Is 5-6:1 a safe or normal ratio for LTAC? My patients just seemed so ill and the expectation on the nurses so high. I worried every shift that I just didn't have time to be as thorough as I needed to be with my people. The nurses orienting me were always telling me to go faster, yet be more thorough. I could not do both.

What are some common medications you typically administer in an LTACH?

What disease processes or patient conditions do you most often see?

Any tips on time management, organization, or handling complex patients would also be super helpful!

I'm really excited (and a little nervous) to start, so I'd love to hear your insights or things you wish you'd known before starting in LTACH nursing.

Thanks in advance! ?

 When I was doing clinicals in LPN school, I noticed that a lot of the LPNs weren't even doing wound care for the patients' bed sores. Patients would go days without their wound dressing being changed. Aren't nurses afraid of the day the State will visit the facility and question about why things are the way they are. If state is in, would it mean that I would need to do med pass, wound care for every single one of the 40- 80 patients within an 8 hr shift? I don't even know if it is possible to do that many people within 8 hours. 

Nursing home says LPNs a decent salary while hospitals pay LPNs nothing which is why I'm leaning towards long term care but I am really afraid of putting my license at risk by doing an unrealistic workload etc. What is your advice? should I just avoid New York nursing homes entirely? Do you think the nurse to patient ratio will be better in drug rehab clinic? 

Do I open an entry and discharge assessment for a resident that is in

the facility for 5 hours?

Do I code an abscess in the M section under surgical wound?

So I have plenty of experience (Stepdown and ER) in a hospital setting, but the 12 hour shifts were causing some difficulties with baby sitting. So I took a job (while staying per diem at the hospital) at a Rehab facility very close to home. It is 8 hour day shifts and the schedule is steady. But the charting makes me uneasy. There are about 20-24 patients on the floor. It is electronic charting, but it is VERY old. I've only oriented two days, but the charting seems to mainly be that wound care was done (not how the wound looked or progressed) and that eye glasses are in place. Nurses commonly borrow medications from other patients, and isolation / infection control consists of gloves and hand washing, no gowns or other protective wear.

Is this common? I'm used to head to toe assessments. I'm also used to not borrowing meds and knowing if a patient has MRSA, VRE, etc. They have had a hard time keeping nurses. I'm starting to wonder if I should plan my exit. Thanks!!

My question is.. how do nurses survive long term care? how do nurses get everything done on time before their shift ends? I feel like I am going nuts every shift. 

The care provided in long-term care facilities has become more specialized and acute today than ever before. Seniors are living longer with more chronic conditions and comorbidities, making the need for skilled care in these facilities critical. 

So, what is long-term care nursing really like? Check out seven myths about long-term care nursing you might have thought were true. 

Myth 1: Long-term care nursing is easy

Long-term care nurses work in stressful, fast-paced atmospheres that are highly regulated by state and federal laws and rules. Each nurse must have a solid and comprehensive knowledge of these rules and overall patient care. They must also be trained in geriatric care and the needs of people living with chronic and long-term disabilities. Long-term care nurses must also be exceptional at handling competing high-priority tasks and communicating with physicians, colleagues, and family members. 

There's no shortage of challenges in this specialty, and the need to specialize is only limited by your imagination. Long-term care areas of specialty include memory care, wound care, and Minimum Data Set, also known as MDS, which is the assessment that must be done for the facility to get paid by Medicare and Medicaid. 

Myth 2: Nurses in long-term care lose their nursing skills

Many long-term care facilities have units where residents needing higher acuity care can stay. In these units, residents can receive IV therapy, highly-skilled wound care, and other higher acuity treatments. LPNs provide the majority of hands-on care in these facilities, while RNs provide leadership and assist with high acuity skills LPNs might not be able to provide. While it's true that long-term care residents might not need an assessment each shift, nurses still use their assessment skills to monitor for changes in this patient population that can change in a matter of seconds. 

Myth 3: Long-term care offers few opportunities to make a difference

Folks living in nursing homes aren't just sitting around waiting to die. They live some of their best days and connect with those around them. This means that the nurses are spending time with residents who have lots of love to give and stories to share. Nurses might not be making life-or-death decisions all day, but they are providing care, compassion, and empathy to people who deserve it!

Myth 4: Facilities are old and dumpy

Long-term care, memory care, and assisted living facilities have made great strides in recent years to elevate their appearance and overall services. Today, seniors can choose from facilities that offer various levels of care, gourmet meals, and a packed activities calendar that might have you wishing you could attend! Along with services, these facilities offer double and single-occupancy rooms, and many offer apartments or homes on their grounds. Hence, the residents have privacy, also easy access when services are needed. 

Myth 5: Nursing in long-term care is thankless

Long-term care nursing is stressful, and you will make many decisions based on rules and regulations. However, as a nurse, you'll receive much love and appreciation from the residents and their families. You'll also become like family to them. And, if you're lucky, you'll work in a facility filled with many loving care staff members who will be thankful for you too. 

Myth 6: RNs work on their own in long-term care

Long-term care facilities offer an excellent opportunity to work with an interdisciplinary team. The nursing team is often comprised of CNAs, LPNs, and RNs. You'll also get to work with physical and occupational therapists, social workers, dietitians, physicians, nurse practitioners, and administrative professionals. And many registered nurses are afforded a level of autonomy in long-term care that may not be found in other specialties.

Myth 7: Residents go to long-term care to die

Many people think long-term care is depressing. You might be surprised to learn that some residents' overall health improves once admitted. This is often because they weren't receiving holistic care living at home alone. Some residents also improve mentally because they are surrounded by people and have the opportunity to participate in activities and events at the facility. 

Ready to Try Long-Term Care Nursing?

Now, you have a more accurate picture of the care provided in long-term care. You understand the importance of the nurses who work in this specialty and the needs of the residents. Is it time to give it a try to see if this specialty is for you?

Do you have other myths you've heard that you need to know if they are true or false? If so, put your thoughts in the comments below, and we'll do our best to help you learn more about long-term care nursing. 

anybody knows anythingabout Kindred hospital ICU unit? Is this good for ICU experince? 

I graduated with my Associate’s in 2019, right before Covid hit. I had about maybe 6 months experience (in a SNF/LTC) before Covid took over and it completely burned me out. I think in many ways this has made me a stronger nurse in some senses, and has taught me to be resilient with my learning and gaining experience, however at the same time, I am just so over nursing, particularly bedside nursing. I left my LTC job after a year due to short staffing, feeling stressed and overwhelmed with no support, and feeling like I was working a job that was not beneficial to my growth and learning as a new nurse.

I started BSN school online and found a new job (my current job) in 2020. I work as a subacute nurse, working on the floor. It was doable in the beginning, I didn’t feel as though I was completely overwhelmed. Staffing was better and my nurse to patient ratios were much more feasible. Fast forward to a couple of months ago. Our census has gone up tremendously (not even Covid patients), my facility takes anyone and everyone because it’s more $ in their pockets, and the overwhelming stress of taking this on is just too much.

I am now lacking motivation, I am now feeling forced to take on a supervisor role on my weekends and a desk position during the week because the facility cannot find anyone else interested in doing it and I am the only nurse qualified to take on the position. I worked my first supervising shift last weekend and felt completely unsupported, stressed and overwhelmed by my bosses and their expectations of everything I needed to get done in 8 hours after the facility received 10 admissions the night prior (and the bosses literally saw nothing wrong with calling nurses on their days off to come in and help). I called out Monday because I was incredibly tired and not feeling well after my weekend, and literally my scheduler was calling me and blowing my phone up with texts at 2pm asking if I could come in 3-11 to help with admissions. After I called out 7-3 because I didn’t feel good?? The boundaries are just not existent and/or maintained and it’s a huge lack of disrespect towards nurses who are treated like robots rather than individuals. 

I hate to say this, but I’m starting to feel trapped and I don’t want to look bad for just upping and leaving, but I don’t know how much more I can do this. I spend many of my days off dreading the next day. I have anxiety and I just don’t want to feel this way. I don’t know if I should request to change shifts? Maybe step away from 7-3 for a while? I’m now looking for more outpatient jobs. Any advice on what I should look in to? I want something that will keep me involved and busy but not overwhelmed to the point I want to scream or go into the bathroom and have a breakdown. I just received my BSN and I am actively looking but many outpatient jobs I feel are hard to come by. Does anyone have any advice on MDS? Informatics? Case management? I just need to take a step back from bedside. Any advice would be appreciated! 

At first I thought maybe it was because so many left to do travel jobs, but even the travel agencies are having trouble filling their slots. Covid has been a driving factor in changing the nursing world along with the vaccine mandates and CMS restrictions. Patient/staff ratios have become more unsafe than they ever were. We are finding that agency staff are not doing a thorough job and the facilities that have contracts are seeing worsening QMs. No offense to the good agency nurses, but most are there for the money and low accountability. 

So, my question is to those out there who have left the profession, or may be considering it. What could the company have done different to get you to stay and what could other companies do to entice you to work there? 

I currently work in an inpatient rehab floor at a well known hospital in the Chicago area. I have been there for 1 year ~6 mos already. Rehab nursing has taught me alot of fundamental skills (med passes, wound care, tube feeds, IV abx, trachs, etc) as well as cases barely discussed in nursing school (LVAD patients, Milrinone drips, TPNs etc) but honestly, I feel like it's beginning to drag and want a change of work pace/environment a.k.a acute care. With the current situation in mind, I'm just currently holding off on applying and just looking at job openings. With regards to transitioning to an acute care setting, is it better to start off at a general medicine/surgical floor, or take it a notch higher (Med/Surg Step Down/ Observation/CCU)? Curious what the learning curve will be for a rehab nurse transitioning into acute care...If you're a nurse based in the Chicago-area, which hospitals do you recommend for relatively-new RNs, and why? Thanks a lot! Looking forward to reading replies! ?

Thank you for any advice you can give! 

This LTAC also has telemetry on all the patients.

It is the first floor of an acute care hospital. It is owned by CareONE.

Everything else as far as nursing skills I am comfortable with.

I know this subject can be redundant and for everything else that is going on with a pandemic I feel like it's out of place, but I'm going to post this anyway!

I will reach my 1 year anniversary as a nurse in mid April, and I feel like I should be more adept/confident/faster than I am....I am always running behind, and especially when I'm floated and don't know any of the patients.

First of all, let me say I work in a Long Term Care Acute Facility, so the patients ratio is 1:20 on non vent floors and 1:10 or more on vent floors if they are short staffed (it happens often). On the non vent floors I'm pretty comfortable (though slow), because patients tends to be less intense (don't have to take BPs 3x per shift, every other patient isn't on contact precautions), but really that's on an assignment I know (even short term patients are there at least a month). If I don't know the assignment, I feel totally overwhelmed and incompetent. Types of meds are different, wound care is different, etc. Does anyone have advice on how to prepare for new patients and develop a flow so to not feel like your drowning? I look up general things about patients like wound care and starting tube feedings but there's only so much time before you need to get moving. Is this something that becomes more comfortable with time or am I missing something? The other nurses I work with are supportive but I still feel embarrassed that I feel so behind. And even though I am more comfortable with familiar assignments I feel like I am always behind. (Experienced nurses how are you so fast at med passes!)

Technical skills....things I passed on a nursing school exam on a dummy but now feel totally ill equipped and terrified to do...IVs, Inserting GT tubes...I rarely do them so when they come up I have an anxiety attack and ask for help, but then never get the experience I need to gain confidence....how do I get past this hurdle? I want to learn the skill but am terrified of hurting a patient, and I can't bother everyone for everything especially when we are short staffed. Am I being too soft/lacking confidence? If so how do I change this?

I don't mind the facility I'm in I just feel overwhelmed sometimes. I'd like to say it's just the patient to nurse ratio but I don't think that's it. I want to move to a hospital setting because I want to learn more but am sometimes worried if I feel incompetent in a LTC facility if I would make it in a hospital....I hear it's more difficult. Any advice to a new nurse who's trying to gain confidence/get it together/manage stress is welcome.

Thanks!

I am not sure how when I don't know the schedule with just a few days prior. It seems she always denies my PTO as well as others and I decided to ask the reason why this once especially when I am following protocol. Is this normal in LTC or healthcare?

I have been offered a position as a CNA at Kindred Hospital, but I am wondering if this experience will eventually get me where I want to be.

According to what these hospitals (Palomar, Scripps, Sharp, Rady Childrens, UCSD) want is 6-12 months acute care.

So my question is for the experienced CNA's, LVN/LPN's, RN's, and MSN's, do hospitals see LTAC as acute care experience?

For us, due to the complex issues our patients come with, we have more failures than success. If they don't die of respiratory problems, that unstageable sacral wound could be the culprit. They usually come to us with multiple organ failure, so we already slighted on that front.

We currently have a LPN who has the "Director of Nursing" title. However, she is highly incompetent and, honestly, I can't help but question her judgement and I don't trust her.

If I suggest something in our meetings or I say something about a resident she says the complete opposite and ignores what I say.

For example, we have a patient who takes a scheduled pain killer 3x a day. I asked if it would be okay to change the times to earlier. Right now they're at 8AM, 2PM and 8PM which is fine, however, he needs/wants them earlier. So what she says back to me is, "Is that just easier for you or does he want that?" And then she goes, "Well I don't want to change his med time it's a lot of work and since you're not a nurse you don't know the standardized times that us nurses like to give meds." And then she said, "You can give it an hour before or after."

I didn't say anything and just walked off. Let me just say that first, I pass the meds. She doesn't touch them. Second, 2PM is not the standard time in the facility, it's 12pm when everyone is down for lunch. Third, it would have taken 2 minutes to change the time.

On top of all of this, I've caught her mistakes with med errors and forgetting to transcribe meds. I've found expired meds in our med storage room and med cart. I'll be off a day or two from work and return with prescriptions not filled and patients who have missed meds because they either haven't been ordered or the Mds haven't approved for refill. This list goes on and on.

When I've asked her if she will talk to the owner about something for all the CNAs about paid lunches during our evening shift when we're in the facility alone, she told me it was my responsibility and she wasn't going to get involved.

What are some things I can do? We recently got a new RN hired and she is great. I try as much as possible to talk to her instead of the LPN. However, when she treats me with contempt how can I stick up for myself? This is my first job as a CNA and I don't care what title someone is. The disrespect and lack of doing her job and me picking up her slack is getting to me.

We frequently have issues with inaccurate vitals, improper technique while obtaining vitals, and we also have *major* delays in reporting "abnormal vitals." I put that in quotes because 97% of the time, vitals are not being verified when an abnormal value is obtained using a device. I am forever finding myself having this conversation at work with the same staff members:

CNA: 146 has a BP of 68/32.

Me: Uhhhhhh, was that done manually?

CNA: No, with the cuff.

Me: Did you use the cuff correctly?

CNA: I dunno. I guess.

Me: Did you recheck the blood pressure manually in both arms after you saw 68/32 on your cuff?

CNA: No.

Me: Why not?

CNA: Uhhhhhhh.

I am updating our vital sheets to have reference ranges on there, along with steps to verify vitals when abnormal vitals are obtained, and correct procedure for obtaining vitals. What else can I do to help with these issues? Drives me nuts. This is Nursing 101.