Need advice about working in LTC-subacute floor

NamasteNurse, BSN, RN · Apr 29, 2011

It is a lot, but at my LTC facility, we have sometimes one LPN for 42 residents. The sub-acute floor has two or three LPN's for 43 res. It will be do-able but yes it's very hard and a steep learning curve. Your orientations sounds good. The nurse who wants nights, is looking for an easier shift. Most residents sleep at night and no matter what it's easier than days. The good thing about days is usually you have extra people around to help and the residents are busy with PT/OT, and other activities. Nursing is hard no matter how you slice it. Best of luck.

kythe, LPN · Apr 29, 2011

I worked sub-acute for several months in a facility that split the unit into 3 halls, with one nurse having up to 20 pts each. When census was low it was alright, but things got difficult when there were a lot of issues going on at once. Sub-acute can turn acute quickly at times, so it isn't just routine med pass and treatments. With that set-up and each nurse having so many of their own patients, it is hard to help each other out when things get rough.

My current facility generally has 35-45 patients on the subacute unit with 3 nurses. The way they are set up, two nurses split the floor for med pass and treatments. The third does admissions, discharges, taking doctor's orders, and helps in whatever other way needed. This seems to work well, and encourages more support and teamwork between each nurse.

Subacute is always busy for everyone, but you get good experience with assessments, treatments, and general time management. I've seen several RN's get hospital jobs after a year in sub-acute.

Shayrey · Apr 29, 2011

Thanks for the advice it's greatly appreciated. I didn't think about them being off the floor. Im kind of hoping I get the job as scary as it sounds:)

ssmandile · Apr 29, 2011

For long term care this is pretty much average, but it an be alot at times especially when you are new to the long term care environment, but what is nice about long term care even in sub-acute is you have time to get to know the patients for a longer length of time and this helps you to be able to manage your time easier. It sounds like your facility is giving you a good orientation, so let them know if you are feeling over-whelmed, most places will extend orientation to keep good nurses on staff. Congratulations on your position.

Chin up · Apr 29, 2011

I think 15 residents is beyond reasonable. I wish more were staffed, as well as yours seems to be. Is it two med nurses and a charge? Or are the 52 divided in three and you do the cart and desk? is there a floating supervisor? Do you have 4 CNA's or 2, I was a little confused. Or do you have two CNA's and 2 RN's as you wrote in addition to the three nurses? Please clarify, as this makes a difference. Peace!

Shayrey · Apr 29, 2011

Sorry if I confused you but this is what she told me---there are 3 nurses and 1 charge nurse who sits at the desk. Each nurse has 2 CNAs and give or take 15 pts each.

imintrouble, BSN, RN · Apr 30, 2011

Fifteen pts on a subacute hall at night. Fifteen on a day shift.........I wouldn't want to do it.

NurseHopefulInOH · Apr 30, 2011

15 residents sounds very good to me. Depending on census I could have up to 30. When i switched from seconds to nights i had about 50...yikes! I thought that was way to much. Also 4 weeks is a reasonable orientation. Good luck!

nurse.sandi · Apr 30, 2011

I worked a subacute unit and the patient load was 15 and at another facility 10. You will have to do assessments, meds, wound care, etc. It is doable but busy. I actually enjoyed the subacute unit. Most of the time these patients can do things for themselves. It is not like working in a LTC where most patients are total care. Monday thru Friday. Yep a dream job. On the flip side... be careful, if it sounds too good to be true..it could be.

chelynn · Apr 30, 2011

It is a lot, but at my LTC facility, we have sometimes one LPN for 42 residents. The sub-acute floor has two or three LPN's for 43 res. It will be do-able but yes it's very hard and a steep learning curve. Your orientations sounds good. The nurse who wants nights, is looking for an easier shift. Most residents sleep at night and no matter what it's easier than days. The good thing about days is usually you have extra people around to help and the residents are busy with PT/OT, and other activities. Nursing is hard no matter how you slice it. Best of luck.

How dare you say the nurse wants an "easier shift." I work nights, I have 45 residents and 2 CNAs. You do understand that these confused residents don't know whether it's night of day. They try to get out of bed several times a night and often end up falling. We also have to prepare all paperwork for dr appts the next day, as well as check the Narc ekits and fridge temps. We have to update alert charting list and start the 24 hour book. We have to finish treatments that day nurses "didn't have time to do" as well as doing our own. We have to call on call pharmacy or the on call dr for coumadin orders or abx orders that you "didn't have time" to get to. We have to go through the whole huge med cart once a week and order meds. We also have to note orders and file lots of things in the chart that day nurses leave there because, "Nights can do it they are not busy." When I come in to work at 6 pm there are charts and papers everywhere, when you come in at 6am and everything is neat and pretty you need to know that didn't happen by magic. During the day there is one nurse for each hall, each nurse has 22 residents and 2 CNAs. At night since I have both halls I have 45 residents that means I have double the meds to pass, double the charting to do. I am NOT saying that nights works harder than days but I want you to understand that nights is not EASIER than days by any means. I have had several nurses tell me that they would never work my shift, mainly because of the 45 residents I have for my med passes. Please educate yourself about what night nurses do before you throw around comments like that again. Thank you.

JMF7755 · Oct 23, 2014

This is an old thread, but I found it tonight, so maybe others are looking at it too...like the OP I am a new RN and I just got my very first nursing job 18 months after graduating with honors from my program. With that in mind, any new nurse offered a job, take it, you need the experience, and jobs in general, but especially for new nurses, are hard to come by if you haven't noticed. My GPA, my volunteer work, my ambition didn't mean squat to anybody. Truthfully, I landed this job because the facility has a hard time keeping people. I will tough it out for a year for the experience and then doors will hopefully open for me. Second, I want to slam the poster that claims night shift is "easier"...uh yeah, no. I might be new at nursing, but I DO KNOW when I'm busting my @zz. I work 7p-7a and although a half hour "lunch" is deducted from my time, I NEVER get one. My lunch break consists of shoveling a chewy granola bar in my mouth while hiding behind a file cabinet. A chewy one because crunchy takes too long to eat. I am lucky to get a pee break, and maybe go outside for five minutes. I am on my feet the entire time. I have about 30 pts, and they DO NOT sleep all night. They are no better in my facility than they were a night ago on med/surg in the hospital. $$$$ dictate discharge. A pt may be marginally improved when they get the boot and end up with me in subacute care, they are by no means "well". I often feel they still belong in the hospital. I have pts with a wide array of acute issues, not to mention a host of comorbidity issues. At least half of my 30 are diabetics, poorly managed. I honestly have never worked so darned hard in my life! And I am a very hard worker at anything I do! My pts do not sleep all night. They ring their call lights, they are in pain from s/p MVAs, surgeries, fxs, TKR, etc...they are vomiting, they are scared, lonely, some are drug seeking. I sometimes don't get to my charting until dawn. We have to do the labs, the pharmacy call ins, treatments, dressing changes and whatever day shift was too busy to get to. Both shifts are HARD and have their challenges. Please do not ever call night shift in subacute care the easier shift, that reflects so much ignorance on your part. Take a subacute care job, you will learn sooo much, and your time management and prioritizing skills will become second to none. So when the hospital job doors open, and you get your 8 pt load, it will be nothing doin' for you. Subacute care is nursing boot camp, take it, learn, and then take the many skills you will acquire wherever you want!