New Grad RN in LTC, what can I do?

CapeCodMermaid, RN · Nov 14, 2010

No LTC in Massachusetts hangs blood. And what, may I ask, is pulling milk?

SuesquatchRN, BSN, RN · Nov 14, 2010

My DON hires the RN over the LPN simply because in NY LPNs have had their scope severely limited - overlimited. We try to have an RN in the building at all times to assess after falls (LPNs can't under the law), as CCM mentioned, the rating, and specifically IVs - LPNs here can't touch one in LTC. We work the floor and hold all supervisory positions again, in accordance with the NYS education law.

springRN · Nov 14, 2010

No LTC in Massachusetts hangs blood. And what, may I ask, is pulling milk?

yes, what is "pulling milk?" (I am almost afraid to ask):uhoh21:

stella2blue · Nov 14, 2010

I saw an ad in the newspaper and called for an interview. Should have noted a red flag since they hired me in a "supervisory" capacity although I was an RN, even though I had no previous work experience.
I quickly saw that I was in over my head. Long term care is best suited for an experienced RN since you are the eyes and ears of the physician and often manage a whole floor of patients as opposed to maybe 4-6 patients. There are times when you have to initiate treatments you may not be familiar with without hospital experience. I remember having difficulty with IV therapy because I wasn't sure of how to troubleshoot the IV or what an infiltration looked like. I missed some things also because I was never exposed to many of the illnesses this clientele presents with. Many of them are on multiple medications and have multiple co-morbidities and your skills really need to be up to par.
It was hard for me to learn because where I worked it was mostly repetitive passing MULTIPLE meds and treatments
I don't know your circumstances but I would never recommend this field to a new nurse.

As a new nurse I was horrified at what I encountered after a few weeks on orientating to a LTC 'skilled' nursing unit. I quit because I could not provide the quality of care I feel obligated to provide (3-11 shift with 30 pts with meds, tx, wound care, notes, labs, unprofessional/unsupportive CNA staff, ect, ect the list goes on and on!). I feared loosing my license the most so I trusted my intuition and quit.

indigonurse · Nov 17, 2010

You can get out the yellow pages and call every long term care facility withing driving distance and ask if they are hiring RN's. Usually RN's have to pass meds, do treatments, admin. Gtube feedings, do blood sugars and admin. insulin to diabetics, do charting, call the MD if a res. gets sick, supervise other direct care staff, etc.

Trubie, LPN · Nov 17, 2010

I am a new grad RN, and LTC is my first job. My job title is technically "RN Charge Nurse", but I try to avoid being in charge because of my inexperience! I am the only floor nurse RN with a regular patient load.

We have a few other RN's in the building, including the DON (who is completely clueless in every way), a treatment nurse, and 2 weekend supervisors.

I work closely with several LVN's who are floor nurses. We share the same duties. I believe I am paid more than them, but I am not sure how much.

Eventually, when I have a little more experience, they will probably require me to work as fill-in weekend supervisor.

At my facility, we do not have differential pay, so I get the same rate for every shift (including days/nights/weekends).

Since your goal is LTC, you have some time before graduation to do some research and find a good facility. I stumbled upon my job after 5 months of searching for hospital jobs. Since I am new to the area, I had no ideas which facilities were good and which were terrible. I applied in person (no jobs listed on their website) and offered a position on the spot. Later, I found out that pretty much everybody who applies there gets hired on the spot- which can really come back to bite you in the butt if the person is a horrible nurse/CNA.

Good luck to you!! I agree with the person who said that you really have to be on your best game in LTC.... I am constantly searching for basic supplies and the only communication link between the patient and the doctor. If the patient is basically stable, they may not see the doctor for a LONG time, so you better be alert for when they need more help!

mb1949 · Nov 19, 2010

Kind of scary, I am also a new grad, giving up on finding a job in a hospital after 5 months, starting to look in LTC, but will I be over my head, I feel confident in what I know, but I have a lot of skills that I have never performed, also as an RN do you feel the LPN's resent you? a few of my fellow newbies went this route some love it some not, I am willing to try but never and I mean never want to put somebody in danger or put my license in danger, well any ideas or suggestions would be appreciated.

indigonurse · Nov 20, 2010

The key is making sure that you get a good orientation with an experienced nurse. It can be a logistical nightmare as far as the amount of multitasking, that is involved. Nights is the best way to ease into it. To get your feet wet. To see if it's for you. As far as LPN's are concerned it is all about trust and respect. They work under their own license and are given a job description that they are qualified and trained to do. You will need to rely on them for guidance for a good long while as well as the rest of your staff.

mb1949 · Nov 20, 2010

Thank you, I will take your suggestions to heart, and do my best, the fact that one of my classmates has like 30 patients with meds, dressings etc, I believe nights might be a blessing.

Thanks again

tyvin, BSN, RN · Nov 20, 2010

Nights would be a blessing. My first LTC experience was on evenings, had 267 residents, multiple CNA's, LPN's, RN's whom I was in charge of. This position called a House Supervisor which meant Charge nurse. With no experience I stood at the front of one of the nurses station (4 story building) and realized I was in deep stool. How can one person be in charge of all that! It's called LTC.

I learned real fast. The experience I gained was unbelievable. I had nurses coming in drunk, at least 4 codes a week; anything that could happen did. Anytime a resident coughed I had to go assess. At least one incident every other night. I was pulled and torn in every direction imaginable and at the same time had no clue as to what I was doing.

I had to come up with a plan fast and did. I survived a year at that place and went on to other things but nothing will ever replace the coping strategy I developed while working there. I try to remember how long my orientation was but can never remember; it's almost as if they just let me loose; I mean no amount of orientation could have prepared me for what came before me. It's sink or swim in many of these LTC facilities; good luck.

actioncat · Nov 21, 2010

HI Nurse2be,

You sound like me. I worked in the hospital as a new grad (and stayed entirely too long), but always knew it wasn't for me. I was not sure how to go about getting a job in the LTC setting and assumed they only wanted LPNs unless it was for supervisory positions. I was wrong! There are floor positions for RNs. But, I would not rely on job postings. My advice is this.

First, go to Medicare.gov and look under "Find a facility". You can do a check of the LTC facilities in your area by putting in your zip code, and compare 3 at a time. They will tell you about staffing, health inspections, quality indicators. I would pay special attention to staffing. It is great if a facility has no deficiencies (of course, you would want to stay away from a place that has an excessive number), but I think a facility can have some and still be a good place. Staffing helps to tell you about priorities. They will aslo let you know the ownership type of the place (corporate owned, non profit church related, etc.) Also, they will tell you the number of beds. This is a good starting point. Take a note of those that seem promising, maybe look them up on the internet. There should be family/resident satisfaction surveys available on the web too. These are provided by your state.

Then...get your resume together with a nice cover letter and apply in person.

Good luck.

FocusRN · Nov 21, 2010

Thanks to all of you that have posted here. You have given some great advice!