Any nurses that have worked hospital AND nursing home?

Specialties Geriatric

Published

Hi,I am a middle-aged male LPN who has four years experience workinglong-term care and corrections. I currently work in home care andhospice. I am nearly finished with my associate degree in registerednursing.

I've reached a cross-roads in my career where I amcurrently under-employed and cannot find another LPN job (because themarket is saturated in my area). I've seriously considered leavingthe profession, because of what I've seen in the past four years:

1)Long-term care. The workload is setup for nurses to fail and tobe blamed for everything. But it's the system that is the problem,not the nurse. I will not work in this area.

2) Corrections. I was able to "get by" working in thisfield, but I will not work in corrections as an RN because of theridiculous workload they have to handle.

3)Hospice. I cannot findenough steady work because of nurse saturation in this area and thenature of hospice. I'm not too enthused about beating the heck outof my car as an RN case manager. I will not work rotating shifts.

4) Home care. I was surprised to discover that nurses earn about2/3 the money they can make in other areas. And your car takes anabsolute beating. You run the risk of getting robbed, because of thegritty areas you visit. My home care company "whores-up" onnurses. They do this because nurses are so plentiful in the area,like sand pebbles on the beach. The company invests very little inbenefits, which transfers expenses to the employee. Nurses are paidper visit, so the company has no incentive to keep the nurses busy. As a result nurses are sitting around at home doing nothing and notgetting paid. This is not for me.

Iwas wondering how the RN workload compares in a hospital vs. nursinghome vs. clinic setting. When I began nursing, I had no idea therewere so many "crummy" jobs in nursing. So I call on fellownurses to enlighten me on the work load in other areas of nursing. My question is, "Why continue in nursing just to find new areas notto work in?"

Anotherproblem: ADN educated RN's are considered only half a nurse by BSNeducated RN's. When do you say "enough is enough!".

Hey Manch---I started out as an ADN nurse but continued to work on my BSN and finished very early in my career. Back then LPNs were actually in the specialty units and very respected. Now it seems they can only find work in the MD office or LTC environments. I have done home health, acute nursing, LTC with emphasis on sub-acute. The patient load in LTC is unrealistic and yes, the nurses do get blamed for everything. Plus with all the cuts in Medicare/Medicaid the LTC environment is under fire like never before. In the acute care environment it really depends on where you work, but I work on a telemetry floor which usually has a 7:1 pt to nurse ratio, most ICU have 2-3:1, med-surg floor can be 8-10:1 depending on the size of the med-surg unit. Usually assignments are based on census not on acuity levels of pts. So, you can have 3 pts who are more unstable and because you are not taking care of 7 patients you can receive admissions etc. during your care of three unstable pts. It depends on the facility and the policy and procedures of that facility. The major difference between acute and LTC is that in acute care there is more proactive

interventions to be taken, in LTC it is almost borderline neglect as usually no one intervenes when an elderly person has an issue due to their chronic health diagnosis, and families are usually not aware unless there is some accident where the resident has fallen etc. Very different environments, acute care is paced much faster with a quicker turn around. Not sure if this supplies the answers you are looking for. Most acute facilities are looking for BSN graduates, it seems a lot of new grads have been having difficulty finding work these last few years. It really depends on where you are located and what the demand is in that area. Most new grads do not start out in the home health environment because a solid foundation is needed and usually you are totally on your own making decisions for follow-ups etc.

Thanks for the info. When you mention that new grads are having trouble finding work, do you mean BSN or ADN prepared students, or both?

Hi,I am a middle-aged male LPN who has four years experience workinglong-term care and corrections. I currently work in home care andhospice. I am nearly finished with my associate degree in registerednursing. I've reached a cross-roads in my career where I amcurrently under-employed and cannot find another LPN job (because themarket is saturated in my area). I've seriously considered leavingthe profession, because of what I've seen in the past four years:

1)Long-term care. The workload is setup for nurses to fail and tobe blamed for everything. But it's the system that is the problem,not the nurse. I will not work in this area.

2) Corrections. I was able to "get by" working in thisfield, but I will not work in corrections as an RN because of theridiculous workload they have to handle.

3)Hospice. I cannot findenough steady work because of nurse saturation in this area and thenature of hospice. I'm not too enthused about beating the heck outof my car as an RN case manager. I will not work rotating shifts.

4) Home care. I was surprised to discover that nurses earn about2/3 the money they can make in other areas. And your car takes anabsolute beating. You run the risk of getting robbed, because of thegritty areas you visit. My home care company "whores-up" onnurses. They do this because nurses are so plentiful in the area,like sand pebbles on the beach. The company invests very little inbenefits, which transfers expenses to the employee. Nurses are paidper visit, so the company has no incentive to keep the nurses busy. As result nurses are sitting around at home doing nothing and notgetting paid. This is not for me.

Iwas wondering how the RN workload compares in a hospital vs. nursinghome vs. clinic setting.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I've worked both and I find them comparable, work-load-wise. A well-run LTC is a bit less stressful than a busy med-surg unit. A poorly-run one is an absolute nightmare. Hospitals tend to have spiffier stuff to streamline your work: computers with barcoding, pyxis machines, PCAs, etc. When I left my hospital job and picked up some LTC agency shifts, I felt like I had gone back in time. Manual narc counts, rolling a cart around, etc.

Of course some hospitals are better staffed than others. And you'll have to work your way up the food chain to get day shift. You'll have to work every other weekend and most holidays. But the pay and benefits are the best, especially if you have a union.

Good luck to you!

Specializes in ER, Trauma, Med-Surg/Tele, LTC.

I've worked in LTC and Med-Surg/Tele at an LTACH as both an LVN and RN. In LTC I've had up to 45 patients on a med cart as a charge nurse on both 7-3 and 3-11 shifts. There's really no difference in the work flow at an LTACH Med-Surg unit and a standard acute hospital. We are still considered acute care and are subject to the same ratios as standard acute care hospitals in California. Our patients are typically more complicated than standard hospital Med-Surg patients (i.e. multiple comorbidities, vents, central lines, etc. walking, talking, independent patients are rare), but because we do not have an ER, we are not subject to the constant admissions and discharges that hospital Med-Surg nurses are. Just wanted to explain my background before answering your question.

I agree with previous poster that workload wise, they can be comparable. In Med-Surg I still find myself to be just as busy and still feel as I do not get enough time to provide the best care for my patients as in LTC. However, it feels a lot easier than LTC because of the amount of support available at all times. Even during night shift, at least there is an in-house MD when something absolutely needs to be done. In LTC it is all on the shoulders of the nurses all the time. Hospital nurses don't understand that these "stable" patients aren't really that stable and that their sheer volume is overwhelming. LTC nurses don't understand that despite hospital nurses "only" having five patients, these patients have a lot going on for each of them -- new orders come in throughout the day as multiple MDs do their rounds and there's usually a lot of preparation needed for a patient going for a procedure. It's absolutely true what Nurse_ said here on all nurses in a different thread that "Everything in nursing is a balancing act you just have to decide on which rodeo you want to be in."

Thanks for the info, much appreciated. I've worked at poorly run LTC facilities that have been nightmarish experiences. I did not know a well run LTC facility even existed.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I worked long-term care on and off for six years. Now I have been working in a freestanding acute rehabilitation hospital for the past few years.

I somewhat prefer the long-term care setting because it's less acute and I'm not charged with making snap decisions. I'm a queen of routine and knowing what I am going to walk into, and that's not possible in the hospital setting.

Specializes in Cardiac, ER, Pediatrics, Corrections.

I think a positive of LTC is they become like family. You get to know your patients, their needs, their personalities. You can get into a routine as Commuter said above.

Specializes in hospice, HH, LTC, ER,OR.

There are pros and cons to every situation you have mention. I was an LPN and I worked in LTC for 2.5 years, then I move to hospice for 3 years and homehealth for 2.5 years. Yes, while working LTC the patient load is mainly stable but unmanageable without cutting corners. Hospice and homehealth you do run up a lot of miles on your car and are sent to bad neighborhoods. I also made the most money with those 2 jobs. I was able to pay for my LPN-RN bridge and my RN-BSN program. Now that I work in the ER at the hospital as an RN, I never know what I am walking into. Its always someone becoming unstable. I am going home tired, beatdown and making way less money as I did as an LPN in hospice and home health. You can still get blamed because everything is so fast paced and so tense. I am trying to find a way to the OR. Good Luck to you.

Specializes in hospice.

1)Long-term care. The workload is setup for nurses to fail and tobe blamed for everything. But it's the system that is the problem,not the nurse. I will not work in this area.

Hallelujah! You have no idea how it thrills me to see this said by someone other then myself. I was starting to think that I'm the only person on earth who sees it this way.

I see my co-workers, the ones who work the units with the ridiculous patient loads (my facility has a pretty wide range) and I want to ask them, "Why do you do this? If you do it, management will assume that every one can do it. You are letting them exploit you. The only reward you will every get for enduring this ridiculous workload is more work!!!!"

Sometimes when we are short, one nurse ends up taking two units. How do they do it? I know that I would have to cut tons of corners to handle the workload that some of my co-workers deal with on a daily basis. I don't see how they get through unless they are giving all meds at once and fudging treatments and refusing to even say "Hello" to the clients.

That's not nursing to me. That's not why I became a nurse. I'm watching this topic with interest, because I, too, would like to find a work environment that will allow me to actually put my schooling to good use.

I'm also on the boat that doesn't see what there is to like about working in LTC if the standard is high patient-nurse ratios and generally poor working conditions. I recently was scheduled to work the night shift LTC unit with 50-60 patients and with no orientation. I almost had a meltdown. It just felt inhumane, having to pass medication to that many patients along with any samples that had to be collected, bed alarms going off, residents with feeding tubes, chart checks,pain med requests, figuring out where to get supplies...If a nurse has to work under such conditions, how can it be possible to provide good, compassionate, safe nursing care? I just don't see it. It made me very angry. It made me feel like what I do doesn't really matter. Like the residents don't really matter. It makes me feel sick thinking about it.

I usually work the subacute and have up to 17 patients. I'm able to handle it although there are nights that have been crazy and unsafe. I've realized the dangers of putting a relative in a nursing home permanently. If it's subacute, it seems reasonable enough though, but can still be unsafe at times depending on the facility.

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