I'm sure you've all seen this before..

NC Girl BSN · Oct 25, 2007

My name is Dave, I've been an LVN for 3 months. In my first three months of work I worked on a Med/Surg floor. Although it was great experience, the pay and hours were terrible (I was lucky if I'd get 30 hours per pay period).
I got a job offer this morning from a nursing/rehab company who had seen my resume on an online job service. They want me to start in two days, and I told them I would give them my answer tomorrow.
Here's the thing. What should I expect? I did rotations in LTC's in nursing school, but I never actually saw any "nursing", just the charge nurse filling out paperwork. (I hope that doesn't sound rude-- I was in my first semester and wasn't sure who was a nurse vs aide in the nursing home).
What can I expect?
Do you think my Med/surg experience will help out?
Are you able to keep current on skills? (IV's, Foley's, injections, etc).
Any information is welcomed. Please POST away! :-D

Hi Dave,

Before you take the job, Call them back and ask them

1.What their patient to nurse Ratio is? Its pretty typical to have 30 or less.

2. What is the acuity of the patients.

3. Also ask them if there will be a shift supervisor that will so all the admission work. Because if you have to do it, it will take up all your time.

4. Ask them what were the results of their last state survey. 2-3 are okay. But if its near 10 or in the teens, they have problems.

5.Ask them how long do they train

6. Ask them what their pressure ulcer and fall percentages are because if they are above 5% them someone is not doing their job.

If its a rehab nursing home, you will have a lot of hip replacements, you may have to dabble in IV. Catherizations, dressing changes, Lots of pills to pass. Its hard work and it pretty standard and the same everyday.

Here is my typical work Schedule:

Come to work

Get report

Count the NARCs

Stock your cart with juice and get your insulins

Start on the cart 3:30-4pm

Pass meds for couple hours

Eat dinner at 6pm

Come back do do treatments

Get back on the cart at 7:30 and pass till 9:30

9:30 Paperwork

11pm report

Good Luck!

TheCommuter, BSN, RN · Oct 25, 2007

I work on a subacute/rehab unit at a large nursing home, and my workplace only gives nurses a 3-day orientation before they are cut loose to work on their own. Not surprisingly, the employee turnover rate is rather atrocious at the facility where I work.

Anyway, here is how I organize for the day. I work 16 hour shifts, from 6am to 10pm. Typically, I have about 15 patients to care for. At the beginning of the shift, I'll go through the MARs and TARs with a fine tooth comb and, as I go, I will jot down the things that must be done in my notebook. My notebook is how I organize the rest of the day, and I usually won't forget to do anything. Here is how Sunday's notebook page looked (names have been changed due to HIPAA):

10-21-2007

DIABETICS, FINGERSTICKS: Agnes (BID), Agatha (AC & HS), Bill (AC & HS), Wendy (AC & HS), Rex (BID), Jack (BID), Esther (AC & HS), Margie (0600, 1200, 1800, 2400)

NEBULIZERS: Margie, Esther, Bill, Jack, Jane

WOUND TREATMENTS: Jane, Bill, John, Jack, Lillian, Rose, Lucille

IV THERAPY: Wendy (Vancomycin), Laura (Flagyl), Rex (ProcAlamine)

COUMADINS: Agnes, Agatha, John, Lucille

INJECTIONS: Agnes (lovenox), Jane (arixtra), Rex (heparin), Bill (70/30 insulin), Esther (lantus), Mary (vitamin B12 shot)

ANTIBIOTICS: Wendy (wound), Laura (C-diff), Rex (pneumonia), Agatha (MRSA)

1200, 1300, 1400 meds: Margie, June, Rose, John, Jane, Jack

1600, 1700, 1800 meds: Rose, John, Rex, Lucille, Lillian, Laura

REMINDERS: assessments due on Agatha, Jill, and Louise; restock the cart; fill all holes in the MAR; follow up on Jane's recent fall, fax all labs to Dr. Smith before I leave, order a CBC on Rex...

David Offenbaker, BSN, RN · Oct 25, 2007

Awesome! TheCommuter I love how you wrote that out! I am the same way, I always carry my trust notebook with me and lay out all my procedures throughout the day. Does your facility have medication aides?

Why is it that there is such a high turnover for LTC? Is that why pay in LTC facilities is higher than hospitals? The pay I am getting for this job is almost $4.00 more-- and it's closer to home!

Thanks again, and if there is anything else you think I should know-- just tell me :nurse:

Jo Dirt · Oct 25, 2007

If it is a skilled facility you will do IV's but still not like you will do in a hospital. They say you lose your skills in the nursing home. I don't necessarily believe this, but I do say if you don't have clinical skills the nursing home is not the place where you would pick them up.

TheCommuter, BSN, RN · Oct 25, 2007

Why is it that there is such a high turnover for LTC? Is that why pay in LTC facilities is higher than hospitals? The pay I am getting for this job is almost $4.00 more-- and it's closer to home!

I can only speak for the LTCFs in my area. They are all "sink or swim" places, meaning that only the strongest and most assertive nurses survive with such a short orientation period. You'll need to constantly ask questions, cover your a**, deal with erratic staffing, and grapple with families who will be backed up by the administration regardless of how badly they treat the staff. In LTC, the family member is always right.

LTCFs pay more than hospitals because the benefits tend to be mediocre. Also, LTC must pay more to fill their staffing needs immediately. A person is less likely to walk away from a $20 hourly LTC offer. However, If both the hospital and the LTC are offering the same $15 hourly, most people would select the hospital as the place where they want to work. The higher LTC pay is an incentive to get nurses to work in that environment.

David Offenbaker, BSN, RN · Oct 26, 2007

My sister works in a LTC facility as a treatment nurse, and she seems to enjoy it. Working in Med/Surg for the past few months has given me lots of skills, so the only thing is that I don't want to 'lose' them. The pay for this job is wonderful, and the schedule will still allow me to continue my education toward becoming an RN.

I'm going through Excelsior-- any of you working in LTC's go through there? Have any trouble with the CPNE?

Thanks again!

RNandlovingit · Oct 26, 2007

I am not sure about losing your skills working LTC. I currently work in a 44 bed nursing home and althought I have not been there long, I am finding out that I do have to use the med surg skills I learned in Nursing school. I am constantly assesing different patients which challenges me to go back and think about different disease processes. There are many different skills that I use now that I never did in the hospital. Yes dealing with the families is hard, but you just have to remember that alot of families either feel guilty that they've left their family in a nursing home or they understand that the nurse is a little out numbered and they are frustrated that THEIR family member is getting the care they need. I will say this. I work my butt off harder in the nursing home then I ever did in the hospital!!!!!!

sharlynn · Oct 26, 2007

In LTC, the residents are usually only seen by their doctor every two months. The nurse has to be able to spot subtle changes that indicate something is wrong and notify the doctor accordingly.

I worked in a facility where administration actually backed the staff, but this is the exception, I'm afraid.

suespets · Oct 26, 2007

also you will be settleling fueds w/cnas, searching for hearing aids etc, filling out fall &/or incident reports,adding to careplans re both, writing summaries,& medicare charting, dressing skin tears etc. if i could just do "nursing" i would save about 2 hrs ea shift,& i would use some of that time to read res histories, careplans etc.

Hellllllo Nurse, BSN, RN · Oct 26, 2007

Also, LTC tends to pay more because you will shoulder more reponsibility yourself. You may have an RN in the building, but she may be all the way on the other side where you'll rarely see her. There are not a whole bunch of other nurses around.