may graduate thinking about going into LTC any advice?

CapeCodMermaid, RN · Jan 28, 2012

If a facility wants to put a new grad into a supervisory position, run the other way. You have to learn the basics before you can supervise anyone.

SuesquatchRN, BSN, RN · Jan 28, 2012

There should be an RN in the facility 24/7. It shouldn't smell like urine unless rounds were just done.

nursecat64 · Jan 28, 2012

The best advice I ever got as a new grad was to do at least 2 years of acute care before specializing in any one area. This will build and cement your skills. If you go into LTC directly from school you may have a very difficult time getting into hospital nursing later if you decide to change. The problem with LTC (or clinic) is that you rarely use some skills (such as IV's) and if "you don't use it you lose it" You need to first build on all the skills you learned but never had a chance to really practice. (I'm not knocking LTC, I've done both acute and LT)

DixieRedHead, ASN, RN · Jan 28, 2012

There should be an RN in the facility 24/7. It shouldn't smell like urine unless rounds were just done.

If you walk in the door, and you smell pee, just turn around and walk back out the door.

Make sure you will have adequate orientation.

You will need to work as a staff nurse before considering any supervisory position.

Remember that if it is your intention to obtain administrative status that the kind of staff nurse you are will reflect greatly on the respect you are given in a supervisory position.

noc4senuf · Jan 28, 2012

LTC does not let your skills lapse. A majority of LTC facilties have post-acute units which allow for wound vacs, trachs, IV's, etc. You need to be on your toes. Also, depending on state regs, there may or may not be an RN in the buidling. Many have LPN's as charge nurses on the off-hours and do a wonderful job. I agree with noting the smell of a facility when entering but also note if the staff seem frazzled, are they smiling and cheerful, do the residents seem occupied or just sitting around with nothing to do.

playmaker2008 · Jan 28, 2012

I think you are misguided unless we are talking about 2 different LTC's..I have worked in Long Term Acute care (specialty hospital for 5 months now here at DFW..I just got a PRN at Baylor starting at 35/hr not including $ 11 night differential and $10 weekend differential....What i have learnt the last 5 months is something that will take years to learn in a big hospital especially med surg unit....I have worked with extremely critically ill patients that you will never see in a med surg unit..pts with Vents, trachs, G-tubes, T-tubes, Rectal tubes, foleys, Picc lines, Jagular lines, all kinds of ostomies, pts with heart transplants, etc...Therefore straight out of school, LTAC will be the best place to start to my opinion..

conscientiousnurse · Jan 28, 2012

The LTC I know of is not in a hospital, but a skilled care facility. It would really, really develop your time management skills, and most SCFs have some I.V.s, many G-tubes, extensive wound care, and many other skills which may vary depending on the facility you are in. I do tend to agree with the earlier post that starting in a hospital would be better for your career, as many jobs want you to have Med-Surg or acute care experience, and if you wait very long after graduating they will make you take a nurse refresher course or most likely not take you at all. HOWEVER, the reality right now is that it is VERY difficult for a new grad to get a job in a hospital. It's very competitive, even for experienced nurses. So you can try your best to get into acute care, but if not there are other options that are also good. I had my first job in LTC. I found it extremely challenging and often frustrating mainly due to time constraints, but a great place to get experience as a new grad. I learned a lot, especially when receiving report from previous shift. LTC nurses have excellent assessment skills usually. They know how to quickly pick up if something's wrong, from across the room, and do super-fast "glancing" assessments (more in-depth if something's wrong) while giving their meds to perhaps 30 residents on day shift. I'm very grateful than in that job I didn't have to be the nursing supervisor, because honestly I would've not had enough nursing judgement for it.

conscientiousnurse · Jan 29, 2012

If I were going to take a LTC job as a new grad, here's what I'd look for.: I would ask right off the bat, what is the ratio of nurse to resident. (It would be better if less than 25:1). Does the nurse do only meds or also treatments? Is there going to be a charge nurse who will look at labs and help with decisions on when to call the doctor, or are you totally responsible for all of this? Do the nurses have to do other duties, like feeding residents or being in charge of the dining room? Do they have any type of preceptorship to ease you into this job as a new grad? (Although LTC jobs with a preceptorship or residency are probably hard to find). You can also find out how they did on their last survey as some indicator of quality care provided and nurse:resident ration. I might even ask to shadow a nurse for 1 day to make sure it's something I think I could handle. And beware of becoming the charge nurse/top supervisor right away. Why? Besides what I mentioned earlier about needing good nursing judgment built up, there's another reason. If you are the supervisor, guess what will happen if a nurse calls in sick and you can't find a replacement? They will probably require you to figure out how all the meds are going to get passed when you're short a nurse. If you can find a nurse to call in or can get other nurses to pick up some of the slack, great. If not, you might have to pass that nurse's meds while continuing to fulfill your own job responsibility.

JMomBaby · Jan 29, 2012

Definately get hold of staff in any place you are thinking of working and *ask them* what the work conditions are like. How is the management? Does the workplace really seem to *care* about the well-being of the residents? How are staff treated? Is staffing adequate? How are any problems/disagreements handled by management?

Also VERY important: if slots on the schedule are empty or workers get sick, does the management use agency or in-house pool to fill the slots, or do they just leave the slots open and let the chips fall where they may? I once worked for a place that REFUSED to use agency for fill-in staff and had NO in-house pool... the consequences were predictable. I got a lot of frantic calls day and night from swamped staffers begging me to come in and help them, I dreaded going in to clean-up the mess but I also felt guilty saying "no" even when saying "yes" meant my second straight 16-hour workday :eek: .

I later went to work at a facility that used agency pool- I thought I had died and gone to Heaven! When workers were sick or we were swamped with patients, these magical people would show up and help us get the work done!!! Jaw drop!!!

Also, in the first workplace any RN was usually used as a charge nurse. The facility had many LPNs and CNAs but very few RNs, and they always needed at least two charge RNs per shift, so... if two RNs were scheduled on a shift, they were the charge nurses :) If 3 RNs were scheduled (rare) then one could work the floor. In the second location I worked, there were more RNs, and specific RNs were hired to be charge nurses while others were floor nurses.

soontobetexan · Jan 31, 2012

wow thank you all so much for the feedback

playmaker2008 · Feb 1, 2012

JMomBaby is misleading you..You are a new graduate and at thos time what you care about is getting a job,,asking all those questions she is telling you to ask might take you years to land a job..the economy is soo bad to even think about being picky on the kind of company you want to work for..The most important thiing right now is to get experience in any hospital, LTAC with med surge or ICU or traditional hospital is perfectly fine or even a rehab... Stay away from nursing home