LTC / subacute accurate picture

[renerian]

I have read the posts on this topic to help make a decision about a SNF/LTC job offer........

Here are the issues I see as discussed: (negatives)

Understaffed

Under paid (my office is 23 and I am an RN)

Team dysfunction

Med pass being overwhelming

Manager dysfunction and lack of support

Family member issues

CNAs angry and nurses and vice versa-finger pointing at each other

On call

Corporate greed

Here are the issues I see as discussed: (positives)

A few people said it was very rewarding

Are these accurate observations and does anyone care to comment? LTC/subacute would be a new venue for me and I sincerely would appreciate experienced nurses who have worked in this type of roll.

Thanks,

renerian

[CapeCodMermaid, RN]

Sub-Acute is a whole different thing in LTC. We are taking care of extremely sick people who, 5 or 6 year ago, would be in the hospital. Unfortunately, most corporations look at numbers and not acuity when staffing their facilities. On my sub-acute floor, for 41 patients,day shift there are 2 med/treatment nurses, a charge nurse, and nurse manager and 4 (!!) CNA's.On 3-11 there are 2 nurses and 3.5 CNA's and 11-7 one nurse and 2 aides. We are desperate for another CNA but we are always told we have more nurses than the other floors. Of course we do-we have the fresh post-ops, IV's, Midlines, PICC lines, and a variety of others...we write easily 6 times the number of orders a day as the other 2 units put together.

Then there are the Admissions Directors who are told to "keep the beds full" so they admit practically anyone. Someone with dementia or an active psych diagnosis does NOT belong on a floor with short term rehab or sub-acute people.

[renerian, BSN, RN]

I am glad your everyone's input. New turf for me......

renerian]

[donmomofnine]

I appreciate your input. May I ask what your nurse ratio is on subacute and ltc?

Thanks,

renerian

We don't have "subacute". We have a very low tech, low key philosophy. Three tube feeds we have right now are as high tech as we get, and we prefer it that way. This is a home like setting.

[CapeCodMermaid, RN]

All the SNF's around here have sub-acute units. We have to to be competitive in this market. All of our 142 beds are Medicare certified and we run an average of 30 med A's and 4 or 5 managed care patients. Not unusual to have 4 admits and 3 discharges in one day.

[renerian, BSN, RN]

Is the admission paperwork bad for subacute? I am used to a 20 page assessment for home health so that I could handle.

renerian

[nightingale, RN]

Done both Ren, it is not bad at all. I do the MDS and that is the comprtehensive one (like HH Oasis). One facility I worked at did have the charge nurse do that but our nurse does a head to toe (about 6 pages). The secretary is more concerned with face sheet and incoming diagnoses, the charge nurse still has to write the meds and set that up.

I hope that helps.

[CapeCodMermaid, RN]

To do an admission assessment the "right" way takes at least 45 minutes....more if the patient is cognitively impaired. Many of the questions can't be answered in the first few hours so we have 48 hours to complete the packet...but if it doesn't get done by the nurse admitting the patient, chances are it won't get done.

[renerian, BSN, RN]

Thanks everyone for your input!

renerian

[barefootlady, ADN, RN]

Renerian,

You can do this job. I wish you the best and hope it turns out better for you

than the hospital job you described some time back. Keep us posted.

[renerian, BSN, RN]

You are very kind. Yes that hospital nightmare was upsetting........to say the least.

renerian :imbar