i was a staff nurse in a hospital. NEURO, ORTHO, AND PEDS. frequently we would also receive overflow from other floors. so, i got a pretty wide range of experience. i now work as charge over noc. yes, i got to do more ng tubes there. but since i have been there in 4 years, i have learned many valuable skills that i would not have gleaned in the hospital setting. number one is handling a crisis at the drop of a hat with this chick the nurse in charge. no respiratory staff to call for a code, no doctor in the house. and now that our census is up lately yes we have to have a rn in the building but i have more experience than most of the rn's. dealing with geriatrics teaches you a whole new aspect for problem solving because there is no black and white. mostly grey's. if you don't know what to look for in these patients they can easily die very quickly. MANY cannot tell you what hurts where, or that they don't feel well, etc. it's my job to figure it out before they get that bad, or that is neglect. in the hospital setting i was a staff nurse only. the rn took the orders and spoke with the doctor in any change of condition situation. now i am the staff nurse, the charge, and i deal with staffing. i also worked with physicians in the office setting. it becomes invaluable when another nurse is having trouble with an order. most of the time i can figure it out, but of course not always. the most interesting thing; i have watched the skill level of acuity increase since i have been in LTC. LTC is evolving for the demand of marketing and the almighty dollar. niches are being sought after and specialties are making facilities more attractive. because of this our facility focuses on rehabilitation. i am now seeing more and more 20 year stroke victims, car accidents. another change is the hospice deal. in the last year i have taken care of countless end stage terminal residents that the family could not care for at home. i had a 47 yo women dying with ca brain mets with TPN. i have been taking care of a gentleman that is 48 with 3 surgeries to his hip because of complications , he has a groshong, dialysis patients with peritonel procedures; MS residents with ulcers that we heal so they can go home. it's kind of cool because of the younger age group that is now pouring in now i have way many full codes than i did before. yes i am sure there are more procedures in the hospital, but the way insurance has changed with hospital stays becoming shorter and shorter, and frequently these patients cannot take care of themselves at home quite yet; well we are becoming a step down unit. and, my job in comparison to the hospital is way more challenging, way more stressful, and equally as rewarding.