Considering changing from Acute Care to LTC

JB2007, ASN, RN · Jan 22, 2009

Do not go into LTC unless you are 100% sure that you want to stay in LTC. I started out as a new RN in the hospital and like you I wanted a change in the kind of stress that I was experiencing. I knew that LTC was stressful because I had worked as a CNA in LTC for years. However, I did not realize how stressful it was working as a nurse in LTC. The amount of stress is ten time what I experienced on the Tele unit I worked on as a new RN and trust me we always worked short on this unit. The kind of stress that I experience is much different than it was when I worked at the hospital. However, I can assure that it is not less stress. When you finally decide that you can not take one more minute in LTC no hospital will hire you because you worked in LTC and they think that you have no skills(or lost the skills that you use to have). I suppose that I sould not say no hospital will hire you, but it will be very difficult to find one that will hire you.

On the flip side you may find the kind of nursing that you were ment to do in LTC. This kind of nursing can be very rewarding and the resident deserve excellant nurses. If you think that you are interested in LTC nursing and you really want to make a difference in people's lives give it a try. Good luck in whatever you decide to do.

Daytonite, BSN, RN · Jan 23, 2009

have you ever actually worked as a charge nurse in ltc because that is what you will be hired for? as a charge nurse you will be responsible for supervising and disciplining the cnas, something which you have not had to do in the acute hospital. you will take and carry out orders for the patients. a big part of your shift will be giving medications to your assigned group of patients. you may also be responsible for their treatments as well. while it is true that the work is routine, it is far from unstressful. we called physicians for all kinds of things because state or federal law required that they be notified for any kind of change in the patient. the charting gets burdensome sometimes. medicare charting requirements are very specific and most facilities want these requirements followed to the letter in order to get their medicare reimbursement. i had to learn how to deal with subordinate cnas when i worked in ltc because there were some humdingers. we had more than half the staff call off on holidays in every single ltc facility i ever worked. when there is an emergency 911 or the police get called. if you've never seen an incompetent nurse before, be prepared because more than likely you will run into one in ltc--they tend to hide out there and if they are able to get by by the seat of their pants it will take dynamite to get rid of them. some ltc facilities get their dons from the acme school of management meaning they have little to no experience in how to lead or manage a team of nurses. in many cases the don was not supportive of the nurses at all since she was so wrapped up in saving her own neck (comply with medicare rules and regs and keep money coming into the place via us nurses charting and following the medicare rules and regs correctly).

once you go to work in ltc most hospitals will not hire you back. they will not consider your experience in ltc comparable to acute hospital nursing skills.

but, if you are looking for autonomy and you like being in charge--go for it. you can carve out a little empire for yourself in ltc and they will love you for it.

TheCommuter, BSN, RN · Jan 23, 2009

With the exception of some brief time as a medication nurse in a small psychiatric hospital, I have spent my entire nursing career in LTCFs.

I have had up to 70 residents by myself during night shift with no other nurses or medication aides to help. I was responsible for passing medications, feeding and flushing PEG tubes, dealing with unruly CNAs, calibrating glucometers, checking the crash cart, doing treatments, Medicare charting, incident reports, collecting specimins, hanging IVs, and mountains of various paperwork. On many nights, I had only 2 techs to do rounds on these 70 residents. You better believe I had to take some shortcuts to get it all done.

I have had up to 40 residents on day shift. If anything out of the norm occurs (chest pains, falls, a code, physical contact, etc.), your day is totally ruined. There's absolutely no time for unusual occurrences in LTC.

The family members can sometimes be hostile. Paramedics and EMTs have gotten nasty with me, and I've had to bite back. Some of the physicians and medical directors in LTCFs do not want to be bothered by you because "these patients are old." Some of your fellow colleagues in other specialties will look down upon you because you're a nurse in LTC. As far as respect is concerned, LTC trends toward the bottom of the barrel.

In addition, the stress is magnified by the fact that we have so many patients.

Lovely_RN, MSN · Jan 23, 2009

If they are willing to give you 40 hours pay for 32 hours of work that should tell you something about LTC. Unless you find work in an absolutely wonderful well staffed LTC then you're going to be very sorry that you left your hospital job to go work in hell. Most of the LPNs I know are going for the RN because they want to get away from LTC and for a lot of us (getting the RN) is the only way out because hospitals are not hiring a lot of us.

Every nurse (myself included) I work with who is in RN school is doing it because LTC/SNF is killing us and we can't get hired in a hospital. The ones who aren't currently in school are planning to return to school, are near retirement, or is the bad nurse Daytonite was talking about who just doesn't give a crap anymore.

I have yet to meet a single LPN who works in LTC/SNF and is content.

TheCommuter, BSN, RN · Jan 23, 2009

In addition, the acuity levels are rising in LTCFs across the country. Many skilled units in LTCFs are admitting very sick patients with jugular central lines, fresh surgeries (laminectomies, kyphoplasties, total knee and hip arthroplasties, hysterectomies, CABGs, thromboembolectomies, limb amputations, brand new colostomy placements, and recent gtube placements). My weekend supervisor, a very experienced hospital nurse who has worked in med/surg and transplant units, told me, "Skilled nursing home units are worse than hospital med/surg units."

I forgot to mention you'll have about 15 to 20 of these postsurgical cases.

southernbeegirl, BSN, RN · Jan 23, 2009

i've spent my career in LTC. thus i feel i have the right to say this....

HAVE YOU LOST YOUR EVERLOVING MIND?????

Lovely_RN, MSN · Jan 23, 2009

In addition, the acuity levels are rising in LTCFs across the country. Many skilled units in LTCFs are admitting very sick patients with jugular central lines, fresh surgeries (laminectomies, kyphoplasties, total knee and hip arthroplasties, hysterectomies, CABGs, thromboembolectomies, limb amputations, brand new colostomy placements, and recent gtube placements). My weekend supervisor, a very experienced hospital nurse who has worked in med/surg and transplant units, told me, "Skilled nursing home units are worse than hospital med/surg units."
I forgot to mention you'll have about 15 to 20 of these postsurgical cases.

Yes I have dealt with all of the above in addition to the regular geriatric patients and psych patients (a few schizophrenics, bipolars, and one lovely lady with BPD). In the last 3 months my facility has also started placing a few trached patients on the floors as well.

On a 3-11 shift I typically have to hang 3-7 feedings....do 5-12 fingersticks (with coverage)...pass all the meds...TXs....suction and do trach care...closely monitor my psych patients....closely monitor my sun downing alzheimers patients....do an admission or two...put a knee replacement on a CPM machine....I do all the nebulizer treatments....chart...do the 24 hour report...make the CNA assignments....do dining room duty 1 day a week...hand out PRN pain meds (we have so many people on narcotics it takes 30 minutes to count them all at beginning/end of shift) run down the CNAs and make sure they do their jobs...get b*tched out by family members because I only have 3 aids for 40 residents and their loved needs to go to bed like right now! Or they are missing a sock and they want to string me up for it....I could go on forever and ever.

I've been doing this for a year and I am losing my mind bit by bit. If I wasn't graduating in less than 3 months you had better believe I would not be working in a LTC/SNF. If I knew I had to do this for too much longer I would get a temp job as a receptionist or go work in McDonald's.

Yes it's that bad and from what I'm told most places are the same.

What galls me about it is that the RNs in the hospital look down on me for being an LPN. When I go to clinical they act as though all I do is pass pills and spoon feed the elderly all day long.

southernbeegirl, BSN, RN · Jan 23, 2009

In addition, the acuity levels are rising in LTCFs across the country. Many skilled units in LTCFs are admitting very sick patients with jugular central lines, fresh surgeries (laminectomies, kyphoplasties, total knee and hip arthroplasties, hysterectomies, CABGs, thromboembolectomies, limb amputations, brand new colostomy placements, and recent gtube placements). My weekend supervisor, a very experienced hospital nurse who has worked in med/surg and transplant units, told me, "Skilled nursing home units are worse than hospital med/surg units."
I forgot to mention you'll have about 15 to 20 of these postsurgical cases.

I'm a weekend supervisor too. I cant help but keep thinking about the 6-8 pts i had when i worked that short time in the hospital. cuz now my nurses have those same type patients only they have 25 of them! its ridiculous and in my little world up in my head i keep hoping one day staffing numbers will change.

this past weekend, for 2 days straight, as the only RN in the building i ran my everwidening butt off going from PICC line to CVL, IV infusion to IV infusion. i went thru so much NS and heplock the pharmacy called me and asked me if i was drinking it. (i keed! i keed! but they did laff at me when i ordered "a truckload"). i changed more dang sterile dressings on CVLs, flushed the ones that werent getting an infusion.

this past weekend was a typical weekend for me, and it was dang exhausting and sometimes i think I have lost my mind for staying! 4 pts passed away but before they did i was constantly calling my oncall doc for more morphine/dilaudid/ativan (and the patients needed stuff too!). the donor service asked me if i was trying to get rid of them all. i told her "dont give me any ideas!" lol

had 2 patients crash, both ended up in the unit..one on the vent, the other died there.

tried to keep a woman alive until her son's plane landed. (she died as soon as he got there but if i tell yall how bootiful the story is you'd cry so i wont)

then ya got the families who think their family is the only pt and they demand to see "the RN" constantly.

between all this you have staff calling in left and right and have to cover those shifts. staff members fighting as always. god forbid one person have one more patient than someone else! *picture me rolling my eyes cuz im too lazy to find the smiliey*

somewhere in all that you gotta draw the stat labs, get the xrays obtained...remember to call for the results cuz you never get them faxed to you on the weekends.

it's overwhelming at times to be the only RN on the weekends to coordinate the care for all 90 pts. but then i think of my poor nurses on the floor trying to care for 25 patients and i shut my whining cuz they are the ones working their hindends off!

but i wouldnt trade it for the world! i love LTC. i hate the politics and the administration fighting you because they want to make money and you want to take care of patients....but you cant ask for a more satisfying job, IMO.

but do i recommend it to other nurses who've never done it? HECK NO! (im afraid they'll come back and keel me dade:p )

TheCommuter, BSN, RN · Jan 23, 2009

On the nursing home rehab unit where I worked, we dealt with a lot of central lines, IV antibiotics, CPM machines, feeding tubes, suture removal, surgical staple removal, complicated wound care, narcotics, ostomy appliances, diabetic management, casts, braces, splints, cervical halos, and so forth.

The medical patients were admitted for recovery from CVAs, acute MIs, debility, cancer, fractures, status post pneumonia, deconditioned states, failure to thrive, status post falls, and generalized weakness. The surgical patients were admitted for surgical procedures such as laminectomies, knee and hip arthroplasties, kyphoplasties, CABGs, hysterectomies, limb amputations, colectomies, thromboembolectomies, and abdominal aortic aneurysm repairs.

I typically had 15 to 17 of these patients during day shift and 30+ during the night shift. Let's talk about stress...

SweetRevelation · Jan 23, 2009

Bx_RN2B wrote:

"On a 3-11 shift I typically have to hang 3-7 feedings....do 5-12 fingersticks (with coverage)...pass all the meds...TXs....suction and do trach care...closely monitor my psych patients....closely monitor my sun downing alzheimers patients....do an admission or two...put a knee replacement on a CPM machine....I do all the nebulizer treatments....chart...do the 24 hour report...make the CNA assignments....do dining room duty 1 day a week...hand out PRN pain meds (we have so many people on narcotics it takes 30 minutes to count them all at beginning/end of shift) run down the CNAs and make sure they do their jobs...get b*tched out by family members because I only have 3 aids for 40 residents and their loved needs to go to bed like right now! Or they are missing a sock and they want to string me up for it....I could go on forever and ever."

^^You just described a typical shift perfectly... and then some!

To MedicalLPN:

First off, if you choose to go to LTC, I applaud you and wish you the best at the same time. LTC is a crazy kind of stress and it's not for everyone and believe me, I've been ready to pull my hair out on more occasions than I care to admit while working LTC. I realize you wish to change the type of stress you have, but sometimes change isn't always for the better. I'd be torn on this decision, too... but again whatever you choose, good luck!

southernbeegirl, BSN, RN · Jan 23, 2009

On the nursing home rehab unit where I worked, we dealt with a lot of central lines, IV antibiotics, CPM machines, feeding tubes, suture removal, surgical staple removal, complicated wound care, narcotics, ostomy appliances, diabetic management, casts, braces, splints, cervical halos, and so forth.
The medical patients were admitted for recovery from CVAs, acute MIs, debility, cancer, fractures, status post pneumonia, deconditioned states, failure to thrive, status post falls, and generalized weakness. The surgical patients were admitted for surgical procedures such as laminectomies, knee and hip arthroplasties, kyphoplasties, CABGs, hysterectomies, limb amputations, colectomies, thromboembolectomies, and abdominal aortic aneurysm repairs.
I typically had 15 to 17 of these patients during day shift and 30+ during the night shift. Let's talk about stress...

preach it sister! can i get a witness?..........