Med surg vs LTC

Lev, MSN, RN, NP · Dec 17, 2015

Never worked in LTC, however RNs who transitioned from LTC to my med surg unit had a big learning curve and they said it was busier in a way than LTC even with much lower ratios. Med surg ratios run from 1:5-1:8 depending on the hospital. I have only chosen to work in hospitals with a med-surg ratio of 1:5. At my old job, when I got that 6th patient things went from manageable to unmanageable. I won't even talk about getting a 7th patient which happened twice. Med surg is great experience and it will help you wherever you go, however, it is not required.

CrazyGoonRN · Dec 17, 2015

I worked LTC/SNF for 3 years. When I started in med/Surg there were a lot of new things to learn, but I was no where as busy as I was at the LTC/SNF.

Postpartum RN · Dec 17, 2015

I worked in A SNF for 2.5 yrs as RN. I will say it is brutal. I now work in med surg/telemetry. Both places are very very busy, but it is a different kind of busy. I did have a big learning curve when I came to med surg because you just don't do all of those same things in LTC; however my time management skills were excellent when I came to med surg.

I will say this though, I never ever want to work in a snf again, I'll take med surg over that any day.

jojo489 · Dec 17, 2015

Thank you for the insight. I was wondering what the ratios were like as well. Anything has to be better than 1:18-30.

The med passes are what kill me right now. I want to go back for my RN because I want that med surg experience and I also want my job to be more than a med pass taking up half my shift.

I think I'd welcome a different kind of crazy.

Postpartum RN · Dec 18, 2015

Thank you for the insight. I was wondering what the ratios were like as well. Anything has to be better than 1:18-30.
The med passes are what kill me right now. I want to go back for my RN because I want that med surg experience and I also want my job to be more than a med pass taking up half my shift.
I think I welcome a different kind of crazy.

On my medsurg/tele floor ratio is 4:1

At the SNF the ratio was about 16-24 per RN if on the rehab/Medicare side where we has all the pts tree for IV atb, wounds with wound vacs, s/p orthopedic surgeries there for rehab, new gtubes, all sorts.

On the ltc side where it's mostly the long term residents ratio was about 1:30-35.

I hated the med pass, especially since most were crushed and mixed with applesauce jbffe the pts hated taking it! It would take forever..I felt like I was pushing pills all day, running around like crazy taking care of the sick pts, I never took my lunch I would clock out and continue working, there was just so much to do and nobody did any of your stuff while you took your lunch!! The most the covering nurse would do is give a prn pain med if a pt requested...I hated it there. Swore I would never go back. We would get into trouble for working OT, but then if we didn't finish our work we would get into trouble also. DON kept telling us to leave what's left to the next shift, "24 hr nursing care" she would say. Well how can I leave my unfinished charting?? If I didn't document it, I didn't do it!! That would be MY license on the line since I cannot prove that I did something for the pt or resident who had something going on that shift, since I didn't chart it! Nurses would hide in the supply closets finishing their charting while off the clock already, so that management wouldn't see them still there..

What I like about my medsurg unit is that the nurse who is covering me for break will continue the care, she will pass any meds that need to be passed and do any other tasks that need to be done...very different from SNF

jojo489 · Dec 24, 2015

That's nice, that the covering nurse would help out like that.

See, where I'm working, we have 60 beds in the long term area but they're slowly integrating rehab patients up there. Which is really hard when you have like 20 LTC residents and 10 rehabs thrown in (usually a 1:30 ratio on long term) and then our rehab we have a 1:18 ratio which is much more manageable for me.

My very first job out of school was on a rehab unit so I was kind of bred for that fast paced, more acute business and I prefer it to LTC.

As I said before, I know med surg is a very different kind of stress, but lately having 30 patients has just felt like way too much. I can't wait for a lower ratio.

Scarlettz, BSN, RN · Jan 1, 2016

OP, I have a question for you. How much time do you get to pass your medications? I am going to be starting a new psych job soon and I forgot to ask this question. Doh! I can have up to 30 patients on this floor.

I am a med-surg nurse and the most patients I ever had was 7. That only happened about three times, though. They try not to go above 6 patients esp. since we are short staffed and usually have no aide. I would say 4-6 is the norm, 5 being the average. The busiest time on my night shift is 7PM - 11 PMish. I pass meds between 8 PM to 10 PM but it can take longer if there is a new admit or two at the same time. The other busy time is between 5 AM to 7 AM with the other big med pass.

There are times when you will only have 4 patients but won't sit down. Sometimes you will have 6 "easy" patients. You just never know! I hated med-surg in clinical but this is where my first job landed me. I am surprised that I like it more than I do. I think because it does stay busy (even on nights) so that makes the time fly. The things I hate most are starting IVs and inserting NG tubes. I am not great at either.

tokmom, BSN, RN · Jan 3, 2016

Med/surg is a specialty and has it's own certification.

jojo489 · Jan 27, 2016

OP, I have a question for you. How much time do you get to pass your medications? I am going to be starting a new psych job soon and I forgot to ask this question. Doh! I can have up to 30 patients on this floor.
I am a med-surg nurse and the most patients I ever had was 7. That only happened about three times, though. They try not to go above 6 patients esp. since we are short staffed and usually have no aide. I would say 4-6 is the norm, 5 being the average. The busiest time on my night shift is 7PM - 11 PMish. I pass meds between 8 PM to 10 PM but it can take longer if there is a new admit or two at the same time. The other busy time is between 5 AM to 7 AM with the other big med pass.
There are times when you will only have 4 patients but won't sit down. Sometimes you will have 6 "easy" patients. You just never know! I hated med-surg in clinical but this is where my first job landed me. I am surprised that I like it more than I do. I think because it does stay busy (even on nights) so that makes the time fly. The things I hate most are starting IVs and inserting NG tubes. I am not great at either.

Better late than never, haha sorry for the delay in my answer.

When I have 30 patients, we try to assign med times by clusters of rooms. So one end of the hall will have 8ams, then another portion has 9ams and so forth. We generally follow the 1 hour before/after the scheduled time rule. It may be different with psych, but in LTC the residents are usually on a lot of meds. I get to work at 7, finish report at 730, and am usually on my morning med pass until close to 11am. Then we have before lunch meds, blood sugars and afternoon meds and whatever treatments/labs/orders to take care of. My day is generally very busy.

But it may be different with psych, it's possible that they are on less meds, so your pass will go a little faster.

KnitterNurse1989 · Feb 8, 2016

I agree completely. This is the same reply I was going to make. I did nearly all of the same things in the LTC/SNF. The things I did have to learn was like... managing drips, continuous bladder irrigation, new charting system, and NG's...

The LTC was for profit but my hospital is not for profit. So we are all about customer service here! The patient always wins!