Am I setting myself up for failure?

[ijuanabhappy]

While unsuccessfully trying to find my niche in nursing over the last year, I am in between jobs and desperately need work. Basically I have only worked in a clinic since graduation last year so my skill set is phone triage and staple removing. You could really consider me a new grad.

There is a 110-bed long term nursing facility close to my home and I have been offered an RN supervisor position. The LVNs and CNAs do practically everything there including med pass. I guess this position is more for keeping staffing issues in check and making sure floor is running smooth. They said they would go over skills with me, but I hope I'm not just a warm body because they need an RN in the house. I don't want to lose my license but I need a job. Can anyone offer me any advice on this?

[diva rn, BSN, RN]

Please find out exactly what your routine shift duties are before you make your final decision.

In the LTC facility I worked in, the RN's had the title of Nurse Supervisor..but we took the same amount of patients per shift as the LPN's and did the same care. (which was 20 or so) and then as the RN you are in charge of all of that "other stuff" that you mentioned b/4...so, just make sure that you don't have to take a full load or at least know that that's what you are getting into.

Unless, you are being hired for the postion of House Supervisor? That person was the RN that did not take patients but was in charge of the entire facility. That would be rough to do if you did not have a lot of experience. The House Sup was called for everything...to pronounce death, to do hard foley's, when people fell out of bed (which was all of the time)..incident reports, call difficult families, call the doctors, (difficult and otherwise) and millions of other things.

The regular RN's job is hard enough, it's very busy. But you can do it. Just find out what it is they expect you to do. It may not be just supervision...most of the facilities here just call the RN's that--cause they technically "oversee" the LPN's but they take a full assignment.

Good luck

[nurse2it]

You should definitely get more info before you decide. In most LTC facilities, 110 pts is the norm, 30-40 is almost unheard of. You consider yourself a new grad, how can you supervise others if you don't know what their job is, most charge positions require at least a yr of experience if not more. I think you already answered your own question with the title of this post, listen to your gut.

[SpEdtacular, MSN, RN, EMT-P]

I'd be wary. The CNAs and LPNs are probably SUPPOSED to do everything (and I'm sure they do or at least try to) but what they don't do gets left for you in addition to your other responsibilities.

[joanna73, BSN, RN]

What are all of your responsibilities? Do you assess all patients and pass meds? I don't think I will have any of these responsibilities for the most part. I would be handling wound care. And while the facility is a 110 bed facility, I am not sure if I would have a section of that... surely not the whole 110 beds or there would be no way I would do it. Our interview was cut short because she had an emergency to tend to, so I need to ask more questions before I make my decision. The HR person couldn't answer my questions when making the offer because she didn't know, she is not clinical.. I'm waiting to hear back.

I am responsible for pt assessments, treatments, med pass, wound care, and whatever else arises. I work nights, so after 11 pm, its me and 1 NA. Processing Drs orders, charting, RAI assessments (MDS), NA shift schedules, replacing sick calls, supervising the evening NAs...etc. It can be hectic, but not that bad. 30 is much different from 110. As the charge RN, even if you are delegating to your LPNs, you would still ultimately be responsible to ensure the smooth operation of all these elements. If there's a code, you deal with it. That's the reality of working as a nurse anywhere. People go downhill, get sick, die. We have to try to intervene and provide comfort and life saving measures where it's warranted.

[mazy]

It would be very rare for you to have a code in LTC. Most patients are DNRs. LTC facilities are not set up to handle codes as in hospitals anyway; if a patient decompensates you would perform initial CPR, call 911 and get them out to the ER.

However you will be responsible for making the decisions when crisis issues come up. The idea of LTC is to keep patients out of the hospital, which is very traumatic and expensive for them. So if something is going on with a patient you have to be able to assess in a moment's notice and decide whether the patient needs to go out or if the issue can be treated in house. Sometimes the lines can be very blurry.

You will need very sharp assessment skills in addition to all the other nursing skills.

LPNs and CNAs may be doing a lot of the work but you need to have a very full understanding of what it is they are doing and if they are doing it correctly and where you need to look to identify problem areas and corrections. If you've never done the job that is going to be very difficult. If you are also carrying a full patient load and trying to learn that job as well you are going to have a really rough time.

I would suggest you think very carefully about questions you have and make sure you can sit down for a full interview before deciding what to do. Be wary of a facility that is hiring an RN who has no floor experience to fill a supervisory position, more often than not they just want a warm body and will not offer you a lot of support.

[sistasoul]

Hi,

Personally I would not do it. I would want to work in the facility as a staff nurse first so you could get some experience (codes, foleys, etc.). Does this facility have a skilled nursing unit? I work with a newly hired nurse at the hospital who worked on a skilled unit in LTC and she is fantastic.

I think it would be too much for a new grad. The stress level the first year as a new grad is tremendous enough without adding supervisor duties into the mix. I can't believe this place was willing to hire a new grad into a position like that. Reeks of desperation in MHO.

Best wishes in your decision

[ijuanabhappy, ASN, RN]

Well, I'm still jobless and the money is dwindling. No hospitals have called me. I tried to turn down the offer today as weekend supervisor at the LTC. They are now asking me if I would consider being Charge nurse on weekends instead and that I would get three days of orientation and lots of backup from other nurses and staff. I expressed my apprehension due to lack of experience but was assured they hire new grads and I will be shown things. The hall has 30 beds. They have someone that passes meds but nurses are in charge of treatments and meds that only nurses can give.

I would be in charge of determining if someone needs to go to the hospital or if they fall, do they stay or go. She said this is basic common sense but still makes me nervous with lack of experience. I was not an LVN or CNA prior to nursing school. Is this a lot of just "common sense" and am I overly worried? I just don't want to risk my license but at the same time I do need a job. Is there really any difference from weekend supervisor to charge nurse? Is being a new-grad charge nurse also a bad idea and risky?

[joanna73, BSN, RN]

I'm a second career nurse, and also a new grad Charge in LTC for 6 months now. Yes, it is overwhelming, but it can be done. It really depends on your facility. In this economy, I would take the job. You will learn a lot.

[nurse2it]

I understand what it's like to need a job, ask the nurse mgr if you can shadow one of the other charge nurses before you make a final decision. You never know what it's really like until you're actually on the job. On weekends, you will be doing your own job as well as picking up the slack from other departments, in most LTC facilities there is no maintenance or front office so most likely you will answer the phones, deal with plumbing and other issues and people fall constantly. They seem desperate to fill the position, kinda raises a red flag...ask the mgr what happened to the last person who held the job. Agree w/the previous post, it is overwhelming esp if you have no experience. Don't mean to be so pessimistic, just real.