Considering a move to acute care from LTC..but confidence is simply shot

firstinfamily, RN · Sep 15, 2014

It is usually hard for anyone going from LTC to acute care. I know some of the younger nurses who could not get jobs in acute care when they graduated, went to LTC only to find out later that they could not get into acute care. It is a complete turn around in thinking. I have been in many worlds of nursing and I truly believe if you could get on a sub-acute or rehab type of area you would be more satisfied than LTC. Sub-acute offers the type of patients who are still really sick but are trying to recover and go home or return to their assisted living, LTC facility. I found it was challenging for me and yet gave me some stability that acute care does not. The problem here where I live is that the sub-acute units are all in LTC facilities(due to reimbursement issues with acute care facilities) therefore, there would be days when I had to float to LTC which sucked for me. I don't have anything against LTC facilities, just that type of nursing is not for me and I dreaded it. I found the LTC facilities are not as up on protocol, they are not encouraging to their nurses to improve themselves, to get more education etc. They seem to want to keep their nurses from growing and I did not feel fulfilled in that environment. See if you can find hospitals that have an acute rehab area, that also might be a better mix although those patients are still very sick. The demand/work load is different in LTC because those patients are not having the acute changes that those in acute care are. Plus, it seems LTC becomes very routine after awhile and the critical thinking skills suffer because you are not using them. Everyone should at least try taking care of 40 patients, of whom at least 20% are demented or confused, and try being a loving, empathetic healthcare provider. It may be a more laid back setting, but it can send your defenses up just like taking care of 6-8 acute patients. See if there is a between step you can take before you take the leap. Also, look to see what is available in the acute setting and what the requirements are. I am finding that a lot of acute facilities want not only a BSN, but a certification is some specialty just for baseline. It can be very defeating, hang in there!!! Try sub-acute first!!

thinkingpositive · Sep 15, 2014

Hi RNSteve. Thank you for sharing. We are on the same boat; I work in a sub-acute unit, and will have been an RN for 3 years in January -- and still have not landed an acute care job. Like you, my confidence has dwindled because sub-aucte (just like LTC), seem to be "insufficient experience" for hospitals to consider. Just like firstinfamily's post, a lot of sub-acute that I know of are attached to LTC facilities, and hospital managers (at least the one that I interviewed with) think that sub-acute is long term skilled nursing, when it's not really the case. You work with patients with vents & trachs, and pt's who are sicker than your average LTC patients. I remember from my Advanced Med Surg rotation in nursing school -- it's pretty much like it, except in sub-acute, you could have as many as 12 patients.

I feel that I've done all that I could do (take certification classes applicable to acute care; applied for hospital volunteering; applied out of town, etc), but almost three years later, I'm still a sub-acute nurse. There is nothing wrong with that, but the routine has made me want more.

I am now looking into travel nursing. I have a friend who started out as a travel nurse to unincorporated towns in the Southeast, and almost three years later, she's now an ER nurse in a major city in the Pacific North West.

Try looking into that. Best of luck.

Nola009 · Sep 15, 2014

Hi. I am kind of in a similar situation. I wasn't interested or really prepared to work in LTC, but took a LTC and SNF job because no hospital around would hire a new grad. And, since I wanted to use my education to work and get paid, I ended up going with that. It left me really dismayed at first, but I have grown to like some aspects of LTC. I would advise you to apply for small, rural hospital positions, because they will tend to take a chance on someone who isn't used to acute care. The ir acuity level will be lower than a 3 or 4 trauma center,

Mr. Murse · Sep 15, 2014

I'm not sure if you have an opportunity in acute care already, but it seems to me it would be a little bit of a difficult leap. Most of our ICU's where I work typically won't just hire anybody without some experience in at least med/surg. I'm actually probably moving to our surgical ICU in the near future, but I've been on our surgical floor for almost 3 years now so I feel as prepared as I'll ever be to move down there.

I've never worked LTC but from what I hear I can't blame you for wanting to move on. I would suggest going to some kind of med/surg floor for at least a few months or so to hone your clinical nursing skills a little before trying to jump into acute care. Besides making the transition easier, it would probably also make you more appealing and hirable to acute care units.

If you already have an opportunity in acute care though then go for it. Just be prepared for a pretty harsh learning curve.

workinmomRN2012, BSN · Sep 15, 2014

I graduated in May 2012 and I took the first job that was offered to me and it was sub-acute care rehab. It was the best experience that I could have gotten, I am very grateful to have had that experience. I learned a lot! Especially time management skills. I dressed wounds, inserted iv's, got experience with IVF pumps, got experience on how to give someone a insulin who is trying to bite you at the same time, I did admissions and learned how to do an assessment on a new patient, how to do a W10 when someone is unstable and needs to go to the hospital. I stayed at the first place for a year and then went to another facility that was more well known in the region, another sub-acute facility. I stayed there while still applying to hospitals and guess what... 6 months ago I was called by a hospital and hired in there ACUTE rehab unit and from there I was hired in another unit in that same hospital obs/medical unit. I put in my time and learned everything I could along the way.

RNsteve · Sep 28, 2014

Thanks for the support, and sorry for the delay.

I had planned on Rural nursing, a small town of ~10k. Lots of positions posted, was encouraged to apply... 5-6 applications/few months later-not a call/email. As a person who is confused at if its the small town life or the area of work that seriously causing me to lose confidence/feel depressed its a hard pill to swallow. Just going toss more applications at the wall.

Had a positive experience on ortho during school so may focus on it- but any mire to a large center just terrifies me.

I trained TNCC last year, and am lined up to do non-violent crisis intervention next month.

RNsteve · Jan 7, 2015

So- 2 weeks away from starting on a medicine unit. Heres hoping it goes well.

Going try and get the most out of my orientation, but far from confident in my ability to do my job.

. With any luck a change to acute care is going help this lack of confidence.

vanfitnurse, BSN · Jun 3, 2016

So- 2 weeks away from starting on a medicine unit. Heres hoping it goes well.
Going try and get the most out of my orientation, but far from confident in my ability to do my job.
. With any luck a change to acute care is going help this lack of confidence.

Hey, I want to know how you're doing with the change. I'm on the same boat, been with LTC the last 3 years and about to start acute in a couple of weeks. Orientation is next week. How was the adjustment?

Dani_Mila, BSN, RN · Oct 25, 2020

On 1/6/2015 at 8:59 PM, RNsteve said:

So- 2 weeks away from starting on a medicine unit. Heres hoping it goes well.

Going try and get the most out of my orientation, but far from confident in my ability to do my job.

. With any luck a change to acute care is going help this lack of confidence.

Hi,

Just want to know how it was? I am 0lanning on going to acute care because I want to leave my LTC job. How was the transition and how long did it take you to find a job?

On 6/3/2016 at 5:13 PM, vanfitnurse said:

Hey, I want to know how you're doing with the change. I'm on the same boat, been with LTC the last 3 years and about to start acute in a couple of weeks. Orientation is next week. How was the adjustment?

Hi,

I know this is like 4 years late, but how was the transition?? I have been at my LTC job for more than 2 uears and I feel like I need change, but I am dreading acute care.

vanfitnurse, BSN · Oct 25, 2020

Hi @Dani_Mila,

SO much has changed since then. Thankfully I am still around this site to see your comment and hoping I can help.

I did 1.5 years on a Medicine unit, did a specialty on High Acuity, then did 2 years of that. And now I just started a job with Informatics, and couldn’t be any happier leaving bedside nursing. Finally.

The medicine experience was great as it exponentially allowed me to grow as a nurse in just a short amount of time. Granted my hospital is located downtown, so we get many marginalized patients and sick patients. I learned a lot not only as a nurse, but also handling other misc. things such as being charge, etc.

I picked up on things right away, from having no IV (in LTC) to doing it daily, among other skills. Looking back I find it interesting how I was scared (rightfully so) but now it’s second nature. Long story short, you will be fine in a couple of months.

Then doing High Acuity with even sicker patients who are critically ill just allowed me to even further my learnings and experience.

I knew I wanted to get out of bedside nursing though, so I looked at opportunities and have always kept Informatics in the back of my head. Happily doing a Monday to Friday now! No night shifts and most of all, no call bells and annoying patients.

8 minutes ago, Dani_Mila said:

Hi,

Just want to know how it was? I am 0lanning on going to acute care because I want to leave my LTC job. How was the transition and how long did it take you to find a job?

Hi,

I know this is like 4 years late, but how was the transition?? I have been at my LTC job for more than 2 uears and I feel like I need change, but I am dreading acute care.

Also, please let me know how else I can help.

Dani_Mila, BSN, RN · Nov 25, 2020

@ vanfitnurse

This sounds awesome! I am almost done with my school for my Bachelors and then I am planning on moving to acute setting. Just like you, I also want to leave bedside and probably do nursing informatics. I am thinking of getting my Masters in Informatics. How do you like it so far?