Give LTC a chance, or get out now?

[mc-escher]

Recently licensed ADN graduate in Illinois, I took the first job offered to me after being rejected from some big hospitals. RN position in a LTC facility, started on the vent floor. Was overwhelmed by how many patients there are, the physical condition of them, the resources available at the facility, and the professionalism of the staff. Now I 'understand how things work' a little better but that doesn't mean I like it.

I'm also still recovering from an ORIF of my proximal tibia from last August, and the 12 hour shifts [really 13 hour when you count hand-off and catching up on unfinished tasks/charting] add up, especially on the vent unit where most of my time is spent passing meds to my 13+ patients, all of whom are on ventilators and have g-tubes, most of whom are comatose. It's a lot of work and my knee throbs after a shift. Compression socks have helped.

I told the DON I'm going to quit because they were consistently scheduling me for 4 day weeks [with a bonus 5 day week] after promising alternating 3 and 4 day weeks. It was too much for my knee and didn't feel like a good fit. They offered me a consistent 3 days a week, and a position on a calmer LTC floor with more independent and medically stable patients [granted, it's about 20 residents now and one nurse, two CNAs]. Still a lot of meds to pass but much less clinical problem solving. Currently I'm going back and forth between this floor and the vent unit, still doing twelve hour shifts. On the next schedule I'll mostly be on the calmer floor.

People are telling me to stick with it because it's good experience and if I stay six months I can be considered for positions in hospitals. I'm honestly afraid that I'm not going to learn anything at this facility unless I take the initiative and come in having studied my residents conditions and medications at home. I just want to get out and look anywhere but LTC, but it seems like that's all that's really available to me at this point with my unimpressive resume. They also seem to have taken back the hiring bonus they promised me, because I threatened to quit. Nobody's said anything but I can't think of another reason. Just another thorn.

What's your experience with a first job in LTC? Are you glad you stayed, or glad you left?

Sorry if this is all over the place. I feel so conflicted about what to do. Some things are shady.

[neuron]

Recently licensed ADN graduate in Illinois, I took the first job offered to me after being rejected from some big hospitals. RN position in a LTC facility, started on the vent floor. Was overwhelmed by how many patients there are, the physical condition of them, the resources available at the facility, and the professionalism of the staff. Now I 'understand how things work' a little better but that doesn't mean I like it.

I'm also still recovering from an ORIF of my proximal tibia from last August, and the 12 hour shifts [really 13 hour when you count hand-off and catching up on unfinished tasks/charting] add up, especially on the vent unit where most of my time is spent passing meds to my 13+ patients, all of whom are on ventilators and have g-tubes, most of whom are comatose. It's a lot of work and my knee throbs after a shift. Compression socks have helped.

I told the DON I'm going to quit because they were consistently scheduling me for 4 day weeks [with a bonus 5 day week] after promising alternating 3 and 4 day weeks. It was too much for my knee and didn't feel like a good fit. They offered me a consistent 3 days a week, and a position on a calmer LTC floor with more independent and medically stable patients [granted, it's about 20 residents now and one nurse, two CNAs]. Still a lot of meds to pass but much less clinical problem solving. Currently I'm going back and forth between this floor and the vent unit, still doing twelve hour shifts. On the next schedule I'll mostly be on the calmer floor.

People are telling me to stick with it because it's good experience and if I stay six months I can be considered for positions in hospitals. I'm honestly afraid that I'm not going to learn anything at this facility unless I take the initiative and come in having studied my residents conditions and medications at home. I just want to get out and look anywhere but LTC, but it seems like that's all that's really available to me at this point with my unimpressive resume. They also seem to have taken back the hiring bonus they promised me, because I threatened to quit. Nobody's said anything but I can't think of another reason. Just another thorn.

What's your experience with a first job in LTC? Are you glad you stayed, or glad you left?

Sorry if this is all over the place. I feel so conflicted about what to do. Some things are shady.

Get out now from this hellhole. That 20 patients you are 'promised', will turn in to 'we don't have staff' for you to have that unit. Then that 20 patients will be all trachs, 15 feeding tubes, all needing sched II meds, with colostomies.

[Neats, BSN]

I am a LNHA and DON. I have been in many LTC facilities as a LNHA who went into troubled facilities. I do not look at LTC as some sub standard nursing avenue. In order to work in LTC your assessment skills must be top notch, you also have the skills of responsibility as autonomy is practiced daily.

I think the reason why we do not have a good reputation stems from the past and now with all the regulations and steps we go through for care it is our geriatric responsibility to fight for better reimbursement and better conditions.

In nursing, until we are reimbursed much like PT/OT and ST we will always be necessary dead weight. I mean this in the most sincere way. We should have nursing codes for inpatient cares in 15 min increments. Until then, we are necessary but costly... in the business world I would call nurses an ordinary necessary business expense.

The impact of nursing staff on hospital costs have been the topic of many studies-some show conflicting relationships between nursing ratios and hospital cost, infection control and many other issues. Not very many studies have evaluated the RN staff level of experience against the hospital issues. We all can guess that what we do as nurses is significant on so many level however what it comes down to is show me the monies. PT/OT/ST/RT and many other specialties to include imaging technicians bill for their services...most nursing services are included in the operation cost/sunk cost and this is where we need to remove our profession from and into the reimbursement for services cost. Unfortunately this would be so very costly I am not sure how it could be completed.

It is a nice thought though, as a nurse be able to chart room arrival at 0900, removed, cleaned and dressed wound left room at 0926 hrs in 26 mins using some sort of CPT code for my nursing services and the facility being able to bill for that service in lieu of daily charges. In addition we bill for medication sometimes it takes us 15 mins to administer that medication or longer (think G-J tube) or having to crush and administer or having to give each individual pill at a time to a patient who has difficulty swallowing but still can. I can stand there for a good 5-7 mins doling out each pill waiting for them to drink/swallow and drink again ready for the next pill. All this takes time and while doing this we are performing an assessment.

I do not think what we are doing will change and perhaps in the future we will become like the TSA-the US government will take over the medical field and we will all be Government workers.

So a long answer to your question LTC is something you ether like or do not. You learn to work within your environment and if you are overwhelmed ask for assistance/delegate. Learning about chronic care disease/respiratory needs is what you put into it. You will surely learn if you care to put forth the effort. Look at those labs coming back, look at the wounds, perform those assessments and you will make a fine floor hospital nurse some day.

I place these long comments for nurses to start communication for better staffing levels and working conditions and a view of nursing worth. I am not trying to be political just trying to make our profession better than what it is now.

[stockmanjr, BSN]

I am a LNHA and DON. I have been in many LTC facilities as a LNHA who went into troubled facilities. I do not look at LTC as some sub standard nursing avenue. In order to work in LTC your assessment skills must be top notch, you also have the skills of responsibility as autonomy is practiced daily.

I think the reason why we do not have a good reputation stems from the past and now with all the regulations and steps we go through for care it is our geriatric responsibility to fight for better reimbursement and better conditions.

In nursing, until we are reimbursed much like PT/OT and ST we will always be necessary dead weight. I mean this in the most sincere way. We should have nursing codes for inpatient cares in 15 min increments. Until then, we are necessary but costly... in the business world I would call nurses an ordinary necessary business expense.

The impact of nursing staff on hospital costs have been the topic of many studies-some show conflicting relationships between nursing ratios and hospital cost, infection control and many other issues. Not very many studies have evaluated the RN staff level of experience against the hospital issues. We all can guess that what we do as nurses is significant on so many level however what it comes down to is show me the monies. PT/OT/ST/RT and many other specialties to include imaging technicians bill for their services...most nursing services are included in the operation cost/sunk cost and this is where we need to remove our profession from and into the reimbursement for services cost. Unfortunately this would be so very costly I am not sure how it could be completed.

It is a nice thought though, as a nurse be able to chart room arrival at 0900, removed, cleaned and dressed wound left room at 0926 hrs in 26 mins using some sort of CPT code for my nursing services and the facility being able to bill for that service in lieu of daily charges. In addition we bill for medication sometimes it takes us 15 mins to administer that medication or longer (think G-J tube) or having to crush and administer or having to give each individual pill at a time to a patient who has difficulty swallowing but still can. I can stand there for a good 5-7 mins doling out each pill waiting for them to drink/swallow and drink again ready for the next pill. All this takes time and while doing this we are performing an assessment.

I do not think what we are doing will change and perhaps in the future we will become like the TSA-the US government will take over the medical field and we will all be Government workers.

So a long answer to your question LTC is something you ether like or do not. You learn to work within your environment and if you are overwhelmed ask for assistance/delegate. Learning about chronic care disease/respiratory needs is what you put into it. You will surely learn if you care to put forth the effort. Look at those labs coming back, look at the wounds, perform those assessments and you will make a fine floor hospital nurse some day.

I place these long comments for nurses to start communication for better staffing levels and working conditions and a view of nursing worth. I am not trying to be political just trying to make our profession better than what it is now.

The problem in LTC is sometimes you have no one to ask for help from. Friend of mine is a recently ADN grad here in NYC, and after 1.5 weeks of "Training" she was abruptly told that she would be by herself all night on the floor. 1.5 weeks isn't enough to allow someone to fly solo safely imho, and she had several near misses that night...

[invictus, BSN]

I would start looking for another job, but wouldn't leave until I had one. If this place lied about the schedule you'd have, and didn't give you your promised signing bonus (which, if you have decided to stay, I think you should still get?? I would look into that) don't feel like you "owe" them a year of your life. If staying benefits you, stay, if leaving benefits you, leave. Do so gracefully, but if you get another opportunity take it and run.

[slauren]

It seems that you've already made up your mind, you aren't happy where you are. I feel you could learn a TON from what you're describing but you deserve to be happy with your job. I worked at a LTC/rehab for a few years, it was challenging and I learned a lot but I honestly hated how it was managed and the lack of help nurses get, unprofessional-ism, etc. Maybe put some feelers out for what your options are and take what you want.

Word of advice - don't let managers/boss know your intentions are to leave soon, I did that with my rehab job and I regretted it even thou it ended on good terms.

[Kooky Korky, BSN, RN]

I'd fight for that bonus.

Read the contract you signed when you hired on and see what it says about that bonus,

what obligations and conditions you have to meet.

Stay if the new unit is OK/better for your leg.

[Xchupa]

I also started as an ADN at a nursing home, was absolutely awful but in hindsight it was great experience, definitely learned how to multitask, and later once I got into a level 1 trauma hospital I was way more calm with stuff compared to most of my coworkers who'd freak out over the most benign issues, so also gave me perspective. Regardless of what job you're in, quitting within the first year will always look bad on your resume... You'll ALWAYS be asked why you left a job so quickly and saying "it was too many patients/too many hours/rough on my knee" will never work in your favor. My advice is to stick it out for at least a year, then you'll have experience behind you and you can comment on how ****** it was but that you worked through it anyways, and that'll sell much better in interviews.

[jeannaj2012]

I am not currently a nurse (taking prereqs for nursing) but i worked about a year and a half in ltc as a cna before going to the hospital i currently work at, so i can not give you experience based on being a nurse. But i think everyone should work in a ltc for atleast 6 months before going to a hospital as it offers good learning experiences.