Advice about job, please

[Salamanda NP, MSN, APRN, NP]

Hi all! I am a new grad (got my RN in September) who has been having a hard time with the job search like most other new grads right now. I know how lucky I am even to be working, but need some advice. I had been working part time in a pedi office for the past few months, but one day a week at wages $10/hr less than anywhere else wasn't cutting it so when I got an offer at a local LTC I took it.

I have only been working at the long term care for a couple of weeks now and I already feel sick when I even think about going in to work. My first day on the floor I was told how to do the med pass when the state is in and how to do it on an everyday basis (because otherwise I'd never finish). There are "shortcuts" left and right that I am told I have to do and I am not getting much guidance, training or support and feel like I am risking my license. I am caring for 22 patients, (some are long-term residents but most are shorter term rehab patients) and I don't even know what the primary diagnosis is for most of them! I pass out meds for hours, start treatments, then it's time for the second med pass. I can barely get that stuff done never mind dealing with family members, labs, doctors orders over the phone, admissions, codes or anything else.

I absolutely hate my job and feel as though I am giving sub-standard care - something I am absolutely not okay with. I mean I've been told to not do BP's unless specifically ordered by the Dr because there isn't enough time (and most of these pt's are on BP and cardiac meds!). The CNAs at my facility hide in residents rooms and refuse to speak English most of the time, they talk to each other while caring for the pt's and ignore the pt's. I have already had an issue with an insubordinate CNA and have been told to get used to it because they;re all like that in this facility. The nurses sometimes sign off on stuff that hasn't been done in the treatment book and will sign off on meds not given in the MAR. And I'm encouraged/expected to do the same. I did not work super hard for my license just to loose it at a job I hate!

I have an offer for a Psych hospital to work PRN, and they're telling me that I could get up to 32hrs a week every week if I want it. I wasn't crazy about psych in school and am worried about doing acute locked unit psych care, but am enticed by the fact that I probably won't be risking my license there and may end up with actually getting two days off in a row once in awhile (doen't happen in the LTC facility). I have to let them know if I am taking the job soon as orientation starts in mid-March.

Then there's the homecare job that I have had one interview for and am supposed to get a second for. I desperately want it and am ridiculously nervous about whther I have a chance at getting it. I am technically unqualified as they want experience, but a RN friend who works there had recomended me so they gave me an interview. I am anxiously awaiting this second interview and praying to get the job - it's exactly what I want to be doing right now. If this job does not come through I do not know what to do - stay at the unsafe miserable LTC or give the psych hospital a chance? I do know I am very fortunate to have gotten these opportunities and hate to complain in this economy, but I really am getting depressed at the thought of staying at the LTC. I'm starting to wonder why I even went to nursing school if I can't work in any of the fields that interest me. Maybe I should have stuck with insurance. I would appreciate any advice/insight on what to do.

[L8RRN]

I, personally, left a position after only 4 weeks due to fear of risking my license and just plain didn't agree with the way the place was ran (insurance fraud, improper documentation, unnecessary procedures, etc). I am sooooo glad I did. If you are that uncomfortable with the LTC facility, I vote leave.

School and real life work are soooo different. Perhaps you would like the psych position better. Who knows unless you try and you might just like it more because the stress that you are under now may not be there. I am working med/surg at a hospital now and actually like it but I didn't enjoy it in school. It is soooo different now from what I experienced in school, though (SAME hospital, same floor even!). :)

I hope the home health position works out, but if it doesn't, good luck in your decision. I know it isn't easy. It was really hard to walk out after only 4 weeks...but I am still so glad I did! GOOD LUCK!

[caliotter3]

Plan A-wait for answer on home health job because that is what you want. Plan B-take psych job. Plan C-Stay at LTC job, but only part time, while you see how the others turn out. Then, when you are secure in new job, LTC only oncall, if you want, until you feel ok to resign. Reason, you don't want a string of resignations, back to back, if you can help it. JMO

[Salamanda NP, MSN, APRN, NP]

Thank you both for the supportive replies. It's good to be validated and to get advice from my peers.

L8RRN - I'm sorry you had such an awful experience in LTC, but am glad that you were able to get a great job at a hospital that you're enjoying! It's good to hear that school clinical experiences aren't always indicative of what it's like in the real world. :-)I am really hoping that if the homecare doesn't work out that psych is a good fit for me.

Caliotter3- I agree that I definitely do not want a string of back-to-back resignations if I can help it. I'm hanging in there for now hoping for the home care job to work out, but if it doesn't Plan B is probably where I'm going to go. I'll have to think about staying on per diem at the LTC; I'm really uncomfortable with a lot of what's going on there and don't want to stay any longer than is necessary. I really am afraid for my license.

[caliotter3]

Unfortunately, what you describe is quite often the norm for LTC. The residents suffer for it. And good nurses leave LTC because of it. And from year to year, it continues.