Offered "ADON2" if I'll stay...what do I do? - page 2

I recently posted about my plight about leaving the nursing home and going to work at an extended care hospital. The idea was that I would get hospital experience (which I've never had) but I've... Read More

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    Does the nursing home have adequate staffing to take you off the floor 2 days/week and allow you the "office" time that you expect to complete you ADON duties, or is there a possibility that you will end up working 4 days on the floor, and still have paperwork to do on top of that?

    The reason I ask is this: in the position that I accepted, I was supposed to have 80% management time and do staffing 20% of the time. We were so short staffed, that I ended up working 8 hours per day as staff, and 4 hours per day doing management duties. I was salary, so I didn't get paid for that, which was bad enough, but working 5 12-hour shifts per week was even worse.

    I just want to caution you not to end up in a similar situation. If the DON plans to cut her hours back regardless of staffing, you might find yourself burning the candle at both ends. Something to clarify before taking the job.

    I'm sorry this is turning out to be so stressful for you!

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    Ah, yes the SRNAs...

    They probably meant that working in a LTAC ICU is not the kind of experience that's needed for a CRNA program. I've never worked in a LTAC ICU so I can't say for sure, but they're probably right. The best ICU experience is probably CVICU or SICU. You do more hemodynamic monitoring on open hearts than probably any other critically ill patients.

    But you're not going to CRNA school, right?

    I think the LTAC would probably be a better experience if you are planning on being a FNP. Yes, familiarity is nice, but you want to do what's best for your future, right?

    And nursing management is thankless anyway, much less when you are management half the time and then a floor nurse the other half.

    Good luck, whatever you decide.
    Jo Dirt and sissiesmama like this.
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    The nursing home is overstaffed. So overstaffed that is why I left-they cut my hours so I went looking for another job, then they told me they'd do whatever it took to get me to stay...

    SRNAs most certainly told me LTAC would not be hospital experience.
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    Jo Dirt, the CRNAs and SRNAs were telling you that LTAC would not count as critical care (like CVICU) experience necessary to start a nurse anesthesia program.:wink2:

    Several CRNAs who have served or are serving on admission committees were giving you good advice.
    Jo Dirt and sissiesmama like this.
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    If you are trying to get into a CRNA program, you had better get yourself into an ICU because most CRNA programs want 1-2 years of ICU experience.
    Jo Dirt likes this.
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    Jo Dirt - if your goal is FNP - hospital experience will only help you. NH care is not suitable for FNP experience and I still state that you need to be at least somewhat familar with peds and adolescent care as the FNP is birth to death.
    VivaRN, sirI, Jo Dirt, and 1 other like this.
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    Quote from Magsulfate
    LTAC hospitals are ACUTE CARE. I cannot stress that enough. They are NOT nursing homes. Although some people think they are, until you work at a good LTAC, you just won't know what to expect.

    LTAC's are acute care, but the average stay is somewhere around 28 days. Sometimes longer, sometimes shorter. Most LTAC's even have ICU's. REAL ICU's.

    The difference in the patient population is that in the LTAC patients need acute care longer. They are too sick to go home, to sick to go to rehab, too sick to go to the nursing home. LTAC's have a lot of rehab services, but there is still acute care going on.

    Whoever told you that an LTAC hospital is like a nursing home is dead wrong.

    Add on: LTAC is definitely acute care experience.
    Exactly!! Any LTAC hospital I have worked at is definetly acute care, dh agrees with me, and until recently he was nurse manager of a busy ltac facility where we both had been working. I have had more acute patients there and run more codes, ect at LTACs than at some of the hospitals. JIMO, the patients are still acutely ill and need that type of care, but they just need it longer. There's just no way they aren't acute. Some days, my assignment has been as critical as a "regular ICU assignment" that one would have while working in an ICU.

    They don't just have vents that are considered "nh vents", or patients that are on vents at home and have been that way. The LTAC where we worked was a unit upstairs insidea regular hospital, and we sent patients to and from surgery, to and from dialysis, wound care out the roof, cardiac monitors and vaso drips, CVLs, art lines, you name it, we had it.

    Anne, RNC
    Jo Dirt and Magsulfate like this.
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    But unless you have peds/adolescent pts, you are still missing the boat by not having peds experience.
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    I can understand your dilemma, Jo Dirt. This offer is intriguing and flattering.

    But, I am with traumaRUs here; if you are to finish an FNP program, you really need hospital experience. Your experience in LTC is excellent, but you need a well-rounded RN experience with acute care (the LTAC would be nice), peds, GYN, young adults treating acute and chronic conditions...etc.

    Think hard and weigh the pros and cons for immediate goals as well as long-term goals.

    (now, if you are still considering CRNA, you need to consider going the route of experience on the level of CVICU)

    Good luck.
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    Here is what justOrtho said about LTACs:

    LTAC is similar to a rehab hosp but with some vents, etc. You won't even have the challenges of a fast paced tele/med/surg because the parts are 'long-term'. Therefore you have a BIG advantage b/c you know everything about their hx. (b/c they are 'long-term' stay pts you've had before you aren't thrown a lot of curve balls.) And they are stable in that their conditions are not usually expected to improve much.

    If you can get hired on a tele/med/surg unit you'll have ever changing pts. That's the experience you should seek. I often d/c and get 2 to 3 new admits out of my total load of 7 pts/per shift. I'm challenged daily b/c they aren't long-term, every shift has new pts with new problems I must assess quickly. After 6 mos in tele/med/surg you'll be able apply for a spot in ICU at the hospital. Several previous RN's on my unit have gone that route and then on to apply to NA school.

    Then, HT3RN added:

    I have worked in two different LTAC's in two different states as well as ICU's in 6 states. An LTAC is not critical care period. If the patient gets "unstable" then they get shipped out to a critical care setting. Like I read earlier they are mostly failure to wean from vent patients. They can't breathe effectively on their own but everything else works okay.... relatively speaking. They may require dialysis, tpn etc. Some eventually go home and some go home. If you know what I mean...

    This came from over on the SRNA forum.

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