LTC questions

[matt59]

1) Is one nurse passing meds to 30 residents the LTC norm?

2) As a brand new RN, is LTC a bad place to start a career? By that, I mean that although I am fine with the work (except for being told I am way too slow getting meds passed), in the future will prospective employers see me in a less desireable light?

Thank you.

[CoffeeRTC, BSN, RN]

Head on over to the Geriatric/ LTC forum...tons of answers to these questions.

1...yes. that is the norm. I personally can't seem to handlle more than 26 residents for a 3-11 shift. That is the # in my hall. I've worked other places with up to 30 and sometimes more and no....can't do it.

Depending on the shift....the numbers will be different. more on 3-11 and 11-7 shifts and maybe less on a 7-3

2...No. for the most part...you will still be able to find a job if you decide to change to acute care. Might not get into an ICU or ER right off the bat, but yes...you will still be able to change fields.

[JB2007, ASN, RN]

Yes, 30+ residents on a hall is about the norm. I have been working in LTC for a little over a year now and on a really good day I can get all 30 of my resident's meds passed in about 2 and 1/2 hours. I work 7-3 shift. The way I look at it is that the facility is asking the impossible to pass meds to 30 residents in 2 hours. I do the best I can to get the meds to my residents in the 2 hour time frame that I have. I will not skip important assessments (taking BP before BP med is given, apical HR for 1 min. before digoxin is given).

If that makes me too slow then someone needs to show me how to safely give that many people meds on time. Many of my residents take 15+ pills during the 0800 med pass, so this is very time consuming also.

I do not know who decided on the nurse to resident ratio in LTC, but whoever did needs to do my job for a day see if this is possible to care for so many safely. I am afraid to say that it is not.

As to you second question, I do not know if prospective employers will frown on my LTC experience as I have only just started applying to some of the hospitals in my area.

I hope that I do not sound too negative, because I love my residents and my job most days. Good luck with your new job.

[TheCommuter, BSN, RN]

1) I have spent my entire short nursing career in LTC. In my city, med passes to 30 residents and relatively short new-hire orientation periods are the normal standards. If you have a lighter patient load, you are considered very fortunate.

2) I don't think LTC is a bad place for a new RN to start his/her career. You might miss out on learning some procedural skills that occur on a daily basis in the acute care hospital setting, but they can always be learned at a later date.

[TheCommuter, BSN, RN]

By the way, here's an idea of what my daily duties were as an LTC nurse on a skilled Medicare hall. I definitely was NOT dealing with the traditional little old ladies.

I dealt with mostly postsurgical patients who were too deconditioned to go home. These patients were CABGs, knee and hip arthroplasties, thromboembolectomies, hysterectomies, post CVAs, fractures, and so forth. One time I received a gentleman who was badly beaten and robbed, and needed reconditioning. Many of my patients were middle-aged, and wouldn't fit the description of the average nursing home patient.

I regularly gave drugs via IVPB and IV push, especially antibiotics. I removed sutures and staples, dressed complicated wounds, operated CPM (continuous positive motion) machines, iceman machines, oxygen tanks, concentrators, and PEG tubes. I had been employed on a traditional long term care unit for a year, and I had not been exposed to some of these skills.

There was always something to learn at my former workplace. The opportunities might not have been so obvious, so one had to have been aggressive enough to seek them out.

[nightmare, RN]

Moved to Ltc forum for more input.

[CT Pixie, BSN, RN]

I am an LPN and brand new one at that. I had 6 weeks orientation on the floor I will be working on 3-11p

My hall consists of 32 patients. When I worked as a CNA, every facility I was at had approx. 30 pts per hall w/one nurse.

I don't think LTC is a bad move to start at for a new RN. I actually have 3 brand new RN;s who work the other halls. One of the 3 isn't brand new (I think she's got 6-9 months under her belt, she worked at a major trauma center and didn't really like it, what she did realize while working there is that she loved the geriatric patients, hense, her moving into a LTC position)

[nursing4nena]

I have a question. I am a new graduate RN-May2008.

I was offered a position in LTC 5 minutes away from my home. With the economy being the way it is, I accepted it, since no hospitals have called me. I originally wanted to work in a hospital, but need to gain experience.

My question is, in the future if I want to work in a hospital, will my LTC experience count in my resume as I'm applying to a postion that requires one year acute care experience?

Thanks for your input.

[CapeCodMermaid, RN]

No. One year in a LTC is NOT one year in acute care. If you have a rehab or sub-acute unit in your building you should try to work there. It has been my experience that nurses who work subacute/rehab have an easier time transitioning to acute care in the hospital.

[NurseExec]

30 LTC residents to one nurse is the norm in my building. I started out as a staff nurse passing meds, and it took me about 2-1/2 hours. I came from acute care, and was slow as all get out the first couple of months. I got in a groove though, and enjoyed it, once I got my time management skills adjusted.

Half of my building is short term rehab, and that ration is 20 patients to one nurse. With all the IVPBs, and the acuity of the patients (mostly post-ops as above), 20 is about all that can be done by one nurse. I also have full-time, free-floating unit managers and supervisors to assist, as well as a desk nurse and wound/treatment nurse.

[nursing4nena]

Thanks, CapeCod, I'm pretty sure the place that I'll be working has an acute area, which is where I'll ask to work at.

[WillyNilly]

I am also a fairly new grad and was unable to find a hospital job right away so I took a LTC job. The ratio where I am was 30ish and they cant staff it so my load is now between 40-48. It is IMPOSSIBLE to pass all of my meds on time and the lack of accountability for time that med is actually passed is not happening. OTOH, my time management skills have picked up quite nicely -lol.