Someone please help me, new to LTC!!!

  1. 2
    So as I posted before, I just started working in LTC I am a RN and have a critical care background, I decided I wanted to try something new, something where I could spend some more time with patients and all that good stuff. I quickly realize that I was mistaken. I am the evening supervisor for 266 bed facility, staffed with 16 cna's and 12 lpns on my shift. There are 2 RN's sometimes, but we also have a rehab unit that needs to be staffed with an RN and when there isn't one the Supervisor takes the entire house, including the patients that come right out of the hospital, fresh post-op patients.

    I have been on orientation for about a week and now they are taking me off orientation and also I have to run the rehab unit on the weekends, and I have never been trained there, I shadowed there for three days, but I don't even know how to do an admission. ALSO they scheduled me for 8 days straight, I never asked for overtime, or even "ok'ed" it so I was shocked that I was given that with one day off followed by 4 more....

    As I said I am from the hospital, I am not used to this, so I have to ask.. is this normal? Is this even doable???

    I am totally freaking out, I talked to the scheduler about the issues with the unexpected overtime, but there isn't anyone overseeing my orientation, so I think I'm going to try to catch the DON today before she leaves.

    Overall, it seems like a nice facility, it's very clean and the staff seems nice, although I do sense some drama in the air, I don't play into that stuff, I don't even have time for that stuff, as I am trying to sift through paperwork, call doctors to clarify orders and deal with staffing, oh goodness the staffing.... we are also, ALWAYS short and at least 1 person calls off on my shift...

    So can someone please tell me, is this the reality of it? I am totally a fish outta water here, it also doesn't help that everyone refers to me as the "baby" nurse... I am youngish 29 years old, but I do have experience clinically, I already feel like the older nurses really aren't loving the idea of a nursing supervisor old enough to be their daughter..... advise guys please!!! what do I do...
    BSNbeDONE and Esme12 like this.
  2. 9 Comments so far...

  3. 2
    I'm sorry....but it probably is the reality. I worked as a supervisor at a LTAC...Long term Acute Care. They had an ICU with vents and sick patients...but it was a small place. I thought....I can run a 300 bed hospital with an ED, cath lab, 18 bed ICU, a NICU, L&D AND psych with a satellite facility of another 30 beds down the road. This place has only 8 ICU beds and about a total of 50 to 60 patients at any given time. NO SWEAT! Uhm....

    I was wrong. The seasoned nurses can be.....difficult....at times. They are used to people coming and going so they have a tough exterior. They don't warm up and can be pretty stubborn...to being almost belligerent...at times.....but they figure why bother...this one will be leaving soon as well.

    It is extremely difficult to make the change from acute care to long term care. At least the patients at the LTAC were acute so I had some familiarity....I acted more like the rapid response nurse and resource nurse than sup. I was the IV team and phlebotomist.
    We had a good supervisor team but staffing was ALWAYS and issue and at t times I was the only ACLS in the house....to watch the line, monitors and drips.

    Welcome to anything outside acute care. ((HUGS))
    JLL41183RN and prnqday like this.
  4. 5
    Yes, this is the reality of ltc. Short staffed, call-offs every shift.
    My advice to you would be---don't try to change things---you are the new one in town, and the staff there really do know what they are doing. They will resent you if you walk in with the attitude that you know everything.
    Second--don't be afraid to ask questions---your lpns know their patients, the families, and the MDs. Most will gladly help you--and appreciate your asking. This shows you appreciate their skills.
    Third--just take it one day at a time----you will find your own way of doing things.
    zunsyne, BrandonLPN, JLL41183RN, and 2 others like this.
  5. 3
    (an ICU with vents and sick patients...but it was a small place. I thought....I can run a 300 bed hospital with an ED, cath lab, 18 bed ICU, a NICU, L&D AND psych with a satellite facility of another 30 beds down the road. This place has only 8 ICU beds and about a total of 50 to 60 patients at any given time. NO SWEAT! Uhm....)

    I had the exact same thoughts wheni left long term care for acute care years ago. I was like....these nurses only have 5-6 patients; what the heck are they crying about??!?!? I've been having 30-40 patients on the regular. Hospitals will be a piece of cake. Well, one million boxes of Kleenex, cold eye packs for the swelling, and the constant taste of soap in my mouth later, quietly I say with my sad puppy look, I UNDERSTAND! The grass is NEVER greener on the other side.....just in a different yard. From where I stand, it's always brown.
    LovedRN, JLL41183RN, and Nascar nurse like this.
  6. 1
    (My advice to you would be---don't try to change things---you are the new one in town, and the staff there really do know what they are doing. They will resent you if you walk in with the attitude that you know everything.)


    That appears to be the cardinal sin in the nursing homes. At least it was when I was one of the charge nurses there. It seems as if EVERYBODY there was related, except the residents, with me being the outsider. But I absolutely LOVED the residents and I must admit that I do miss long term care....haven't been in it since the early 2000s when I would still do a couple of stents thru there as an agency nurse.
    JLL41183RN likes this.
  7. 1
    I just left LTC for a hosp job. I was only RN working the floor (I did the rehab unit). Always short staff. Sometimes it was me and one CNA for 17 pts. I loved the pts, there was an "old guard" group there, but for the most part it was fine. There were a very few who never warmed up to me, but for the most part, it was good. I didn't get a lot of help. If you don't let it overwhelm you, you will find a way through. I left b/c I got an opportunity of a lifetime at a great hosp. I have only just started but I already like that it is different everyday.

    Good luck!!
    JLL41183RN likes this.
  8. 2
    I went to LTC after 17 years of acute care. Your experience sounds just like mine. They've cut the RN's in LTC to just a supervisor. I moved to a small town where there was only that nursing home. they all were related and grew up with each other too. They warmed up to me after about 6 months. It's a real hustle, especially when your rehab it full or you have tons of imminent hospice patients. CNA's can be difficult and attitudinal and LPN's definitely don't let new supervisors in very easily. Remember it takes awhile to earn their respect, but you will in time. Remember that when you're new they'll test you to see how far they can go. Believe it or not, you have to hone you leadership skills even more in LTC. Be humble and admit when you need help. LPN's will warm up to you faster. Short staffing is defintely the norm. My place doesn't let us use agency either. Just give it a little time. I would definitely let the DON know you're not interested in all the overtime.
    AheleneLPN and JLL41183RN like this.
  9. 2
    Maybe since I'm a DNS, I come from a different perspective. Change is essential for growth both professionally and to maintain the business end of things. I've found if you tell the staff WHY you want things done a certain way, based on regulations or evidence based practice, people will be enthusiastic. The "do it because I said so" never worked for me as a staff nurse and it's not how I run my buildings now.
    That being said, I think it's appalling that you are put on the schedule for that many days without your permission.
    AheleneLPN and JLL41183RN like this.
  10. 2
    I am an RN who transitioned from critical care to long term care many years ago purely for scheduling reasons. I am now a DON and have been for many years. There are a lot of fulfilling opportunities in long term care. The industry would benefit from an infusion of fresh blood, so to speak. Try to schedule a face to face meeting with your DON. In my experience, large facilities like yours have an unintentional tendency to eat their young. There is no way I would support the type of scheduling you describe. You may want to look aroung for a smaller facility that can afford you a little more nurturing.
    JLL41183RN and Spidey's mom like this.
  11. 0
    Thank you everyone for all the great advise and support!

    I did talk to my DON yesterday, I was beside myself with everything, and once I sat down and talked to her and told her that I really have no idea how the building is run and that I don't even have access to the computer to look at lab work, she realized the problem, She has (thank GOODNESS) lengthened my orientation, and they are going to give me a day off now, so that was taken care of as well.

    The shift last night was very eventful, lots of patient issues, lots of family issues and then a gas leak in the kitchen, but with the help of my preceptor, we survived, until the night RN called off, I didn't know what to do and my poor D.O.N came in because I didn't know I had to call all the other nurses and then call her, I thought I called her to make her aware and then looked for staff, so when she offered to come in, I just thought she was being nice, no she is supposed to be the last call after I already made the calls.... I felt so stupid and bad for her as she explained to me the scheduling (yeah I had no idea)...

    I can't believe I ever thought that LTC was easy when I worked in the hospital, lol, I am eating my words on that one, it really REALLY isn't but I am looking forward to the challenge. I just have never honestly supervised and worry all the time because I really can't please everyone. I am so used to befriending all the staff, but was specifically told yesterday not to do that, to be friendly, but not friends, which makes sense, although I personally need to get over my people pleaser issues and just do what is right for the residents, and that includes staffing.

    All of this is such a change, and I am so glad that I found this site, and there are actually people that can relate!!!

    This is going to be a wild and crazy ride...
    Last edit by JLL41183RN on Feb 27, '13


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