Complete surprise, in a good way, LTC experience so far

Specialties Geriatric

Published

I'm a new LTC nurse, been there a whole two weeks. I have to admit, it was the last place I had expected, or hoped, to be. Everyone that knows me would say "you'd be a great ER nurse" or something else acute care related (my true love is cardiac). I'm a task-oriented person, without much 'touchy-feely' about me, so when people talked about the relationships with patients in LTC, it really made me nervous that I just wouldn't enjoy it at all. Life being what it is, this opportunity unexpectedly came up and I figured I at least owed it a shot and went in with as open a mind as I could (still had some big reservations about whether I'd fit). I have to say, I really like it. I'm constantly on the move, and med pass on 30 residents makes my 4 patient med pass nights in clinicals look like a cake walk. I'm learning to navigate two med passes, a treatment pass, charting and any number of things that will come up. I think that acute care and LTC are just completely different animals. Some of my classmates have apologized to me that I ended up in LTC, and I can see why they'd have that opinion. I don't want to debate which is "harder" or "better", I'm no less of a nurse caring for my 30 residents than my former classmates caring for their trauma patients in the ER. My treatments might be skin tears and not surgical wounds, my assessments are more focused and maybe not as life or death, but my residents are no less important than any of those people walking into a hospital. Most of my residents led productive lives at one point, and now their world has been reduced to one floor of a building, or for some- four walls of a room. They rely on the care provided by my excellent fellow-nurses, our wonderful CNAs, and myself, and I'll do my best to provide what I can. Just thought I'd post this in case there are any new grads, or soon-to-be-grads, or even students that think they'll "never even consider LTC", you might want to be open to what life sends your way, it could be the best move you make.

My only gripe is that I've had a number of people tell me I'll "grow out of it" when I answer lights and help people with bedpans, or stop and get snacks, and I understand that people can get burnt out. Rose colored glasses of a new nurse or not, I don't intend to grow out of it, it's part of my care as long as I'm able.

Specializes in Director of Nursing.

Nurse Guy Bri,

You seem to be on this site frequently. I would like to ask your opinion about taking the DON position. I am new to long term care and am going for my 3rd interview tomorrow for the DON position. I have no idea what kind of money to expect or to ask for. I have been an RN for over 20 years. Also I have to do a competency verification training test can you give me any ideas what that will be like. i anticipate about a 50 hour week. Oh, I should tell you it is a 60 bed facility. Aprox 20 of those are skilled rehab, the other are long term care. It is a large non-profit organization. There are 2 RCM's (resident care managers) one on each of the two units. Can you give me any advice as to things to say or ask at this 3rd interview. This one is the panel interview and the regional nurse consultant with be on a conference phone for the interview. Thanks in advance for any assistance you can give me.

Harley

Wow! Good for you! I am starting to consider LTC because I suffered so much in med surg d/ t high acuity!

Can someone tell me a little bit more about LTC? Anything will help. Please excuse my ignorance!

Is LTC a nursing home , or the pts come there for recovery and to gain strength and independence and they get discharged home?

Is there a pharmacy in LTC? Can you page MDs like in the hospital?

As a new grad , will LTC help me improve my skills and expand my knowledge?

Will LTC help my critical thinking?

Would it be a good place for a new grad to start ?

Thank you

Specializes in New Critical care NP, Critical care, Med-surg, LTC.

Some LTC facilities are only nursing homes for stable long-term patients, others are a mix of long term and short term rehabilitation patients. Sometimes the rehab rooms are clustered together, sometimes they're not. On my assignment, most of the patients will not be discharged to home, but a few are recovering from different things and will go back home when they're able (according to insurance).

Here's a quick rundown of my shift (3-11)

I come in and check my treatment book and see what treatments I'm doing on my shift, who gets a shower (because I have to do a body audit/skin assessment on shower day), and other stuff like that.

Then I have to check and see who needs milk of mag because it's been a while since they've gone- that goes on my med list.

I've got 4-6pm med pass and 8-10pm med pass, so I usually get started on the first med pass right after report and narc count. Then it's first med pass, sit for five minutes and call home to say goodnight to my kids, then second med pass and treatment pass I combine together. I try to be finished with that by 10:30pm because then I've got to finish my charting before my shift ends at 11:30pm. We chart on anyone with a current issue- recent fall, on antibiotics, on any kind of watch (behavior, UTI, etc).

The dr. usually isn't on site during much of my shift. For an emergency I can always call my supervisor and/or MD if necessary. For non-emergencies, there's a "MD board" where we leave notes about which residents they should see on the next day. Pharmacy comes and delivers, but there are people available by phone if we've got questions.

I think that the organizational skills and time management I'm getting in LTC will serve me well no matter where I go. No, I'm not dealing with anything as acute as a med-surg assignment, but it works for me. Some day I'll manage to pee more than once a shift!

Good luck with whatever you decide.

Nurse Guy Bri,

You seem to be on this site frequently. I would like to ask your opinion about taking the DON position. I am new to long term care and am going for my 3rd interview tomorrow for the DON position. I have no idea what kind of money to expect or to ask for. I have been an RN for over 20 years. Also I have to do a competency verification training test can you give me any ideas what that will be like. i anticipate about a 50 hour week. Oh, I should tell you it is a 60 bed facility. Aprox 20 of those are skilled rehab, the other are long term care. It is a large non-profit organization. There are 2 RCM's (resident care managers) one on each of the two units. Can you give me any advice as to things to say or ask at this 3rd interview. This one is the panel interview and the regional nurse consultant with be on a conference phone for the interview. Thanks in advance for any assistance you can give me.

Harley

I have been a DON in LTC for over 25 years. I have watched the profession change and grow. And yes it is a profession. Check out NADONA/LTC website they have tons of info. I would hope in your interview they ask about infection control and quality improvement. They will also want to know what you know about staffing minimums and other state regs You can find these on the internet by going to your states website Go to ___(state).gov then look up long term care There will be good weeks and bad weeks and you will wear a variety of hats. The goal is to develop your team in order to delegate as much as you need to still know your residents. I suggest deciding now what special things you have to offer and what your philosphy is

Specializes in Hospice, Palliative Care.

Thank you for sharing, JBMmommy:

As a task oriented, process management type of person who recently applied to nursing school (this is a complete career transition from IT / fighting hackers), hearing your story gives me greater hope I can fit into the field.

Thank you.

So glad I found this post! I just graduated in May and obtained my license in July. I just got my first nursing job ever and I will be going on the floor on Saturday. My DON said I will start off on the LTC floor to gain experience and I am nervous because I am brand new. She told me I will most likely in have 20 patients and that got me anxious. However, I love the geriatric population and I am very excited to learn how to be a better nurse. Reading your post got me excited and I am ready to start my nursing career on the LTC unit. Seems like an amazing learning experience

Specializes in LTC, Rehab.

Get as much help, training, and/or questions answered as you can. I ended up totally by accident in LTC nursing for my first job, received very little training, and for the first several months (sometimes even much later than that), my response to many 'Why didn't you do -------?' 'was 'Nobody told me'. I'm still there, almost 2.5 years later.

Sure will! My nurse educator said it'll take time to get use to but if I need extra help I need to speak up or they'll assume I know it. I start orienting on the floor on Saturday so we'll see how it goes

Specializes in New Critical care NP, Critical care, Med-surg, LTC.

Wow, it was funny to see my old thread pop up again. Here I am 2.5 years later, still at my LTC job. Good luck to you, it can be a great place to work! Hope you find success with your orientation. And yes, ask lots of questions.

My job has changed a bit, I'm no longer regularly on a floor shift. My regular position is a catch all, getting lab results to the MDs/APRN, entering orders, taking care of reports, helping with any care the floor nurses need a hand with, etc. I also work per diem supervising shifts. I'm still slow as molasses on a med pass, so it was a good transition into a different sort of shift- it also changed my hours so I can see my family almost every evening, a bonus when working two jobs.

Specializes in LTC, Med-surg.

I work long-term care. I am going to shift 7 of a 10-day orientation period. I am thankful that they are giving me more time to get used to being a nurse. I really like my coworkers and the environment of this place. The nurses are excellent and they have been so kind to me. I plan to give this place a 2-year commitment.

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