Going into LTC Nursing

Hard to answer this without knowing what your position title and shift are! But whatever it is you will be busy with a capital BUSY!

Hi, first let me say congrats! and it's funny as I just came on this forum to ask about rn case manager positions, as I have been working in a LTC facility and am now starting an RN case manager position next week, and wondering what that is going to be like. As for the LTC, alot of the facilities are not profitable at this point, due to the economy, rising costs and no increase from medicare. It depends on the % of private pay versus medicare patients. That being said, they are staffed accordingly. At my facility, I have 21 patients. No matter what is going on with them, I do not have enough time in my day to finish my work. There is always something to be done. And mind you we don't have a desk nurse, sometimes no manager, and are down CNAs alot of the time too. The budget at this facility is tight tight tight! And it reflects in the level of dressing supplies, the way things are run and stocked, even the gloves we use. Things have gone downhill in the last two years. But the patients are wonderful. You just get attached to them and it is very fulfilling, if not extremely exhausting! The typical day consists of getting report, auditing labs, doing a 2-4 hour med pass, doing dressings, helping with meals, following up on labs and new orders, another med pass, CBGs, insulin injections, booking transport for patients to go out, dealing with families, another med pass...you'll feel like a giant pill bottle. Then finishing any treatments, toileting patients after meals and upon waking, delegating to your CNAs, who without them you just simply cannot do your job, and answering calls. THEN you will write your notes, every medicare patient has to have a note each day, as well as any patient with a change in condition or anything note worthy, then doing a nursing summary, which is a focused assessment on one patient, then cleaning and re-stocking your medicine cart, making copies, taping report for the next shift, then counting off the narcotics (taking inventory.) all this in 8 hours? I usually do 12s, as it literally takes me every bit of 12 hours to do all of this. Nobody usually gets breaks, although we are supposed to take them, there's simply no time. If you take a break, you know you will not be in compliance or you are going to neglect someone or something. It's grueling and thankless as administration often forgets how difficult this pace is, you need to be super organized, delegate constantly, and just be on your toes. There's often no time to call home to check on your family, lol. If your facility is on computers, this may be alot different, mine is not. Everything is documented in five places by hand, notes all by hand, medications are on cards and you pop them out into cups. There are also showers, weights, rehab services, dietary changes and other consults to make during the day, hospice visits as well... hope that helps!!

What shift are you going to work? Days are WAY busier than nights but either way, once you get used to the routine (takes about a month) it's amazing..i love my job and my residents are like family..

Sherpalicious, I think you did an excellent job summarizing the life of a LTC nurse!!