New grad, shoud I take this position?

CapeCodMermaid, RN · Oct 17, 2007

It sounds pretty standard for a medicare unit in a skilled facility. Find out how long your orientation will be. My company has a 4 week orientation for all new grads which is unheard of in long term care. It's worth the investment up front to teach the new grads the right way to do things. We get a better nurse and someone who wants to stay and work there because they weren't overwhelmed as a brand new nurse.

missdeevah, NP · Oct 17, 2007

wow..wish i could have 4 weeks. i'm to have orientation on monday, then work with a nurse the reset of the week, and "possibly" part of the following week. so this sounds standard, huh? so is it do-able for a new nurse? i'm just wondering how one can assess all the patients skin every night and chart on all of them. i just don't want to learn to do everything the short-cut way, though i know there are things i will not do the way i was taught...i will find my own way that works without compromisng the standard of care.

LVNwannaBE2007 · Oct 17, 2007

are we twins or something?

i jsut graduated with my LVN also... i started out in a LTC on the medicare hall i had up to 6 gtubes, breathing treatments, medications (i was on nights and there wasnt a med aide) plus vitals charting etc etc plus being over a secured unit **not medicare**

it is my first nursing job and on my second night i was BY MYSELF

i also took it as a challenge to see if i could handle it.....

at first i was so stressed out trying to learn my way around the facility plus everything else but it got easier and easier...... by my second week i had time to actually sit down and was like " there has to be something i forgot because i didnt have this free time earlier" lol

but it turned out great! i loved it... i did switch to the other side of the LTC facility but really do miss where i started out at... i say go for it

TheCommuter, BSN, RN · Oct 17, 2007

My opinion might go against the grain, but I would take this job. Much of your time will be freed up, since you do not have to pass your own pills. You've got a medication aide to pass the pills, which means you can devote your precious time to admission paperwork, charting, treatments, wound care, g-tubes, and complaining family members.

I currently work on a skilled floor, and I wish I had a medication aide to pass my pills for me. I must pass the pills 4 times per shift in addition to the admits, whiny family members, dressing chenges, treatments, blood glucose checks, and so forth. It may seem overwhelming at first, but it will become easier with time and grace. Good luck!

CapeCodMermaid, RN · Oct 18, 2007

So why are you doing skin assessments and tube feeds at night? People are supposed to sleep at night not be fed or have their skin checked. There are 16 other hours in the 24 that someone can have their skin checked and their tube feed. And why in the world are you doing skin checks daily? Standard of practice is a skin check weekly unless the person has a wound or pressure ulcer and again treatments should be done on days or evenings.

Take the job and make a difference.

LVNwannaBE2007 · Oct 18, 2007

where i worked we didnt have to do the daily assessment per say but it was like a check box thingie to put if they had a ulcer if tehy were A&O ..... catheter etc.... and what i call mode of transportation **wheel chair bed bound geri chair etc** all i really had to do was their vital signs and on the tube feedings i had to change the tubing and dressing which was 3x a day......

Hospice Nurse LPN, BSN, RN · Oct 19, 2007

I don't remember if you stated how many pts. you'd have. What I wouldn't give for someone to help me (or do!) my med pass. I have 65 pts on my end and med pass takes me approx. 2.5 hours (without anyone having a problem). We do complete body audits of bedbound/incontinent pts Q Sunday on the 6p to 6a shift. Wound care is done on days. But there's still breathing treatments, blood glucose checks, and charting to be done. The evening can be going really well until someone falls or there is a behavior on the secured unit and don't forget that people usually die at night. Night shift is also supposed to do chart checks (I don't have time to do all of them every noc).

:monkeydance:

I'd sure take the job!

missdeevah, NP · Oct 22, 2007

update: i decided not to go for the position. i found out that they can't keep anyone on that hall. one guy worked that hall for a week and quit. no one that currently works there will take it, even for higher pay. so i figured as a new grad, it may not be the wisest thing to do. also...i called in to say i will not be accepting the position, only to find that the person that interviewed and hired me, and who was to start with my orientation today no longer works there! i was shocked, as i had only spoken to her about 3 days ago...not really sure what happened. i will say however that the other halls are apparently ok, and those that work there love it.

so i went to a different place to look for a job and the hiring nurse/staff co-coordinator asks me whether she can count on me to show up and work because the last hire they had just walked out after a week. i laughed to myself a little wondering why she would tell me this...it leaves the question in my mind...what happened that she just up and left? ltc seems to be a different type of ball game than i was briefly exposed to in the hospital setting during my clinicals.

with all that said, i did find another job, i start tomorrow. wish me luck! i really don't know what to expect :uhoh21:

CapeCodMermaid, RN · Oct 22, 2007

Long Term Care is definitely NOT for sissies!

sassysteph7 · Oct 27, 2007

Long Term Care is definitely NOT for sissies!

Yeah I wish hospital nurses would realize that a little bit more. I'd like to see some of them take care of 25-30 people (meds, accu checks, treatments, orders, family stuff, IV's, updrafts, and the never ending charting). Oh yeah and the phone ringing off the hook when you have no secretary on the unit.

Did I mention that I love LTC :) I really do!

swimmom · Dec 5, 2007

i just graduated as an lvn a little over a month ago and haven't started working . i have been offered a position at a nursing home but have since learned the following: i will be working in the "heavy load" hall, i.e the medicare ward. there is a med-aide, but no admission nurse. i am told that the shift i will be working is when the most admits take place. they gave me an example of the current condition: there are 8 wounds, i would be doing the breathing tx, skin tx, 3 g-tubes (currently). i'd have to assess all the patient's skin nightly and chart on all of them nightly as well. however they said it would be a good learning opportunity (hmm...) for me as i go through excelsior for my rn as i will be trained on iv's and something else (can't remember). i was told these will be patients who have just come in from the hospitals. also the families can be very demanding (aren't they all), but that families are very involved at this facility.
i'm due for orientation on monday and i am just so unsure as to whether to take this or not. there's a certain thrill that comes with the idea of a challenge, but at the same time, being a new grad, i don't want to chew off more than i can bite. any advise? is this what is normal for an ltc? they did say that they will try to get one of their more experienced nurses to take the floor, but they doubt that she would .

how many patients? sounds normal. the typical medicare unit in my state has about 30. i've got 60. how may cnas. they will make you or break you with the families. say, if there are 15 patients, you, a cma, and one aid, and you get 3 admissions and 2 discharges on your shift, it is not possible. those new patients families will have them discharging an hour after they arrive. new families want 100% attention from someone at all times, plus admission assessments, ordering meds, clarifying orders. they will want you to get bed rails or a tv at that moment, but then they at the same time will want a new order for pain medication for someone who is so recently out of surgery that they just took them off of that morphine drip for a triple bypass but didn't even send with an order for tylenol. they will come to you for toilet paper and malfunctioning heater vents. no matter what you do it will not be good enough. waiting 5 minutes for a call light or a fresh towel or a second roll of toilet paper will translate to a week, and as they tell you that you run this facility so poorly and they have just waited a week for a second roll of toilet paper that they asked for five minutes ago, their family will say i think she's in pain and she needs her oxygen right now, when she has come with no orders for oxygen and her spo2 is 99% with a pulse of 62 and yours is 92% with a pulse of 178 from running around trying to get this stuff these people want that you do not have access to because it sounds like you are on second shift. meanwhile your second admission comes in and the family is there to pick up one of your discharges in which no one has done any paperwork on, but social services told them everything would be ready to go when they got there. so they want you to fill out a complaint form right then and there, but no one has even written discharge orders. and it is all your fault because the nurse is the middle man and gets the blame for everyone. good luck getting an ltc doctor to call you back. god forbid there is an emergency or fall with someone. then when someone is bleeding on the floor with 15 people standing around and no one will do anything without the nurse. then they will be screaming your name to hurry up while you are administering someone's tube feeding or doing cpr and then report to the don that you wouldn't come get this person off of the floor for 2 minutes, and as you are running down the hall to get this person off of the floor a resident will yell after you "will you push me to my room?, i have to go to the bathroom." you yell back i'm sorry i can't i have an emergency, i will tell your aid." they mumble ya right and then report you to state for refusing to take them to the bathroom. your superiors will not back you up, because they were there all along and would not answer your pages for help, but their butts are covered because they had that many people in the building who were supposedly providing direct care. typically in the midst of all of this, they will come yell at you because one of your people has not been moved in their chair for 2 hours and they want you to locate the cna and have you assist in moving them. or "why has this person not had pain meds?" ok sorry, but this is how it is. i had a housekeeping person try to give me their mop today and tell me to go find the other housekeeper they had borrowed it from. this was in the midst of a situation like the above. i paged the other housekeeper who gave this guy a dirty look when she came and he said "it's not my fault. i tried to delegate the responsibility but this girl wouldn't do it. :trout:

the nurses are the lowest of the low despite the fact that we are the one's taking care of everything and cooridinating all of the departments. all each department sees is themselves.