Insight About a LTC Job Interview I Just Had?

[Funnybunny]

So I'll try to keep this as summarized as I can:

- I just got married and needed to move an hour away from the hospital I've worked with since I graduated (for 2 years) but with 12 hour shifts and all the tolls/gas I am paying, it is not feasible to keep this job in the long term. I also have been doing nights for a few years now, and it's beginning to significantly impact me physically and mentally, so I am very much hoping to get a 1st or 2nd shift job.

- I live in the new england area and (I kid you not) applied to over 100 jobs in the last 6 months. The only call back I have gotten is with a LTC facility that I applied for a rehab position with. I have worked in LTC before as a CNA and it was a very negative experience. This place is owned by one of those large companies and has 1 RN per 20-something residents on the evening shift with 2 CNA's. I've never worked as a RN in LTC and I don't have enough experience to know if this is adequate staffing. According to the Medicare site, it is ranked very poorly for safety, but I don't know how necessarily significant that is (I've been surprised at what is ranked high on there, for instance.) On all appearances, it LOOKS very clean/posh, but the fact that they offered me the job on the spot in the interview has me very concerned.

I really want my sanity back with the evening instead of night shift and with having a job that I don't need to drive an hour for but I am very nervous of taking a LTC position. I don't mind LTC in principle at all, I actually enjoy the rapport of having the same residents/rehab patients and have missed that in the hospital setting, but my negative experience in the past / general bad rep of LTC really spooks me of making a bad decision. Just looking for insight from other LTC RN's - Thanks in advance :)

Edit: of note, I have not accepted this position yet... I told them I would consider it and call them to let them know. Hence why I am seriously debating the whole "I really want the hours/pay/commute, but I'm not sure about the job!"

[BSNbeauty, BSN, RN]

Take the LTC job for now and keep applying at hospitals closer to you. It seems like the commute and hours are really affecting you. You have to pick your poison. If it were me, I'd do the LTC job....

[sallyrnrrt, ADN, RN]

it could become an interesting and rewarding job experience. l have found a lot of satisfaction in LTC, and i came from a critical care background

[nurseprnRN, BSN, RN]

If they are who I think they are, the decreased commute may well not make up for the grief you will be getting for working for them. Would it be possible to add one or two days per diem with them while keeping your 12s/long commute job, just for a little while, to learn more about them? This could also lead to your being more desirable to one of the better LTACs/short-term rehab hospitals in the NE area.

[mazy]

Doesn't sound like a good facility, especially if Medicare is ranking them poorly. If it's a rehab facility, and not just long-term care, you will be drowning with only a 1 RN to 20 patient ratio, especially if you only have two CNAs.

GrnTea makes a good point, you could pick up some per diem shifts and see how it works.

[Funnybunny]

Thanks for the replies/insight...

To clarify, I believe that the rehab portion is less than 20:1 resident to nurse... I want to say it's maybe 10-15 per nurse, if I recall. (I do remember it was quite a few less.) I'm so used to the hospital ratios, so this is just altogether unfamiliar to me.

My spidey-sense is tingling about this (and I can't tell if it's because there is truly something wrong, or because of my previous negative experience) so I don't think I will be taking the regular position. I didn't consider the per diem aspect, since the listing was for regular hours, but I think I will ask them if that could be an option instead and see if they accept.

[wyogypsy, RN]

Depending on the company, the rehab hall can be OK or sheer hell. I am just leaving a facility where we had one rehab hall with one nurse, one CNA (sometimes shared with another hall of 16 patients) and anywhere between 15-24 patients, plus I had 7 long term care patients. This company insists on admitting everyone that the hospital talks to them about - so for about two months we had 10 diabetics (some getting blood sugars and insulin with each meal), 5 that went to dialysis, and a lot of wound care. Just 3 of the wound care patients took 2.5 hours per shift. Rehab patients tend to have a lot more offsite appointments and order changes than long term care patients. It wasn't feasible, and we were so busy that we couldn't follow up on issues, couldn't get everything done, and for charting? I wish. My license was on the line and I gave my notice. I got to where I felt like a failure every day - the patients were upset, their families and friends were upset, therapy/doctors/dialysis, etc. - they all thought I was a crappy nurse bececause they knew that 'they' or 'their patient' weren't getting taken care of.

I am now temporarily working at a facility I used to work at - patient staff ratios are great, everyone has time to help each other, the Medicare unit has 2 nurses and several CNAs. The other day I was giving a patient her medication and sat down and visited with her. Turns out she was from a small town in another state and knew family that I had there. What a great change.

It is better to work the long term care halls than the Medicare hall - please don't judge long term care based on that. I like the facilities that share the Medicare patients throughout the facility so everyone can have some of the burden, not just one nurse.

[Funnybunny]

Thanks for the insights everyone :)

I actually declined any hours after the interview... I slept on it, and still couldn't shake the weird feeling I was getting. I liked the DON a great deal, but I've been down that road before (I worked a hell job as a CNA with a wonderful DON in LTC). I hated to turn down the pay, hours and distance from home but I just had an ominous feeling about the whole thing.

As it turns out, right after I called to politely decline, I got an interview offer from a rehab hospital with med-surg type patient ratios that I am used to. So in the end, I am hoping this works out!

[nervousnurse, ASN]

wyogypsy---I am so new to this terminology! What does "Medicare" patient mean? I couldn't tell if it meant the same as a rehab patient or skilled, or....?

FunnyBunny---that is great how it worked out for you!!! I know EXACTLY what you mean! I interviewed at a *gorgeous* facility, but there were too many red flags in the interview, plus, once I researched their bad ratings, I knew NOT to take the job!!!

[sallyrnrrt, ADN, RN]

wyogypsy---I am so new to this terminology! What does "Medicare" patient mean? I couldn't tell if it meant the same as a rehab patient or skilled, or....?

FunnyBunny---that is great how it worked out for you!!! I know EXACTLY what you mean! I interviewed at a *gorgeous* facility, but there were too many red flags in the interview, plus, once I researched their bad ratings, I knew NOT to take the job!!!

medicare patient, after a qualifying hosp. stay, a resident admitting to or returning to ltc skilled nursing facility, is potentially eligible for 100days skilled, including therapy, the first 20days medicare pays 100%, the next 80 days are paid at 80% medicare rate. a really sick resident, high adl support needs, requiring significant therapy support, daily medicare rate can approach $800.00+ /day....... the adverage reimbursement daily, non medicaire in the south is 120-130.00 / daily.....