my first job interview experience and shocking work environment

[nurse_dot]

Hi guys! I just want to share my very first interview experience. After applying to almost all job posting online, plus personally delivering about 10 resumes to HR in different hospitals, nursing homes, long term care facility, rehab center. Maybe 1 out of 50, I finally got a call from a facility. Im so excited to speak with the unit manager and when she invited me to come for interview! Yey! I prepared myself for the interview. So I arrived in the facility 30 minutes early. She introduced herself to me. She was very nice. She conducted the interview in her office. I believe that it went very well. I was able to answer her questions. She even told me that she likes me and she can see herself in me. When I heard that compliment I was really happy. Then after the interview, she told me that she need to speak with the director of nursing and I will hear from them after a week. She gave me a quick tour with the facility. Then again, im very much excited to see the workplace and see the patients. I was totally shocked! We visited the floor with dementia and alzheimers patients, she orient me to the floor telling this is the floor with 52 patients "stable patient" according to her. Then she brought me to her unit the complex subacute unit another 50 plus patients in that area with patient on trach, peg, picc, vent. I was totally overwhelm! Then I asked her usually whats the ratio of nurse in here. She said "3 nurses in am, 2 in pm, 1 at night"! In my head I was like?? Omg? What?? 1 nurse to 52 patient!!! wow! Thats alot! I used to work in the hospital in Med-surg and whenever i get 15 pt per day, its really so much work so I wonder how they can give quality nursing care if you have 50 patient to take care. Im so disappointed with the facility, it was not clean at all, you can see the patient everywhere, patients in the hallway, trashcan just all over the place, she even said that some pt have infectious disease, The smell isnt really good at all!!!I tried not to breathe while we are walking in the floor. Its totally horrible! I just cant believe how can they tolerate to work in that kind of environment. I was so disappointed. When I first saw that facility I liked it very much because I saw the reception area was really nice, people are very warm but I wasnt expecting that its totally opposite what's inside the facility!

When I came home I was really sad. I asked myself if thats where I wana work with. Or is there's something wrong with me? I am being too picky or expecting too much?? But just I dont feel like thats not a safe environment to work with.

Guys, pls help me, my husband seems not to understand coz he is not in nursing field, he told me that if I get the job offer I should accept it. I even have second thoughts if I even want to go back to that facility. I know its really hard to find a job nowadays. Should I really have to take that job and take the risk in working with them? IS it worth it?

To those who are working in the long term care facility, is this really the usual kind of environment I have to expect when I work in LTCF? Its my first job interview and even If the interview went well, Im not satisfied with the workplace and the ratio of nurse patient. So Im really feel sad and frustrated. Please give me some advice.

Thank you very much.

[NC Girl BSN]

The ratios that you are quoting are pretty common in LTC. When I was a LPN, I had 30 patients. At first it was hard but once you learn the meds that you patient takes, you can whip through the med pass in no time. At night the nurse had 60 patients. They did not have alot to do at night. Just a few PRNs and a big medpass in the am. Mostly Bloodsugars and Prilosec. I wanted more out of life than the same routing so I got my RN and now orienting on a Neuroscience floor in a hospital.

If I were you, I would call everyone that I had put in a application to and worry the poop out of them. Have you tried physically taking your Resume to the Manager on a hospital floor. A guy that I am working with did that and got the job. Good Luck in you finding a job. The situation that you describe is typical for LTC. You can try it but it is what it is.

[mina123]

I agree with NC girl post that;s very common in LTC I hope you are referring to night shift with that ratio, then it;s accurate ratio. Mostly blood sugars, no admissions at night and 6am meds. Most LTC facilities do smell like urine. In this economy if u need the money take the job keep your other options open, while still working there. I had a bad incident with one of nursing homes though. Used to work 3-11 shift 1:32 ratio, nursing assistants were very bad they would disappear on me and go on break without telling me. When they came back they smelled like pot smoke. I complained immediately to the owner of the nursing home and resigned the same evening. In between all this they manage to steal my purse and money and also my car keys. I called the local cops and everybody got investigated. So you do have to be very careful in picking your LTC facilities. Keep in mind the location of the place, staff u are working with. Some are good some i just don;t know how state keeps them functioning. Also most NH lacks supplies for u to work effeicently so if a person codes and your o2 tank is empty you are REALLY out of luck. So be careful in making your decision i won't do this for ever but because of economy u need to put your foot in door do so at your risk but always remember to leave the other foot on other end. Just my:twocents:!

[CoffeeRTC, BSN, RN]

I work LTC. I think that 52 is doable for an 11-7 shift. We have 47 beds. Mixed LTC pts...a good bit of skilled rehab with some LTC patients.

To all the other posters that said no way....think about your LTC patients. Yes, they are sicker than what they were years ago, but for a good bit they are stable and you get to know the patient and get into routines. It is much different from acute care.

As far as the smells and cleanliness...Smells happen at certain times of the day...changing rounds. We never have lingering urine odors. Trash cans etc....I dunno. One or two filled cans maybe...but if the place looks like a hurricane hit it???

Check into the state website to find out more about the surveys, etc.

Head over to the LTC forum for more info in this field.

Now....as a new grad...might not be the best job to take.

[Moogie]

What I would like to know is how do people get away with staffing ALFs and LTCs like this? How do they expect 1 RN to care for 52 patients?

Ah, but remember---night shift "doesn't do anything". The residents are always asleep; they have no needs for toileting, dressings or PRN meds. They never have sundowner's syndrome; the residents with dementia are all snuggled in their beds and quiet for the entire shift. No one falls on nights. No one becomes acutely ill or has an emergency. No resident wakes in the middle of the night with chest pains. No resident is every sad or lonely or unable to sleep and needs a cup of warm milk and a hug.

The reason the bean counters justify such poor staffing is that they're looking at numbers, not at human needs and conditions. If they think everyone sleeps all night, why should they hire more help than the bare minimum at night? Moreover, they don't understand nursing. They don't understand----or care---about educational preparation and they don't see why a CNA or TMA or universal worker is not the same as an LPN or RN. A warm body is just a warm body.

Another thing the OP said that scared me was the high acuity of the residents. I'm sorry but PICC lines, vents and trachs---and only one nurse for 50+ residents? Yes, these are becoming more commonplace in LTC but how can they be cared for properly when the only licensed nurse has 49 other residents? I've had as many as 49 residents on a night shift in LTC and some nights were okay---even very quiet---and others were utter chaos, often because of acute needs of only one or two people. I had many nights in which I ran from 11 PM to 7 AM without a bathroom break and other nights in which the biggest chore was trying to stay awake. If the latter were more common, I wouldn't have such a problem with the staffing ratios. But IMHO, the high acuity of the residents and the low staffing is a recipe for disaster.

BTW, I really liked LilPeonNo.1's post. Can I come and work with you? :)

[wizeone7]

What State do you live in? Here in Raleigh, NC there is NOTHING! I hear Texas has jobs. Any chance you can move? I would NOT move without a firm job offer on the table.

[nurse_dot]

Hi guys, thank you very much for kind words and insightful advices. It really helped me to realize lot of things.

To be honest, when I got that tour in the facility I just want to run away and disappear. I can't imagine how 150 residents can fit in that small facility. Actually the position is available for night so that means it just 1 nurse to all patients on the floor. She said she might put me in morning shift while orienting so I could ask for help from other nurses before putting me on night shift. With all the experiences you shared with me I got really scared, I worked hard to earn my license, I can't afford to lose it. I did also research about that facility and seems like that's not the real picture of what's happening in that facility.

Here's some information listed online regarding the facility which I believe is not really accurate with the real scenario in that facility...

"This facility is participating in Medicare and Medicaid. The type of ownership for this nursing home is for profit - corporation and it has 150 Medicare and Medicaid certified beds. At the time of the last inspection this nursing home had 138 residents and the occupancy rate was 95 percent. Nursing Home has a resident council to address issues and communicate with the administration and staff. The total number of resident care hours provided daily by licensed staff is 1.4. Registered nurses spend on average 0.68 hours with each patient daily. Certified nursing assistants spend on average 0.97 hours with every resident daily. This directory contains information about certified Medicaid and Medicare nursing homes. The information about nursing homes and skilled care facilities on this web site is for general informational and educational purposes only. This web site makes no representation that the information is accurate, reliable, complete or timely"

How can it possible that an RN can spend average of 0.68 hrs per patient when u have 50 of them???

I love nursing so much. I want to give my patients the best nursing care I can possibly give. Being part of the health progress of my patient would be a great achievement for me. I feel like it's a very rewarding profession. I am really excited to work and learn different things everyday. I imagine myself waking up, going to work in hospital or any facility looking forward of seeing my patients, in a safe work environment. But with that kind of workplace I feel like everyday will be a struggle to go to work and I am gonna get frustrated with my job because even if I want to give time with all my patients, it's going to be hard with that kind of ratio. I know with the economy right now you cannot afford to be picky. As most of the posters advised me, it's not really worth it to put my license at stake. That's totally true. I'll just try to be more patient applying for more jobs. I should not give up.

I decided to sign up for volunteer job in the hospital near my city while waiting for a job opportunity to come. I ve been spending my time lately staying home, applying for jobs. I want to be productive. Maybe it will be a good opportunity to get to know some people in that hospital and hopefully if they see my perseverance and a position come up, they might offer the job to me. It's a good way to start to get some reference. Plus it will help me gain more knowledge and skills by observing and assisting them with their needs in the hospital.

Again, thank you very much! I really appreciate all your help!

BTW, I live in Massachusetts

[wizeone7]

First, I want to say I believe you made the right decision. You were wise to go to the site and see that what they said didn't even make sense about house time a nurse spends with a patient. This is a very hard time to find a job. There WILL be one out there for you. Hang in there. No job is owrth losing your license over.

[DaFreak71]

I JUST experienced the same thing last week! Night shift= 1 RN 1 LPN for about the same amount of patients...NO CNA's. The place smelled horrible. My eyes burned from the ammonia smell of urine. I would NOT work there. It was a for-profit facility as well.

Just a word about smelly facilities:

When you enter a facility you should NOT be able to smell foul odors. When you are in a patient room, you should not smell urine or feces unless they VERY recently voided. If you do enter a facility and the smell is strong, you are looking at a facility that is so overstaffed that the staff cannot (or perhaps will not) attend to hygiene issues. There is ZERO excuse for a stinky place. What happens sometimes in for-profit LTC is that they won't spend the money on disposable briefs..opting instead for reusable cloth. Those cloth briefs get tossed in a can where they stagnate until someone has enough time (or the inclination) to empty them. NOT COOL.

RUN Forrest, RUN!

[JaneyW]

Good decision. Let me also add that job searching is not a passive activity--especially in this market. Don't just drop off a resume---call!!! Then call again. Then send a follow up letter and resume to HR and a nurse manager. Be proactive in your search. Especially with the on-line ones. Make sure you also call. You can't guarantee that your application was seen.

[roadrunner-in-icu]

Do you need $$$ right now?

One nurse to 52 patients might be a lot; but you might only have to give meds to 20 patients, 10 finger-sticks, and a couple of dressings in the sacral area for a night shift. Patients in the long term care facility are stable. After all, you might still have a couple of hours to sleep in the med room.

[wizeone7]

I can only hope that roadrunner-in-icu was joking. Sleeping on the job is grounds for loss of license!! Do NOT take this advice. Patients are NOT always stable.

[loveshospital]

Run seriously!!!