. Keep the replies coming!!!
    I know we're not supposed to get upset with patients or their family members, but that just burns me up. I had that happen to me. This guy who didn't know me did the same thing. I told him I had been caring for his mother for about 7 months, but he wouldn't know since he only comes around when he needs her to sign more papers to steal her wealth! Yes, before I finish this story, I had consequences, and no longer work there. Anyway, I got sick and tired of the mess. The only people's whose opinions really matter are the patient. But no one cares what they think. I told this so-called man, when you go to nursing school, and you pass the boards, and you gain all of my certifications, then I will ask for your opinion concerning my capability in practice. Until then, you are ignorant, self-righteous and disgusting.

    It's not so much about defending myself, my credentials, as much as the frustrations over this stupid healthcare system. Always fussing over petty crap and never attending to the REAL issues!


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