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Any nurses work ER and LTC in the past?

Posted

Specializes in ER. Has 3 years experience.

This is a long shot...but I'm wondering if anyone has worked both ER and LTC. I am currently an ER nurse and considering some per diem nursing at a LTC facility. I'd be charge nurse. I'm a little bit scared and wondering if I can even do it! I know that sounds crazy but all I know is ER nursing. I'm nervous to switch to a whole new world with an MD right there. Any input appreciated!

vapn

Specializes in LTC,ALF,Hospice, Home Health, Correction. Has 5 years experience.

It is a different world, but if you know your med-surg and are familiar with basic gerontology, then you should be fine. Take a leap, LTC has its rewards.

PAERRN20

Specializes in ER. Has 3 years experience.

It is a different world, but if you know your med-surg and are familiar with basic gerontology, then you should be fine. Take a leap, LTC has its rewards.

Never have worked med/surg but we get a large number of patients that are residents at local LTCs.

JB2007, ASN, RN

Specializes in LTC, Med-SURG,STICU. Has 5 years experience.

At the facility that you are going to what do they mean by charge nurse? The LTC facility that I am currently at the "charge nurse" passes the meds to all 30 or so residents on their hall and also does all of the txs on her res too. The charge nurse also calls the MD with any changes, takes new orders, basically in charge of their hall.

PAERRN20

Specializes in ER. Has 3 years experience.

At the facility that you are going to what do they mean by charge nurse? The LTC facility that I am currently at the "charge nurse" passes the meds to all 30 or so residents on their hall and also does all of the txs on her res too. The charge nurse also calls the MD with any changes, takes new orders, basically in charge of their hall.

Charge nurse would not pass meds...rather RN supervisor for the small (less than 100 beds) facility. I'd call the MD, do paperwork, all IVs, etc.

JB2007, ASN, RN

Specializes in LTC, Med-SURG,STICU. Has 5 years experience.

Oh then you will be fine. I went from a tele unit to LTC charge nurse (in my facility=work them until they fall over dead from too much work nurse) and I did fine. It took sometime to get use to the differences of acute vs LTC, but if you managed the stress of ER you will be fine.

LTC has it own stressers. You are most like use to the crazy family members who expect a miracle and make impossible demands. Personally that is the biggest stressor in my job.

As far as the MD not being right there, if in doubt ship them out. Unless the POA says differently. That is another thing running EVERYTHING by the POA before it is done. Drives me nuts. I am a get in there and get it done kind of gal and LTC can be very tedious for those of us that just wants to take care of the problem and move on.

Good luck in the wonderful world of LTC.

If you dont mind having your license cover 60+ residents then GO for it! Take my advice... stay where you are! I am a "new" graduate and the only job offered to me was a charge nurse in LTC. Yes a new graduate who had 60 patients under her belt. How did it feel?? AWFUL! I resigned after 5 months and of course I am jobless because I am STILL A NEW GRAD. If you go to LTC you cannot transition back into acute care (usually) They think LTC nurses have bad habits. STAY WHERE YOU ARE OR GO TO A SCHOOL!

JB2007, ASN, RN

Specializes in LTC, Med-SURG,STICU. Has 5 years experience.

If you dont mind having your license cover 60+ residents then GO for it! Take my advice... stay where you are! I am a "new" graduate and the only job offered to me was a charge nurse in LTC. Yes a new graduate who had 60 patients under her belt. How did it feel?? AWFUL! I resigned after 5 months and of course I am jobless because I am STILL A NEW GRAD. If you go to LTC you cannot transition back into acute care (usually) They think LTC nurses have bad habits. STAY WHERE YOU ARE OR GO TO A SCHOOL!

You are wrong. I recently started back at a hospital. You can go back to the hospital. Yes some nurse do have something against LTC nurse, but they do not know what they are talking about. They are usually making a generalized assumption based on a few LTC nurses that do have bad habits. However, you will find nurses with bad habits no matter what area of nursing you go into, just be sure that you do not pick up their bad habits.

Trust me since going back to the hospital I have seen some nurses that have worked in the acute care setting their entire career do somethings that I as a LTC nurse KNOW is wrong. You will have nurses that do not care if they are doing a good job or not anywhere you go.

Iam an old RN- med/surg/ tele and some ICU. I tried LTC. I loved LTC, I loved the elderly- dementia and all. I tried the 30 pt's med cart, care plan thing and the nursing supervisor thing. But LTC didn't like me. I don't want to offend anyone but LTC is run by the LPN's- unlike the hospital enviornment, very few hospitals have LPN's anymore and the LPN's let you not forget that. We(staff Rn's ) had nothing to do with that but it is taken out on you in LTC. They resent the RN- we are now there to take over that domain. You are ER- high energy, deal with the issue and move on- that may get in the way also. It can be frustrating w/ not having things at your finger tips, time runs much slower in LTC but I was still able to use my med/surg skills. Which is why I liked it. Remember too, think about how acutely ill pt's are being discharged today- they end up in LTC- so LTC's acutity has stepped up to the old med/surg units of 10-15yrs ago, especially if the facility has a sub acute unit( that's an old fashion med/surg unit) As supervisor I would be called nightly to hang IV antibiotics, TPN, flush PICC lines because the LPN's can't. The LPN's resent that and if you know some of the standard equipment we are used to dealing with in the hospital IV pumps, CPM machines, wound vacs- look out you are really in for it. They become threatened- it's all about feeling threatened! I came across LPN's who didn't know some of the meds they were giving- real example AVelox vs. Avenox and transcribed the wrong drug off the order sheet. The pt was an MS patient did not need an antibiotic. As nursing supervisor, I had to double check the orders on new admits and the transcription of them. An other insident- a resident's daughter was irrate at the nurse, I was called to 'speak' to this daughter! The daughter just wanted to know why mom was on Iron pills- mom was post ortho surgery. When the nurse was asked why by the dgter, the nurse became flustered because she didn't know. All in all- enough war stories, LTC is a nice place because of the resident's- I can not say I found any of the families unreasonable, demanding, picky yes but no more so than the hospital, if anything easier to deal with. For me, it was the staff- Not the CNA's . CNA's in LTC are the hardest working CNA you will ever work with, and if they like you, they will do anything for you. Most Nurse Manager's were ok, now the DON's there's another story. I would get phone calls @ 9:30 Pm from this one DON's husband looking for Miss twinkle toes, she left @ 5PM.!! She was best buddies with the female Administrator- the 2 of them went way back, old work buddies in another state and another facility. Administrator had lost her nursing license.HUMMMM!! I did some agency in LTC as supervisor and would here the gossip in one facilty how after 15 yrs, the night sup left, I would go to a different facility 3 nights later and guess who the new RN was. I also heard LTC nursing management travels in packs(pairs). One will leave one facility, get a new job and then bring in her buddy. LTC is a RN revolving door. This is the part of LTC I don't like- the last thing demented elderly need is instability (in staff), at least that is what the Superior court judge told my sister and I when we went for guardianship of my 83 yr old demented mother. My sister and I were going to share taking care of her- she would be with me on my days off and with my sister on her days off. Judge said No, one home for mom. I guess it's all in who you are!! DON, Administrators it's ok: family it's not. JMO

OttawaRPN

Specializes in acute care med/surg, LTC, orthopedics. Has 5 years experience.

Wow, ER to LTC... talk about opposite ends of the spectrum. I can't help thinking you'd be bored, unless a downshift in pace and relinquishing all decision making powers to management, is what you're looking for.

PAERRN20

Specializes in ER. Has 3 years experience.

Wow, ER to LTC... talk about opposite ends of the spectrum. I can't help thinking you'd be bored, unless a downshift in pace and relinquishing all decision making powers to management, is what you're looking for.

I'm looking for a downshift in pace. I am sick of the drug seekers, the drunks, and I am tired of the violence.

himilayaneyes

Specializes in Critical Care/Coronary Care Unit,.

If you enjoy ER nursing, chances are that you'll be bored in LTC. However, you won't know until you try. My sister is a LPN and she also tells me that SNFs are run by the LPNs. If you don't mind being responsible for all of those patients b/c you're the RN at the end of the day, then go for it. You may want to consider picking up a per-diem job in the ICU or a tele floor, unless you just want to leave acute care as far as a 2nd job. And there's always home health. Good luck.

JenniferSews

Specializes in Professional Development Specialist.

I agree with many others. I work subacute and my patients are as or more acute than my clinical patients in med surg! A big part of the family issue is that often their loved one when from ICU to a day or two on the floor to the subacute unit. Meaning they went from 1-1 or 1-2 patient ratio to a day or so of 1-5 or 1-6 ratio to 1 to 15 in the space of days! Many cannot grasp why their nurse simply cannot give them the individualized attention they received in the hospital. 15 patients in an 8 hour shift leaves less than 30 mins per patient, including 4 med passes. They feel abandoned and neglected, and both the patients and families will drive you NUTS trying to carve our a little more than those 30 minutes. But if you give that, then someone else is getting shortchanged or you are staying late. As charge, you may end up dealing with those families. IME though, you have more time to deal with them and make them happy. It has it's rewards, but it's not easy.

I am a charge LPN in a SNF. Each floor has 21 patients, 2 CNA's. I am in charge of 21 patients meds and treatments and everything in between. I am also in charge of the 2 CNA's on my floor. For each shift there is one RN that is the supervisor for all the floors, there are four floors in my facility, they are the person you call if a patients condition changes, they notify the families and Dr's. They are also the ones who fill out the paper work if there happens to be a fall, and they do head to toe assesments if there is a fall or change in patient condition. It's a chain of command sort of thing. The RN's are in charge of all the patients on each floor, the LPN's, CNA's. The LPN's are in charge of the patients and CNA's on their floor. The CNA's do the ADL's for the patients on their floor and report back to the LPN's on any changes in the resident, the LPN's then report to the RN's. While in school I did alot of clinical's in hospital's and some in the ER. I enjoyed the med-surg hospital units, and once I finish my RN schooling thats where I'll hopfully go. Or maybe the ER because I work well in a fast paced enviroments. Good luck in what ever you do. SNF can be draining, it's alot of repetition.

CoffeeRTC, BSN, RN

Has 25 years experience.

Ugh...lets not do another LPN VS RN thing.

Head over to the LTC threads and browse thru them. I think there was a thread about this excact same question.

Remember that no two places are the exact same. LPNs dont "run" our place or any that I've worked in. They do play a valuable role in the nursing care tho.

Being the supervisor might be a nice change of pace (slower at most times) but you will have tons of opportunity to pitch in and get busy.

PAERRN20

Specializes in ER. Has 3 years experience.

Thanks for all the advice!

agldragonRN

Specializes in Wound Care, LTC, Sub-Acute, Vents. Has 5 years experience.

this is a long shot...but i'm wondering if anyone has worked both er and ltc. i am currently an er nurse and considering some per diem nursing at a ltc facility. i'd be charge nurse. i'm a little bit scared and wondering if i can even do it! i know that sounds crazy but all i know is er nursing. i'm nervous to switch to a whole new world with an md right there. any input appreciated!

good luck with the new experience. ltc can be overwhelming for you as well even if it's "slow" pace. since you will be the rn supervisor, your experience will be different compare to the staff floor nurse. my 3-11 rn supervisor has rarely help me with anything. i almost do everything for my 25 patients e.g. calling mds, doing admission including initial assessments, filling out the incident reports, etc... as an lpn. i guess your job description will be thoroughly explain to you. i agree with the poster who said some lpns not all will resent you because you are the rn. heck, as soon as i became an rn and was trying to help an lpn with something, i get this "oh just because you're an rn now doesn't mean...yada..yada...".

on the other note, i recently applied to a couple of er jobs i've seen in the classifieds. i want to try hospital nursing.

good luck,

angel, rn

We need to stop with the RN LPN thing! My first job was in LTC and the LPN's showed me how to be an nurse! They were awesome its just being in charge of 60 patients was NOT awesome!