LTC Nurses I need some advice Please

HeatherLPN · Dec 19, 2006

Staffing ratios--do they staff at or above state standards, what area are they hiring for (Alzheimer's, rehab, ect) or will you be trained/moved form hall to hall, find out exactly what the med tech is responsible for.

You can also go online and find out what their ratings are on pressure ulcers, safety violations, ect are from their state visits. If they are way above state averages, run the other way.

Talino · Dec 19, 2006

Get to know the facility first...

Medicare.gov - Nursing Home Compare - Geography Questions

adrienurse, LPN · Dec 19, 2006

I think what you're asking may differ from facility to facility and these are questions you need to ask when you interview. Some facilities do the bare minimum that they are required to do by law and others have enhanced services/staff because they are committed to positive outcomes.

Simplepleasures · Dec 19, 2006

I would advise against ever working in LTC.You will find alot of info about these places by just reading the threads in LTC section or even in the General section.Good Luck.:uhoh21:

RNHawaii34 · Dec 19, 2006

I think if you should try to apply into another hospitals around your area, or at least try to apply somewhere else and consider Long term care as a lasr resort. I am not against long term care, however, it is very hard. I work in a LTC facility and last night was my first time to be on my own without a preceptor ( after orienting for 3 weeks), it was so exciting, because I try to juggle giving all meds, answer phone calls and respond to my co worker aides. I have 40 individual interesting residents, 4 nurse aides, 1 treatment aide. its not that bad, but I hate to stay over my shift to finish my charting and blah blahs...I don't have any complaints for now, I love nursing, and I also want to work in special areas later on, maybe ICU, or whatevers, but for now I am just trying to earn an experience..maybe later I will say adios to LTC

TheCommuter, BSN, RN · Dec 19, 2006

In my opinion, 24 residents is a very safe patient load in LTC. After all, most LTC patients tend to be in stable condition and do not require a whole lot of excessive monitoring.

With 24 patients, it is unlikely that an LPN will be helping you. 24 patients is considered a 'small load' when compared to the 40+ patients that other LTC nurses are expected to care for in other facilities. You are also thankful to have a medication aide to pass all of your pills. Passing meds consumes a great deal of the LTC nurse's time, so a medication tech is a great help. It will probably take a couple of weeks for you to develop a time-saving routine, but everything will fall together wonderfully once you do manage to conjure up that routine. Good luck!

bargainhound, RN · Dec 19, 2006

Also, remember that some hospital employers/decision makers

consider nurses who have worked in LTC to not be "hospital

material".

Midwest4me · Dec 19, 2006

I am considering a job in LTC. I have no previous experience. I am a new nurse w/7mos med surg experience. I was told in a brief conversation that I would be responsible for 24 pts. I would have a med tech on one side (unsure what that means) I would do all treatments, labs, admits, dc's. I would like to have input as what questions I need to ask & if this is a safe pt ratio. I am unsure if there will be an LPN to help or not. I have these questions in mind, so please add to the list of things I need to know/ask as I really don't have a clue. It is 3 12's & possibly every other weekend. My biggest concern of course is being safe, and giving good care. Thanks in advance!
1. Call In's who is going to come in after my 12 is up
2. how many Pt's are ambulatory..pretty much acuity of these 24
3. how many CNA's...coverage for these call In's
4. orientation time...& who is available to help w/problems
5. will there be an LPN to help.
6. who arranges out of facility treatments
7. will I have the supplies I need to care for my pt's

Here's a continuation of your list: #8: Find out the plan when your medication tech(or aide) doesn't show up or calls in---find out if it's expected that YOU will pass the meds. #9 Make sure your orientation time is down in writing and that you can ask for more if needed and get it. Oftentimes after a day or two of orientation, suddenly there is no trainer and management thinks/says: "oh you'll be ok on your own". #10: When CNAs call in, whose job is it to start calling for replacements? What happens if you can't find any replacements? I've been in situations where I also had to take on 1-2 pts in addition to my nsg duties because I can't find replacement CNAs to come in----and there are WAY too many of those nsg duties to also have 2 pts to be solely responsible for!

Sadly, I agree with some others and recommend NOT taking an LTC position----get a few years of experience in the hospital first--I have found the majority of LTCs to be short-staffed, supply-challenged, and constantly changing DNS's(average length of stay for a DNS was 6 mos in the places I worked).

crb613, BSN, RN · Dec 19, 2006

Thank you all so much. I went to the website to check them out & found ...long term residents w/pressure ulcers was 33% state avg is 19%. Also 3 Health Deficiencies, & 2 Fire Safety Deficiencies. The other LTC place in town had 19% on pressure ulcers for same residents. Ya'll have got to thinking maybe I need to reconsider working in LTC. I know I could not stand for my Pt's to get substandard care.....Thanks for all opinions & views!

Todd SPN · Dec 19, 2006

I have been in LTC for 3 years at 2 different facilities. From my observations and experience they are not good places to work and things seem to get worse, not better. I'm sure it has to do with money and facilities getting less, having to wait longer to get it and more paperwork and rules and regulations. Your questions and my experience:

#1 I worked a double shift on Thanksgiving because there was no one to relieve me. Oh, management knew but chose to ignore it. All my emergency numbers--on call nurse, DON, ED where switched to voice mail that didn't get checked. You are usually on your own to find a replacement for a call-in.

#2 Acuity changes with discharges and admits. Also what unit. Medicare can get tough and hectic eating up a large portion of time making it difficult to attend to your other duties. IVs, tube feedings, trachs, dressing changes, etc. BTW, the 24 res you will be taking care of, are you sure they just don't have low census now and the unit has room for 30 that you will have to take care of when it fills up?

#3 I've found CNA coverage to vary from day to day. They are usually pretty stretched out and again, if there is a call in it may be up to you to find coverage. Also, when the facility has to start cutting expenses because of low census, the hard and usually overworked CNA is the first place they take the knife. Most facilities do not have a full staff of CNAs and will take any "body" if need be. These CNAs are not much help.

#4 I got 2 days of orientation at my present job. You will know who to ask for help. Those that know anything will stand out. The rest that pretend to know things are obvious.

#5 You and any LPNs will likely be doing the same work. If you are equating being the person to oversee a staff (LPN) or for that matter (CNA) you may be mistaken. You mention a med tech on one side. Maybe this means on another unit. You of course will oversee the CNAs, but if they are any good they will not have to be told what to do and will report any problems to you. You will come to appreciated a hard working, on the ball CNA as a gift from heaven. But as the RN you have the ultimate responsibility. This is a whole different situation than a hospital.

#6 A ward clerk if you are lucky enough to have one. Ours died so they decided to save the $9.00 and hour and have the nurses do it instead of hiring another. Oh, we also have to answer the phone by the 3rd ring. (Not anything you asked, but when someone calls for a resident and we transfer the call, if the resident doesn't answer, the caller will call back and tell us there was no answer and they will try again later or request you go track them down!?)

#7 That varies with each facility. The last one I worked at was terrible for supplies. Each cath res got one new bag a month. If it started leaking it was up to the nurse to figure out how to patch it. We had 2 sizes of 18 gauge needles that afixed to non luer lock syringes. The supplies were locked up at night and on weekends so if you needed say a diabetic syringe you went begging to another nurse. It didn't make sense and didn't have to. When you complained they looked at you like what's the problem?

All is not lost if you take the job and don't like it. You can always go elsewhere.

banditrn · Dec 19, 2006

Get to know the facility first...
Medicare.gov - Nursing Home Compare - Geography Questions

I found this site to be of great help. When I first found it, the place that I was working at had a lot of 'dings' - which didn't surprise me. So I compared it to the place I currently work at which rated much higher, and quit the other place.