Can anyone give me a quick rundown of what RNs do in LTC?

[ashleyisawesome, BSN, RN]

I work part time (24 hrs a week) on a med surg floor at the hospital. I like my job and like having a lot of time off, allowing my schedule to be pretty open. I have had an itch to try something different and have been looking at per diem jobs, hoping to work one or two days a week but still be able to skip a week or two here and there if i feel like it. something very casual that can make me a few extra bucks and give me some new experiences as a nurse.

so i applied for a LTC that is literally 2 mins away from my house. I figured it would be a good place to pick up shifts on a whim. They also have a vented unit, which I find interesting and would like to get experience in. I got a call back and several emails the very next day! (which sort of scares me, are they desperate for help?)

I applied for a staff RN per diem position and have a few questions:

1. Is working per diem vs full or part time in LTC with no prior LTC experience a bad idea? Will I be slow to pick up the routine? what kind of orientation would i normally get? i've heard some horror stories (1 week or less!), but would like to hear from your experiences!

2. What are the general responsibilities for a staff RN in LTC? I worked for about a year in assisted living connected to a skilled facility with RNs, so thats as much as I've seen. My general idea is that you pass meds, do wound care, lots of paper work, help with turning/toileting, oversee LPNs and CNAs... But from what I remember LPNs do most of the med administration and treatments, so do RNs do it as well?

3. In one of her 6! emails she has sent me in the 4 days since I've applied, she mentioned she also has a part time supervisor RN position and a part time charge nurse position. Why is she offering me these? I feel hardly qualified to work in a supervisory position, especially in an area I have no experience. I have only been an RN for a year and a half. Is it a bad sign if they are offering these positions to people with little to no experience?

4. On night shift especially, are you ever the only RN in the building? I seemed to remember when I worked in AL, if we had an emergency, needed a written order taken down, a death, etc, we were to call "the" RN on the skilled side to come deal with it. As in there was one RN (i think?). That sounds... frightening. I would like at least one other RN to use as a resource person if i run into trouble!

5. What kinds of different skills might I learn/experience if I take the job that I might not see in acute care?

Thanks in advance for reading and answering!

[pinkiepieRN]

I work as an 11-7 weekday RN house supervisor for a 126 bed NH. I am indeed usually the only RN in the building - most of the staff that work here aside from management are LPNs. As far as work duties, whether you're an RN or an LPN, your floor duties are pretty much identical. Duties include medication passes, assessment (since you're an RN), admissions, discharges and transfers, wound care, g-tube feedings, trach care, and documentation off the top of my head. I was a floor nurse for 4 months before they asked me to step up and take a position on nights as the RN supervisor.

My job description is a lot more nebulous now. I'm responsible for census verification, taking report from the 3-11 supervisor, acting as nursing coverage for a last minute call out, making unit assignments for the GNAs, assessments on any change in status or anything one of my nurses finds out of the norm or different, helping with things like inserting Foleys, talking to Pharmacy, writing notes for my DON regarding the shift (I don't have anyone to report off to at the end of my shift because that's when all 3 unit managers come in and take over), chart reviews for admissions, taking call outs and calling staff in and following up on anything significant that happened during the day. It's often hard for me to quantify what I do during my shift, because I really use a lot more of my "soft" skills like crisis management and interpersonal skills, but I love it.

[JBMmom, MSN, NP]

I know at our facility, if you're being hired for per diem, there is minimal orientation. That may vary between facilities, so you should definitely ask about that. Our facility also seems to be staffed with more RNs than many other LTCs, I think we almost always have at least 2 RNs in the building, although only 1 RN supervisor per shift. As far as duties, that would depend on the position you are offered. For us, a charge/floor/staff nurse position is basically the same whether you're an RN or LPN. If you're the nurse on the unit, you're doing meds, treatments, charting, etc. We do sort of oversee the CNA staff, but there's no difference between RN and LPN as far as floor duties. Except that I guess LPNs can't take phone orders, so if another unit needed a phone order technically an RN could be asked to take care of that for them. Also, if you're not IV certified- RN or LPN, you'll need someone to cover any IV meds. I'm not surprised you were asked about the RN supervisor position, quite a few of my nursing school friends were given these supervisor positions right out of nursing school. Because there are a few things that only RNs can do (pronounce, take phone orders, send out to ER), they are eager to get RNs into supervisory positions. Personally, I'm not comfortable with the supervisor RN role after a year on the floor (I'm only part time), but as I mentioned, a few colleagues of mine from school have had those positions without ever working a floor. If you decide to take it, the transition may be overwhelming at first. I'm not saying in any way that LTC is harder than med-surg, they're just different. Med pass on 30 residents, but very few comprehensive assessments, may not use your nursing skills in the same way that you have been using them, but it is still nursing, and has some very gratifying aspects. Hope you enjoy it if you pursue it.

[motherof3sons]

Our facility is 57 beds so at night there is only one RN. The night RN does all meds, neb tx, wound care, insulin ect. There are probably 12-15 med passes at 6am. I had no LTC experience when I started, came from med-surg. It was a long time before I felt comfortable to be charge and the only licensed staff in the building.

[ashleyisawesome, BSN, RN]

Would I have to have an actual certification, like a piece of paper saying i took some kind of class? I give IV meds and start IVs all the time at the hospital and I am chemotherapy certified as well. It would be weird to ask someone else to do my IV meds!

[SunnyCaliRN]

I'm a recent grad who started out in LTC, and have a few months experience, but here's what I know:

1. My facility does orientation the same for per diem, full time/part time. I chose to be per diem (but work full time) so I get pay in lieu of benefits, which is 12% more hourly. I had 8 days of orientation which covered every side of every unit in my facility, plus one day with the treatment nurse. Orientation is something I would definitely ask about.

2. Pass meds, admit/discharge, assess any change of condition, supervise CNAs, communicate with other team members (dietary, activities, doctors, pharmacy). My facility has a treatment nurse for wound dressings etc on AM shift, but I work PM so I do treatments if they are scheduled for PM.

3. I would clarify the difference in those roles. I started as charge nurse, meaning I supervise CNAs. Our supervisor RNs supervise charge nurses, which I would not be comfortable doing with my level of experience. They may be understaffed?

4. Depends on the number of patients and the ratios and the size of the facility. One of our buildings has only one RN for 22 patients on NOC, but our unit with 60 patients has 2 on NOC. Definitely something to clarify.

5. I manage way more patients in LTC than I would in acute care. I've learned a lot of time management skills and become much better at delegating, because with 20+ residents, I just can't be everywhere. And I do learn medical things as well from my experience managing medical conditions, having to send residents to the hospital, communicating COC with the MD, etc, but certainly no more than in a hospital. I think what makes LTC special is the opportunity to really get to know your residents and care for them long term.

[pinkiepinkPN]

Would I have to have an actual certification like a piece of paper saying i took some kind of class? I give IV meds and start IVs all the time at the hospital and I am chemotherapy certified as well. It would be weird to ask someone else to do my IV meds![/quote']

In my area, LPNs must take a special IV certification course that, when someone would look up your license on DORA, they'd be able to verify that you're certified. I was not issued a physical certificate by I was sent. Letter by my state stating that I am indeed certified. RNs in the AAS or the BSN program are not required to be separately IV certified since they receive a longer exposure to IV therapy learning in those programs.

[CapeCodMermaid, RN]

Needing certification in IVs is a facility choice. Most RNs have had IV training in school.