My new grad experience at an SNF

  1. Hello all! I love this site and just wanted to share my 4 months experience of working as a brand new nurse in a LTC/SNF. I started off my first month with one week of orientation on the "long term care halls" where I had close to 60 patients. I was really overwhelmed and could not for the life of me get everything done on time. But let me mention this as I know not all facilities have them. I do have med aides and a treatment nurse, so that, im sure makes a world of a difference.

    After about a month and half I got moved to the rehab/skilled hall where I have up to 22 patients. Here I have done many many skills like insert IVs, IV meds, insert foleys, ostomy changes, Peg tubers, IM injections galore, Resp tx, PICC care and removal, among numerous other things! I have had to call codes, perform CPR, assess sudden changes in pts and of course call docs and input orders. I have loved it and think it was a great start to my nursing career. In the beginning I heard it all from, nobody will hire you to you will lose your skills...this is not true at all! It took some time to find my mojo but I have and enjoy going to work. I will say you have to be determined and strong enough to be able to stay. In the short 4 months I have seen many come and go.

    I wanted to share because I know alot of new grads are in the position of needing a job but unsure of where to go and hear the negatives of starting in SNF/LTC so here is a little positive. Yes I know having the med aides and tx nurse is a HUGE factor in my positive experience, but I am always on the move and hardly sit as there is always something needing to be done.

    I will admit that I am getting bored at times because it can be repetitive but for now I am okay with it as i go through my RN-BSN program and plus have my baby I will eventually leave after the birth but for now it works.
  2. Visit alltheway2013 profile page

    About alltheway2013

    Joined: Apr '13; Posts: 14; Likes: 18


  3. by   Wokini1
    alltheway2013, thank you for your post. I am a brand new nurse looking forward to LTC/SNF nursing and appreciate hearing your positive experience. Thank you for sharing.
  4. by   krisiepoo
    Thanks for sharing! so many negative posts about LTC/SNF that it's refreshing to hear a positive one!
  5. by   imintrouble
    When I worked SNF in a LTC setting, we did everything the hospital did but hang blood. Our nurse/pt ratio was 2-3 times that of a med/surg unit. We did all of it without the luxury of a rounding MD everyday.
    I remember it as my favorite nursing job. I'm sure the passage of time has softened the more miserable days, but it remains the yardstick I've measured every job I've ever had against.
    Last edit by imintrouble on Oct 21, '13
  6. by   x19amanda
    I love this post! I am two at my 4mth mark as a new RN in LTC; my training was all over the place because I'm only part time and they would schedule me twice a week so it was hard to remember everything week to week. Now I definitely have a grasp on what I need to do since I work overnights, and the workload is a lot less stressful than days. I do pick up all the time on 3-11, as I feel this has taught me a lot of things that I wouldn't have learned at night, especially asking questions from seasoned nurses. It's hard sometimes to get the big picture of all resident's statuses when you are the only RN on at night, so working 3-11 gets me to know more important info so I can better care for my residents at night. I am now confident in calling doctors, writing orders, working with family members, sending res. to the hospital. I was never formally trained on the med pass, but I do do this task often when I pick up on other shifts, and I feel it is a lot easier since I started at the desk and understand why a lot of the se tx's and meds are given. I am still learning everyday, but I do feel pretty comfortable. At times situations come up where I really wish I wasn't the only RN in the building, but I work with a seasoned LPN some nights so I know I can ask her if I have any questions. So far I have been told my charting is excellent, but that's the only real feedback I have been given. I really want to work on my critical thinking skills, and I feel as though I need to learn from other RNs more often to do so. I know so many girls I graduated with that are waiting for that perfect hospital job, but LTC does give you experience in buidling your confidence, time management and charting skills.
  7. by   nervousnurse
    I am happy to hear this! I am not a new nurse; but new-ish to LTC/SNF. The ratios you have honestly amaze me, since it basically sounds like MED-SURG! You should be very proud of yourself!!! I also realize MANY people think we "lose our skills" in LTC/SNF, and/or that it's easy.....after all, don't the cute little residents sleep and play Bingo all day?

    I am a VERY hard worker and I can tell you, I KNOW I could not handle 22 residents with the acuity you! Where I am now, we have VERY few "SNF", and in seven months, I have only had to deal with ONE PICC Line, and have not had one resident with a peripheral, nor do we have trachs, but we (nurses) do give all the respiratory treatments. We also have a treatment nurse and CMAs also. Unfortunately, we have a high turnover and WAYYY too much drama with many of our aides.

    Anyway, all this to say.....when I'm dealing with 40:1 LTC, I can BARELY make it, nor can any of the other excellent nurses I work with. If they had IVs, lots of IMs, lots of ostomies, etc....I don't know how we could do that with our ratios.

    What still amazes me in this type of nursing is the constant FAMILY drama we have to deal with......oh. my. goodness...!!! Take up an hour of my valuable time to complain, but you live 10 minutes away and haven't visited in over a YEAR..... Then you threaten to call our administrator tomorrow---PLEASE call her, because I have been nice to you and lost an HOUR of precious time dealing with patient care...!!!
    Last edit by nervousnurse on Oct 21, '13 : Reason: paragraph indention/ wrong wording :-)
  8. by   microkate
    I hear you - I'm also at the 4 month mark on the rehab floor of a SNF, and it's been a great experience. Friendly fellow staff, supportive management, awesome aides. When we're down a nurse, the case managers, MDS nurse, or even the DNS will take a cart if needed. I get to do a ton with PICCs and central lines, complex wound care, breathing treatments, PEG tubes, ostomies, catheters, EKGs, and anything else they come in with orders for. My usual hallway also gets the end-stage hospice patients. Our ratio is 8-14 patients to 1 nurse, and up on the LTC units it's around 19-22:1. I'm definitely learning a lot and it's a low-key, relaxed and friendly environment. Also, considering the number of nurses who leave after one year to go work at the local hospital - I don't think working here is locking anyone out of acute care!
  9. by   dlrrn2013
    kudo's to you!!! I have worked in ltc/snf my three years of nursing and have entered into management. snf's are the med surg, at least in our area. many area hospitals are closing med surg wings , and flexing nursing hours. I honestly believe this is because snf's are seeing a surge in acuity and due to financial reasons patients are being released earlier and earlier. it takes a dedicated and determined nurse to care for these individuals especially with the caseload! keep up the good work!
  10. by   dlrrn2013
    you are doing acute care! and it's marketable!!! y0ur patient loads are great. in my area we have 1:17 or 18 acute residents (skilled) and 1:27-30 ltc. take pride in what you do because ltc/snf's provide holistic care to co-morbilities and provide holistic care!
  11. by   dlrrn2013
    I know I don't work with you but 1:40 (dayshift? evenings?) you are greatly appreciated here...that is tremendous!
  12. by   alltheway2013
    I am so happy to hear all of your stories and glad mine could help. Yes family drama lol is daily! I work day shift 6-2 which is very very nice! The DON just spoke with me the other day about getting more acute patients and how I felt about taking the whole hall to equal up to 34 patients. I had to really think about it and told her higher acuity is great but I didn't think it would be a good idea for one nurse to take on that many. As of right now I am able to go in each pts room and at least spend a couple minutes to assess, yes just a couple minutes for some, mainly my knee replacements.. but can fully assess my more sick pt's with current ratios the way they are. I think with 34 pts that would just be ridiculous and cut down on care.

    I do love it but go back and forth about what to do as far as my future. I want to become either a womens health NP or CNM and figure LD experience would help me get into those fields but am still researching. Also I am 2 months pregnant and changing jobs probably wouldn't be beneficial since I have a great schedule lol Thoughts?
  13. by   nbamus
    Hi, I am a new grad. I got 3 job offers. I am hesitating between working a registry that is sending me to an acute care hospital without any training or experience
    or 2. for a SNF/rehabilitation
    or 3. simply SNF

    After reading all these posts, I understand that rehab will be the best place to start of and gain some acute care experience. Then after about 6 months of gaining experience, I should do the registry.

    Any advice? I have to make a decision quick. Thanks.
  14. by   thenightnurse456
    I'd go for option 2. Rehab plus SNF so you'll get experience in 2 areas which will look better on your resume when applying for other jobs later on.

    Avoid the registry, that is optimal for experienced nurses.

    All the best

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