Need advice about working in LTC-subacute floor

JMF7755 · Oct 23, 2014

@ chelynn You go girl! So true!

ceccia · Oct 23, 2014

i work in subacute rehab and have 15-16 patients per shift; i find it reasonable (and i don't deal well with stress and i get overwhelmed easily- so if i can handle 15-16 patients you probably can too. :) ) we do also have a med tech, so i'm not passing meds to my patients; that makes a big difference obviously.

JMF7755 · Oct 23, 2014

@ ceccia, That does sound very reasonable and having a med tech is an enormous difference!! I can never get the all the med pass/accu checks done on time for all 30 by myself. In my place the CNAs are very limited on what they are allowed to do, for instance in the hospital they are allowed to do the accu checks for us, in subacute they are not. It's comical how me as the RN is running my butt off, and the aides are sitting around at their station texting and eating. I have to frequently ask them to do their job, like the pungent odor of feces appears and she's still sitting there, and I'm like, "Can you please go take care of so & so? I try to hopscotch around to get the diabetics covered and those in pain/distress at least give them their pain/anxiety meds, and then round back around with routine meds so they are at least not in 10/10 pain waiting on me to finish with the other 25+ people. @ OP this is an old thread so I don't know what became of you, but to anyone else out there as well, my facility is a sucky place that has a really hard time hanging onto staff, that's why they hire new nurses because we come cheaper and don't often know any better. Most other subacute rehabs are similar to ceccia's, you have a dozen or more pts, your own CNA and maybe even a med tech, so I still suggest subacute care to new nurses like me, because in the short time I've been there, even on night shift, I've learned sooo much. I've done wound vacs, suprapubic caths, Foley caths, dressing changes, drains, comatose pts, PEG tubes, IVs, IV meds, seizure pts, just to name a few. And even though I feel they overwork me, I'm still grateful because I will feel sooo prepared in a year for the hospital environment and won't balk at the 6-8 pt load they typically have in the hosp. When I was in clinical I worked with an RN who was rather new, she had been on tele for a year at the hospital I was assigned to, and she had never done a catheter on anyone, or dealt much with wounds, per her own words: she basically pulled meds and did apical pulses. So like I said I do feel grateful and think this work experience will get me prepped for a multitude of pt care situations.

extremenurse4u · Oct 27, 2014

"Most residents sleep at night and no matter what it's easier than days. " Umm...sorry I have to disagree with you here on this one. I have worked all three shifts. No matter what shift you work; its busy. I work mostly nights now and yes, I chose this shift and not because its "easier". This shift allows me to be a mother at home when my children need me the most. Most resident do not sleep ..how can they? We are in their room every two hours taking them to the bathroom; turning them in their bed or giving them pain meds. I have several very brittle diabetics who I am checking their sugars every 3 hours and several other patients who, for what ever reason, chose to sit and fold wash clothes and drink coffee at 3 am. At any given time, I may have 6-7 residents up in the lobby and 10-15 awake in their rooms while the rest are sleeping. In my opinion; there is no "easy" shift. Its all hard work, all day long.

To answer the original poster's question: It sounds like a good job. It will take some getting used to. Get a routine down and have a good report sheet. Remember that your CNAs are your eyes and ears; they know the residents and they can spot something very quick if there is a problem. Good luck!!

eggyweggy, MSN, RN · Oct 30, 2014

I'm with JMF7755 -- often overworked because I'm still learning how to manage 12 "sub-acute" patients when I work in the TCU, but learning A TON. I'm hoping that I'll get more downtime once I get more familiar with how things work at my facility (I'm only 6 months into this job, the first 4 months of which I only worked PRN) and we get some better systems in place, but if/when I move on to acute care, 6 patients will seem like a breeze! Thanks to hospitals kicking patients out so quickly, I usually have a few that are still pretty acute when we first get them. The sheer variety of skills and conditions has been great -- I feel like I'm getting exposure to everything from cardio to ortho to oncology to hospice to psych. Nursing boot camp is spot on. I really do like the acuity level of the TCU when they are a few days into their stays and ready to start the actual rehab process. The other cool thing about the TCU is that the difficulty level changes as patients start to become more independent. As you get to know the residents, they get "easier" because you know who needs their meds crushed, how long that wound vac dressing change usually takes, and the concerns that need to be addressed with the MD or NP often become fewer and smaller as they get closer to discharge. So for me, the difficulty level in the TCU goes in cycles. If I'm lucky enough to keep the same group of 12 that I've been working with regularly for the past week or two, I might get a couple of low-key days where I actually have time to tackle the extra stuff.

L8dybugM · Feb 5, 2022

I am recently up for a position in subacute... and I am kinda nervous to say the least. I do have over a year of SNF experience but still a bit worried ? Any tips??