Interview Tues, leaving ICU for LTC

Art_Vandelay · Jul 17, 2011

I am headed in the opposite direction and have my goal set on the ER in the long run. I don't know about LTC where you are, but the facilities where I am would only staff the RNs on the skilled rehab side. However, since I floated I knew of two that had landed a position in LTC. Not the norm, but still possible.

I'm not in NC, but in my experience, hospitals pay less than skilled rehab units and LTC.

kimmersRN · Jul 17, 2011

You go for it. You can have that ED. I have to say, the best thing about ED is always having a MD right there.

Thanks for the reply. And, best of luck to you!

JulieCVICURN, BSN, RN · Jul 17, 2011

I have not done this, but 3 of my friends from cardiac ICU all went to LTC, and they are all happier there. Having said that, there were management issues in the ICU that made them leave (they couldn't take it anymore) and the LTC was the easiest route to get them out of that unit. However, they all say they're glad they made the move. They did not take pay cuts - it was a lateral move. I don't know if it will be the same for you - in this case the LTC is also owned by the hospital so it was a transfer, not starting in a totally new company.

vanburbian · Jul 17, 2011

I have never seen any LTC facility pay more than an acute care hospital. They'll love you there, more than likely will be very happy for your massive experience.

Good luck.

tyvin, BSN, RN · Jul 17, 2011

Where I am LTC and the hosptials pay the same. If they are not union they pay union scale to attract the RNs. It's in the docs office and home health where they pay less in my state. Good luck to you on your move.

lilredrn · Jul 17, 2011

I'm headed the other direction. LTC at $25/hr to ICU which will be $32/hr once I'm done with my 18 week residency. I had 180 patients solo on NOC. It was assisted living. I hope you find your niche there!

kimmersRN · Jul 17, 2011

Yeah, thanks guys! I really was hoping for more specialized care, etc do more for each patient. But, really, it's so much more charting that I have LESS time with the patients and their families and I come across looking like a mean person because I don't have time to take care of the patients or the family members. It's really hard. And, our unit doesn't have visiting hours so you have to do everything in front of the families and they complain about mouth care and suctioning...chest PT keeping them up all night. It's just ...ridiculous. SOOO...thanks for the kind words. I'm hoping it'll work out for me. I'm sure the grass is always greener. Hugs to you all!!

GalRN · Jul 17, 2011

Hi,

I went from resp step down ICU to psych, where I come that is considered a step down from regular nursing and not paid as much per hr. LTC is around there in "status" and a little lower in pay. God forbid we pay our nurses equally, skills are different in each setting and nursing is hard no matter where you work!

I love psych, and left acute medical nursing in 2001! I am still in the same specialty, and have not regretted my "self demotion" in that whole time. I have an entirely different skill set and it is something I am proud of. My mom, who works neuro at a well known hospital, say she's a "real" nurse,. I guess she is entitled to her opinion, but I see other wise. Guess who she's calling when she has a pt with borderline personality disorder, and putting me on speaker phone while her co workers ask me questions too?

I have worked plenty of LTC, as registry and for stints as a staff member. It is HARD. No constant drug calculations, or pts crashing, but it is challenging. Less medically acute pts means MORE. Day shift had anywhere from 1 RN per 15 pts, and on night shift, I had 50 alzheimers pts with 2 CNA's.

I have a dad with dementia now, and can't imagine being the nurse who deals with me every day. And I'm just 1 family member. I recognize now, the importance of the job, even more so than when I did it!

One thing I wondered if you had considered. I don't know the specific things that made you dislike acute care. I hated so many parts of it. But it seems like you must've been ok at it, even if you hated it. Have you considered signing up for a staffing registry? There's a lot to be said for predictable hours, and benefits, so it might not be an option, but ave you considered working for a registry? I do now, full time, and have insurance, although if I wasn't a little flexible with my hours I wouldn't get 40.

Just a thought, it seems like you have a lot of variety in your skill set....

LTC will use those skills too, and you'll learn a whole set more. If you can't duck, wait til you give an old lady a shower! And trust me, it isn't your job, but some day when theCNA's are trying to feed everyone and a pt ends up covered head to toe in whatever, you'll end up doing it.

Good luck! I hope the drop in pay is manageable. It is worth it, or was for me anyway. I hated my job, now I like it most of the time, and even a bad day for me is better than a good day in acute!

CapeCodMermaid, RN · Jul 17, 2011

Not to burst your bubble, and I, for one, like it when nurses with experiences elsewhere come to a skilled facility, but.......

you'll have just as much charting to do in a SNF, just as many nasty,unrealistic, annoying family members, MORE regulations to deal with, less staff, the dreaded DPH, and a slew of other things.

What you also will have is knowing that you made a difference in someone's life every day.

JenniferSews · Jul 17, 2011

I have to agree with CapeCodMermaid. Although the pay here is far better than hospitals. A coworker recently got a coveted hospital job offer but the pay cut was so bad he couldn't accept it.

But with 15 patients I still have to chart, handwritten, and entire assessment every shift. Plus the other requirements such as the reason for their stay with us, ambulatory status, and a dozen other random things that MDS needs to know for billing. Talk about wasting time? Addressing whether someone is continent, how they transfer, whether they need help dressing, etc every 12 hours for weeks on end. The notes are so full of useless info that no one ever reads them. Plus the dozens of other things that someone else does in the hospital that you are responsible for as the nurse in a SNF. And it can be scarey to not have a doctor nearby. When a patient is circling the drain and you are waiting for the doc to call back so you can send them out it's terrifying.

That said, I do love what I do. While I don't have as much time as I'd like to do actual patient care I take care of the same people for at least a week and often longer. I truly get to know them and their families and most of the time I am able earn their respect and they leave feeling like they got great care from someone who cared about them. It's very rewarding to see people come in near death and leave months later at the highest level of function possible. Through those weeks you have held their hand while they mourned their losses, hugged them when they reached little victories, and laughed with them.

DNS on the go · Jul 17, 2011

Please do not run to LTC thinking it is easier or less stressful.

LTC is chronically short staffed, little supplies and paperwork galore. Every bruise, scratch, etc requires an occurence form and pages of documentation with an update to the care plan. You are going to document until your hand hurts.

LTC is not like an acute care setting...there is no doctor always available nor do you have colleagues on the floor with you. In LTC it is a nurse with a few aides on the unit. In Sub acute or a skilled care unit you may have an LPN with you but you also have 40-50 patients/residents.

LTC is not fun and will not advance your career. If you must go LTC, please work PD in acute care otherwise you will be locked out of the acute care job market.

LTC is open to nurses regardless of the background so you will get the job as long as personality do not clash.

In acute care, LTC is looked down upon with disregard. Remember the statement..."She is a nursing home nurse". That is not a good thing to be. Additionally, even if you want to do a good job, the management may not want that but rather for you to conform to their P&P.

The majority of LTC facilities are for profit which means the less they spend the more money they get to keep. Also do not just look at the wage but also the benefits. LTC facilities are known for very poor to none existent benefit packages including cheap health insurance (assuming they offer you health benefits). Please also remember these places do not contribute to 401K or have pensions like hospitals.

LTC are business and cost containment is the game. Please do not jump into this job because you are "escaping" another bad situation. LTC is much worse of a place to be then in a hospital. Additionally, as a nurse, once you go from acute care to LTC you will be perceived as a nurse who could not make it in the real world.

Pray about your decision and good luck in what ever you decide to do. Peace.