Already Burned out.....heading to LTC

TheCommuter, BSN, RN · Aug 3, 2006

I love my job at a local upscale nursing home. The pace is realistic and I do not foresee much burnout in the near future. However, some LTCFs are quite understaffed and understocked, which leads to low morale and high employee turnover rates. Carefully research your new place of employment.

I love working with the geriatric patients. They helped build this country and bring human life into this world, so their contributions should be respected and dignity upheld.

Good luck to you!

Captain America · Aug 3, 2006

More power to you. I've worked at a local acute care hospital for years and I don't regret working at a nursing home anyday. LTC's are more laid back, but then again, not having supplies and staffing sucks in LTC.

[EVIL][/EVIL]

catlady, BSN, RN · Aug 3, 2006

I've been out of nursing for a while due to medical reasons and have returned to what is worse than when I left. Units are merged, the CNA's are gone and everyone is running with thier heads cut off and nursing seems to be conveyer belt style. The patients are in and out so fast and those that stay if you can get a bath in, your lucky. It's pressure all the time on most days. I'm no spring chicken and its hard.
I have an opportunity to work at a nice nursing home, the interview went smooth and I feel so like a ton of bricks have been lifted. The CNA's do all patient care, LVN's do wound care.
I have a feeling I will be making some nice friends too, the patients. Anyone have any input or insight? I'd like to hear. Kit

Yeah, don't fool yourself that the CNAs do all the patient care and the LPNs do all the wound care. If you think that, you're either dreaming or you're in the world's best SNF. Some days it is like working a med-surg unit except you have 20-60 patients. In the building I just left, the nurses routinely stayed over 2-3 hours every day and still never got caught up. The families are all now "empowered," so they are in your face every day about everything. The paperwork requirements are overwhelming, due to the intense regulation of LTC.

Sorry to sound so bitter but I'll never work in LTC again. I really do hope your experience is better than my experiences have been.

Antikigirl, ASN, RN · Aug 3, 2006

Some things to look out for before taking on the job!

I worked in an ALF that was more LTC than anything...the CNA's did med pass and simple treatments and all ADL. The RN's and LPN's did injections, complex dressings, and the never ending pile of Dr. Orders, MAR's, Office visits, contacting family...all the office duties you can imagine, and that is when you got a break from being called to rooms for everything under the sun (our pts loved having a nurse handy and believe me some found anything to complain about just to use that service!).

So what I would look for, and what snuck up on me after employement were the following:

1. Only one RN per shift, 150 residents!!!! Even with CNA's doing much of the work...that was still too much!

2. CNA training and once you did the training you were still held responsible for the CNA's whether you trained them, or if they were even on your shift!!!! That opened me up to liablity for people I had not even met or talked to!!!!!!

3. RN's were purposely fitted for PT slots so no benifits or raises needed to be given! They would get you to 36-37 hours...and they considered 40 hours full time!

4. Administration had no concerns about nursing issues, and would take in folks without an RN consult...many a misplaced person was let in!

5. We became baby sitters for all CNA's! (they didn't need a babysitter!!!). If we saw an error or found out about one, if we didn't report it...we were found as guilty as the one doing it...constant threats towards all of us!

6. Nurses were NOT respected, and were basically told to keep our mouths shut and just do our jobs! Ideas for improvement were rejected immediately without even being read or discussed!

7. Mandatory inservices twice monthly that we would have to find the time to do...typically it had to be done on your own time, and your own dime!!!!

8. Lunches were not paid for, even though you were on duty and told to stay on campus in case of an emergency..which included if a family wanted to talk to you!!!!

9. We had to purchase our own uniforms, which could not be scrubs since CNA's wore those...and we had to search for white vests that were hard to find, and the ones we did find were cheep and fell apart after a few washings!

10. General moral was horrible, so gossip and complaining was the name of the game 24/7! That ranks on your nerves!!!!!!

11. Since I was RN I was basically there for a signature to make things right for state! They tried having me sign things that I hadn't read, and got mad when I read them or declined! Theatened me if I didn't...and basically I was like "go for it! Give me a reason not to come in!".

Just think about these kind of things before accepting the job...these things can sneek up on you, and really make you miserable. I didn't get to do bedside nursing or even get to know my residents like I thought...I was far too busy doing all the paperwork, disipline, scheduling, CME, and responding to many a call for a 'new bruise' issue that was about 1 hour of paperwork each incident!!!!

CyndieRN2007 · Aug 3, 2006

Great post Triage RN. Do your homework before accepting the job. Also talk to some of the nurses there and ask them their likes and dislikes.

Furoffire · Aug 4, 2006

Thanks for all your honest input. Funny today, the very things I have just read, its like that 6th sense but I started thinking much of what you all mentioned.

I think 4 patients are a handful, but reading the above puts things into perspective and the wealth of supplies and food we have at the acute center I am in + the benefits are the best.

At the LTC the DON was never available, I got interviewed by her assistant that that little info regarding ratios, benefits etc. It just sounded all too good.

Pray that I go down the right path. Kit :smackingf I'll take any more doses of reality.

LoriAlabamaRN · Aug 4, 2006

Personally, I love my job. I work night shift at a wonderful LTC. Yes, I am the only RN with 165 residents, but the LPNs do the med passes and treatments, and the CNAs do basic care so I am here for emergencies and to handle staffing issues, as well as to supervise. It's a lot of work and responsibility, but I love the residents. I love getting to know them and their families. If you honestly want to get to know the people you take care of, and to be there for them through the end, you will enjoy the job. It just takes compassion and patience. I wouldn't work anywhere else.

weetziebat · Aug 4, 2006

Sorry to throw cold water on your dream job, but don't beleive a word they say. LTC facilities can be great. I know they do exist, but they are very few and far between.

More realistically, you'll be the only R.N. with maybe an LPN to do dressing changes and such. She will no doubt be swamped with work. The CNA's are a whole other subject - some are truly angels of mercy, who know a lot, care about their jobs and the residents, and will be a wonderful help. In my experience though, many of them are lazy (I admit, their jobs are dirty, hard, back-breaking labor with usually far too many patients per CNA) but they disappear, take untold 'smoke breaks' and are never around when you need them. Or roll their eyes, and give you 'that attitude'.

Just check it out REAL carefully. Who is responsible for answering the phone that rings non-stop? Who is the one responsible for calling, faxing and talking with the doctors when you finally do get ahold of them? Are you expected to run down a hundred foot hall because you are the only one who is allowed to take doctor's orders? Will you be expected to come in to work as a CNA if they are short-staffed? What happens if your releif nurse doesn't show up - are you expected to pull a double?

I've found they will promise you the sun, moon and stars and then conveniently forget they ever told you that. Get everything in writind.

Don't forget dealing with the families, who can tie up a considerable part of your time. Do you get to do 'tours' when the appropriate staff member is not around? When I worked LTC, getting a break was next to impossible. I used to go out in my car, after letting folks know I'm right outside the door in case of an emergency. Forget it - instead of getting 1/2 hour of peace, they were out there nightly, banging on my windows to tell my someone had scraped their elbow, or whatever - and I was expected to drop everything and take care of the abrasion - despite the fact that it was superficial and the treatment nurse was sitting there.

Never say never, but I highly doubt I will ever be tempted to go to work in a LTC facility. Also check out the staff turnover. If you find staff staying there 10, 15, 20 years, and out of hearing of others, they tell you they love their job and get great support from management, that is a very good sign. I rarely encounter that.