advice on changing jobs

[8781RN]

Hello,

I need some advice on a decision I need to make. I will try to make this short. First here's my background:

I've been a nurse for 8 years. I have been away from the hospital setting for about 3 years. I remember the dread at the start of my shift just wishing I could find an 8-5 job. I was disgruntled, I knew I wasn't getting paid well. Also I had a newborn so I wanted different hours. So I left and did 2 years as an RN Case Manager in a Supported Living Facility for disabled individuals. I didn't like the lack of structure and the attitude towards nurses was awful. I left and became a Coumadin Nurse for 1 year. That was really cool but as our clinic grew they wouldn't get me help, I had 270 patients! So I left. My previous boss where I worked at the Supported Living Center offered me the job I have now. It's hard to explain what I do. I work with mentally/physically disabled individuals (love my patients by the way). I have several patients whose care I oversee on group homes, and another handful in foster care, and some live on their own. It's very unstructured. No offense to my boss she came in and started trying to make things better but she doesn't even know what we are supposed to be doing. She's called the State Board to get clarification on things and they keep referring her back to the website. I have 50 plus people on my caseload and I haven't seen them all. So it's a liability and I don't like not knowing what the State Board of nursing requires of us. It's 8-5 and on call once a month. One nurse left and they decided not to refill her position. So I panicked and looked for a job elsewhere and got one! I haven't told my boss yet, i'm going to give her two weeks notice so I have a week to tell her. The thing is, NOW after I've accepted a new position, my current job is now going to fill the nurses position that's leaving with an LVN so that's good. They are going to hire on-call people so we won't have to be on call. So things are looking up. Although I don't trust that the positive changes will stick. SO HERE IS MY CURRENT DILEMMA I NEED ADVICE ON:

The new job I accepted is at a Specialty Hospital, it's med-surg LTAC. It's only 3 12 hour shifts a week. (I chose this floor because there's not a revolving door of admits and discharges). I know at heart i'm a hospital nurse. It's what I'm used to and everything you need is right there (most of the time). In these 8-5 jobs that I once longed for, i've always ran into the same problem, LACK of structure and not always having the means to do the job, IF i was lucky to know what my job was. So maybe I needed to do all of that to realize I need to be in the hospital? I dunno BUT I'M SCARED!!!! I've forgotten so many things. I'm going to read, practice my med calculations, and ask lots of questions but i'm still scared. I've had patients crash on me before but i've never been in a code. This place has codes, the patients are sick. I'm afraid I will forget what I need to do. I think the pay is going to be good for what I'm doing but it will be about 270$ a month less than what I get now. So i'm having second thoughts!! The fear of all of this, and the possible changes they are going to make at my current job are making me think about staying.

Do I take this big risk and go back to the hospital and get paid less but POSSIBLY be happier? Or do I stick with my current job, get paid more, get weekends/holidays off, and just HOPE that they stick to their guns with these positive changes? (even still I don't know how much better it will be).

Any advice?

[Been there,done that, ASN, RN]

LTAC is not hospital nursing. It's the sickest of the sick with no where else to go.

I pulled a few shifts in one ( sounds exactly like your description). It was the worst experience in my 30 years of nursing.

Seven patients,two on ventilators. Everyone on tube feedings and crushed meds. THIRTY dressings , mostly for decubs that had started there.. because nobody had time to turn these people. Help from a CNA that had 15 patients.

Dispense your meds from a Pyxus... just pulling the meds took an hour. Unbelievably lengthy documentation .

I get the creeps whenever I drive by the place.

Have you spent time observing a shift there?

[8781RN]

No I haven't. I do understand they are very complex patients. The nurse to patient ratio is 1:6 there. The LTAC hospital has an ICU, a Step-down unit, and a med surg floor. They have a Mon-Fri wound care nurse and a 24 hr. RT.....

[Patchouli]

ICU pt's on vents are typically sedated, only there for a short time, and you get a 1:2 ratio. Stepdown a little less critical, but typically a 1:4 ratio. You can get LTACH pt's on the stepdown unit when they leave the ICU. They are usually the most demanding, and the sickest. LTACH pt's are the ones requiring the most work. Constant turns, clean ups, TF, wnd care, never ending call lights, etc. Do you get any techs in this LTACH, because you're going to need them! I would often take them on my Stepdown unit because I had ICU experience, but let me tell you, they can really be challenging. Both physically and emotionally. Often the families of these poor pts are the ones that keep them going, full code and all. I can tell you a great portion of them do not want to live like they do.

[Patchouli]

IMHO, if you really want a hospital gig, go into med surg. If you want something a bit more challenging start out on a Tele floor. I would stay far, far away from an LTACH. If they offer techs, that may be better, but if not, no way with 1:6 ratio!

[8781RN]

Yes they have aides. Well I didn't go for regular med surg because I always hated starting out with 6 pt.'s, discharging them all, then getting 6 more. I used to do Cardiac Acute care but we had the same discharge admit rate (it wasn't strictly cardiac patients) and constantly had post Cath pt.'s with sheaths still in place or those worthless closure devices, etc. This med surg floor I'm going to has some Tele pt.s....I don't know maybe I'm way over my head and should call them back and let them know I've changed my mind.

[8781RN]

I learned some more about the unit i'm going to. It does truly sound like a med-surg LTAC. It is a specialty hospital, the vents and the critical things will of course be on ICU, then there is a step down. They don't even do Cardiac gtts on the med surg, they send them to the step down for closer monitoring. So yes they will be more complex med-surg pt.'s but it's not 6 critical patients.....

[Patchouli]

That sounds better than the LTACs I'm accustomed to. Is there a way for you to tour the floor for a few hours, and maybe ask the staff questions?

[Esme12, ASN, BSN, RN]

I learned some more about the unit i'm going to. It does truly sound like a med-surg LTAC. It is a specialty hospital, the vents and the critical things will of course be on ICU, then there is a step down. They don't even do Cardiac gtts on the med surg, they send them to the step down for closer monitoring. So yes they will be more complex med-surg pt.'s but it's not 6 critical patients.....

I wish I read this first...I answered your other post now it isn't that accurate...LOL

There are scary LTACH companies out there. Contrary to popular belief they are licensed ACUTE CARE facilities. You will work hard. I'm not going to lie. You are correct you will not be discharging and admitting like you do in a short term hospital. I will say that there is usually more CNA's for the LTACH 6 patients than in a hospital but it will be challenging.

LTACH's are going to be the future. Most of them are willing to train. If you are looking to get back into a hospital then get your skills down here...maybe move into their ICU then you can transition into the short term acute care.

I wouldn't be do quick to not accept the position...the other one seems to be...worse.