Changing jobs

[DoloresC14, ASN]

Hi all! I’m new here and need a bit of advice. I’m an LPN, have been for 7 years. Prior, I was a CNA for 14 years, and 99% of my experience is in LTC. I am applying to a bridge program in the fall and fingers crossed I get in. 
So, I am very discouraged, burnt out on LTC as it seems that the focus is more on star ratings and not what is in the best interest of the resident. CMS is in control and makes blanket requirements and regulations that are couched in “resident safety” but do the complete opposite. Prime example is that a 90 year old dementia patient has the “right to fall” and we have very limited tools to keep it from happening. I can go on but the point is that I want out.
Hospitals in my area are hiring LPNs again and I had an interview yesterday for a med-surg unit. I have a good feeling about it but I am very nervous about switching to acute care. While LTC residents are sicker and I am no stranger to IVs, PICCs and wound vacs, there is so much that I don’t know or have forgotten. I’m afraid that I will miss something or look like an utter idiot when I am on the floor with experienced nurses. I know where I am weak and plan to brush up on those areas but as a whole I am very insecure. Any advice? Thanks!

[JBMmom, MSN, NP]

When I started out in acute care nursing, it was after 4 years as a nurse in long-term care. You are comparing very different atmospheres but I found that my LTC background was invaluable to me in the transition to a hospital position. The benefits that I found to a background in LTC were as follows: First, time management was a key. While I had not yet had patients with the same general acuity in LTC, I could get through two medication passes and a treatment pass for 30 residents in an eight hour shift. While not all residents needed something on each pass, there were about 15-20 patients that required something each time, and that was in addition to getting pulled in to assist with patient care activities because we were almost always short staffed on techs. That was very helpful when approaching a 7-8 patient night shift patient assignment. Second, in the LTC facility on nights there were even more limited resources than in the hospital. My aides were key in helping to identify patients that needed more assessment, and I needed to use my assessment skills to determine whether a call to charge and the covering provider was sufficient, or the patient needed a trip to the ED. Also, I learned out to build relationships with my CNAs and fellow nurses, with all the attitudes and issues that go with dealing with coworkers. 

Many people look at LTC nursing as babysitting, and I have seen so many threads about nurses fearing they will lose their skill set in LTC. Not true! Now I work in the ICU with all the bells, whistles, monitors and resources I should need at my disposable. But, if I couldn't assess a patient properly, a lot of that fancy stuff couldn't make me a strong nurse. 

You can learn the task portion of nursing in the hospital, how to hang medications and blood, the interventions that will be appropriate for patients with that acuity. Don't downplay the strong background you have after working in the challenging work environment of LTC. Good luck with your job search!

[Jedrnurse, BSN, RN]

If you weren't nervous, I'd be worried- it's only natural!

Don't let that temporary emotion control your long term goals...

[DoloresC14, ASN]

Thanks! I was at my 1st facility for 5 years, the last 3 as Unit Manager, a position I got after only 2 years as a nurse. Currently, I work Fri-Sun 7a-7p and talk about no resources or staff on the weekends! I am very comfortable with managing a resident load with a heavy med pass and developing rapport with other staff and providers. I know there are the so-called “soft skills” I have learned in LTC will transfer well into acute care, like time management. You can’t survive, let alone thrive in LTC unless you can do that and prioritize tasks. 
I can knock out a 3 hour medpass, wound care, charting and another medpass in an 8 hour shift no sweat. I know my residents and when something is off I can handle it. What absolutely terrifies me is the ability to recognize changes in someone I haven’t been taking care of for months. Am I going to recognize an emergency situation in time? 

[JBMmom, MSN, NP]

1 hour ago, Cw2014 said:

Am I going to recognize an emergency situation in time? 

Initially, maybe not. But that's why you'll have an orientation with a preceptor and you will develop relationships with the techs and nurses on your floor so you have resources available to help you initially. And yes, with time you will absolutely see and avoid emergencies because of your assessment skills. You can do this. Good luck.