LTC but want to switch to a hospital immediately

Leesha · Oct 27, 2013

I am also working at a similar facility. I'm not thrilled with it either...although I have made it there for over a year now. I recently took a PRN position at a neuro-rehab hospital. For me it's the best way to try out a new place without leaving my full time job entirely. I am able to work my full time job Monday through Friday and pick up at the hospital on weekends. I hope you can find something similar.

Good luck,

Leesha

CrossCountryRN2008 · Oct 27, 2013

I graduated from nursing school with my RN/BSN. After having difficulty getting into hospitals, last month I got my first job at a LTC/rehab center. It has been up and down since I started, but this week, things have been very rough.
I expect nursing to be tough and for it to be nothing but hard work the whole shift. I'm totally cool with that; it makes the work shift fly by every single day. However, this place has already made it clear to me that I will be much better off somewhere else, such as a hospital with just half-way decent organization.
The main two complaints have been that the management is calling me on nearly every day I'm off and putting me on entirely different units every day I'm there, and there was a total lack of organization in my 'orientation.' I simply haven't been taught many of the things that they claim I should know. I end up being thrown to the wolves and learning most of it on my own; which in most cases is fine, but it can end up being very time consuming and I am much more prone to making mistakes. I have been shuffled through almost every unit at the center at least once (it has three sub-acute and many LTC units). Because of the chronic under-staffing, I have been on my own entirely for half of the orientation days. No doubt I have learned a ton about nursing already, and as tough as this has been, the experience has been very valuable but the biggest problem for me has been them putting me on different units and giving me absolutely no consistency.
Yesterday I made my first major med error. Ultimately I do believe that it was my fault. However, because they put me on a LTC unit (I was hired for sub-acute) where I had 26 residents and I did not know any of them, I know that the staffing situation made me much more prone to making the mistake. The most patients I have on sub-acute is 14, and the most patients I had in nursing school was 4. Anyway, I missed an insulin order at lunchtime, and the patient was sitting around hours later with a very high BS. The patient was fine, but I never want to make this kind of mistake again. I owe it to everyone to make sure that this never happens, but if I get put on a unit that I don't know as the only nurse with only a month of real-world experience, this type of thing can happen.
I'm generally not a quitter, but I know that I can get a better deal somewhere else. I planned on doing at least 6-12 months there but I am honestly already ready to explore other options at other hospitals. I don't know how it will look to a future employer on my resume or during my interview that I've only been at the LTC facility for a month. Any ideas for how to spin this positively? Is it too early to consider this change? I was thinking of saying that I was interested in a hospital the whole time but wanted to get some experience somewhere first. No doubt this place has been extremely valuable experience, even as difficult as it has been.
The good news is that I still really like the profession and that I am very confident that it's just where I'm at that has been getting me down. The second I get out and find a better place to work I know that I will be in much better shape. It's just a matter of getting to that point.
Any tips/suggestions, please let me know.

Are they med books or emar? During am pass check the mar for lunch meds and flag. In report get who are blood sugars high light their name. Do your wound care between meals and lunch naps. You have skin checks in ltd whole body head to toe assessments. Do those when the aid does the shower. I did ltc rehab for 4 years before finally geting an acute job. I bounced between rehabs and prison. And your ratios are lower than the ones I had up to 42 ltd and 25-30rehab.

teterichko123 · Oct 27, 2013

I'm in the same boat. I work on sub acute which is manageable still I'm always short. When I complain they say well the hospital is also often short but there is a big difference between 4-8 patients and 14-28. Also sometimes when short they float me to a LTC unit but when I'm short no one ever wants to come to my sub acute side even thought everyone believes that I have the easiest unit in the facility bc it's only 14 pts. I love sub acute but I'm really looking to move to a hospital. I waited 6 months and would suggest you do the same.

MunoRN, RN · Oct 27, 2013

I'd be careful about expecting to have a hospital experience that is all that much different.

hope3456, ASN, RN · Oct 28, 2013

Muno is correct - hospital conditions don't sound like they are getting any better.

I would be curious to know if your facility is using EMAR or paper MARS?

If you read other posts here on allnurses, you are not alone in your situation. A lot of nurses have had to relocate to get the job they want.

joemomma35 · Oct 30, 2013

After more consideration, I will stick this one out for a while unless things somehow get a lot worse. I expect to get my ass handed to me at any first nursing job. There's a lack of consistency between managers, but at least I didn't get chewed out for making the mistake with the insulin. The problem, as I mentioned in the first post, is all of the different units that they have been placing me on. I told them that I need consistency for now, and they told me that they are going to keep me on the sub-acute unit that they originally hired me for.

The incident with the high BS showed me that I need to be even more organized; especially on units that I am not familiar with. I started flagging the blood sugars/insulins and the medications according to when they are delivered. I don't make the same mistake twice. Skin checks are generally done once a week and I will coordinate better with aides once I get the chance.

To those who asked, the MARs and TARs are on paper. Admission and shift assessments are done on the computer system.

Misskala · Nov 2, 2013

I'd be careful about expecting to have a hospital experience that is all that much different.

Agree. This is interesting to really think about. I have med-surg experience on a medical oncology unit and am currently in a subacute rehab unit. I don't think my work style or interest is a real match for the rehab unit, and I struggle with 12 patients and getting all the meds/ treatments/ doctor orders/ and charting done on time. I run my butt off and long for the acute hospital floor with "just" 4-5 patients and really focusing on their care. But you know in all honesty, 4 acute patients was really really stressful and I don't experience the same kind of "stress" in subacute with 12 pts. 12 pt load is stressful because you are non-stop busy but I don't get that sinking stomach feeling that I might kill someone if I forgot something as I used to daily on the med-surg floor. I don't know the med-surg floor I worked on also was very cut-throat in terms of personalities, I feared my manager, and the night shift nurses were a team who loved to pick on the day shift and always wanted to find their mistakes and report them.

So yea, I think both are stressful and it is not determined by the number of pts.