Horrified, disappointed and need advice......

Published

I am a senior in a BSN program. Have maintained a good GPA, have always had good grades, and have been on honor rolll most semesters. I have always had a good rapport with the professors and administrators at my school, and have had no "issues". We are entering our one on one preceptorship, and were asked to give 3 areas of preference for placement. I selected 1) Critical Care Unit, 2) Emergency Dept., and 3) Progressive care/step-down unit. Well, I received my assignment yesterday and have been assigned to a long term care facility. I am so upset! I have goals to work in an ICU or Emergency Dept., and do not feel that spending what should be the pinnacle of nursing school in long term care will benefit me. Yes, I will get patient experience, but I have been a tech at a hospitall for 4 years, that is not an area for which I need experience. I addressed it with my school and was told, that's where you are assigned. It can't be changed. If you don't want to go there, you can withdraw and take this class next semester.

What really frustrates me, is that in speaking to other students in my class, I am the ONLY student that did not get an assignment that was on the "preferences".

I don't know what to do! If I withdraw, that moves my graduation from May to end of summer. If I just go to LTC, I am missing the opportunity to develop and hone the skillsets that I will need working in an acute care hospital, not to mention the opportunity to network and build rapport in order to find a job after graduation.

Any thoughts out there???

Up Vote Up Vote ×
Specializes in PICU, Sedation/Radiology, PACU.

It's really to bad you didn't get a placement that you are more excited about. Who did you talk to in your school? Is there someone else you can talk to and ask why you were placed there?

I also think you're under the misconception that nurses at LTC do "tech work." In reality, their jobs are much more diverse. There are a lot of nursing skills used in LTC- wound care, tube feedings, trach care, even vents in some places. You'll also have the unique experience of learning to manage a large patient load, which can be really helpful in the future. you get to work with a lot more independance in LTC- no doctors there every day to write new orders and look at the patient. So you've really got to learn to be on top of your assessments, med management, and communication skills. There is A LOT to be learned from a LTC placement.

You're looking at all the negatives in the situation and focusing on how this was not where you invisioned yourself being. But this could really be a great experience for you, if you approach it with an open mind and are willing to learn. You might even discover that you really enjoy a side of nursing that you never considered.

That being said, delaying your graduation a few months isn't really that long. There are people in your class who won't even have passed their NCLEX or have a job by that time. So if you really want a different placement, that's always an option. But remember there is no guarantee you'll get the placement you want next semester either.

Up Vote Up Vote ×

With healthcare being what it is, LTCs are getting much more complex patients (and a treasure trove of wound care experience). Many do longer term IV antibiotics, and more rehab oriented care- it's not just a warehouse, like it used to be 30+ years ago. Even when I graduated in 1985, I went to LTC and had trachs, did the respiratory treatments, all wound care, meds on 30 patients (along with the treatments), a lot of diabetic "stuff", etc.

You will get more opportunities with a greater number of people...just let the preceptor know that you would really appreciate being allowed to do whatever procedures needed- no matter where in the facility; IVs aren't uncommon (and PICC care is always a possibility), and you will learn more than you know ;)

If I hadn't had the 6 months in LTC before moving to another state, and getting a job in acute neuro (with 14 acute hospital neuro patients at night with no aide or ward clerk....just me, another RN, and 28 beds....coma city, and all that goes with neuro), I would have sunk with those 14 patients ...as it was, after 30 on evenings and 60 on nights, 14 sounded like a party :D

You get great time management skills in LTC....this is NOT a bad thing. You may end up liking it a LOT (or not- but you will not have a wasted experience :up:).

Up Vote Up Vote ×

Thank you, Ashley and Xtxrn! I am starting to be a little more optimistic about the opportunity. I do not understand the placement process (students that were barely passing were being placed in ICU's and a student that had been on discipline action was given PACU), but the "powers that be" are standing firm in their placements.

I hope that you are right, and that I will leave there with skills and confidence that will carry over into my future. I have been a tech in ED, PCU, and ICU. My heart is set on nursing in the ICU. :nurse:

Up Vote Up Vote ×
Thank you, Ashley and Xtxrn! I am starting to be a little more optimistic about the opportunity. I do not understand the placement process (students that were barely passing were being placed in ICU's and a student that had been on discipline action was given PACU), but the "powers that be" are standing firm in their placements.

I hope that you are right, and that I will leave there with skills and confidence that will carry over into my future. I have been a tech in ED, PCU, and ICU. My heart is set on nursing in the ICU. :nurse:

I can't say this for sure, but some of those placements may have been a "safe" way to weed out those who are never going to make it while they have someone looking over them :) To give the students with problems the least critical patients wouldn't weed out who is just not going to make it. So, in some ways, going to LTC is a sideways compliment...they may know that you will make the best of it, where the others might kick back and empty garbage for their preceptorship. :up:

Up Vote Up Vote ×
Specializes in Gerontological, cardiac, med-surg, peds.

I also think you're under the misconception that nurses at LTC do "tech work." In reality, their jobs are much more diverse. There are a lot of nursing skills used in LTC- wound care, tube feedings, trach care, even vents in some places. You'll also have the unique experience of learning to manage a large patient load, which can be really helpful in the future. you get to work with a lot more independance in LTC- no doctors there every day to write new orders and look at the patient. So you've really got to learn to be on top of your assessments, med management, and communication skills. There is A LOT to be learned from a LTC placement.

You're looking at all the negatives in the situation and focusing on how this was not where you invisioned yourself being. But this could really be a great experience for you, if you approach it with an open mind and are willing to learn. You might even discover that you really enjoy a side of nursing that you never considered.

I totally agree. I used to have a med-surg clinical on a general rehabilitation floor - a type of skilled long-term care nursing. Out of all the med-surg clinical sites, my clinical group had the opportunity for the most skills and most varied experiences and the students loved it. :yeah:This experience could be invaluable for your goal of eventually becoming an ICU nurse, as many of the skilled patients spend weeks in an ICU (for a wide variety of reasons such as MI, trauma, etc) before coming to rehab.

Up Vote Up Vote ×
Specializes in Nursing Professional Development.

Here are the questions I would want to resolve in my head as I made a decision if I were in your position:

1. Will the school guarantee you a more desirable placement if you choose to wait a semester? Can you get that in writing? It would be truly tragic if you delayed your graduation and then didn't get a placement more in line with your career goals.

2. Are you still working as a tech? Could you get sufficient hours as a tech to support yourself for a few months while you waited?

3. Do you want to work for the same hospital (where you work as a tech) after you graduate? If so, what do they say about your situation? If they are willing to hire you as an RN based on your tech experience, then maybe it doesn't matter so much where you do your preceptorship. I'd be talking to the people at the hospital as part of my decision-making process. Tell them of your desire to work there as an RN and ask them whether or not the preceptorship site will make a difference or not. If it is going to compromise your chances of being hired by them, then waiting may well be worth it. But if it doesn't make a difference to them, then waiting might not be worth it.

Also, knowing your situation ... your current employer may be able to help you in some way. You never know until you talk to them. I'd talk to them and see what they say before making a final decision.

Good luck with whatever you decide.

Up Vote Up Vote ×

keep looking at the positives and move forward. You will gain alot of experience in LTC and that is invaluable even if it isnt the experiences that you were aiming for.

Up Vote Up Vote ×
Specializes in LDRP.

ive talked to my teachers about what they take into consideration when choosing who gets what preceptor sites.. we also get to put our top three choices and i was told pretty much everyone gets at least one of their three, and if not they recieve a call and talk with the teachers to figure something else out if its not available..

these are the criteria my school uses:

1. grades - obviously higher gpa gets the higher preference

2.personality - if someone puts down something like Peds, but was observed during thier peds rotation as not good with kids, they are not going to put them there.

3. where you work - someone who is already a tech in an ICU will more likely be placed there than someone who maybe works in LTC, even if they have lower grades than the other person.. it is also a bonus if you work on that specific unit.

4. who you know - if you work on an ICU unit and one of the nurses on your unit is able to be a preceptor they can request you. from what i hear this trumps all other criteria, so if someones got a nurse friend (or just really impressed the nurses on that unit) they are pretty much in.

those are the things i can think of right now, there may have been more. but as you can see it doesnt just go by grades. they look at the whole person and whether or not THEY think you are a good fit for the area. im sorry you didnt get what you wanted, i would be disappointed too, but maybe just do your best and get as much as you can out of it, get the preceptor on your side because they can be used as a reference when you are looking for a job.

Up Vote Up Vote ×
Specializes in ortho, hospice volunteer, psych,.

it didn't turn out to be your dream assignment, but it isn't all bad either. my husband was discharged a week ago from a combination nursing home/rehab unit. built about forty years ago as a nursing home, today one wing is short and longer term rehab, while the other wing is skilled nursing and an ad unit and adult dementia daycare facility.

his care was unmatched! he has been diabetic since he was in fourth grade and has never had any problems. he was hiking in the woods with the two brothers he mentors, when he scratched his ankle and leg badly, without really being aware of it at the time. following many debridements, whirlpool tx, several dressing types, three different wound vacs, many pt sessions, he was sent to the dreaded (or so we thought!) ltc/rehab center.

best thing that could have happened! the array of nurse specialists was amazing. wound care, wound vac trouble shooters, diabetic nps, current icu and er nurses working extra days.... also pt, ot, speech therapists, respiratory specialists, stroke specialists, and the medical staff was great too.

as mentioned above, you will see and learn a lot. you have to be willing to stick your neck out while still knowing your limits to work in ltc, you'll develop some excellent communication and tact skills you never had before as you learn to deal with families.

it will teach you a lot more than you think possible right now. good luck!

Up Vote Up Vote ×

I did my "specialty" in LTC during my final rotation.

I was the only one who signed up for it.

Guess what?

Some of my classmates were sorry they didn't do it.

I gained a lot of valuable experience there and it turned out to be my all-time favorite clinical experience.

You would be surprised at what you can learn.

It was nothing like "aide/tech work".

I also think it may be in your best interest to accept the assignment with a grin and a good attitude... just to show them how you know no experience is wasted and how flexible you are ;)

Up Vote Up Vote ×
Specializes in Psych.

I did my precepting in transplant icu while my friend did the LTC route (not by choice). She got a job before passing nclex on a step down unit while I waited until after I passed nclex to even get an interview. Do I think our experiences while precepting really mattered on our resumes? No, I don't think it really meant anything.

Up Vote Up Vote ×
+ Join the Discussion