Former Med Surg RN to LTC

CoffeeRTC, BSN, RN · Jan 11, 2016

Welcome to LTC! First step is realizing how different it will be. A lot of how crazy it will be will depend on what type of facility you will work in. Larger facilities might have more support staff and of course more nurses. Smaller places you might need to wear a few more hats.

Read thru some of the new grad posts already in the forum. Good tips.

Even though you have some time in, ask for as long of an orientation as you can get. Will you be more of a supervisor or floor nurse working the cart? Ask to get training in both areas. Keep cheat sheets. Depending on what type of facility, some of the residents will be long term and you won't have many changes. My sheet has room number, name, Dr, code status, top dx (they will have tons of them, but what are we treating them for?) and a spot for IVS/ Accu Checks. How do they take meds? Whole or Crushed? and if they need anything special...thickened liquids, etc.

In LTC, you will be doing focused assessments. Rarely do you have time to do a full head to toe like med surg.

Get a cheat sheet for important phone numbers or extensions. Big places can be confusing. In a new place, I find it useful to have drs phone and fax # handy along with the pharmacy's. I also make notes about what drs like certain things. All of our drs are so different.

My biggest piece of advice.....not be afraid to ask questions!!!

RegisteredNuisance, RN · Jan 11, 2016

Thanks Michelle126!

So, I live in a town of about 70k people with a snowbird population but we get snow so it's a little slow this time of year so the census is a little bit down I hear, which will probably be helpful for me. The facility sees mostly older patients and we have a partnership with the hospital so patients go back and forth. We can also trade supplies and run labs quickly from there.

I'm training to work one of the halls, but not sure about specific roles yet. My orientation is about a month, according to my chat with the DON. She said it used to be two weeks but RNs have been doing better with more time. I'll be doing nights, but I'll train on a few day shifts as well, most likely.

This place is a bit larger than some, it also has an attached independent living and assisted living side. There are two halls, and the ratios for RNs are 10:1 during slow times and up to 20:1 during faster times. That's about all I know for now. I'm not intimidated by the ratios since the acuity is obviously less than the hospital, but I haven't worked a floor in a few years so it might take me a couple shifts to warm up my clinical skills again.

CoffeeRTC, BSN, RN · Jan 12, 2016

Sounds like a nice bit of training and that they are willing to invest in their employees. Good luck!

RegisteredNuisance, RN · Jan 12, 2016

Thanks! And thank you again for the tips. I'm sure I'll be fine, just new workplace jitters.

quiltynurse56, LPN, LVN · Jan 14, 2016

I have sketched out a schedule of when I should get what type of jobs done. Now this is always subject to change LOL. Then I have a check list of who gets what when. Medications, treatments, blood glucoses, etc. It really helps me to keep focused on what comes next. I also have spots where I can do charting if nothing out of the ordinary happens.

Hope these ideas help out a bit.

Hoosier_RN, MSN · Jan 16, 2016

In LTC, just learn to go with the flow, within the guidelines of your state practice act, scope of practice, and facility policy. As with all nursing, flexibility is key, but even more so in LTC. These people see you day in and day out and depend on you. Remember, in LTC and AL, we are working in their home, they are not living at our workplace! Just find your own rhythm, and work with that. You'll be fine

CapeCodMermaid, RN · Jan 18, 2016

Sorry still laughing about the acuity being less than it is in the hospital. If you're working on a post acute unit, you will, indeed, have acutely ill patients with a lot less staff than in the hospital. We had on a 46 bed unit, any where from 10-20 people on IV meds every 4 hours, 6 or 7 people with new chest tubes, CHF, pnemonia,...the list goes on. Constant 'discussions' with admission people about why we weren't doing IV push Lasix...you have 20 other people to care for-how do you expect to have the time to constantly assess someone you're giving IV Lasix to?

You will be busier than you were on a Med-Surg floor. Your assessment skills and time management skills are essential for your success and the success and health of the patients in your care. I can't imagine working in any other area of nursing and the rewards are great, but you have to know what you're getting into. Good luck.

KDuncan890 · Jan 19, 2016

LTC is a totally different ball game than Med- Surg. I have worked both and actually enjoy LTC the most if working the night shift. LTC allows you to use alot of critical thinking skills due to the fact that its just you. No hospitalist to come see the patient, no RT to come help you, the only people there to help you are your co- workers. LTC allows you to really obtain some good time management skills along with great communication skills. The only advice I can really give you is pay attention to the complaints of your patients, get to know the culture of your facility, know your chain of command, keep some cheat sheets on how to do things, always have your own supplies ( such as BP cuffs and ect.) just in case something doesnt work, learn to look for the information you need, and lastly PLEASE RESPECT YOUR CNA. They will help you greatly if you are respectful to them.

Zyprexa_Ho · Jan 23, 2016

Can I ask why you left Med Surg for LTC? :)

RegisteredNuisance, RN · Jan 23, 2016

Can I ask why you left Med Surg for LTC? :)

Of course you can. I didn't leave M/S and go straight to LTC. I'm returning after a break of about two years. This seems like a lot, but I had to take some time off after a rough couple of years. Upon considering my options for returning to work, I knew I like home health having worked in that specialty for a few years, but was willing to give clinical work another go.

I did not like the two hospitals I worked in in terms of employee culture or the chaos of the hospital floor. Lots and lots of backbiting, tattling, etc. From the replies here it sounds like LTC can be just as busy and confusing, but I feel like the place I'll be working at has a better working environment and more supportive team. I'm not saying Med Surg is awful or that it's any less valuable or busy than LTC, but I do feel the latter might be a better fit. At any rate I'm committed to making it work. I feel more rested and my personal life is much more stable, so I'm hoping this will work out.

Make sense?

RegisteredNuisance, RN · Jan 23, 2016

Also, the CNAs that just got hired were told they were critically needed by the DON and I agree. When I worked on the floors my CNAs were the only thing keeping me from being buried in work and I've always *tried* to make them know that. You always get a few that see RNs as lazy chair sitters who use charting as an excuse to boss them around, but typically if I'm delegating something to my CNA, it's because I have something that HAS to be done that they CAN do, that I just don't have the time to at the moment. Sometimes that involves charting. I try to give a rationale so they know I'm not just pointing fingers and throwing orders around.

Rambling now, leaving...