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Going from 30 to 5 ...


I am a newer grad who completed all nursing clinicals in an acute care setting. First there was a Med-Surg unit, and another one, then OB, Psych, Oncology, a Renal/Telemetry floor, and last but not least, CVICU stepdown.Then I graduated and took the NCLEX as soon as I could. When I went to look for a job, all I and many of my former cohort could find are jobs in LTC. I have prior experience working with a geriatric population in another capacity. And while I enjoy working with my residents, I did want to work in acute care since nursing school. I feel like I have just got a good routine going in LTC. Obviously the level of patient acuity is lower in LTC than in a hospital. Anybody gone through this and have any advice on what to do? I heard Med-Surg nurses stay very busy. What keeps you the busiest?

melizerd, ASN, RN

Specializes in Med/surg, Onc.

My patients keep me busy. I'm on a med/surg, oncology floor.

Days I have 4 and occasionally 5. This weekend I had a patient in restraints, with a sitter, frequent checks, I had another receiving blood...second unit had a hemolytic reaction, another patient doing colon prep and up with two to the commode, the fourth was a fall who was q2turn. Two of those four had heparin drips running and needed titration.

Every day is different and every day is busy. I had no idea I'd really enjoy med/surg so much. I love the variety and the craziness of so many different patients.

I did the same thing. I've worked in LTC for two years and just transitioned to a new position where I work both LTC and acute care. I was afraid of staying in LTC and losing some of those more critical skill. I'm really glad that I made the switch even though there is a lot to learn. I get the benefit of still working in LTC where I feel comfortable so after a few shifts in acute care where I feel like I know nothing, I get to go back to what I know. If something more acute is where you want to be, go for it!

I worked in LTC for 4 months before going to acute care. I didn't hate it but I didn't love it. I work there now per diem. Working per diem in LTC is awesome! No admissions, no drama, you do your work,give report and leave.

I work in med- surge now. Been doing this 8 months. My patient load is a lot like melizerd. Some times as chaotic other nights, very smooth and down right boring. If you want to keep your skills and at the very least, make your experience more diverse, I suggest getting acute care experience.

The RN trainer at the LTC I worked suggested I get "hospital experience." He said when you say you are a nurse, you are expected to have a certain set of skills you won't get in LTC

Hope that helps.


Specializes in LTC.

I started with LTC for a couple of years, then transitioned to LTAC where I had 12 patients. I can honestly say that I can work circles around my med-surg coworkers. I am a pro at time management and rarely find taking care of 5 or 6 patients overwhelming. I really believe handling 25-30 patients at a time benefited me.

RedInScrubs, ASN, RN

Specializes in Medical-Surgial, Cardiac, Pediatrics. Has 3 years experience.

I usually have anywhere from 4-6, depending in the shift and what's going on with the floor, and there are nights where I don't stop moving. It's amazing how the shift in acuity makes a difference in terms of needs, because each patient has different levels of focus, and there are so many different things to keep organized and prioritized, and things tend to change very quickly depending on what's going on with the patient. Like the other day, I had a septic patient, a hypoglycemic, a cervical fracture waiting for surgery, a bowel resection, and a very bad case of pancreatitis with more lines in him than my car. You get a bit of everything, and things can change very quickly from stable to unstable, and you have to be ready for whatever happens to roll with it all.

It's a challenge every single shift, and I've been surprised how much I enjoy the craziness of it. I didn't think I'd like it as much as I do, but I've come to look forward to the unknown and challenges, despite it being exhausting and very hard.