JBMmom, MSN, RN 10,142 Views
Joined: Jun 24, '09;
Posts: 548 (46% Liked)
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I started out in long-term care over five years ago, I've been a charge nurse and supervisor and still work per diem because I really like my coworkers and residents. I transitioned into an acute care med-surg position this past summer and I'm transferring to the ICU in the next month. I've seen many new grads lament that the *only* thing they can find is LTC positions and will that effectively end their career if they start there. I wanted to share to not only let you know that a long-term care position is not only NOT the end of a career, but you shouldn't underestimate the value of the skills that you will develop in that care environment.
When I first started, I had classmates that would apologize to me when I told them where I worked, as if their hospital positions were what I really wanted, but just couldn't get. In reality, the schedule options of LTC worked for me, not a hospital job. Learning how juggle med passes, treatment passes, dealing with families, getting lab and test results, calling MDs, and spending time with patients with a 30 patient assignment was a great way to learn time management. Having many stable patients, not everyone gets daily vitals, I had to develop strong assessment skills to identify patients that had a change in condition (like a non-verbal quadriplegic going into sepsis). On our short term rehab unit we've had probably 20 of the 30 patients that were easily as acute as the patients on my current med-surg floor, IVs, wound vacs, dressing changes, etc. And it's a 4-hour med nurse and the charge, for all 30 patients, with 3 CNAs. Those were some run-your-butt-off shifts, and my hat is off to my coworkers that pull those shifts day in and day out. Point being, the skills of prioritization and assessment are key to success in that environment and those skills are hugely beneficial when faced with a 6-8 patient acute care assignment.
When I started in the med-surg position, I was a little intimidated at first by the change in acuity, would I know when someone was facing a crisis? Could I handle the higher acuity environment? Turns out, the skills I developed in LTC continue to come in handy and my new manager in the ICU even commented that she has found that nurses with similar backgrounds have to have strong assessment skills and when they're given the extra tools of constant monitors in the room, they often find success. I hope that will be the outcome of my story and I'm excited for the new challenge.
I hope that my story helps others considering or currently in long-term care positions that don't feel they're putting themselves in a position to move out. And for those that love LTC and want to stay there, more power to you, we're all nurses and we're all using the skills we learned to make a positive impact on the lives of our patients.
Thank you to you, and your fellow staff members, for all that you did for those patients and their families on such a tragic day. While it must a have been a horrific experience for everyone, you did your best to help, my thoughts and prayers go out to you and your colleagues.
Sorry I don't have anything helpful to offer for CEUs, but I just wanted to wish you luck next time around. You can do it!
The only one I had more than once was when I first became charge and I dreamed that I forgot to assign a patient for day shift and they died. A couple times I've run downstairs in the middle of the day to find a COW in my kitchen to pass meds to the patients (in my kitchen?). And the other night I took a nap on my break and had a dream my patient was in the middle of my kitchen floor. I checked on him when I got back from break and told him I was glad to see he wasn't on my kitchen floor- he thought it was pretty funny.
I think I would look at the big picture and realize 10 months to fulfill a contract isn't so long and allows me to meet a responsibility. However, I quit a per diem job after four weeks because I couldn't stand it. Only you know if you can really wait it out.
Long-term care is often behind acute care settings in terms of technology so I have to say the additional of an EHR into our long-term care facility was the biggest change in the past five years. Especially for those that worked flip night!
Years ago I was a candy striper in the hospital. I'd had all the pre-volunteer testing, including negative TB test. The following year I had repeat testing and my arm blew up positive. No known interaction with a TB patient, they attributed it to potential hospital exposure. This was almost 30 years ago, had a year of INH therapy, never became active or anything. Although it is annoying the number of chest x-rays I have needed over the years to confirm the negative.
You're well within your scope to place this resident on extra charting/interventions because you're concerned about a change in condition. While other nurses shouldn't be ignoring these interventions, they may see them as unnecessary after their years of experience. As long as you're doing what you know is right, there's not much you can do about others, unless you're willing to go over their heads and point it out to management. Might not be worth it to do so, that will not make you any friends. Hopefully he will not have any adverse effects. Was the 200mL output much below the patient's baseline? If so, you should notify MD.
It all depends on the job and industry. I worked in pharmaceutical research in a location without many employers. I knew that eventually I'd have to be willing to relocate to keep my job, or change careers to stay where I am. Weighing all the options, changing careers was going to work better for me and my family. I don't regret that decision, but I miss my former profession.
Well, I'm the opposite. Spent 17 years as a research scientist and now I'm a nurse. I miss being a scientist, but the job market has changed and this is how I can support my family.
Thanks. Just venting. The assignment in this case was small enough that I've managed to finish most of it and I just don't have the energy to pursue it with the professor.
I'm well aware that group work follows us into the workplace. I've had 17+ years of experience working with others, but I've encountered less trouble with collaboration in the work environment.
I went the RN-MSN route because I had a BS in science. I recommend that route (12 classes as opposed to 8 for BSN. I went to Sacred Heart- good program but expensive), however I had one bad experience after school where I was offered a job and told that because of union requirements I would be paid at the lower ADN rate than the BSN rate because my MSN didn't meet the requirement. I guess some hospitals require the specific letters BSN. I didn't pursue that so I'm not sure whether I could have argued against it more or not. Just to make you aware it's possible that not having the BSN could be a drawback.
I know that others have mentioned this as well, I just have to reiterate that group assignments are the worst aspect of school. Especially with a bunch of working nurses that all work different schedules, trying to get assignments done is a nightmare. I set up a shared document three weeks ago for an assignment due this Sunday. Has anyone else contributed a single word yet? Nope. I've been working 50+ hours on nights for the past six weeks, and I admit I'm a bit exhausted. I finally have a weekend off and apparently I'll be doing the assignment for the whole group. I'm always tempted to just let things fail, but then my Type A kicks in and I have to get it done. sigh. Only 22 more months..... (and I'm hoping once I hit the clinical portion the group work will go away)
I also went to a CC program with many students (including myself) with previous BS/MS degrees from previous careers. However, the minimum overall GPA for applying to my school was 2.7. Of applicants with at least a 2.7, 40% of the class was a lottery of students after the first 60% was from the top applicants. However, we also had hundreds of applications for the 96 slots. As someone else mentioned, you may be limited in your options due to the minimum requirements. Wish you all the best in reaching your goals.
I don't think anyone else can determine what's "worth it" for someone else. If you know you don't want to be a nurse, then do what you can to get where you want to me. There are days that I regret leaving the medical school program I was in, but I know I wouldn't have my current life or family if I had gone that route, and I would still be paying off the medical school bills. So, I'll be happy in an APRN role when I finish school. You're young, work for what you want and the rest will work itself out. Good luck.
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