So is hospital nursing better than long term care?

[SuesquatchRN]

I am a fairly new - licensed last june, in fact - LPN. I'm now in my second position.

This place has the following nurse pick up and document any med errors. Well, I'm fine on my own unit but when I go to a unit of 30 - 40 people where I haven't popped meds in three weeks I inevitably make a couple of errors of neglect.

I. hate. meds. I hate having 30 - 40 people who all want something and I have to rush past them. I hate having to ASK if I can hold a freaking colace or give an Ativan to someone about to smack an aide and elope through the front door. I hate the smarmy social workers who actually think they're doing something good for these poor folks in God's waiting room. I hate nurses tattling on one another per facility policy on missed meds. I hate it. I do love my residents. Passionately.

Is there anything better? I'm pursuing my RN, but will it matter?

[Happy2CU]

First, please don't jump to the conclusion that you are in the wrong line of work. I'm like you, a relatively new (two and half years) LPN. I started in LTC but found it exhausting and found the patient load to be overwhelming. I never took a break or meal period, just always worked straight through, that was the only way I could do the meds, treatments and charting for 30 patients. Every day I went home frustrated and exhausted. I now work in dialysis, it doesn't pay as well as LTC, but I feel like I've found a good place for me. I still work LTC occasionally per diem, but every time I work there I swear it will be my last ~ LOL!! But, like you I love working with the elderly, they can be such a joy!! Stay strong and look for other areas to work in. Don't let one bad experience sour you on nursing!!!!!! Big hugs to you!!!!!!!

[jjjoy, LPN]

There is much potential for LTC nursing to be much more satisfying than it is. However, the way it is set up in many places, it just sets nurses up for failure and burn out. In many places, there is NO WAY to play by the rules AND get everything done and documented properly.

So you have miserable choices. Do things by the book and not get everything done (and be reprimanded). Rush everything and inevitably make mistakes (and be reprimanded). Judiciously skip things that can't be easily monitored or caught (and find a way to justify that to yourself).

These situations seem to be more common in LTC than acute care, but some hospitals can be bad, too. You just have fewer patient with a wider variety of needs. However, generally speaking, hospital work will likely seem more reasonable after this LTC stint of yours.

Most important, I think, is finding a place with a reasonable workload and a supportive environment, be that in a hospital or an LTC facility. Can you get some agency work so that you can see first hand how different facilities are run? I'd imagine the best places have the lowest turnover.

I can't recall what specifics we've exchanged before, but I personally have struggled with questioning whether it's nursing that I don't like or if it's just that I haven't found what works for me. I have discovered that I actually like working in front of computer all day! I honestly hadn't realized that before as I also enjoy interacting with people as well, especially when I'm able to assist them. I'm still keeping my eyes open for a nursing job that might suit me but I'm not forcing the issue and am currently working in health information... and my mental health is much improved! I can't say what will work for you. These are very personal choices. I hope that you can find a satisfying niche in nursing. I'm sorry to hear you're LTC experience has been so frustrating. Best wishes to you!

[SuesquatchRN, BSN, RN]

Thanks again for your kind words, everyone.

I know I would like emergency. I'm an adrenaline junkie. But I also know one burns out on that.

I also know I like teaching, and I'm good at it. I have a possibility once I get that old RN again, which, now that I'm back to p/t with no per diem, I should have by December.

And like joy, I was a programmer for years until DH and I were "outsourced." Prior to that I was a sales/trading assistant on Wall Street until I got automated. Can we say, tired of being flexible?

I'm feeling much better today. I just have to bite my lip and bide my time.

:)

[reesern63, RN]

Thanks, Calla. Very much. I'm pretty whipped today and I needed the encouragement.

Just the the thought of having to do med pass in an LTC is enough to make me cringe. I can't imagine the circumstances that would make me look for a job in LTC; you're almost beaten before you've begun.

I agree with those who say you need to find your niche. I don't think it's you, I think it's the job.

[Ms.RN]

if you are "inevitably making a couple errors of neglect" every time you pass meds on another unit, you might want to seriously consider another line of work.

wow, i can tell you never worked in nursing home before. i worked in nursing home where i had 40 patients and each patient take more than 10 pills and iv meds. most patients have dementia or dependent on vents so i have to crush them, mix with applesauce or dissolve it in water. oh and there is no unit secretary like in the hospital so nurses have to stop in the middle of med pass, answer the phone, talk to family, answer call light if cenas are nowhere to be found, supervise cena's and carry out physician order, call x-ray company for stat x-ray, obtain stat lab specimen, call lab company to pick them up. no wonder why nurses make med errors...

when i did my med/surg clinical rotation in the hospital each patients took no more than 5 medications and most had iv access so i had to draw them up, flush iv line and give it by ivp. i found that med pass was lot easier in the hospital then nursing home. med/surg unit had unit secretary where they took care of physician orders.

i know its hard due to time limitation and lot of interruptions, but when you are doing med pass, just concentrate on doing just passing meds and try not to be interrupted. and before you give medication to the patient, double check your mar and double check your meds. i found that helped me to reduce med error...

[TazziRN, RN]

1. If you hate giving meds, you might hate being an RN, because then you'll not only be passing pills, but giving IV meds as well.

2. If you notice that another nurse missed a med or made an error, it is not only your facilitiy's policy (as you stated), but it is the PROPER THING TO DO to report it. Not saying anything when you discover an error is WRONG, and makes you just as much to blame as the person who made the error.

3. If you are "inevitably making a couple errors of neglect" every time you pass meds on another unit, you might want to seriously consider another line of work. Sorry if this sounds harsh, but any nurse who is making that many med errors on a regular basis is a danger to his/her patients, especially if you then become upset at your co-workers for discovering & reporting these errors.

I didn't see this the first time around, until someone else commented on it.

1. There is a huge difference between giving meds to 30-40 LTC residents and the handful (in comparison) of acute care pts that you and I are used to.

2. You're right about policy but that isn't the crux of the OP.

3. Not everyone can adapt easily outside of one's home unit. This does not mean she's a poor nurse. Since she doesn't make these errors on her home unit, I'd say she's safe when in her comfort zone.

[VivaLasViejas, ASN, RN]

Sue, I'm probably coming at this from a different angle than previous posters, because I've worked both acute AND long-term care. I would hate to see you set your sights on hospital work and then be crushed again under the disappointment of being unable to spend adequate time with your patients, having to deal with impossible supervisors, facing the wrath of patients and families who seem to think you're a glorified waitress and don't get why you can't fetch them that warm blanket while you're running to a code, being yanked around and given several different assignments per shift, and generally treated like a mushroom (you know, kept in the dark and fed b.s.).

I know you're thinking ER, but they usually want some medical/surgical or ICU experience first, and M/S is a nightmare in a good many institutions. The patients are usually terribly sick.......many are on multiple IVs, they have tubes and wires going into or coming out of multiple orifices, they're incontinent, demented, confused, and immobile. Many are hugely obese and have wounds that make the average stage III pressure ulcer look like a flea bite. Others are frequent flyers---'noncompliant' diabetics, COPD'ers who continue to smoke 2 packs a day, and so on. Then you have the incredible amount of admissions/discharges on the floor........when I worked M/S, it wasn't at all unusual for me to have five or six patients on day shift, with 100% turnover in a single eight-hour shift!

I'm not saying LTC work isn't tough..........it is AWFUL in the majority of facilities. But acute care is just as difficult, both physically and mentally; and mistakes are as common, if not more so, because of the unrealistic workloads and the expectations of perfection on the part of both patients AND management.

Please, don't set yourself up for failure by adopting the "grass is always greener on the other side of the fence" way of thinking. Instead, think about what your strengths and interests are; what about becoming a CNA instructor, since you enjoy teaching? Or you may even want to consider going on to get your master's degree---there is a terrible shortage of nursing faculty nationwide.

Just a few thoughts. I wish you all the best.........you'll find your niche someday!

[SuesquatchRN, BSN, RN]

Thanks, mjlrn.

I have a CNA teaching spot lined up WHEN I get the RN.

What I need to do right now is focus. Do my scheduled days on my unit and only those days and study on the off. Pass the NCLEX-RN. Then I have some choices.

:)

Oh, as to reporting med errors - I reported MYSELF last week on two that were important. However, it isn't just noticing that a signature is missing here. You have to really research the card, the times, the pills, get the sheets - as George Carlin would say, you have to wanna. And I don't.

[SuesquatchRN, BSN, RN]

Oh, and the difference between a hospital and LTC is the tedium. I don't mind busy chaos. I mind mind-numbing tedium. And LTC has it in droves unless someone is trying to elope. Along with a smell like the elephant house and the constant stench of impending death.

And know what's worst? I care about my folks.

[pinksugar]

I am a brand new graduate nurse but I really don't think I could ever work LTC. I have so much respect for the ones of you who do. I think that you all are expected to do beyond what is capable for any human being to do! How can you possibly give meticulous, excellent care to 30-40 (or more) needy people in one shift? IMO it is impossible.

Suesquatch, I agree with what Tazzi said. I am new on this board but I have been reading for a long time. You seem like a very nice person and you seem to be a great nurse, one that really cares. Getting your RN will be a good step for you, IMO.

From what you have said, I think that ICU would be a good place for you to try. I absolutely love the ICU/CCU unit I am working on. I really cannot see myself doing anything but critical care. While I was in school I was a nurse extern for a year on an onc/med-surg unit and while I loved the patients, the work was overwhelming - not just for me, but for the more experienced nurses as well. I didn't feel like I could give the kind of care I wanted to give, especially to all of the dying comfort care pts. I get that same impression from you. I really like being able to focus my attention on 1-2 patients in the ICU/CCU. It gets busy, but none of the nurses, new or experienced, run around all day like we all did on the med-surg unit. It is a different kind of 'busy'. I feel that I am more capable of meeting pts' needs. There is plenty of adrenaline for an adrenaline junkie, too!

Hang in there. I think you will eventually find your niche. :balloons:

[FireStarterRN, BSN, RN]

I've worked both and I definately find the hospital more interesting. I remember very well what you're describing, with residents moaning and you're trying to talk them into taking some med, they are totally demented, but the State is breathing down your back about pt rights. Meanwhile, you wonder what you are really accomplishing, since the quality of life is so poor, the regulatory oversight is so absurd, and the med pass is unreal! Then, you have an utter reliance on CNAs, who can drive you crazy with their petty quarreling amongst themselves, and their smoke breaks. They seem to like to pick on the occasional saint amongst their ranks.

I like the hospital setting better. You have a more interesting mix of pts, it's not so repetative, the whole situation is more hopeful, you work with higher caliber people also. I worked with some awesome nurses in LTC, you're probably one of them, but there were some who were really washed up. So, from my point of view, yes I'll bet you're ready to go to the hospital and try that out.

[SuesquatchRN, BSN, RN]

And more thanks.

I'm feeling better about myself and my future today. I just have to keep remembering that I need to hang onto this job because it pays our bennies and concentrate on getting out.