LTC: 3 Strikes I'm OUT???

Mel_81_99 · Sep 11, 2013

Night shift is usually slower. That doesn't mean every night is slow. But if you feel like you want to be a nurse, but just need to start at a slower pace, then I would tell you to try night shift.

doppelganger2 · Sep 11, 2013

Ltc is about as slow paced as it get.and yes night shift can be slower but you still have to get things done in a timely manner. Maybe you need to look for other areas of nursing that fits you better or stick it out and try night shift and see how that goes. Best of luck to you.

libran1984, ASN, RN · Sep 11, 2013

Ltc is about as slow paced as it get.and yes night shift can be slower but you still have to get things done in a timely manner. Maybe you need to look for other areas of nursing that fits you better or stick it out and try night shift and see how that goes. Best of luck to you.

I am an LPN in the ER with a very large scope of practice. I can tell you that LTC is about as fast paced as it gets! I tried Rehab PRN, i was stuck with 18 patients between myself and 1 CNA. It was the worst experience i've ever had.

In the ER, when I act as a Primary Nurse, I rarely have more than 4 patients I'm responsible for. I'm doing PE protocols, CP work ups, kidney stone work ups, and lots of vag bleeds and unknown abdominal pains. I can handle all of that with not a single problem. In LTC... I can't cut it. It is too much.

I read a post once giving RNs on the med-surg floors major props for being so amazing at managing their work load. I only know what it is like to be on a med-surg floor from my clinicals in school and I can tell you I worked so much harder than any of those people in on the med surg floor when I was in LTC. I was provided an opportunity to shadow in the ICU and even now, in my transition program, I'm in a CICU for clinicals and in both of those ICUs, I truly believe, I see LTC as more of a challenge than anything acute care settings can throw at me.

Being an LPN sux b/c we get the hardest and worst jobs in the job pool. I was just very lucky to have made it into a hospital.

Good luck. Keep trying to do your best. There is a place somewhere for you!

OrganizedChaos, LVN · Sep 11, 2013

LTC is pretty much the fast lane. It's not uncommon to have 20+ residents assigned to you. There are nurses who love geriatrics/LTC & other nurses just don't. If as a new grad you find LTC to be over whelming you're not alone, I felt the same way. I was offered good pay to work at a NH & "figured why not?".

I'll tell you why not! Lol. As a new grad LVN I had no idea what I was in for. I was scared to take on 3 patients in clinicals but here I was at my job trying to care for 30-40 residents. How does one nurse really care for that many people? Honestly.

So don't beat yourself up, LTC isn't for you. You just have to pick another area that is. That is what's so great about nursing! :)

BrandonLPN, LPN · Sep 11, 2013

Ltc is about as slow paced as it get.and yes night shift can be slower but you still have to get things done in a timely manner. Maybe you need to look for other areas of nursing that fits you better or stick it out and try night shift and see how that goes. Best of luck to you.

Slow paced??

What nursing home do you work at?

Long Term Care Columnist / Guide · Sep 11, 2013

I worked nights in a SNF for a couple of years, and I ran my bohunkus off the entire time, even though I had excellent staffing (6 CNAs and a CMA for 90 patients/residents) and the acuity wasn't as high back then. LTC is not a job for the nurse who doesn't love it---it's among the lowest-paid and is totally the least-respected of all the nursing specialties, and if you don't have a passion for it you'll never survive.

It's OK if long-term care isn't for you.....that's why there are so many other things to do in nursing. You may want to consider an LPN-to-RN bridge program if you want better opportunities; in the meantime, you could become a CNA instructor, teach CPR classes, work in home health, even stay in LTC but on a per diem basis, doing admissions and QA/QI (which is my current job, but you wouldn't necessarily have to be an RN to do it). Get creative! You have only your stress levels to lose. :yes:

MedChica · Sep 11, 2013

That's the nursing home, for you.

Do you have any certifications?

I just hit a year. Maybe a year and 2 months. Recently got my ACLS and IV cert, reworked my resume and was contacted by the hospital system for 2 positions: Juvie Detention (no thanks) and an urgent care clinic. I interview with the latter on monday.

I'm not exactly enthused over working in a clinic or hospital but, honestly, I applied because I'm beginning to hate my current main job. (LTC) Honestly, I could use more experience, too.

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Sep 11, 2013

I would give LTC another shot, if I were you. Try this:

1. Make a list do your accuchecks and insulins and times.

2. Make a list of your tube feeds.

3. Make a list of your crushed-meds residents.

4. Make several copies of the above and place them on a clipboards and keep them at the nurses desk.

5. When you report to work, grab a copy of your accuchecks and head down the hall to get them done first.

6. Get your ambulatory residents' medications done. (I would go through and flag everybody's record, and unflag when I was done).

7. Save your crushed meds and tube feeds for last, unless something in the medication record indicates otherwise, because these were the most time-consuming..

If you're having issues with time management, these steps should help you tremendously. I would stay away from night shift for the time being, until you at least are able to place a name with the face because EVERYBODY appears to get accuchecks at 0630am. And a lot of those tend to be low, requiring treatment. On evening shift, you are mainly finishing up the BID, TID, and QID. Night includes adding all of those and the DAILY accuchecks, not to mention you may have the WHOLE floor instead of splitting the floor with one nurse on an end and you on another. Only knowing the residents for your particular end when you have to do both ends on night shift might encourage you to make a mad dash to the front door in the morning and never look back.

So try out those steps first on your current shift and see how it goes. Once you learn your residents, ask if you can work another end, using those same steps, to get to know those residents. Once you do that, things will fall in place like second nature, THEN, you will be ready for night shift when you will be able to manage them all.

Just my suggestion of what worked for me when I worked long term care. Those steps really save my a$$ when I decide to go agency, where the only orientation was "here are the keys and the patients are that way".

Good luck to you! This feeling of inept will definitely pass in time! :yes:

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Sep 11, 2013

I am an LPN in the ER with a very large scope of practice. I can tell you that LTC is about as fast paced as it gets! I tried Rehab PRN, i was stuck with 18 patients between myself and 1 CNA. It was the worst experience i've ever had.
In the ER, when I act as a Primary Nurse, I rarely have more than 4 patients I'm responsible for. I'm doing PE protocols, CP work ups, kidney stone work ups, and lots of vag bleeds and unknown abdominal pains. I can handle all of that with not a single problem. In LTC... I can't cut it. It is too much.
I read a post once giving RNs on the med-surg floors major props for being so amazing at managing their work load. I only know what it is like to be on a med-surg floor from my clinicals in school and I can tell you I worked so much harder than any of those people in on the med surg floor when I was in LTC. I was provided an opportunity to shadow in the ICU and even now, in my transition program, I'm in a CICU for clinicals and in both of those ICUs, I truly believe, I see LTC as more of a challenge than anything acute care settings can throw at me.
Being an LPN sux b/c we get the hardest and worst jobs in the job pool. I was just very lucky to have made it into a hospital.
Good luck. Keep trying to do your best. There is a place somewhere for you!

Don't knock it until you try it. Observing med/surg nurses at work and BEING a med/surg nurse at work ar totally opposite ends of the spectrum. As a former LPN of 24 years with LTC and med/surg experience, the right combination of circumstances and staff can make your life a living hell no matter where you punch the time clock! As an RN of 3 years, the only difference in what I've experienced over the years is the pay.

We all need to cease with that "my job is more difficult than your job" because that is NEVER the case. If you are at the bedside, you have a difficult job, PERIOD! If you are a manager, (yes, I did that too, for 7 years), you have a difficult job, PERIOD, because then you have the impossible task of trying to satisfy everybody at once. I've also done a few rotations through ICU and the even-more frequent phone calls to physicians that do NOT want to be call, makes your life hell when you're only trying to maintain homeostasis with a sicker clientele.

I don't have all the answers to a lot of stuff and after 27+ years in nursing, I CAN tell you that the grass is NEVER greener on the other side.....it's just not as brown as others.

eeffoc_emmig · Sep 11, 2013

I have worked at two LTC facilities. Day shift was nuts! Too many people to pull you in too many different directions. I worked nights at both places. Both of them had far too many residents for a nurse to handle alone. (Day shift would have two nurses working the hall and night shift had only one nurse). I could get through med pass within the required time as long as there were no falls, etc or family members calling or stopping me in the halls. Not to be mean, but some families thought their resident was my ONLY one to care for.

newrnltc · Sep 11, 2013

Theres no management meetings or family to interrupt you on night shift but remember you are working with a skeleton crew. In my place there were no Docs in the house. I was the one they came too when there was an emergency. Keep your eyes and ears open and don't underestimate the night! lol They also like to put wound cares, weights and showers at night "since its not busy". You try telling a resident he has to take a shower at 4am. See what he says. Also AM finger sticks with insulin coverage 1 hr before dayshift comes in and you have to prepare report ... Welcome to LTC. :/ I loved my residents but am much less stressed in clinic. I actually have time to do real nursing duties there.