Considering LTC in the future

CapeCodMermaid, RN · Oct 21, 2011

You've never worked as an RN in LTC but you want to be the DON? You'd be better starting as a floor nurse or supervisor and learning the business that way.

debRN0417 · Oct 22, 2011

I agree with CCM. The position of DON is NOT a position that is easy. You must have a good solid knowledge of the workings of LTC. Starting as a staff nurse or supervisor is the best way. Not only will you learn the workings, but you will be more respected by your staff because "you were once one of them" and will have an understanding of what the "real" world is like on the floor. I'm not saying that you don't know some of this already since you have had past experience, but being in a position of supervisor or charge certainly opens the door to more of the reality of administration. It will help you determine if it is really something that you want to do.

SE_BSN_RN, BSN · Nov 8, 2011

I want you to come work with me. I want to do the same thing but I won't finish my BSN till 2013. I want to make things better in my facility but that looks impossible right now. I can tell you what company to stay away from, LOL

emptyboxcars · Nov 9, 2011

Not to sabotage the thread, but debRN 0417, can you tell me more about what it is like to work in a LTC facility? I am a nursing student who would love to work in an assisted living home or nursing home as a nurse. What are the nursing duties in this job? Is it a good place for a new grad? I have worked in this setting as a receptionist and loved working with the same residents on a daily basis. It was by far my favorite job. However, I am unfamiliar with this environment from a nurse's role.

SE_BSN_RN, BSN · Nov 9, 2011

Not to sabotage the thread, but debRN 0417, can you tell me more about what it is like to work in a LTC facility? I am a nursing student who would love to work in an assisted living home or nursing home as a nurse. What are the nursing duties in this job? Is it a good place for a new grad? I have worked in this setting as a receptionist and loved working with the same residents on a daily basis. It was by far my favorite job. However, I am unfamiliar with this environment from a nurse's role.

I know you addressed this to Deb, but let me tell you as a nurse on the floor you will be run ragged. You will be expected to do things that are nearly impossible....and not always safe. Staffing is not up to par. Our elders our treated like crap, the aides AND nurses almost always work short staffed. LTC is considered the worst of the worst. It infuriates me what I see at my job, and the fact that I can't change ANYTHING. The bottom line in LTC facilities is ALWAYS money....and not for the staff and the money is not spent for the residents to improve care.

I admire the fact that you are considering LTC as a career but work for awhile as a staff nurse and I guarantee you will change your mind. If you do absolutely have your heart set on LTC, go in as a supervisor, not as a nurse on the floor....but that is just my 2 cents.

CapeCodMermaid, RN · Nov 11, 2011

I wouldn't hire someone as a supervisor who didn't have experience as a staff nurse. Not every facility is short staffed with or horrible. If you want to work in LTC, find a good one and work there. Please don't listen to every negative idea you see posted here.

SE_BSN_RN, BSN · Nov 11, 2011

I wouldn't hire someone as a supervisor who didn't have experience as a staff nurse. Not every facility is short staffed with or horrible. If you want to work in LTC, find a good one and work there. Please don't listen to every negative idea you see posted here.

So tell me, then....you are a DON, right? If the bottom line is not money.....LTC is mostly for profit, correct, unless they are privately owned....and even then, come on, you can't tell me its not about the money. Tell me how I can improve my facility when I am just a staff nurse? I work for a HUGE corporation that just cut everyone's pay because of medicare and medicaid cuts. Since I am just a little puny LPN that doesn't know jack, what, pray tell can I possibly do to improve my workplace? I have long since quit going to management about concerns or suggestions because they are flat out ignored. I don't go in with a negative attitude and I don't allow my aides to, either. A lot of the nursing homes out there are crappy. I have done agency work in many of them.

So, please, tell me, since I want to be DON someday at my facility, what can staff nurses do to make things better when management only cares about their bonuses?

iceprincess492 · Nov 12, 2011

so tell me, then....you are a don, right? if the bottom line is not money.....ltc is mostly for profit, correct, unless they are privately owned....and even then, come on, you can't tell me its not about the money. tell me how i can improve my facility when i am just a staff nurse? i work for a huge corporation that just cut everyone's pay because of medicare and medicaid cuts. since i am just a little puny lpn that doesn't know jack, what, pray tell can i possibly do to improve my workplace? i have long since quit going to management about concerns or suggestions because they are flat out ignored. i don't go in with a negative attitude and i don't allow my aides to, either. a lot of the nursing homes out there are crappy. i have done agency work in many of them.
so, please, tell me, since i want to be don someday at my facility, what can staff nurses do to make things better when management only cares about their bonuses?

i realize this was not addressed to me but as a don in a very busy snf i felt compelled to answer anyway :) first of all you need to realize that the mcr and mcd cuts that you mention were very significant and in order for many facilities to be able to stay in business they have had to make pretty significant cuts in their budgets. think of it like your own home....if you are used to having an income of 4,000 dollars a month and something happens and now you are only receiving 2,000 dollars a month, i'm assuming you would have to make some financial changes to your budget. that is what is happening in ltc right now.

secondly, you also need to realize that for profit nursing homes are a business. as with any business if you do not have good profits you cannot produce a good product. the same is true in snf's....in order to be able to pay for high quality staff, equipment, etc....you have to have a profit. i'm pretty sure that the nurses that work in my facility like to get paid every 2 weeks and would be upset if we didn't make enough of a profit to make payroll...

lastly the way you feel about ltc/snf's and their management why would you want to become a don? it sounds like you may enjoy another specialty more. ltc is definitely not for everyone.

SE_BSN_RN, BSN · Nov 12, 2011

i realize this was not addressed to me but as a don in a very busy snf i felt compelled to answer anyway :) first of all you need to realize that the mcr and mcd cuts that you mention were very significant and in order for many facilities to be able to stay in business they have had to make pretty significant cuts in their budgets. think of it like your own home....if you are used to having an income of 4,000 dollars a month and something happens and now you are only receiving 2,000 dollars a month, i'm assuming you would have to make some financial changes to your budget. that is what is happening in ltc right now.
secondly, you also need to realize that for profit nursing homes are a business. as with any business if you do not have good profits you cannot produce a good product. the same is true in snf's....in order to be able to pay for high quality staff, equipment, etc....you have to have a profit. i'm pretty sure that the nurses that work in my facility like to get paid every 2 weeks and would be upset if we didn't make enough of a profit to make payroll...
lastly the way you feel about ltc/snf's and their management why would you want to become a don? it sounds like you may enjoy another specialty more. ltc is definitely not for everyone.

i'd like to be don for the experience.....and the bonuses. apparently the don and administrator and admissions liason get hefty bonuses twice a year, they always cut hours before the end of the year. i don't see them taking a cut in pay, they always take from the bottom when they should start by taking from the top. but, that is jmho. i have been a staff nurse for 6 years and i would like to learn a different side of the business. i know my coworkers, i know the residents, and would like to see the business side. and they must not make enough of a profit if they can't even order enough supplies for us to do our jobs. i work my butt off, get my charting done, clock in, out, take my lunches, have no un-approved overtime, keep my work station clean and organized.....and do some of my aide's work, too, that is not my responsibility. so, in other words, my high quality work isn't good enough for high quality pay??

and, yes, i don't plan on staying in ltc after i get my bsn if i can't be don. i have a specific specialty that i would like to do, as a career. like all "new" nurses, ltc is just a stepping stone for me. if no one in my facility values my opinion and doesn't feel they need to take my concerns to heart then i will find some place else who values my skills more....cuz, obviously, my skills aren't good enough.

CapeCodMermaid, RN · Nov 12, 2011

I find your post to be highly insulting. I didn't become a nurse to make money and I didn't work my way up to be a DNS for the bonuses. I love what I do since every day as the clinical leader of the building I have a positive impact on the lives of the residents in my facility. Of course I keep my eye on spending. If I can control overtime costs, I can use the money I save to hire another staff person. If I keep an eye on supply usage and know the supplies are being used appropriately and not being wasted, I can use those savings to buy a new piece of equipment.

Walk a mile in someone else's shoes before you trash what they do. In my facility, it's truly all about the residents....what they need, what they want, what would make their lives better. Do I think I'm well paid? Yes. I am responsible for 181 residents and 200+ employees not to mention making sure the clinical care is excellent and and and. Do I get a bonus? No.

Was LTC a stepping stone?no. I started my career in med surg. I couldn't stand the way the elderly patients were being treated so I changed to a specialty where I could make sure those elderly people were treated with respect and dignity. And, by, the way, the employees are also treated with respect and dignity.

Please don't ever work in LTC, especially as a DNS. We don't need people with your attitude.

SE_BSN_RN, BSN · Nov 12, 2011

I find your post to be highly insulting. I didn't become a nurse to make money and I didn't work my way up to be a DNS for the bonuses. I love what I do since every day as the clinical leader of the building I have a positive impact on the lives of the residents in my facility. Of course I keep my eye on spending. If I can control overtime costs, I can use the money I save to hire another staff person. If I keep an eye on supply usage and know the supplies are being used appropriately and not being wasted, I can use those savings to buy a new piece of equipment.
Walk a mile in someone else's shoes before you trash what they do. In my facility, it's truly all about the residents....what they need, what they want, what would make their lives better. Do I think I'm well paid? Yes. I am responsible for 181 residents and 200+ employees not to mention making sure the clinical care is excellent and and and. Do I get a bonus? No.
Was LTC a stepping stone?no. I started my career in med surg. I couldn't stand the way the elderly patients were being treated so I changed to a specialty where I could make sure those elderly people were treated with respect and dignity. And, by, the way, the employees are also treated with respect and dignity.
Please don't ever work in LTC, especially as a DNS. We don't need people with your attitude.

You are missing my whole point. I believe I asked you a specific question in my original reply, and you haven't addressed it yet. Again, I work for a huge corporation whose bottom line is money...not staff, not residents. Come work in my facility and see how the staff is treated by our DON and how the administrator sits back and allows it. Our DON was hired to "fix" things in our facility and she is screwing it up. She won't hire more staff and we always work short. Residents complain and are ignored. Staff complains, and is ignored. Staff offers solutions, and is ignored.

I already work in LTC. You must have missed my other posts, too. So, tell me, how as a puny dumb LPN that doesn't know jack, how I can possibly make a difference with a DON who thinks its ok to yell at staff in front of others...and why the numerous (and I mean numerous!!) complaints to the compliance hotline are even ignored? What can I possibly do to make my workplace better?