LTC / subacute accurate picture

  1. I have read the posts on this topic to help make a decision about a SNF/LTC job offer........

    Here are the issues I see as discussed: (negatives)

    Understaffed
    Under paid (my office is 23 and I am an RN)
    Team dysfunction
    Med pass being overwhelming
    Manager dysfunction and lack of support
    Family member issues
    CNAs angry and nurses and vice versa-finger pointing at each other
    On call
    Corporate greed


    Here are the issues I see as discussed: (positives)

    A few people said it was very rewarding



    Are these accurate observations and does anyone care to comment? LTC/subacute would be a new venue for me and I sincerely would appreciate experienced nurses who have worked in this type of roll.

    Thanks,

    renerian
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    About renerian

    Joined: Aug '02; Posts: 7,472; Likes: 46
    RN, MS home health

    21 Comments

  3. by   snowfreeze
    Renarian,
    Much depends on the facility you work in. I work in a LTC/Sub-acute facility and I like it. Many staff members have been there for over 20 years. It is a large enough facility to have well staffed departments besides nursing. I work as a staff RN and I supervise. I came from Critical care on a specialty transport team in a facility that closed 2 years after I left. This facility is connected to Lutheran Affiliated Services so has a corporate office and some other sister facilities in the local area. It is a 12 minute drive for me, parking is free. I work steady daylight and I supervise every other weekend. I can pick up adequate overtime but it is not mandated. I have been here for over 4 years, there have been some positive changes in the last 9 months. New retention incentives, new DON, a better shift of the responsibilities. Everyone is now accountable for their job and this includes the paperwork. RNACs do all the MDS's with our charting being fine tuned to MDS requirements. Much check-list charting has been initiated that seems to be working well. Nurse aids chart the hands on care in an MDS number code
    Right now you won't get rich quick working in LTC but you will have the energy to enjoy your life. I am not exhausted when I leave work like I was in ICU, Trama and CCU.
    Even on a bad day I have time to pass medications, do treatments and some special 1:1 with the residents.
    Family member issues are usually handled by the social workers. If at night or a weekend the supervisor handles this and the social workers are all easily contacted at home if necessary.
    Med passes are not that bad, anywhere from 10 to 36 patients depending on where you are working taking 2 to 3 hours in the morning and about 45 minutes in the afternoon.
    Many families visit daily.
    We do find the occasional angry employee but they seem to quit when no one else appreciates their behavior.
    Feel free to e-mail me for further insight.
  4. by   Antikigirl
    Okay I don't know about some, but there are times when you are really REALLY there for a patient when they need you the most and you feel your worth so much it makes you cry! Yeah sure it may happen once in a blue moon, those times when you walk to your car and you say "dang...wow, I really helped!!!! WOW I feel great!".

    For instance...I had a patient dying alone...family was out of state and could frankly care less. It had been obvious from family statement that they were only waiting for Grandpa to die so they could get his rather large fortune he saved up for retirement, and the less medical expenses the better for them! So here is this sweet gent alone and scared out of his mind! I pushed off my non-urgent duties and held his hand, wiped his brow, gave his pain meds like clockwork, and changed his NC more times that I could count (CHF...lots of secretions..very sad way to go!). He died holding my hand, and I not only finally got to say goodbye to a resident, but got to help him all the way to the end with the compassion I possess and never get to show because of my busy work schedule.

    So once in a blue moon, for me anyway...I walk out those doors from work and say "holly cow girl, you really do make a difference~!". That tends to make it all worth while...for a while anyway..LOL!

    So it depends on your facility, your patients, and your own feelings about what it is you believe makes a difference in your work! I find the happier folks I work for find a way to make things gratifying for themselves as well as their patients...it just takes practice sometimes between all the duties thrown at you in a day. Somedays I have more time to sit back and say..wow, other times..I go home and pass out on the couch from a hard day! But when all is said and done, I can certainly look back at working with assisted living facililities and say ..one I learned A LOT!, and two...I did very well and helped out more people that I can even think of anymore!
  5. by   renerian
    Thank you very much for your thoughts and at least hearing something positive. I did see bits and pieces elsewhere that was good. I think this place has a high turnover.......not sure how much... It is an HCR facility.......

    renerian
  6. by   donmomofnine
    I agree with Snowfreeze! I have wonderful residents with deeply caring families. We have good to great staffing. We are paid well ~ not like corporates, but pretty good for non-profit! We have lots of equipment. We do have some bad employees from time to time, but we counsel them and hope they turn around, and if not, they are shown the door. Our departments work well together as a team. Our facility is clean and our residents are well cared for. We treat our employees as valuable, because they are! I personally try to treat all my staff members well and my door is always open. We have a philosophy that treats death and dying as natural, so we have lots of hospice and palliative care and little heroics. Our residents are deeply cared about by our staff and the families appreciate them and commend them, as do I! It's all about finding the right place to work and if you do, I think long term care is very, very rewarding.
  7. by   steff_rn1
    I agree with the above posters. Even in my current position as DON, I am able to make a difference in the lives of the residents we care for. Last month, I held a woman's hand as she passed away. Last night, I comforted and cared for a man who is ready to give up and die. His wife has been gone for five years, and he sees no reason to live. After going to his room a few times and talking and listening to him, he seemed much more content.

    Staffing is an issue anywhere in nursing. Yes, if you work in LTC, you will probably get stuck at work sometimes when you would rather be at home.
    As far as the CNA's go, I have found that if you let them know that you will lend a hand when needed and address their concerns, they are fairly easy to get along with. They usually go above and beyond if they know you share their desire to take care of the residents. Of course, this is not always true. In these cases, the facility needs to get rid of them.
    Family members, for the most part, want their family member to be taken care of. If the facility makes a mistake, it is best to address it and move on. I can not count the number of families who have been satisfied with the care that we have given.
    Overall, I truly enjoy working in LTC. I enjoy the daily interaction with the same residents and making a difference in their life. I enjoy knowing that the families are happy with the care that we give. And most of all, I am happy to care for people that were the bankers, teachers, farmers, housewives, supervisors, and nurses years ago. What a great feeling to give them the care and respect they deserve at the end of their lives!
  8. by   nightingale
    What job are you looking at Ren?

    I am doing the MDS Coordination, and it has its ups and downs (and side ways) but I have many good days (more then I had as a float nurse). I am also doing Restorative Nursing and feel quite happy with how it is progressing (but ofcourse do not "have enough time" to get it done).

    I would watch HCA but I am not familiar with HCR. Could you sit and watch the floor for a bit (espcially for the 0800 AM med pass) or shadow someone you may be replacing for a few hours?

    Let us know how you are doing.
  9. by   renerian
    It is so nice to see people who do like long term care /subacute. I have heard horror stories about HCA in the travelers clubs. Sounds awful.

    The job I am considering is a staff nurse/12/days... 1-12 to 18 ratio on the sub acute. CNA is 1:15 which I am guessing from the list is higher than normal. Pay I thought was low at 23.00 for Ohio. I asked for a shadow date but was told due to hippa that was not possible.

    Thanks everyone for your comments. I appreciate hearing points of view fromt the different team members.

    renerian
  10. by   donmomofnine
    Our ratio for NAs is 1:8 on days and 1:9 on 3-11. We allow shadowing and don't see it as a HIPAA issue ~ I guess it just depends on your interpretation of the law! Good luck!
  11. by   renerian
    I appreciate your input. May I ask what your nurse ratio is on subacute and ltc?

    Thanks,

    renerian
  12. by   Blackcat99
    :chuckle I won't say anything negative about LTC's except for the med passes. I work nights so it is not a problem for me. The med passes for days and evenings at my LTC are called "the med passes from Hell." Good luck to you Renerian- Hope you will enjoy your new LTC job.
  13. by   CoffeeRTC
    Not sure about the sub acute staffing. Here is our LTC ratio for 48 pts.
    7-3 1 RN
    1 LPN
    5 CNA + Restorative CNA

    3-11 1 RN
    1 LPN
    3-4 CNAs

    11-7 1 RN or LPN
    2 CNAs

    This is totally do-able
  14. by   CapeCodMermaid
    Sub-Acute is a whole different thing in LTC. We are taking care of extremely sick people who, 5 or 6 year ago, would be in the hospital. Unfortunately, most corporations look at numbers and not acuity when staffing their facilities. On my sub-acute floor, for 41 patients,day shift there are 2 med/treatment nurses, a charge nurse, and nurse manager and 4 (!!) CNA's.On 3-11 there are 2 nurses and 3.5 CNA's and 11-7 one nurse and 2 aides. We are desperate for another CNA but we are always told we have more nurses than the other floors. Of course we do-we have the fresh post-ops, IV's, Midlines, PICC lines, and a variety of others...we write easily 6 times the number of orders a day as the other 2 units put together.
    Then there are the Admissions Directors who are told to "keep the beds full" so they admit practically anyone. Someone with dementia or an active psych diagnosis does NOT belong on a floor with short term rehab or sub-acute people.

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