New Grad LTC

Posted

I am a new grad, ASN (taking the NCLEX on 7/28) and am interested in LTC. In fact, the reason why I wanted to become a nurse was to work with the geriatric population. I don't ever see myself in acute care.

That being said, I do have some questions regarding LTC:

How much orientation should a new grad receive?

What is a safe or "good" nurse to patient ratio? ( I am seeing a lot of insane ratios like 1:45 or 1:50... I am hoping that is not the norm)

What is the average pay for a new grad in LTC? (I will be living in the Denver area, where cost of living is quite high)

Thanks in advance.

Miss Rayanne

Miss Rayanne

Specializes in LTC/Rehab, Pediatric Home Care. Has 9 years experience. 41 Posts

How much orientation should a new grad receive?

Personally, I think a new grad with no medical experience, should get at least 6 months of close supervision. However the amount of orientation you will get will depend on the company. When I took my first job in LTC, I only had two days. In retrospect, it was not enough time. I would aim for as much orientation as you can get. If they are offering less then a week or two, I would only take it if you have no other options.

What is a safe or "good" nurse to patient ratio? ( I am seeing a lot of insane ratios like 1:45 or 1:50... I am hoping that is not the norm)

Unfortunately, LTC has a very high nurse to patient ratio. In my career, I've have had to deal with anywhere from 20 to 45 patients. If I am passing my own meds, typically that number is in the low twenties. When determining the amount of patient a nurse can safely care for, one must factor in more then just the number of patients. Patient acuity can make or break an assignment. You also have to consider how many CNA's or other auxiliary staff members you will have on the floor. If you have 40 patients who don't require anything more then a few pills, then that is doable. On the other had if you have 20 patients who all have G-tubes, wounds, psych issues, confusion, etc, then that workload can be unsafe.

What is the average pay for a new grad in LTC? (I will be living in the Denver area, where cost of living is quite high)

I don't really know how much average pay is in Denver, but down in Colorado Springs, I was able to get hired for $23/hour (LPN, 8 years of LTC experience). Hope that helps.

Just_Kidney

Just_Kidney, ADN, BSN, RN

Specializes in Nephrology. Has 7 years experience. 92 Posts

I am a new grad ADN in the greater Seattle area and I just got hired at a combination LTC/SNF. My pay will be $28/hr plus shift differentials. Patient/nurse ratios are 1:15 on the SNF side and 1:18-20 on LTC. Orientation is 2-4 weeks with options to extend that if I feel it's necessary (I'm hoping I won't!). I specifically looked for a facility with low patient/staff ratios (well, low-ish) and a decent orientation length. I haven't started yet, so I don't know how it will be in practice, only in theory. Good luck!

SquishyRN

SquishyRN, BSN, RN

Specializes in ER, Trauma, Med-Surg/Tele, LTC. Has 12 years experience. 516 Posts

Personally, I think a new grad with no medical experience, should get at least 6 months of close supervision.

We can only dream... 6 months of orientation in LTC would never happen. Ever. The only specialties I've ever come across to have 6 months of orientation are ICU and OR. Other acute specialties don't even get that much either. Even weeks long orientations in LTC might as well be unicorns to me -- I've heard about them, primarily from here on allnurses like the poster above, but have never actually seen one myself.

I've worked in four different LTC/SNFs and received no more than 3 days of orientation at any facility, even as a new grad. When I worked the floor and had to pass meds, my patient load would be around 25-30 patients in one facility to 35-45 patients in two others. The former wasn't bad at all since those 25-30 patients were LTC, but in the latter facilities those 35-45 patients were skilled. This meant a lot of wound care, pain meds, additional charting, etc. And these places weren't dumps either, they all had 5 star ratings in DHS surveys. In the fourth place I was the RN Supervisor, so I didn't pass meds. I'd be responsible for about 20-30 patients and the nurses taking care of them, but each of those nurses only had 8-10 patients because this was a sub-acute unit and every single one of the patients were on ventilators. Oh, and these were during 7-3 or 3-11 shifts, not night shift. Night shift could potentially be more because there's less to do at night, but at the facilities I worked, the number of patients stayed the same across all shifts, so night shift usually got stuck with more of the paperwork and organizing stuff.

I think the 3-day orientations are common where I live, Southern California, because of how saturated the market is. If I were you, I would definitely shop around and not settle for anything less than 2 weeks. It might take some time, but the previous poster above found one because they made that a priority for them, so hopefully you'll have the same luck.

bijoutRN

bijoutRN, ADN, BSN, LPN, RN

Specializes in Home Health. Has 10 years experience. 92 Posts

4 weeks orientation & ratios anywhere from 1:15-1:60. It's not as bad as it sounds though. I've been in LTC for 3 years now starting as an LPN for 1 1/2 years. I have my BSN now & I am itching for some acute care hospital experience.

Good luck in all that you do & be sure to persue that BSN!

sallyrnrrt, ADN, RN

Specializes in critical care, ER,ICU, CVSURG, CCU. 2,395 Posts

Many opportunities

you will at times be overwhelmed....even with 43 years experience I at times found myself over whelmed.

orrientation time fast paced, and often inadequate, But you use your nursing skills, critical thinking, to compensate....

my my most over whelmed was as DON....

ratios on always way "out there"

best wishes, can be very rewarding.

as U.S. Baby boomers age, More demands LTC and Home health, with more complex level of care will materialize ✌

wanderlustnurse88

wanderlustnurse88, RN

Specializes in OR/PACU/med surg/LTC. Has 11 years experience. 198 Posts

I got two days and two nights. Had been a nurse for only 18 months in acute care before that. I just kept asking lots of questions of other staff. My ratio is 31 residents on days with 2 PSWs (plus one who floats between two floors) and on nights 62 residents with 3 PSWs.

MeganStar

MeganStar

31 Posts

Extremely helpful, thanks fellow Coloradoan! :)

Although like a few posters mentioned, 6 months of orientation in LTC as a new grad is unheard of. Based on what I'm finding out, I would be lucky to get 2-3 weeks. I want to be somewhat picky with orientation and nurse to pt ratio, but I feel if I'm TOO picky, I will be waiting several months before I can find a job...and I can't do that. Thanks again for your helpful reply

Personally, I think a new grad with no medical experience, should get at least 6 months of close supervision. However the amount of orientation you will get will depend on the company. When I took my first job in LTC, I only had two days. In retrospect, it was not enough time. I would aim for as much orientation as you can get. If they are offering less then a week or two, I would only take it if you have no other options.

Unfortunately, LTC has a very high nurse to patient ratio. In my career, I've have had to deal with anywhere from 20 to 45 patients. If I am passing my own meds, typically that number is in the low twenties. When determining the amount of patient a nurse can safely care for, one must factor in more then just the number of patients. Patient acuity can make or break an assignment. You also have to consider how many CNA's or other auxiliary staff members you will have on the floor. If you have 40 patients who don't require anything more then a few pills, then that is doable. On the other had if you have 20 patients who all have G-tubes, wounds, psych issues, confusion, etc, then that workload can be unsafe.

I don't really know how much average pay is in Denver, but down in Colorado Springs, I was able to get hired for $23/hour (LPN, 8 years of LTC experience). Hope that helps.

Wallace2014

Wallace2014

27 Posts

I'm a new nurse and I am starting out at rehab/hospice/LTC facility. We get 4-6 weeks orientation... We work 12 hours shifts 7am-7pm and I love the hours... I wanted to work at the hospital but they actually paid $4 less than LTC ... As a new nurse with two children and being broke while in school that was a straight solid NO!!! I'm going to take every advantage of my orientation time ... One of my classmates got 2 days of orientation before she was on a medicine cart by herself... At my job offer I specifically ask about orientation time and I informed them that I don't expect to be an expert on the cart but I wanted proper time for learning and understand that I am a new nurse with many questions and need assistance.