Re: Warning to New Grads

Thank you for your poignant message. After reading your post, I am much relieved about not taking an RN position in an LTC that offered two 16 hours shifts and a 30 patient assignment. The DON was shifty at the interview to say it nicely and am glad s/he was a double-talker and gave the hours to someone else and was proud to say they "Contract" RN's for 3 years from Southeast Asia....is this modern-day slavery going on? Best wishes to you and you'll land a better suited RN job!

Re: Warning to New Grads

Welcome to LTC and the world of nursing and you have just begun in this exciting and easy field, not.

Re: Warning to New Grads

Originally Posted by Little_Mouse

I just quit today after two weeks. I thought I was lucky enough to land a job at a SNF/subacute place nearby. After the first week, I was in for a rude awakening.

I had only 5 days of orientation in a 98 bed facility and was labeled charge nurse. Half the place is LTC, the other half subacute. 1st and 2nd shift have 3 nurses--usually 1RN and 3 LVN; 3rd shift usually has 2LVNs. Once I was on my own, passing meds to about 35 pts (in the LTC side) pretty much took me my entire shift. It was overwhelming and frustrating. On top of that, since I was an RN, I was responsible to hang IVs for all IV pts, no matter what side. I barely had time to document, and little to no time to assess the pts. As a friend had said, it felt like an assembly line--and that's how I felt I was treating the pts. There was no time to chat, no time to care, no time to critically think. Many of the staff members actually work on their OWN time (i.e. Not getting paid!) to chart, since many of them are afraid to get too much overtime since Administration will question them about it and may affect their performance review.

Many of my co workers were trying to convince me to stay, saying that it'll get better, that everything will become routine. But why is it that they are still taking more than their shift to do their work? It's simple: it's understaffed.

I brought all my issues up to the DON. All she said to me was, "I told you it's a lot of work and that it's a lot of patients. It wasn't going to be easy." Of course I didn't expect the work to be "easy", but I explained to her that there was no amount of training that could help me provide quality patient care if there is no time given to do that. She said she would like to hire more nurses, but Administration apparently doesn't want to hire anymore for any one shift. She just didn't seem to care too much.

I just had to vent and bring this up to all you new grads. I know I'm not the only that experienced this since I spoke and heard about a few people that experienced the same thing. I just want to give you some advice if you're looking into LTC or SNF. Some things I wish I had done before hand:

1) Research the facility.
Go to http://www.medicare.gov/Nursing/Overview.asp and do a nursing home comparison.
2) Tour the facility.
You may not see everything that goes on behind the scenes with this, but at least it's a good overview of the place. It's better than making any judgements based on how nice the building looks upfront or the nice painting and furniture in the reception area.
3) Ask the DON a lot of questions.
How many beds? As a new grad RN what are the job responsibilities? The job description? Expectations? Number of patients in your care? What is used for documentation/charting?
4)If you do commit, remember to buy some malpractice insurance (I guess that goes for any place you work at, but especially at a high liability job)

I hope this will be of some help to someone out there considering a job in a nursing home. I understand that many of us are still looking for a hospital job, but the pickings are few and far between. I haven't given up hope in finding that job, or even finding a job at another, better LTC facility in the mean time, but these are just some things to consider... Hopefully it'll save you from being burnt out or at least some tears.

Welcome to MY world. Let me state right up front I am not talking about YOU personally. I am an Lpn and have been taking care of this kind of patient load for YEARS. Those of us LPN's/ LVN's who have been breaking our backs in these kind of facilities, BECAUSE WE ARE NOT GOOD ENOUGHT TO WORK IN THE HOSPITALS, get tired of nurses who have only taken care of 4-5 patient's at a time & are shocked about how they are expected to perform in SNF's. Can you imagine the great job we LPN's could do, working in a hospital, after taking care of 50+ patients. And yes, when you have that many patient's you don't have time to chit-chat. You only have time to take care of their essential needs. Rn's don't want to do what we LPN's do- anymore than LPN's want to do what CNA's do. And in LTC/SNF's we only see the doctors every few days -if wer'e lucky, and since I work the midnight shift, I NEVER SEE A PHYSICIAN! We are discouraged from calling them before 8am.(I work 11PM to 7AM) since the on call NP. will be ****** off. Oh, by the way, nurse prac's handle the majority of the work load from the MD's. My only saving grace is that for years I worked day shift and most of the MDs and NP know me and trust my judgement. By law in AZ. the MD's only have to see the patient every 30days. You can't believe what LPN's do. That's why I am very sensitive to criticism from a lot of RN's who WON'T OR CAN'T do what we do. And when it is time for the State to do their yearly inspection,everything changes. We get staff, supplies, new paint, etc. A lot of us LPN's get written up for B.S. so the state thinks the management is paying attention. I just got a "written" write up today for doing what I thought was behavioral charting on a patient. I made the entry 7 months ago about a television dispute between two roommates. Although I had asked several times for clarification of the facilty policy on when TV's have to be off (if the roommate complains,) I was accused of violating the patients rights and a dignity issue, because I turned her TV off at 11pm. It didn't matter that I could show the DON that I had written on the 24 hour report sheet, several times, asking for clarification of the issue of TV's, Radio's, and Lighting at night. She has had 3 roommates in the last year and ALL 3 complained. The Social Worker was the prompter of this write up. Need I say, it was her, that should have dealt with this issue, and chose to ignore it- She's too busy! WE ARE DUE FOR STATE INSPECTION ANYDAY! ???? It used to be that people had a lot of respect for nurses. Not any more and they don't understand that we are put in these positions by the hunt for the all mightly dollar, and the cover your butt at all cost mentation. Any more the patient has the right to commit suicide as long as they do it between your 15min. checks. Just my thoughts!

Re: Warning to New Grads

Thanks for all the replies. I didn't expect to get so many or such a variety. I really appreciate all your thoughts on this issue.

To clarify, I'm not harping on anyone who works at a facility like the one I mentioned. I understand people have to make a living and they gotta do what they gotta do. But for me, personally, I did not want to risk losing my license that I spent years and thousands of $$$ on just to lose it down the line, plus I'm lucky enough to afford not having a job right now. The staff at my ex-facility was, overall, great. It was team work; we each had each others back. But when is that going to all backfire? Considering that an RN license is considered "higher" than an LPN/LVN license, I felt like I was in a very dangerous position and that any thing that could go wrong would fall on me because, even though I lack experience, my license would be weighed heavier being that I was the only RN for a 98 bed facility during that shift...

Re: Warning to New Grads

When the **** hits the fan, they don't care if you are the doctor at the facility! Somebody has got to take the fall!!! This is why I left long term care for good 4 years ago. I called the doctor from a LTC facility and identified myself and before I could tell him what the problem was, HE RUDELY STATED FOR ME NOT TO CALL HIM AND HE HUNG UP!!!! I reported this to management that night and their response was, "oh he does that". Well for me, that was NOT acceptable and they told me that they were not going to do anything about it. So when I clocked out the next morning, that was the last that they saw of my ***! I love geriatrics and the elderly but I cannot work there because I cannot sit back and watch **** like that continue to happen day after day. I returned to my agency hospital assignments and have been doing SOLELY med/surg ever since!!!!! These elderly folks need care and I go above and beyond for them WHEN they come into the hospital because with the everday situations that those folks are subjected to because mgmt doesn't give a flying u-know-what, they WILL be coming into the hospital!!!! I applaud nursing home nurses everyday for sticking around when some of us just couldn't take it anymore when it came to dealing with mgmt's neglect of these defenseless history makers!!!

Re: Warning to New Grads

OMG - I feel as if someone is writing my memoir. Put "Gizmo44" as the poster and all would fit my experience. I went through the same thing only as a new grad LPN. I got my license in Aug.08 & started PRN in LTC. I asked if it was doable for a new nurse to do PRN and was told yes. I needed a job so I took it. Training was 3 days-1 day in each unit, I got 5 days because I asked for additional time since I would be floating. It was so unorganized - took over 3 weeks mind you to get my 5 days in. My title was Charge Nurse which I thought strange because I didn't feel as if I knew enough to be in charge of anything. I should have listened to my instincts when experienced nurses were complaining about the work load. I saw so many corners get cut I couldn't believe what I was seeing. Was told this is how it is in the real world. By the time I was on my own, it was almost 2 months before I got a shift. I had nearly 40 residents of all acuity levels, had j-tubes, treatments, blood sugars/insulins, supervised meal time-including recording nutrition/fluid intake, Supervised 2 CNAs in my unit, lucky if we had a 3rd that floated, had a killer med pass-most got them crushed or floated-felt like I was doing nothing but passing meds. We had a 2 hour window to pass to everyone and I hate to admit it but I couldn't do it in that time period. Not do it to policy & procedures - then I found out hardly anyone did. The person who trained me on this unit didn't crack open the med/treatment books. Said she had everyone's meds/treatments memorized. Charted on her med pass/treatments at the the end of her shift. I never had time to assess anyone for changes, have a conversation with anyone, I barely got the required assessments in as it was. Speaking of assessments, during a training shift, I as given a stack of assessment forms that needed filled out on some of my residents. I thought, I didn't assess anyone, I can't fill this out, I don't even know anyone's name. The response I got was sure you can you saw everyone today. I said to myself this is nuts but said outloud that I did not do any assessments, don't know the people or their condition, so I would not feel comfortable charting on them.

Then, when I was at my lowest, wondering how can I do this, why is it like this, why am I so slow, I found out that it was common for people to clock out at the scheduled time and work off clock to finish their paperwork or charting. I was shocked at how wrong that was. For one thing, it puts you at risk if anything happens to you (slip/fall, etc) because Workman's comp will NOT cover anything that happens off the clock. But it was common practice among nurses because OT wasn't allowed.

Now, I did not go into nursing thinking it would be easy, on the contrary. I wanted to work hard, be challenged, help people, and learn new things. I did not want to sit behind a desk staring at a computer all day anymore. I was bored & needed a change. Through my experience I decided to achieve this the best thing would be continue to get my RN to broaden my opportunities. But due to the economy, no one wants to hire new nurses whether LPN or RN. The more I learn about this subject the more I wonder about my decision - as a result I am also looking into other areas of healthcare like surgery tech or RT. I also do not believe there is really a nursing shortage. There is, however, a shortage of nurses wanting to work so short-staffed, putting themselves & health, their patients, and licenses on the line. I bet if they took a poll of everyone who ever held a nursing license, they would find enough people to satisfy the need. Also, if they polled the people with or without a current license to find out why they weren't working in the field I bet it would be somewhere a long the lines of working conditions.

I, for one, will not accept the status quo so anyone who says suck it up & deal with it, is wrong. The thing we must remember is that residents in LTC are someone's mother/father or husband/wife or sister/brother. Would you want your's to be treated like this?

Re: Warning to New Grads

kudos to you and thanks for the advice. The fact remains that sometimes finicial desperation makes people to bite more than they can chew.

Re: Warning to New Grads

Very scary.

With this bad job market the rehabilitation centers I went are not hiring new graduates either. They are only looking for per diem experienced. How sad! On one side I think I might be lucky get a job in any place, on the other side I don't feel like going there for long term. Am also afraid got stuck in rehab if that is my first nursing job.

Re: Warning to New Grads

I just want ot remind everyone that not "all" SNF's are terrible. I am the DON of a SNF, and staff at a much higher rate than what those of you have listed. I feel blessed to have wonderful LPN's and RN's working for our facility. I have hired new grads in the past and am very clear on the challenges that they will face once hired, most stay. I would never consider letting a new hire start working on their own without at least a month of full time orientation to the floor. If it is a new grad, it may take longer, each individual is different. Myself, the ADOn and the nurse managers are always available to assist when needed, and yes, i have come in during the night and weekends. I start my day at 5:30 AM and go until 4:00PM so I can see the staff on all shifts.

Please don't give up hope on LTC, the elderly need us.

Re: Warning to New Grads

The funny part is that I graduated in 95' with a BSN, had worked as a tech for 2 years and couldn't find a job back then either-they wouldn't accept new grads! The conditions you describe aren't just at nursing homes, they are at hospitals also. I can't count all the times I've been in that same situation over the years. There are some better situations but a lot are like that. Hospitals are businesses and a business is out to make money which means less overhead. They could care less about the pt. and the workers, they just want to make money. Funny thing is, you never see the CEO running like a banschee!!!If you ever wonder why there is a shortage of nurses, this is why. I remember in 92' hearing an LPN telling me she was overworked and under payed and she was dead right. School isn't an accurate description of nursing at all-you never hear about the conditions you mentioned just the good stuff and what you see on T.V.I recently got out of nursing, started my own company and am much happier. No more threats of being written for BS, no more bedpans, no more admitting 2-3 pt's at the same time, no more MD's blaming you for something they did and writing you up, no more 12 hr. shifts turning into 13,14,15 hr. shifts. I hope you find that happiness! Good luck.