LTC or Clinic for a new grad?

[Lovely_RN, MSN]

Hi all!

I'm kinda desperate for a job at this point because not working for the last year has left me beyond broke, hence the rush here.

I graduated about a week ago and I am waiting to take NCLEX. In the meantime I have been sending out resumes and I got a response from an outpatient clinic of a major hospital.

I was surprised because in my resume and cover letter I specifically stated that I was a new grad and had not taken NCLEX yet so I wasn't expecting any responses.

OK, so the clinic is focused on adult, peds, women's health and HIV/AIDs and it's in an economically depressed area.

When I mentioned that to an LPN that I know she said that it wasn't a good idea because of the neighborhood and the population of people I will be working with. She then offered to take my resume into her job at an LTC and basically guaranteed me that the supervisor (her friend) will make sure that I am hired.

I have worked LTC as a CNA and I was running out of there for the hospital as fast as my feet could carry me. Is it that much different for an LPN vs a CNA? My friend has told me that days are unbearable but nights are not so bad but I have to be oriented on days before I can switch to nights.

As far as the clinic goes it's not a sure thing because I have to be interviewed for it but will I be missing out on learning critical skills if I go straight to a clinic? I'm not worried about the neighborhood or the people because I dealt with many nasty and unpleasant people working in one of the wealthiest zip codes in NYC and I have found that the lower SES people are a little less obnoxious so I'm not worried about that.

Opinions please

[TheCommuter, BSN, RN]

I've never worked in a clinic, so I cannot accurately convey clinic work to you.

I've worked as an LVN/LPN in LTC throughout the past 2 years, and it has its remarkable advantages and drawbacks. The benefits of LTC include the ability to build ongoing relationships with residents and family members, the routine nature of the job, the pay, and learning about hundreds of different meds.

The disadvantages of LTC include the lack of respect from the rest of the medical community, difficult family members who think you're out to abuse Grandma, understaffing, high employee turnover rates, high patient loads, and the rising acuity level of these elderly people.

I work on the rehab unit of a nursing home, and it is hellish due to the acuity level of the residents. My patients have all had recent surgeries and/or afflictions such as laminectomies, arthroplasties, kyphoplasties, hysterectomies, CABGs, CVAs, acute MIs, amputations, pneumonia, fractures, and the list goes on. The nursing home does not maintain adequate staffing, supplies, or amenities to care for these very sick people, yet their unreasonable family members expect the nursing staff to work wonders.

Though I've never worked in a clinic, it must be nice to not have to see the same patient 8 to 16 hours per day, every day, for several weeks. The clinic patients tend to be in and out, like a revolving door. In LTC, if I have a disgusting patient, I must deal with them every waking moment until they get discharged from the facility.

[lil' girl, LPN]

Well as a nurse at LTC you will have more pts. than you did as a CNA. The "work" part of course is different, however don't believe that you will not have to do CNA work at times. Of course at LTC most LPN's are responsible for the CNA's also. But of course you can remember how the pts. were and what went on, and from your post sounds like you were glad to get away. So to make a long story short you will have much more responsibility as an LPN than you did as a CNA. Good Luck.

[pagandeva2000, LPN]

I started work in a hospital clinic right after I received my license, and I was a bit surprized because my job paid my way through school to become a practical nurse. I am working in the same clinic I worked in as an aide. I was under the impression that they would have placed me on the floors to 'pay my dues' since they sponsored my education, but instead, I oriented in med-surg for 6 weeks, then came to the clinic. I have weekends and holidays off, and am happy about it, to be honest. The floors are rough (again, so is the clinic, really, but the margin or error is less than the floor). Now, I do plan to work per diem on the floors every now and then as soon as they orient me to their computer charting of medications up there, but otherwise, I do not plan to work there permanently.

Maybe it is me, but nursing is not what it is glamourized to be. It is disorganized, nurses in general are overworked, many are disrespected and are tired. I feel this way working in a clinic. On the floors, for me, it is suicide. I do believe that one should obtain all that they can, in case a situation arises where having floor experience will help get you in the door elsewhere, but, don't think that nurses do not learn a great deal in the clinic as well. Best of luck in your decision!

[Lovely_RN, MSN]

Thanks for the feedback, I'm still not sure about what I want but I guess time will tell me what to do.

I have held off on sending in my resume with my friend because I want to see what happens at the clinic first.

I asked her about the staffing ratios and she said that on days it is 1 LPN and 1 RN for 40 patient with 4 CNAs. One nights it's one LPN or RN for 40 patients and 2 CNAs.

Whether that is good or bad I don't really know.

[TheCommuter, BSN, RN]

Thanks for the feedback, I'm still not sure about what I want but I guess time will tell me what to do.

I have held off on sending in my resume with my friend because I want to see what happens at the clinic first.

I asked her about the staffing ratios and she said that on days it is 1 LPN and 1 RN for 40 patient with 4 CNAs. One nights it's one LPN or RN for 40 patients and 2 CNAs.

Whether that is good or bad I don't really know.

The ratios you have mentioned are good.

Some nurses are legally responsible for over 100 patients during night shift, all by themselves. During day shift, some nurses have up to 60 patients by themselves. My friends cared for 55 elderly patients by herself during the evening (2 to 10pm) shift.

[MedicalLPN, LPN]

LTC and Clinics definately offer many opprotunities to LPN's might want to keep in mind that Corrections usually offers great pay, benefits, and is really interesting, or at least from what I've been told, I've never worked corrections but have several friends who do and they love it.