LTC hurt opps for hospital jobs?

TonyaM73, ASN, RN · Dec 8, 2010

Straight out of school there were no job opportunities in the hospital anywhere in my area for a new grad. I went to a LTC with rehab instead for a year. When the year was up, I went to the hospital again to try to get a med/surg job. When they heard LTC, they assumed the same thing that you are hearing, that I just babysat and sat on my butt. I played up all that I did there, which sounds a lot like what you are doing. (g-tubes, foleys, suprapubic foleys, picc lines, etc.) I also played up the fact that I had all of these things plus the fact that I had anywhere from 20-30 patients a shift which means that I have gotten really good at time management and that the CNAs were not allowed to do anything other than ADLs. (no accuchecks, no messing with foleys, or anything else that might be considered invasive.) They hired me on the spot. I have been on the med/surg floor for about 3 months now and absolutley love it. When everyone else is complaining about haveing 6 patients, I am thanking my luck stars that I don't have 5 times that many anymore. I am definately just as busy, but I don't feel as scattered and I know when my patient is going bad because I can be in there at least once an hour. When you are ready to go back, play up everything that you do in LTC and the fact that you have to be highly organized to even survive in that type of nursing. Good luck!

LPNnowRN · Dec 8, 2010

I absolutely agree!! I've been managing 35 patients as an LPN, some in swing beds with high acuity (what fool puts metamucil down a feeding tube anyway!? Took me 45 minutes to unclog it!!). Lots of health care people sneer at LTC, but you have to really be on the ball and you work your buns off! Having 4 patients in my very last RN clinical was a snap. Why do people look down on the LTC nurses? I'd like to see them do the job for a week before they make comments.

Meowmixer · Dec 8, 2010

Welll, i worked in an ER for quite some time. I applaud those nurses that can work in LTC, at least the handful that actually know what they're doing. Depending on the LTC facility, we've had some send us patients that needed a foley placed, no other complications, sent back in 5 minutes once it was done. Those that actually do their job well are like no others. You should most defiantly brag up all of the skills you constantly use, make sure they know that not only do you do everything the floor nurses do but more efficiently, faster, and with less errors.

Nurse_Candice · Dec 8, 2010

When I was in my ER rotaion there was a LPN working there, a rarity and I asked her how she got in as I thought that Id never see an ER again from this side of the curtain untill returning to school for RN. She said the only reason she got it was her extensive experiance as a LTC nurse. In LTC we nurses have to "run the show" as we may not see a dr for weeks unless there is a problem and even then we are instructed to send them out. Not to say the dr.s dont come in ever,(Q30 days per medicare) but when they do there in and out so fast and on to the next floor, so we need to be able to use all our skills that much more.

tyvin, BSN, RN · Dec 8, 2010

Welll, i worked in an ER for quite some time. I applaud those nurses that can work in LTC, at least the handful that actually know what they're doing. Depending on the LTC facility, we've had some send us patients that needed a foley placed, no other complications, sent back in 5 minutes once it was done. Those that actually do their job well are like no others. You should most defiantly brag up all of the skills you constantly use, make sure they know that not only do you do everything the floor nurses do but more efficiently, faster, and with less errors.

I worked in a LTC facility about 15 years ago as a charge/house supervisor. So they come and get me (the nurses) and tell me that they can't get a foely in this resident as she stands there with the tubing flashing frank blood all over the place. I was agitated! How is it that there is so much frank blood in the tubing............anyway; I go and access this poor man who by now looks like he's 7 months pregnant, sweating profusely, and the look in his eyes was one of desperation. I attempted to put a new foley in him with no success. It kept rolling so I sent him out to the ER stat. Oh yes, I had a friend that was working in the ER at the time.

When he came into the ER I guess they all joked about how inept I was etc... having a good old time. Turns out after 3 RNs tried they finally had a doc come and access. The guys prostrate was enlarged to the point that the tubing was curling and couldn't get past into the bladder so they all got to learn how to use a coude catheter that day; check mate......that poor man.

Yep; hah ha ye ye. After that I ordered the coudes to be in stock at all time in case any further cases came up. I've been on both sides and sometimes LTC sends ridiculous things to the ER and sometimes the hospitals send out patients in compromised conditions. With my experience it seems about even for both sides.

As for experience for med/surg; with the acuity of many of the residents in LTC someone has to know how to do all that stuff. Tubes, trachs, IVs, wound care, admissions/discharge, labs, doc orders, documentation; I could go on for hours but I think the key skill one learns in LTC is time management.

Walking on water................that comes with experience.

TakeOne · Dec 8, 2010

When I started in nursing, LTC was seen as somewhere that patients went to die while nurses passed pills. Much has changed in the interim. The long term patients that SNFs admit now are more complex and less medically stable than the med-surg patients I took care of as little as eight years ago, and LTC nurses (who, make no mistake, DO run the show there as there are no emergency response teams or flanks of consultants or cadres of physicians available at a moment's notice) are highly skilled decision makers and masters of multitasking and time management, not to mention PRN high-level diplomacy.

Mags_RN, BSN · Dec 8, 2010

at the hospital were i currently work, they will not hire a rn from ltc that has been away from an acute setting for more than 1 year, unless s/he takes a refresher course - which is pretty much an 8 wk course through a local community college's rn program which includes class time and a clinical portion at the hospital.

so i guess it all depends on the facility.

LuvScrubs2, BSN, RN · Dec 8, 2010

tonyam73

grrrrrrt advice i work on a short stay unit within snf/ltc place and i have been their 7 months and counting... i am hoping in a year that i can get in a hospital network as well :))

CapeCodMermaid, RN · Dec 8, 2010

I've done quite a lot of skills since I took this job, IV's, peg tubes, picc lines, atb's, ng tubes, foley cath, etc. True, it's not critical care, but I still have to use all my assessment skills to watch and see that patients don't go bad on me.

You've answered your own question. You still have skills useful to hospital nursing. Our local hospital had a bridges program....they hire nurses who work LTC but only from a place with sub acute patients. You'll be fine.

itsmejuli · Dec 9, 2010

Just the other day a doctor asked me if I should send the patient out or order a chest x-ray. She wasn't coming in to assess the patient, it was my job. I told her a chest x-ray would be appropriate since I suspected pneumonia and the resident wasn't in resp distress.

Yeah...we use all of our assessment skills in LTC. We also get good at just looking at people and knowing something is wrong. I continually do mental assessments ever resident I see on my wing, not just the ones assigned to me.

Hoosiernurse, ADN, RN · Dec 9, 2010

Me too, on the assessment thing on patients. I called a doctor one night for significant lady partsl bleeding for a patient. I was giving background information to the doc, who clearly had no idea what the hell to decide to do. She finally asked me if I thought the patient needed to be sent out or if it was something that could wait. As lady partsl bleeding was something the resident had in her recent past and it was clotting off, I said that I felt as long as she didn't bleed more than she was she could probably wait for an ultrasound the next day, but that I would monitor her and call back if there was an increase in bleeding. I had mainly called to cover my ass in case of further developments. You know, keep the communications open.

It literally DOES boil down to your assessment of these people and not as often a doctor's opinion. Sometimes I think the attitude towards LTC nurses isn't so much about what the nurse does, but more a reflection of the residents and how they are just regarded as "coming there to die". As if there is no nursing involved in their care! And yet, people rant and rave about what an art hospice nursing is. I agree, it is...but we do hospice-like care regularly, along with everything else we do. I was really astounded at how much harder LTC nursing is from what I had been told.

I have certainly learned a lot of time management skills from other nurses on how to pass meds to 20 or more patients, along with getting their treatments done and completing documentation.