Job Offer - Need Advice

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I’ve been out of clinical setting for 10 years. Before that I had two years in the operating room. I’m being offered a 3-11pm shift at a nursing home. I will be the only RN in the shift with about 72 patients. I’ve been reassured that I will have at least 1 week of training and RN in call 24 hours for help. I’ve also been told that the LVNs do all led passes. I would only be doing assessments, IV ABX and admissions. Am I crazy to do this?

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Specializes in Clinical Research, Outpt Women's Health.

Do you need the money?

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Not really. I just want to get back into nursing.

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Specializes in retired LTC.

LVN - Texas or Calif. don't know much about their scope of practice. Also is there a union for nurses and/or CNAs?

Sounds like you'll be like a shift supervisor??? I'd make ABSOLUTELY sure I knew that and that you sign a job description. Supervisor comes with a whole slew of other responsibilities. I'd be reeeeeally cautious about that job description. A facility usually will only have 1 RN for the whole shift (a state reg, I believe). And 3-11 is usually slammed with all the admissions. So supervisor + pushing a cart + ADMISSIONS + STAFFING COVERAGE + family + gen'l issues + etc = BIG responsibility.

So, if you're a supervisor, you should be receiving the compensation. Don't let them snooker you re RN responsibilities versus RN Supervisor. As the only house RN, you're the top licensed professional so everything prob falls on you. So don't let them say "oh, no. You're staff RN". Unless they have some other system in place that covers all the kinks, but I doubt it.

Proceed cautiously. LTC can be a worthwhile field,, or it can be a killer, esp at first and if you're being snookered.

Good luck. Stay safe.

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Thank you! I have orientation tomorrow and will bring up all of those issues. My job title is RN Supervisor and I think the pay is decent. I was told there would be 9-10 CNA AND 2 LVN. To be honest I’m terrified of being the senior (and only) nurse on the shift. I told them I’ve been out of clinical settling for a decade and they said they’d have another RN with me until I feel comfortable on my own. Fingers crossed. Thanks again for the response.

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Specializes in Clinical Research, Outpt Women's Health.

Worth a try. Just be prepared they may not keep those staffing promises. If they do then a good place.

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Specializes in retired LTC.

I wouldn't fret/worry about your clinical skills. Kinda' like riding a bicycle - you'll pick it right back up. That's NOT the tough part. It's the time management of EVERYTHING else.

Prioritorizing (sp?) is everything! Getting an unstable SOB pt ready for immed hosp transport out beats out a PIA family whining about Nana's hot dog dinner. Pt on the floor beats out presenting inservices. Etc.

Just make sure that you're not being unnecessarily taken ADVANTAGE of by staff. They should know what they're responsible for - nurses AND CNAs.

Just FYI - there have been NUMEROUS postings here by new-to-LTC/NH nurses asking about shift responsibilities, rules & regs, gen'l flow, etc. Excellent responses & suggestions avail by the bucketful! Interesting readings for your reading pleasure!

Welcome to LTC.

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Thank you so much! I just got back from my 2 hours of "orientation"...if you can call it that. I look at patients with tube feedings, IV ABX, O2, etc and I freak out! It's been since clinicals 12 years ago that I had patients like that. I've been reassured a number of times by the DON that the LVNs that are Charge Nurses on each shift have all been there for years and know the patients. I will keep your words in my mind to reassure me. I'm an anxious person in general, and this is the first time that I will be in a supervisory role. The DON has promised me that next week I will have another RN working the shift with me that I will basically "shadow". I feel like if they keep that promise I'll be OK. As far as patient assessments, emergencies, meds, treatments...do you have any advice on what I should study this weekend? I don't start until Monday.

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Specializes in retired LTC.

CONGRATS on the new job. In this time of C19, much of your focus needs to be tuned into family/staff reassurance and isol/inf control practices of staff.

It does sound like your DON is reaching out to having you fitting in. That's good. Also the LVNS should be a great asset - remember to let them know that you respect their skill and expertise. They will be your crux. And the CNAs - they are the ones who SUPER DUPER know the pts 'best-es't!

It was always my approach as NEW supervisor that my priority was to know my staff first and then the residents just right after that. I figured the pts were being taken care of WITHOUT ME before I arrived at the NH. So that will continue to merrily roll along as I focus on staff and getting to know the routines, doctors, family, other dept staff, equipment location, keys, phone #s and faxes, etc. (my favorites)

Your 11-7 supervisor should be an asset as well as the Unit Managers. Also whoever does Inf Control, Staff Dev, etc. And other dept heads can be allies. Touch base with them as well as poss.

Remember, to always alert family re changes in pt status. You don't want them to be surprised if THEY find a big bandage on Nana's shin (she got bumped by another pt's whch in the dining room - simple accident, right?) - but if they don't know about it ... OYE! Be proactive re family. Remember you can always go up the on-call Admin chain for serious questions.

Again, I refer you to the numerous LTC postings here. Different folk react to different things so there's a WIDE variety of information.

You'll learn. I'll prob post back again

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Thank you again! I am going to hold onto you like my security blanket as I start this new journey. I am going through this specialty thread like you suggested and grabbing what looks helpful. I will also be printing out a list of common labs, meds, med-surg type stuff to brush up on this weekend. Youtube will be my best friend too! I want to be a good nurse who feels confident...that seems like an impossible task right now, but I don't want to give up this time. This might actually be a good time to be starting because with COVID 19 they census is low (72 instead of 92), no families, no admissions. This may be like a "training wheels" few weeks. Thank you again for taking the time to respond to my posts. I am so anxious and scared. It really helps to know that there is a kind and experienced voice out there. Stay safe and I might be DMing you at some point, if you don't mind. Best, Jennifer.

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Specializes in retired LTC.

Hadn't deeply thought out the effect of C19 on adm/disch pt. You're right, it might be a good time blessing in disguise.

Just know, I was 11-7, mostly. Years & years. But I've been 3-11, 7-3 UM, SD/IC, been there, done that...

Hang in there.

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Seventy-two Residents sounds like too much. Those seemingly light tasks come with detailed documentation and follow-up. This load can pile up quickly. Won’t hurt to try it out, though. Best wishes.

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