Need advice!

Nurses General Nursing

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I am a new grad RN (graduated May ‘19) and have been working at my current job as a floor nurse at a LTC/SNF for just about 4 months now. I absolutely hate it! I understand whatever area of nursing I get myself in to it will be stressful. I also understand that the first year of nursing is always the hardest... and to just give it time before I feel more comfortable and confident. But I’m starting to think it’s the job that’s giving me anxiety not being a new nurse overall! I feel very overwhelmed. I’ve been caring for a lot of residents (all on my own, I am the only floor nurse on my unit) my highest census being 27 at the moment. I am not comfortable with taking on that big responsibility... something goes wrong it’s MY license at risk.

I also feel as though LTC is not for me. I’ve done all my clinicals in a hospital setting so I feel I could benefit better from either a hospital setting or in a subacute setting. Geriatrics is not my issue, but when I’m the only nurse on the floor with help from only 2 CNA’s, it becomes very overwhelming to the point where I lose patience, I lose compassion and I just want to walk out and never come back. And people tell me once I lose the compassion, it’s nursing burnout. It’s very hard walking into work with a positive attitude but I really just hate my job. I hate the hours as well. The facility is very short handed and I find it very difficult to do my job. Most of my residents have end stage dementia, fall risks. About 95% of them have bed alarms and don’t understand their limitations. I can’t even begin to tell you how many times I’ve had to stop med pass to run down the hallway because there are bed alarms constantly going off. Or when I really need to concentrate while putting in doctor’s orders and I have to babysit my fall risks residents. It’s just too much and I feel like I’m not making progress here. Also all the RNs who work at the facility are supervisors, doing admissions and discharges. And LPNs work on the floor. I have yet to shadow an RN doing those tasks. I feel out of place and I feel taken advantage of.

I spoke with the corporate nurse at the company recently and expressed my desire to learn more RN tasks and to transfer to their sub acute facility for more acute care; where I have a smaller ratio, I work with other nurses on the floor. She said I wouldn’t be eligible for transfer until 6 months (March), but in the mean time she will try working on me getting some morning hours and working with the supervisors to learn more of the RN’s job and if I feel like a transfer is better suited for me come March, she'll "work out a transfer". I spoke to her almost 3 weeks ago, and securing morning hours, working alongside an RN has yet to happen. I’m trying to hold out until March, but I can’t depend nor trust the nurse to actually secure me a job there. She could have just been saying that to shut me up. Back in July, before my NCLEX, I applied for their subacute facility. I was told no full time positions were available there at the time. Hence why they transferred me to their LTC/SNF facility. The problem is, is that I worked for this particular company for over 8.5 years, so just walking away is difficult for me. And other facilities in my area are paying NO where near close to what I am currently making at my current job. So leaving would definitely result in a significant pay cut. But I don’t wait to wait around until March to be told there aren’t any positions for me at their sub acute facility, and I'm back at square one. I am starting to feel hopeless, depressed, and unsure of my abilities to handle the tasks of a nurse, and I don't know if I should just start looking now for a job, or stick this out to March if she can really work me out a transfer. She has told me that the company would not want to lose me as an employee, that I have great potential, but I also can't continue working at a facility that makes me feel this way. All in all, this is about what benefits me and my career, not what is best for the company!

Any opinions on what I should do? I have started a job search... hospitals, subacute facilities, outpatient centers like a physicians practice. This is just weighing heavily on me. It’s very important to me as a new nurse to make sure I’m comfortable in an environment where I feel like I’m learning and making progress as an RN. Any feedback would be appreciated!

0 Votes

Not to be discouraging, but it sounds like you're describing acute care med/surg, too. The ratio is lower, and that's the one positive thing, but the patients also have acute issues which can create quite a bit more work.

In fact, where do you send your patients when they become too sick or injured to be cared for at the SNF? They're climbing out of their beds and even more agitated when you put them in an unfamiliar place.

You should purse whatever you'd like, but just don't romanticize acute care. You'll have plenty of anxiety there, too. ?

1 Votes

I think the anxiety and the feeling of being overwhelmed comes not only from the staffing issue but also because I’m taking care of so many people. The unit I work on is a mixture of acute patients (some have trachs, gtubes, catheters), and residents who are just there to live (LTC) and need someone to just administer medications to them. My problem/issue is not acuity. I know med surg is no walk in the park - I have done school clinicals and have witnessed these floors. Like I mentioned no nursing job is easy... but I feel as though LTC is just WAY too much, especially for a brand new nurse who still needs to develop skills. I sometimes feel like I don’t even have time to think because I need to accomplish SO much in an 8 hr period. I also work the floor alone - I do have a supervisor but she rarely will help with orders, labs and won’t touch meds. I have no other nurse that I can work alongside. There’s no teamwork, no communication, no consistency. Acuity is not my problem. I can learn in a fast paced environment and could utilize and build on the skills I learned in nursing school if I had 1/2 the patients I’m taking care of now.

0 Votes
Specializes in Progressive Care, Sub-Acute, Hospice, Geriatrics.
On 1/1/2020 at 8:00 PM, jennsrn said:

I think the anxiety and the feeling of being overwhelmed comes not only from the staffing issue but also because I’m taking care of so many people. The unit I work on is a mixture of acute patients (some have trachs, gtubes, catheters), and residents who are just there to live (LTC) and need someone to just administer medications to them. My problem/issue is not acuity. I know med surg is no walk in the park - I have done school clinicals and have witnessed these floors. Like I mentioned no nursing job is easy... but I feel as though LTC is just WAY too much, especially for a brand new nurse who still needs to develop skills. I sometimes feel like I don’t even have time to think because I need to accomplish SO much in an 8 hr period. I also work the floor alone - I do have a supervisor but she rarely will help with orders, labs and won’t touch meds. I have no other nurse that I can work alongside. There’s no teamwork, no communication, no consistency. Acuity is not my problem. I can learn in a fast paced environment and could utilize and build on the skills I learned in nursing school if I had 1/2 the patients I’m taking care of now.

Sounds like my current job atm. I work on the sub-acute/rehab floor. I have mix patients as well with 27 patient:1 nurse ratio. I work night shift. It was overwhelming at first, but you get to know their medications and you will get hand of it. I know most of my patients and I get an admission once in a blue moon. Unfortunately, most LTC are gonna be like this. Nurses are forced to do a 2 nurses job, while having high patient ratio to take care of, while dealing with CNAs and management, and other nursing duties. I am starting to not like LTC, but it is an easy way to get into, temp job, while looking elsewhere for a more stable job.

2 Votes

get out now before you become stereotyped to LTC. long term care is just a nice term for nursing home only patients are sicker and need more attention. the enviornment you are in is there to stay and only get worse.

i am an LVN with 26 years of LTC/SNF and trying to get another job out of this area is nearly impossible because most employers think "nursing home" and think you dont know anything. i dont know where you live but a brand new grad should be able to get a good job anywhere. it may pay less but a lighter load may be worth it. there is a hospital in the city where i live is offering a $15000.00 sign on bonuse for RNs.

0 Votes

I have read a lot of posts here with Nurses stating that they ban not find jobs that pay the same or more as the LTC's.

I have also heard that for new grads that work for a LTC/SNF get stuck there after 6 to 12 months. In other words hospitals etc... just will not hire them. (I do not know if this was true or not).

0 Votes

That’s how I felt when I was a new grad in a nursing home, I didn’t want to be a nurse anymore. Don’t be discouraged and continue to apply everywhere. Try long term acute care facilities (LTACH), hospitals, etc. When I got out I went to an LTACH, then moved on to acute care. The hospital setting is definitely better, in my opinion. You will have your good and bad days in the hospital too but I find that I have less bad days in the hospital. Don’t give up, good luck!

1 Votes

I would try to get on at a hospital, work med surg for a year and then decide if you want a change. I've worked both areas and they're both equally difficult and stressful.

1 Votes
Specializes in Emergency.

My first post-licensing job was also LTC/SNF. I had a load of up to 38 patients. It was hell. I never gave any one patient fair attention and became a task-master based on pure survival. There were some good moments and I did like most of the residents and came to really care about some but mostly it was awful.

Now I'm med-tele. Not a lot of difference in the patients or the procedures. Still running my *** off in the morning and playing catch-up all afternoon.

BUT...I have no more than 6 patients, hopefully only 5. I have many other nurses on the floor from whom to draw advice, opinions, assistance, etc. There is a charge nurse that takes care of time sucking admin stuff like arguing with pharmacy or tracking down a doctor that can't be found. So it is better than LTC/SNF in a lot of ways with a lot of similarities in others.

Work at getting into LTAC or acute care immediately though. Once stuck in sub-acute it can be hard to get out.

1 Votes
Specializes in NICU/Mother-Baby/Peds/Mgmt.

If you want good staffing try a NICU. I've worked in 4 civilian ones and there have been VERY few times when I thought staffing was inappropriate. Yes, there are shifts that are crazy busy but the good thing is your patients aren't very heavy. And they're usually closer to each other so not as much running around.

0 Votes
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