Med-surg vs. LTC (new LPN needs advice!)

NursesRmofun, ASN, RN · Dec 12, 2004

Hello everyone.:) I'm new here and I need some advice!
I graduated from PN school in August, and since October I have worked at a LTC. From what I understand from speaking to some of the veteran nurses who have worked everywhere, this home is one of the best in the area as far as working conditions for nurses go. I like my job and my co-workers, and have grown to love my residents.
The problem is, I feel like I am not utilizing 1/10th of what I learned in PN school. I pass meds (I have a couple of GT's), do wound care, and that's about it. And since I am going to start pursing my RN online this winter, I am thinking that I should get some med-surg experience. I have been offered a job in a med-surg unit (liver transplant) of one of the best teaching hospitals in the country. I am torn though, because I would be making $4.00 less per hour in the hospital, and it is also an additional 30 minute commute each way (my current commute is 5 minutes!). Also, the hospital job is 11-7. Would I get *enough* med-surg experience overnight, or would it be perfect way for a new graduate to get their feet wet in med surg?
Please help me! Any advice or perspective would be much appreciated.
Michelle

I only want to chime in that hospital nursing is tough but the best experience you can get as far as seeing what you learned up close and personal and using your skills including assessment skills. Good luck!

michelle-new-lpn · Dec 12, 2004

Thanks for all your replies. I am leaning towards leaving LTC. I hear so many awful stories not only from nurses, but from families of my residents about what goes on in some LTC's, and it makes me wary of making a career out of LTC nursing.

I work at a small home, and work two 3-11 shifts each week with no RN supervisor on duty. There is an RN on duty 3-11 who has a subacute unit, but she has told me that since they won't pay her the supervisor rate, she is not going to deal with problems on any of the other units, nor does she want anyone asking her any questions. I don't really blame her b/c she was promised an RN supervisor position on the 7-3 shift when she was hired, but now she's a 3-11 subacute nurse. On 7-3, I have alot of support, but on 3-11 I feel like I am on my own. Are they required to have an RN supervisor on duty on all shifts, or are they just required to have an RN there on the premises?

I share your sentiments, debinohio: I hope and pray at the start of each shift that everyone is okay, because I will not have time to take care of everyone properly if something goes wrong, yet that's what I want, experience taking care of people who are ill!

CashewLPN, LPN · Dec 12, 2004

hi... I know how you're feeling michelle... I've recently given my notice to my lpn job at a local nursing home due to too many of the above mentioned aggregiousnesses(Is that a word? I hope it is... tired this morning)... Nurses sleeping, favoritism, people not doing rounds (one man recently got aspiration pneumonia due to the nurse not checking him all night... his ngt migrated up(resident probably pulled on it) and got a lung full of feeding... so on and so forth....

I left to a 9 dollar an hour pay cut.. (but seeing that my boss took my 4 day a week job, and reduced it to a 1-2 day a week job through creative hiring, I'm actually getting paid more... sad, isint it?), in a different industry (I"m now a roundsman cook in a private club in lower manhattan)

My advice is... Be happy! if you are happy in LTC, by all means, stay... if you have doubts, go for the med-surg... the joy of medsurg, is that it never (and I mean never) sleeps... admits and discharges all hours of the day and night, procedures and everything...

:) good luck!

--Barbara

boxerlewis · Dec 12, 2004

Hello everyone.:) I'm new here and I need some advice!
I graduated from PN school in August, and since October I have worked at a LTC. From what I understand from speaking to some of the veteran nurses who have worked everywhere, this home is one of the best in the area as far as working conditions for nurses go. I like my job and my co-workers, and have grown to love my residents.
The problem is, I feel like I am not utilizing 1/10th of what I learned in PN school. I pass meds (I have a couple of GT's), do wound care, and that's about it. And since I am going to start pursing my RN online this winter, I am thinking that I should get some med-surg experience. I have been offered a job in a med-surg unit (liver transplant) of one of the best teaching hospitals in the country. I am torn though, because I would be making $4.00 less per hour in the hospital, and it is also an additional 30 minute commute each way (my current commute is 5 minutes!). Also, the hospital job is 11-7. Would I get *enough* med-surg experience overnight, or would it be perfect way for a new graduate to get their feet wet in med surg?
Please help me! Any advice or perspective would be much appreciated.
Michelle

I went to work in LTC right out of school. It was for me the biggest mistake I had ever made. When they started cutting my hours back to give them to others who had been there longer I deciced to go ot a hospital to fill the gap. The LTC facility was all for it as that's what many of thier nurses do, but they canned me because I had to go for a week of orintation. That's ok, because I know now that there is a big difference in the kind of nursing done here and there. I would have lost alot of my skills at LTC, where at a hospital I continue to learn. Nurses are needed everywhere but, knowing what kind of nurse you want to be makes the difference.

needatag · Dec 12, 2004

Hi Guys & Gals . I also am an August grad and started in L.T.C. on the sub-acute floor. And I'm told by other nurses that the things we do there now was Med-Surg work not that long ago. Wound -Vacs, Trachs, Recent amputees and other treatments.I feel I'm getting great experience. I've covered 3-11,11-7,7-3 shifts and never seen anyone on staff sleeping.I hope to also go RN online.And the tuition will be paid by my employer . The grass is always greener untill you walk on it . Thanks CRG

michelle-new-lpn · Dec 12, 2004

do you feel like you have too much of a work load as a new nurse on subacute? how many pts are you responsible for?

needatag · Dec 12, 2004

HI ,yes it's hard work .However,there are great nurses to help. Some have been there 15+ yrs. I carry about 12 pts BUT that changes with call outs ect. The most I've had was 18 .And if someone wants to learn thats the place pts turn around in 1-2 mths and something new is always coming in . CRG

not now, RN · Dec 14, 2004

If the LTC is more practicle then by all means stay there. You'll keep up your skills during your clinical practice. Working and RN school is going to be taxing. Why not stay where you already know the residents, you know your co-workers, you know the routine and you're employer is more likely to work around school?

michelle-new-lpn · Dec 15, 2004

I have decided to take the med-surg job. It is a $5.00 an hour pay cut, but I have great health insurance through my hubby so I'll get a benefits buyout package (I have no idea how much it is). Three weeks vacation -- the first week I can take after 6 months. Very friendly nurses and staff. Nurse/patient ratio is 1:8. I'll have a preceptor 4-6 weeks. All-in-all, it feels *right*. I really want to use what I learned in school before I forget it! I start on January 3. Thanks for all your input!

allmynez · Dec 15, 2004

Hello everyone.:) I'm new here and I need some advice!
I graduated from PN school in August, and since October I have worked at a LTC. From what I understand from speaking to some of the veteran nurses who have worked everywhere, this home is one of the best in the area as far as working conditions for nurses go. I like my job and my co-workers, and have grown to love my residents.
The problem is, I feel like I am not utilizing 1/10th of what I learned in PN school. I pass meds (I have a couple of GT's), do wound care, and that's about it. And since I am going to start pursing my RN online this winter, I am thinking that I should get some med-surg experience. I have been offered a job in a med-surg unit (liver transplant) of one of the best teaching hospitals in the country. I am torn though, because I would be making $4.00 less per hour in the hospital, and it is also an additional 30 minute commute each way (my current commute is 5 minutes!). Also, the hospital job is 11-7. Would I get *enough* med-surg experience overnight, or would it be perfect way for a new graduate to get their feet wet in med surg?
Please help me! Any advice or perspective would be much appreciated.
Michelle

I can see your dilemma I onced faced the same problem and chose med-surg suprisingly enough it wasn't that much different less patients yes but could be double the work sometimes. When I worked in the nursing home you do learn alot you would be surprised what you can apply in the hospital from your LTC experience. I know returned back to long term care and it is the same all nonsenese that I had in the hospital short staff and people complaining constantly. But it all depends on the facility you work at and the people u work with. I don't lose skill because I take the time to find out about things research seminars and I still remeber what I learned in school and I graduated almost 4 years ago. It will probably help u in your studies or maybe it won't as an RN. When I started school for my RN even up to the other day the teacher always says not to think like an Lpn and to start thinkin like an RN. What you learn is up to u. I worked in LTC rehab and I also learned alot just like int the hospital depends on you.

DeLynn, RN · Dec 16, 2004

I'm also a new LPN and going for my RN thru Excelsior. I work the 11-7 shift on a med/surg floor at a Hospital. I've learned a lot in the 6 months I've been there, and I really think it will help me with Excelsior. I like the 11-7 shift and there is plenty to learn. I'm getting experience with IV's, blood, picc lines and so much more. And there is always an RN around to help with questions. I would recommend med/surg for any new grad, and when we do get our RN we will have that much of a head start on a new RN grad with no Hospital experience.

Hope this helps, and let us know how you like your new job.

pioneer555 · Dec 26, 2004

I started working as an LPN in a nursing home because I could not find any hospitals in new york offering a position for LPNs without experience. I worked for twelve years as a charge nurse on a unit with forty-one residents, many of them with Alzheimer's, fourteen tube feedings, physical abuse and more than enough decubiti care. I was in charge of five nurse aides and at times,had another LPN as a medication nurse.I say at times, because during the holidays and weekends and on days when the doctor wasn't coming to make rounds, I would work alone. Since I was very conscientous worker, the supervisors would have me work alone, also I worked on the same floor all these years. I worked during the 7-3 shift which was hard because I would have to answer to family of the residents, supervisors, and my director of nursing. Not to mention I was nineteen years old when I started, so the nurses aides were a little resentful of me,at first. Honestly,nurses' aides are worked like dogs in the nursing home, at least during the day shift. I used to leave two,three hours after my shift was officially over so I know the aides worked hard then too. I did overtime at nights, so I know they worked hard also. But once in a while, I did find aides who were not doing as much as they should have, but I also found many LPNs who worked "under me" who only did as little as possible and would leave as soon as the clock struck three. I got tired of working alone day after day, I was afraid I would make a serious med error working under this condition,to make a long story short, I sacrificed the higher pay check for a city hospital position as an LPN in a med/surg unit.The bottom line was that hospitals offer more opportunity for advancement than nursing homes. In the nursing home I worked like a dog,alongside my nurse aides,I also changed incontinent pads ,took patients out of bed, used the hoyer lifter myself. But I would also work as chargenurse receiving pay of LPN. The nursing home did nothing to help me advance. So,why would I want to stay there? If your employers are not going to help you advance, why should you stay there either? My hospital helps with advancing education and there's no better experience for new grads than hopital experience. I'm just sorry I didn't find this out sooner.