Difference between LTC facilities and Hospital CNA

megykilo · Feb 20, 2008

In LTC you will have between 8-15 residents and be responsible for incontinence care, feeding, ambulation, dressing, transfers, getting them to the dining room and making sure they all eat enough at meals. Plus vitals and coordinating with family outings/activities etc. I'm sure you knew that and realize by now that it is not easy.

In the hospital I do clinicals at for NS, there is about 1 CNA for 8 patients on MedSurg, most of whom can transfer with minimal assistance and are continent. They don't typically require help with getting clothes on (they will stay in a nightgown as admits and very often there are family members with them to help) and they eat in their rooms. Expect to do cath care with all indwelling catheters, vital signs, I&0 and baths and showers for those who need help on day shift. There are more nurses to help in the hospital, plus PT, OT, dietary, RT to help with the various issues patients will ask you to resolve.

I thought the same thing that you did about hospital versus LTC. I never ended up taking the hospital job as a CNA and will graduate with my ADN next year, but I feel like my 3 years in LTC is priceless. You learn SO MUCH about time management, multitasking, management of behavioral issues, patient/family dynamics. There are coworkers of mine in school with me, and those who have worked as hospital CNA's. It seems that those even with experience in the hospital become easily frazzled; it almost makes me glad for all of those hectic shifts in the nursing home. The wealth of knowledge to be gained in LTC is SO much more than meets the eye; don't ever think that 'settling' for the nursing home could ever be detrimental to your career. I'm glad I stuck it out.

nasaodds · Feb 20, 2008

I think that is great advice. I would rather not work in ltc and am trying my hardest to get a hospital job(not any luck though). Those are are good reasons to get what you can out of ltc.

Billsgirl, CNA · Feb 23, 2008

I wanted to work at a hospital as a CNA myself for the same reasons as you, and I figured the experience would be more realistic to what I would be doing once I graduate nursing school. I did my CNA clinicals at a beautiful nursing home, but knew I didn't want to work in one. It took me months but I finally got a job at a hospital!! I work 3-11, we average 8-10 patients each as the CNA's, and we are responsible for all of their needs as far as ADL's and other comfort measures. There is still a lot of changing of briefs and all. Being the evening shift we don't do baths and only have one meal to assist with so that's a plus, but we tend to get a lot of admits so things get crazy!!I work on the medical/peds unit, we get ALL ages of patients!!

In the hospital I have learned a TON from the other aides and nurses. I have learned to take out a heplock, foley, and change a colostomy bag, all of which I don't know I would have had the chance to do at a LTC facility. I wanted the whole hospital enviornment, when they need people to float I volunteer because I want to learn all different areas of the hospital. I have floated to the CICU, ICU,and Oncology, where I have learned much more and been exposed to priceless experiences.

Hope I have helped!

OH, also, working in the hospital I have inquired about shadowing nurses in the ER and Birth place because I want to experience those units as well. I won't get paid but the learning experience is invaluable!

need714 · Feb 29, 2008

I wanted to work at a hospital as a CNA myself for the same reasons as you, and I figured the experience would be more realistic to what I would be doing once I graduate nursing school. I did my CNA clinicals at a beautiful nursing home, but knew I didn't want to work in one. It took me months but I finally got a job at a hospital!! I work 3-11, we average 8-10 patients each as the CNA's, and we are responsible for all of their needs as far as ADL's and other comfort measures. There is still a lot of changing of briefs and all. Being the evening shift we don't do baths and only have one meal to assist with so that's a plus, but we tend to get a lot of admits so things get crazy!!I work on the medical/peds unit, we get ALL ages of patients!!
In the hospital I have learned a TON from the other aides and nurses. I have learned to take out a heplock, foley, and change a colostomy bag, all of which I don't know I would have had the chance to do at a LTC facility. I wanted the whole hospital enviornment, when they need people to float I volunteer because I want to learn all different areas of the hospital. I have floated to the CICU, ICU,and Oncology, where I have learned much more and been exposed to priceless experiences.
Hope I have helped!
OH, also, working in the hospital I have inquired about shadowing nurses in the ER and Birth place because I want to experience those units as well. I won't get paid but the learning experience is invaluable!

Hi Billsgirl,

Being that you worked in the ICU... Can you tell me a little bit about your experience? I got a job in the ICU working 7pm-7am shifts and I haven't started yet. I'm obviously really curious about how it is... Thanks!

ChristineN, BSN, RN · Feb 29, 2008

Hi, hospital aide with 17 months experience

When in adult med-surg, I typically had around 20 mainly geriatric pts to take care of, of varying levels of care.

Now, in a peds hospital, I have anywhere from 10-13 pts that require minimal care.

rn2bnwi, BSN, RN · Mar 1, 2008

I wanted to work at a hospital as a CNA myself for the same reasons as you, and I figured the experience would be more realistic to what I would be doing once I graduate nursing school. I did my CNA clinicals at a beautiful nursing home, but knew I didn't want to work in one. It took me months but I finally got a job at a hospital!! I work 3-11, we average 8-10 patients each as the CNA's, and we are responsible for all of their needs as far as ADL's and other comfort measures. There is still a lot of changing of briefs and all. Being the evening shift we don't do baths and only have one meal to assist with so that's a plus, but we tend to get a lot of admits so things get crazy!!I work on the medical/peds unit, we get ALL ages of patients!!
In the hospital I have learned a TON from the other aides and nurses. I have learned to take out a heplock, foley, and change a colostomy bag, all of which I don't know I would have had the chance to do at a LTC facility. I wanted the whole hospital enviornment, when they need people to float I volunteer because I want to learn all different areas of the hospital. I have floated to the CICU, ICU,and Oncology, where I have learned much more and been exposed to priceless experiences.
Hope I have helped!
OH, also, working in the hospital I have inquired about shadowing nurses in the ER and Birth place because I want to experience those units as well. I won't get paid but the learning experience is invaluable!

I think colostomy bags are actually fairly common in long term care. but I thougth that taking out cath was out of of our scope of practice ?

Heidi W · Mar 3, 2008

Hi, I went from LTC to a peds floor at the hospital and it is soooo different...I don't know where to begin. I love the hospital.

The main thing I think is the difference in attitudes...from the patients and the staff. I'm still learning, but I know I'm going to love it.

I have alot less patients with alot less demanding care.

And I do more "nursing" type stuff, it seemed like in LTC all I did was change briefs and clean up. I don't reget working in LTC for a while b/c I learned some valuable lessons there, but this is where I want to be when I get my RN.

scrapgirl2000 · Mar 8, 2008

I would work in a hospital and not long term. In a SNF, you work so hard for so little pay. I quit long term after 3 weeks because it was so horrible!! The smell was awful, the way the residents were treated was awful, and co-workers did not help, since I don't speak spanish and most of them did. I worked at an acute hospital for three years and am now a Nurse, so the hospital is much better. The nurses will show you things that you will learn in nursing school if you go that route. You work typically 12 hr shifts in the hospital. Here was my routine on tele unit: Clock in at 7pm, check vitals and change patients, do lab runs until 9pm. Sit at the nurses station and relax until 11pm then do midnight vitals, i&o's, change patients. Sit at nurses station until break at 2am. Relax until 5:30 am and then start last rounds, i&0, last lab run. The patient ratio in the hospital is 1 CNA for 12 patients, BUT the patients are able to walk or need minimal assistance. Maybe 2 of your patients may be bedrest. Also, the cool thing was sometime you can work as a sitter. That is a CNA who sits with 1 patient who may be suicide risk or altered (elderly) and you sit in the room with them for 12 hours and you can watch t.v, read magazines or books. The pay is higher in the hospital because I left working 2 days per week (like per diem) at 15.00 hr. I made more changing my hourly status than if I was working full time. The patient ratio in a SNF is the same, but in a SNF, they are all mostly bedridden or are high acuity. You will learn how to do things the right way in the hospital. SNF's usually cut corners. Hope this helps! Also, if you work in the hospital on night shift 7pm to 7am you get paid a higher rate (shift differential).

aerorunner80, ADN, BSN, MSN, APRN · Mar 8, 2008

In a hospital it is going to vary greatly depending on which floor or unit you work on. I work on a ICU stepdown unit and we get all kinds of patients from total care to self care. We get more total care than not and we stay very busy. We take a full set of vital signs every 4 hours. On our diabetic, tube feed, or steroid pts we take blood sugars anywhere from q1h to q6h to AC/HS. It just depends. We have a 22 bed unit and we typically have only two techs so that is 11:1 for us which is not enough. We are one of the busiest units in the hospital. Sometimes there are people waiting for 3-4 days to get to our unit from the ER. Needless to say there isn't much downtime.

Mornings are typically reserved for doing baths and getting people up and out of bed. I usually get all but 2 or 3 of my baths done by 1130. In the afternoon we are busy finishing up our morning baths and then doing patient transfers which take up a lot of time.

At the end of the shift we do our last set of vitals at 1600, sit down to chart those, then do our blood sugars, then do our I's and O's. That takes about 2 hours total so by the time we finish, it's time to give report.

LoveMyBugs, BSN, CNA, RN · Mar 9, 2008

I worked LTC for 11 months and now I have been working in the hospital in the ED for about 5 months now.

For me the difference is night and day, in the ED, we do EKG, CBG, HCG and dips.

I have gotten to see so much in terms of procedures, see central lines and chest tubes put in and I have now done CPR several times.

However working in LTC, I learned propper lifting and body machanics, so when we do get in elderly patients I know how to lift and transfer them, (the LTC I was at didnt use lifts).

At times I still do peri-care and the big part of the CNA job in the ED is cleaning and changing the bed before the next patient, so there are days when I feel that is all I do is make beds.