How do you feel about New Grad RNs in LTC?

[BonnieSc]

I asked a similar question in the General forum, hope no one minds if I refocus for LTC nurses...

I'm thinking of applying to an LTC, pretty much just because I haven't been able to find a hospital job. I have experience as an ALF caregiver, before nursing school.

Honestly, I'm not interested in making LTC a career and wouldn't be staying more than a year (just to give the blunt truth!). I want a JOB. But I'm a hard worker with good integrity and would absolutely do my best (and not make a big deal about how I'm only there because I couldn't find anything better!).

My questions:

--what do you think? is LTC really only for people with a passion for the work? or is it all right for me to pursue a job there?

--at first I bought into the "you'll lose your skills" thing, but after reading a few posts in this forum, I wonder... am I even close to skilled enough? how would I handle all of this without six weeks or more of preceptorship like I'd get in the hospital? I've never done a bladder scan or given TPN! (my senior preceptorship was in ER).

--LVNs, how would you feel about working with such an inexperienced RN? I do think I have something to offer--leadership and organizational skills, for instance, and I did do very well with nursing skills in school--but you'd all be far more skilled than I.

I'm really struggling with this decision, so any words of advice, even if you want to tear me apart, are welcome.

:bowingpur:bowingpur:bowingpur

[Ms.RN]

hi wendy

i'm in the same boat as you are in. i graduated in may of last year and i still cant find a job in the hospital. luckily i worked in ltc as a lpn for 3 years. now i work in ltc facility. frankly my hourly wage is lot higher than the wage i will be paid working as a new grad nurse in the hospital setting. i want to tell you little bit of my experience working in ltc. i have worked in a long term care facility where patients conditions are stable and they stay there forever. nowdays, many long term care facility have become a rehab facility where patients stay there short term for rehabilitation and are discharged home. the work in rehab facility is very hectic. i did more than what i've seen nurses do in med/surg unit of hospital. in the hospital where i did my clinicals, they had unit secretary who do all the physician orders, they have lab techs who draw bloods, they have iv nurses who start ivs and draw blood from iv site, they had respiratory therapist who gave respiratory treatments. in rehab unit, nurses do everything. each nurse have about 20 to 25 patients, almost everyday there are about 2 new admissions. nurses draw blood, start iv,access med ports, we have to measure wounds and do treatments, lot of wound vaccums, iv fluid, antibiotics, tpn, tube feeding, trach care, nurses have to note physician orders. there is always change in patients condition and constantly sending patient to the hospital and we will be behind our work and at the end of the shift we have to chart on every medicare patients. so if you work in rehab facility, you will gain experience.

[Dolce, RN]

I couldn't find a hospital job that I wanted after graduating with my RN in 2004. I signed on with a LTC and was worried about losing my skills but I quickly realized that LTC requires a whole other skill set. Things I learned in LTC:

--Meds!!! That is all you do is meds, meds, more meds...good learning opportunity to look them all up when you get home. Memorize them. This will serve you well where-ever you go.

--Drawing labs on difficult, old veins.

--End of life care

--Communicating with the severely demented

--Time management (this is a BIG one)

--Placing foleys and suprapubics

--Tons of wound care

--Doing your own nebs, breathing tx's

--Delegating/collaborating with CNAs

--Feeding tubes

--Etc, etc, etc.

You do not lose your skills in LTC, but it is a different environment than hospital nursing. After 7 months I quit my job and found one I liked much better in a hospital setting. I think most people would tell you that it is the politics of LTC nursing that causes such a high turnover of staff.

Any job can be a tremendous experience if you choose to take advantage of every opportunity to learn. Continue to study when you go home at night! Your first year of nursing is going to be a wild, wild ride!

[Noryn]

Any job is what you make out of it. No nursing speciality requires more "skills" than another.

Learning about the normal aging process in adults can be every bit as challenging as learning critical care values.

[Kymmi]

Although I work CVICU and have done that for a very long time before that I worked home care and found that very rewarding and prior to that LTC which I also found rewarding. The skills needed in critical care compared to home care compared to LTC are quite different but they all require the basic foundation of nursing....time management, assessment skills and physical skills related to the area you are practicing in.

What I guess I do not understand is why you or the others that have said can't find a job in the hospital setting. Maybe its the area of the country Im in (Florida) but there are so many RN positions opened that I could quit my job today and be working by the end of this week somewhere else. Im wondering if this is a regional problem of not being able to find a hospital based job because I've been under the impression that jobs were available. I'd like to know more about why it is so difficult to find a job as a new grad.

[TheCommuter, BSN, RN]

I've worked with new grad RNs in LTC. Most often, I see them utilized in the medicare wings and skilled rehab units of nursing homes. The 'skilled' patients tend to be sicker and higher acuity than the traditional LTC patient. Therefore, they require many procedures that you would normally see on a med/surg floor.

I work on a rehab unit at a nursing home, but our rehab wing is structured very much like a free-standing rehabilitation hospital. On this particular unit, we deal with many central lines, IV antibiotics, CPM machines, feeding tubes, suture removal, surgical staple removal, complicated wound care, ostomy appliances, diabetic management, casts, braces, splints, cervical halos, and so forth. The list goes on.

Most of my patients have recently underwent surgical procedures such as laminectomies, knee and hip arthroplasties (joint replacements), kyphoplasties, CABGs, hysterectomies, limb amputations, colectomies, thromboembolectomies, and abdominal aortic aneurysm repairs. While the vast majority of my patients are elderly, some are middle aged.

The non-surgical patients are typically admitted to our unit for recovery from CVAs, acute MIs, debility, various cancers, fractures, status post pneumonia, deconditioned states, failure to thrive, status post falls, generalized weakness, and other afflictions. I even had an elderly patient who was beaten and mugged after a real estate transaction, and he was admitted to the unit for reconditioning.

Rehab is a physical and emotional challenge for even the most experienced nurse, but I'm assured you will have the learning experience of your life!

[Old_Duffer]

I couldn't find a hospital job that I wanted after graduating with my RN in 2004. I signed on with a LTC and was worried about losing my skills but I quickly realized that LTC requires a whole other skill set. Things I learned in LTC:

--Meds!!! That is all you do is meds, meds, more meds...good learning opportunity to look them all up when you get home. Memorize them. This will serve you well where-ever you go.

--Drawing labs on difficult, old veins.

--End of life care

--Communicating with the severely demented

--Time management (this is a BIG one)

--Placing foleys and suprapubics

--Tons of wound care

--Doing your own nebs, breathing tx's

--Delegating/collaborating with CNAs

--Feeding tubes

--Etc, etc, etc.

You do not lose your skills in LTC, but it is a different environment than hospital nursing. After 7 months I quit my job and found one I liked much better in a hospital setting. I think most people would tell you that it is the politics of LTC nursing that causes such a high turnover of staff.

Any job can be a tremendous experience if you choose to take advantage of every opportunity to learn. Continue to study when you go home at night! Your first year of nursing is going to be a wild, wild ride!

Dolce hit it spot on. My reply would mirror this one. LTC for 12 yrs, and PRN at Hospital last 4 yrs. Just have to remember to switch modes when I go to work.

[emmycRN]

Although I work CVICU and have done that for a very long time before that I worked home care and found that very rewarding and prior to that LTC which I also found rewarding. The skills needed in critical care compared to home care compared to LTC are quite different but they all require the basic foundation of nursing....time management, assessment skills and physical skills related to the area you are practicing in.

What I guess I do not understand is why you or the others that have said can't find a job in the hospital setting. Maybe its the area of the country Im in (Florida) but there are so many RN positions opened that I could quit my job today and be working by the end of this week somewhere else. Im wondering if this is a regional problem of not being able to find a hospital based job because I've been under the impression that jobs were available. I'd like to know more about why it is so difficult to find a job as a new grad.

I'm curious about this as well. In my area of the country hospital positions are plentiful. All a new grad has to do is pick the specialty and the hospital. If I were to quit my job I could be working in another facility the very next day!! However, pay for nurses is among the worst in the nation here so that may very well have something to do with it.

[BonnieSc]

As I said in my first post, really, I do understand about all the skills required in LTC and how much there is to learn! I don't "look down" on LTC at all. (It's just that I'm not interested in making it my life's work.) What I'm worried about is whether I CAN do it. It all sounds pretty intense. From what I hear, they do a lot more hand-holding in the hospital for new grads.

The job thing--it's definitely regional. Too many new graduates around here (northern CA), not enough units willing/able to take them on. Managers have told me they are seeing 70-150 applicants for every new grad position.

[CoffeeRTC, BSN, RN]

When I graduated in the early 90s it was hard to find a job, so I took one in a LTC where I was working as a CNA with plans of just getting a year or so in for the experience. 15 yrs later...I'm still doing LTC. I've worked in just about all positions from the CNA to DON. You will get experiences that you would never have in acute care.

LTC can be rough on a new grad, but it is doable if you have a good preceptor (heck...if you have a preceptor) and your facility offers skilled care.

I don't think when you decide to change jobs you will have a problem getting a new one in acute. It might take a while, but it will happen.

[hope3456, ASN, RN]

I also live where it is very competitive to get into new grad jobs in hospitals (northern CO). I worked in a LTC as a new grad RN b/c it was the only job I could get at the time....and on the night shift.

I agree with the previous posts that you definately do use skills, as long as you are working on the medicare rehab unit.

I didn't mind the job in itself but the management was horrible, as was the pay and bennys.

[TheCommuter, BSN, RN]

I think most people would tell you that it is the politics of LTC nursing that causes such a high turnover of staff.

Bingo! You hit the nail on the head.

My experiences in LTC have been loaded with politics and passive-aggressive managers. After a while, it truly zaps away at the soul.