New LPN, SNF With 22 Patients Looks Overwhelming

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

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Dear Nurse Beth,

I graduated in July and passed NCLEX 2 weeks ago. Went to school (LPN) during early days of pandemic and many of my clinical hours were online, including pharm. Literally, I have administered insulin twice and heparin once. Have offers for FT work at LTAC, SNF and at a behavioral unit (mostly things like anxiety/depression, eating disorders). I have heard the SNF AND LTAC facilities new nurses get about 3 days orientation/training, with 22-24 patients. At the BU the supervisor says only 6-8 patients per nurse. I am worried that with vaccine mandate more staff will quit and I could have even more patients. Am wondering if it would be best choice to take the BU position and try to improve on my clinical skills instead of being likely overwhelmed if I accept one of the other offers. Thanks for any advice!

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Specializes in Tele, ICU, Staff Development.

Dear Passed NCLEX,

Congratulations! 

It's been a hard year and a half for nursing students, both because employers want to onboard them so quickly and because clinical hours were reduced.

As far as developing clinical skills, you are far better off at both LTAC and SNF settings than behavioral health. You will get very little to no typical MedSurg experience in a behavioural health unit. No feeding tubes, foleys, exposure to management of various medical disorders such as pneumonia, heart failure, post-op surgical care, and more.

It may be overwhelming to consider LTAC or SNF, yes, but you won't know unless you try. School was overwhelming at times as well, and you got through that. I don't know that fear is the best rationale for making your decision. You can always ask for a longer orientation, and ask what support is available to you as a new nurse.

You also have to keep your eye on your long-term goals.

My concern is that if you go into behavioural health, 1-2 yrs will go by, and you may find it hard to get a job outside of the speciality. Skills learned in LTAC and SNF are more transferable than skills learned in behavioural health. Going to behavioural health as your first job is OK if your end goal is to specialise in behavioural health, but I'm not hearing that.

Also keep in mind that after years of no LVNs/LPNs in acute care, some hospitals are beginning to hire LPNs/LVNs into the ED and I've recently seen LVN/LPN positions in NICU. Keep your eyes open for those opportunities.

Best wishes in your decision,

Nurse Beth

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