Culture Shock! Hospital to LTC..

Blackcat99 · Aug 31, 2005

I am an ex-LTC LPN. I have been told that hospitals do accept RN's/LPN's who are working in LTC to return to hospital jobs. I work in hospice now but I had been told by nurses at this site that they do accept LTC nurses back to hospitals. Good luck :)

CapeCodMermaid, RN · Aug 31, 2005

Our local hospital has a "Bridges Program". They hire nurses who have been out of acute care for a while and give them a 3-6 month orientation. Many nurses from my SNF have applied, but the only ones ever hired were those nurses who worked on the subacute unit.

Judee Smudee, ADN, RN · Aug 31, 2005

Hello everyone! I have been an RN for almost 4 years now. I spent the first three in a large OR in a large hospital in Florida, and the last year in a CVICU. We recently moved from FL to Michigan, and I was hoping to get back into an OR. However, the hospitals nearby were more interested in placing me back in CVICU (which I don't like) and the pay they are offering is pretty lame. As far as the OR goes, since I have been out for over a year, I would need to be re-oriented, and the largest hospital nearby has a semi-annual new nurse orientation that doesnt begin until January. Obviously, I needed a job before then, so I answered an ad for a very well paying position in a LTC. (6.00 more per hour than the CVICU position!)
Well, I started in this LTC facility (never having even done med-surg before, mind you) and I am scared to death most nights! I knew what I was in for, but I didn't realize all the potential for error that exists in LTC! Polypharmacy notwithstanding-- there is no system in place for identifying residents. (they don't wear armbands) and I have to ask the CNA's who is who! The other nurses tell me that they just get to recognize the residents with time, but for now, I am flippin out! Not only that, but they keep floating me all over the floors, so that when I do begin to become familiar with some of the residents, I have to start all over again, and my med passes take three and a half hours! I feel like a crummy nurse, and am beginning to worry about making med errors due to all the distractions during med pass. (dementia patients, staff, and families). Not to mention that there is no easy system in place for identifying the pts who are DNR or Full code. I was shocked to find that there is no crash cart here, and in fact only one ambu bag per floor. Is this the norm? Supplies are short as well. Things like tissues are hard to come by, denture cups are a rarity, and I am so spoiled from the hospitals I feel like I am now in a third world country.
I was on one floor for a full week, seeing the same pts every day, and I was starting to get to know them, and even to get a little attached to them. Then-- WHAM I am on another floor, and the next day another. Never getting back to the floor I was getting comfortable with.
I am also worried about losing some of my clinical skills. We don't start IV's, in fact none of our pts have any kinds of lines. I am wondering if I will ever be able to get back into the hospital after being in LTC for 6 months (which it will be by the time I am able to re-orient to the OR program).
In case you are wondering, I only left the OR because I want to go to CRNA school, in which you need one year ICU experience. Now, due to financial reasons, that is not going to happen.
Has anyone successfully gone from LTC back to the hospitals? Thanks!

You did a very good job of describing the problems I had with long term care. It is nice to know I am not the only one.

essbee · Sep 1, 2005

Hello everyone! I have been an RN for almost 4 years now. I spent the first three in a large OR in a large hospital in Florida, and the last year in a CVICU. We recently moved from FL to Michigan, and I was hoping to get back into an OR. However, the hospitals nearby were more interested in placing me back in CVICU (which I don't like) and the pay they are offering is pretty lame. As far as the OR goes, since I have been out for over a year, I would need to be re-oriented, and the largest hospital nearby has a semi-annual new nurse orientation that doesnt begin until January. Obviously, I needed a job before then, so I answered an ad for a very well paying position in a LTC. (6.00 more per hour than the CVICU position!)
Well, I started in this LTC facility (never having even done med-surg before, mind you) and I am scared to death most nights! I knew what I was in for, but I didn't realize all the potential for error that exists in LTC! Polypharmacy notwithstanding-- there is no system in place for identifying residents. (they don't wear armbands) and I have to ask the CNA's who is who! The other nurses tell me that they just get to recognize the residents with time, but for now, I am flippin out! Not only that, but they keep floating me all over the floors, so that when I do begin to become familiar with some of the residents, I have to start all over again, and my med passes take three and a half hours! I feel like a crummy nurse, and am beginning to worry about making med errors due to all the distractions during med pass. (dementia patients, staff, and families). Not to mention that there is no easy system in place for identifying the pts who are DNR or Full code. I was shocked to find that there is no crash cart here, and in fact only one ambu bag per floor. Is this the norm? Supplies are short as well. Things like tissues are hard to come by, denture cups are a rarity, and I am so spoiled from the hospitals I feel like I am now in a third world country.
I was on one floor for a full week, seeing the same pts every day, and I was starting to get to know them, and even to get a little attached to them. Then-- WHAM I am on another floor, and the next day another. Never getting back to the floor I was getting comfortable with.
I am also worried about losing some of my clinical skills. We don't start IV's, in fact none of our pts have any kinds of lines. I am wondering if I will ever be able to get back into the hospital after being in LTC for 6 months (which it will be by the time I am able to re-orient to the OR program).
In case you are wondering, I only left the OR because I want to go to CRNA school, in which you need one year ICU experience. Now, due to financial reasons, that is not going to happen.
Has anyone successfully gone from LTC back to the hospitals? Thanks!

You may want to use your talents on a skilled rehab unit in a LTC facility. Many hospital nurses find these units to be closer to what they are used to. Most LTC nurses consider LTC to be a specialty and would probably suffer the same shock u have at going to a hospital where developing a longterm relationship with patients and their families/friends can not be the focus due to length of stay protocols. LTC is indeed a different kind of nursing setting and because of tough state regulations, a challenge to deliver care and avoid state citations while doing so often takes up more time than actual care giving due to LTC's past history of patient care . More patients to care for, same basic rules to follow that we all learned in nursing school, challenging indeed but often a roadblock to those from other nursing settings.

CoffeeRTC, BSN, RN · Sep 1, 2005

Let me start by saying that it is not all like that. It does sound like you would be better in a skilled unit/ facility.

The lack of id for the residents is alarming? If they don't have armbands, do they have thier pics taken? Polypharmacy is an issue everywhere...I've tried fighting it and some docs are actually listening...What ever happened to the Beer's list?

Supplies...yep they are an issue...the issue in our facility is that a non nursing person was doing the ordering and had no clue. Ask management what is going on with that? Are they just being cheap? As far as the Codes...lost of post on that issue. Fact remains, most elderly in LTC are DNR. What no IVs???? Heck some nights I feel like I am on a med surg unit with all of mine (TPN, KVOs, I had 9 of 22 res with more than one IV running...piccs, midline, centrals, and peripherals) All depends on the type of residents...now starting one...I'm alittle rusty.

What I want to say is that LTC varies, but yep...its a cultural shock for some.

While some skills might be lost, you will definalty learn a whole bunch of new ones!

AlixCoastRN · Sep 1, 2005

After 6 years working LTC, I am leaving it next month to go to workas a staff nurse on med/surg at and 80 bed hospital. I was the manager for the skilled unit, and the hospital did not think the transition back to acute care would be difficult. I will have about 3 to 6 weeks orientation depending on my needs. As an aside, my base pay will be about 7 bucks more per hour. I am excited about the return to acute care...

dinkymouse · Sep 1, 2005

Let me start by saying that it is not all like that. It does sound like you would be better in a skilled unit/ facility.
The lack of id for the residents is alarming? If they don't have armbands, do they have thier pics taken? Polypharmacy is an issue everywhere...I've tried fighting it and some docs are actually listening...What ever happened to the Beer's list?
Supplies...yep they are an issue...the issue in our facility is that a non nursing person was doing the ordering and had no clue. Ask management what is going on with that? Are they just being cheap? As far as the Codes...lost of post on that issue. Fact remains, most elderly in LTC are DNR. What no IVs???? Heck some nights I feel like I am on a med surg unit with all of mine (TPN, KVOs, I had 9 of 22 res with more than one IV running...piccs, midline, centrals, and peripherals) All depends on the type of residents...now starting one...I'm alittle rusty.
What I want to say is that LTC varies, but yep...its a cultural shock for some.
While some skills might be lost, you will definalty learn a whole bunch of new ones!

Not knowing who is who is a problem in my LTC also. They have pictures of some but they are from when they came in and can look totally different now. We do skilled nursing and have GTubes. We do IV's and I am the only one experienced enough to do them. I usually work days on one station but did some 3-11's on the other. Yesterday I did a 7-3 on that unit and I had to ask who was who so many times it wasn't funny. They certainly look different out of bed with their own clothes and dentures in. :rotfl:

luckymichelle · Sep 6, 2005

They certainly look different out of bed with their own clothes and dentures in. :rotfl:

:rotfl: Ain't that the truth! I almost don't recognize my patients sometimes! If you only ever see someone with their dentures out and in a hospital gown, it sure is different when they've got teeth, hair combed and clothes on!

dian57 · Sep 10, 2005

No identification system for the residents is not only unsafe and disturbing, it may be illegal, depending on your state. What is the facility policy on identification? We have name bands (blue for DNR), photos in chart, on room door and in MAR. Depending on a staff member to give you an ID, is setting yourself up for an undefendable medication error, in my opinion.

Also having no system for all staff to identify advanced directives is an indication of poor management. Blue name bands, a colored dot system on chart spines, indicators on MARs/TARs, advanced directive list postings at the nurses station and in med rooms are all in place in my facility.

Floating a new employee is also an unsafe practice. We try and keep new staff on one assignment for at least a month before floating them.

With your experience and situation, the suggestion to request a transfer to your facility's rehab or subacute unit is a good one.

Or if you fall in love with LTC, as many have (myself included), become an advocate for change--form or join committees and institute changes for safety for both residents and staff.

Blackcat99 · Sep 10, 2005

I remember years ago when they first got rid of the ID bracelets. I was new at the LTC,passing medications and asked a CNA if this patient was so and so. She said "Yes". For some reason I felt uneasy and I decided that I would ask another CNA for reconfirmation. The next CNA told me "No that's not him." :angryfire At that time we didn't have any photos of the patients. :angryfire

live4today, RN · Sep 10, 2005

Hello everyone! I have been an RN for almost 4 years now. I spent the first three in a large OR in a large hospital in Florida, and the last year in a CVICU. We recently moved from FL to Michigan, and I was hoping to get back into an OR. However, the hospitals nearby were more interested in placing me back in CVICU (which I don't like) and the pay they are offering is pretty lame. As far as the OR goes, since I have been out for over a year, I would need to be re-oriented, and the largest hospital nearby has a semi-annual new nurse orientation that doesnt begin until January. Obviously, I needed a job before then, so I answered an ad for a very well paying position in a LTC. (6.00 more per hour than the CVICU position!)
Well, I started in this LTC facility (never having even done med-surg before, mind you) and I am scared to death most nights! I knew what I was in for, but I didn't realize all the potential for error that exists in LTC! Polypharmacy notwithstanding-- there is no system in place for identifying residents. (they don't wear armbands) and I have to ask the CNA's who is who! The other nurses tell me that they just get to recognize the residents with time, but for now, I am flippin out! Not only that, but they keep floating me all over the floors, so that when I do begin to become familiar with some of the residents, I have to start all over again, and my med passes take three and a half hours! I feel like a crummy nurse, and am beginning to worry about making med errors due to all the distractions during med pass. (dementia patients, staff, and families). Not to mention that there is no easy system in place for identifying the pts who are DNR or Full code. I was shocked to find that there is no crash cart here, and in fact only one ambu bag per floor. Is this the norm? Supplies are short as well. Things like tissues are hard to come by, denture cups are a rarity, and I am so spoiled from the hospitals I feel like I am now in a third world country.
I was on one floor for a full week, seeing the same pts every day, and I was starting to get to know them, and even to get a little attached to them. Then-- WHAM I am on another floor, and the next day another. Never getting back to the floor I was getting comfortable with.
I am also worried about losing some of my clinical skills. We don't start IV's, in fact none of our pts have any kinds of lines. I am wondering if I will ever be able to get back into the hospital after being in LTC for 6 months (which it will be by the time I am able to re-orient to the OR program).
In case you are wondering, I only left the OR because I want to go to CRNA school, in which you need one year ICU experience. Now, due to financial reasons, that is not going to happen.
Has anyone successfully gone from LTC back to the hospitals? Thanks!

Your story is the very reason I left LTC after only being onboard one week. :rotfl: It's scarier than scary, and I did not want to lose my license over that scary stuff. No more LTCs for me UNLESS I own the place, and make the rules. And you better believe those patients will wear ID bracelets, will be taken to a med window for all their meds where a med tech or nurse gives them their meds everyday instead of having to chase them down in PT or outside or during meal times to give them their meds. THAT is soooooooo ridiculous and poor time management at that! :rolleyes: