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Discussion

LTC interview

I have an interview at a LTC facility. They also have short stay residents. I'd appreciate any helpful info. I have a few questions:

At a LTC facility, do the RN's have to start IV's or insert NG tubes much? I'm not very experienced with those skills.

In your opinion, is the stress level/chaos better or worse than working as a floor nurse in a big teaching hospital? I worked in a teaching hospital for 7 months and did not like it. The medical residents were either on the floor asking a million questions (instead of reading the chart) or calling on the phone, writing/calling in orders then changing their minds after their meetings with the attending doctor, taking the charts for hours at a time to their meetings, etc. Do you have to deal with residents and med students much at a LTC facility?

I have not done direct patient care for over two years. Do most LTC facilities have the resources to orient me back to this? (they do know that I currently don't provide direct patient care and that I want to get back to it)

I have been told this is one of the newer, better, cleaner LTC facilities in the area. That makes me even more interested in the job, so I want the interview to go well. So fill me in on anything I need to know. Thanks!

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    There are IVs started in my facility but only by the DON. Never did an NG tube.

    You'll get some orientation mostly on the med carts. I would ask for a list of what you need to do for admissions or sending to the hospital (forms, notifications, etc).

    The biggest thing for treatments will be wounds and breathing - nebs, O2, Advair, etc.

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    If LTC is where your heart lies, that's very good. But if not, then try to read up on skills and stuff to keep up to date, so you don't exactly forget them.

    As in any nursing field, a cheat sheet would be a good way of starting.

    -Pls always ask, ask and ask. It never hurts.

    - If you can, try to avoid unneccessary short-cuts.

    -Find a mentor if you can, that's always helpful.

    -Keep your eyes open and say less.

    -Don't ask to be baby fed. Take on responsibilities. It only becomes easier the more you work at something.

    SMILE...a lot.:)

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    In many of the LTC facilities in my area, most RNs are in charge. On my old unit RNs were either charge or passed meds. IVs were started by any RN that could do one or the IV team was brought in (agency). Not many were started in our facility. I believe they do insert NG tubes, but not sure it is alot.

    Remember the interview is not only for those hiring, but for you also. Ask questions specific to patient load, duties, orientation, etc. Ask if you can precept with a CNA for a week or so to get some patient care training. Ask to precept with a LPN to get an idea of what they do.

    But all in all, most LTC facilites are understaffed and differ in job duties. With the economy as it is not, the staffing is a bit better.

    Good luck and keep us posted on how it goes. :)

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    All my nurses are expected to learn how to start IVs. We do NOT use NG tubes. They are not safe. I worked at one SNF that had nursing students and an occasional resident who would come in with the medical director. Make sure you ask if you can extend orientation if you need to.

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    I'm an old school nurse who has done many NG tubes, but haven't seen any in years. The ones I did insert were always verified with an abdominal x-ray to ensure proper placement. One lady we cared for was always yanking hers out, that is where most of my NG tube experience came from.

    I suck at IV starting and blood draws. Only in very healthy people can I seem to be successful. By the time a geriatric patient needs an IV, for dehydration or IV antibiotics usually, they are usually pretty hard to start. We usually send ours to the local hospital for a PICC line. In our facility, night shift does all the lab draws early of a morning unless I would take an order for a stat draw. LPN's that are IV certified, or otherwise trained, can draw too. My crutch is that our facility is huge and there are many stations, each with either an RN or LPN in charge. Many people to come assist if you can't get it done.

    In each facility I have ever worked in, I specifically asked to go with a CNA for a week to learn the residents. Then I went with whoever was in charge, LPN or RN. Good luck!

    Blessings, Michelle

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    At a LTC facility, do the RN's have to start IV's or insert NG tubes much? I'm not very experienced with those skills.
    Once in a blue moon, we will need an IV started. In my state, LVNs/LPNs are permitted to start IVs, so we will ask the RN for help only after we are unsuccessful with the IV start. All of our residents with feeding tubes have GTs (gastrostomy tubes), not NG tubes. The facility where I work does not have NG tubes.

    In your opinion, is the stress level/chaos better or worse than working as a floor nurse in a big teaching hospital?
    I think it is a different type of stress. While the nursing home pace is slower, keep in mind that you will have less help, less staff, more patients, and less supplies than in a hospital setting.

    Do you have to deal with residents and med students much at a LTC facility?
    I've worked at several nursing homes, and only one of the facilities had residents and medical students. However, they only popped in 3 times per week and were usually gone in a couple of hours. However, you will be dealing with attending physicians and medical directors who frequently do not want to be bothered.

    I have not done direct patient care for over two years. Do most LTC facilities have the resources to orient me back to this?
    In my area, the average orientation time for a nurse in LTC is 3 days, regardless of whether you are a new grad, seasoned nurse, or haven't done direct patient care in a while. The short orientations are related to the fact that many LTCFs do not have it in the budget for lengthy hospital-style orientations.

    I have been told this is one of the newer, better, cleaner LTC facilities in the area. That makes me even more interested in the job, so I want the interview to go well. So fill me in on anything I need to know. Thanks!
    Don't judge a book by its cover. Some of the new, clean, upscale-looking nursing homes in my area have chronic staffing problems, high employee turnover rates, and generally provide poor care. However, some of the old, smallish LTCFs provide excellent care.
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