New to LTC and charge?

SNjamie · Apr 6, 2010

i would say don't bite off more than you can chew because it's your liscense on the line, but i'm still a student.

elprup, BSN, RN · Apr 6, 2010

Check out the LTC by googling it's name + complaints or survey. Then you can get a good idea if the place is negligent, has alot of complaints etc. Also check out the LTC thread under specialties. That gave me a ton of info-number of patients, up to date survey, medicare rating.

I too was offerred a LTC charge position as a new grad/old grad and only have 3.5 months of experience. Not that you could not do it....just have to check out the place first and see if it is even worth putting your license on the line.

SuesquatchRN, BSN, RN · Apr 6, 2010

Do you want to leave SICU?

I love LTC but it is not remotely similar to hospital nursing.

jnrsmommy · Apr 6, 2010

I am a night shift rehab charge nurse. I can have up to 34 pts at a time. It can be overwhelming, especially the paperwork (I just love medicare charting). My pt population can include: CVA, hips, knees, spinal (and associated hardware w/ the ortho pts), MI, respiratory (including trachs), PEGs, wounds/wound vacs, IV therapy (peripheral, PICCs, and central lines).. just to give you an idea.

starletRN · Apr 7, 2010

I'm glad I found this thread. I just got offered a night shift charge nurse position as well. I have over a year experience as a nurse and it was in a hospital. I noticed someone in the thread said it is completely different from hospital nursing. In what ways?

Also, for anyone who has gone from med-surg to LTC, which do you like better? More stress, less stress, different kind of stress? I have to admit I'm a little intimidated at the thought of being responisible for 30 patients as opposed to 5-6 patients. Any info would be greatly appreciated.

asfreeasabird · Apr 7, 2010

It is a different kind of stress. As the charge in LTC I was in charge of my 15-20 residents as well as the 120bed facility, which during the week wasn't bad but on the weekends when everybody wanted to call in it was HELL. I had meds to pass, I was also in charge of call ins. There were several occasions that my CNA did not show up so I had to wear that hat too. I was also the nurse for the dining room. I had to pass out clothing protectors and drinks. As the RN I had to initiate the plan of care on any new admissions perform the initial assessment. I would also have to touch base with my other nurses to see if they needed anything. Many of the LPNs I supervised were great they didn't need much from me. I had to draw from central lines, and help set up an IV pump mostly skills. If anybody showed up during this crazy circus on the weekend and wanted a tour I had to show them around. All this for a few dollars less than I make at the hospital, no thank you. I had 2 years experience as an LPN before I started charging and a Registered Nurse. Maybe if you are hired on with a better call in policy. Find out what your duties are before you take the job. Best of luck.

SuesquatchRN, BSN, RN · Apr 7, 2010

I'm glad I found this thread. I just got offered a night shift charge nurse position as well. I have over a year experience as a nurse and it was in a hospital. I noticed someone in the thread said it is completely different from hospital nursing. In what ways?
Also, for anyone who has gone from med-surg to LTC, which do you like better? More stress, less stress, different kind of stress? I have to admit I'm a little intimidated at the thought of being responisible for 30 patients as opposed to 5-6 patients. Any info would be greatly appreciated.

You have a lot more patients. They are chronically ill, most have dementia. The families can be harder to deal with than the residents. You are not paid hospital money and won't be. You don't do much "sexy" stuff, but as an RN a lot of paperwork to meet regulations. You are more removed from bedside care as ADLs are done by aides. Depending on your position you bang out meds and treatments. All freaking day.

Charge at night means you will have your own patients plus, since you have an RN license, will be taking charge of any "events" such as falls, sending someone to the hospital, etc.

starletRN · Apr 7, 2010

It is a different kind of stress. As the charge in LTC I was in charge of my 15-20 residents as well as the 120bed facility, which during the week wasn't bad but on the weekends when everybody wanted to call in it was HELL. I had meds to pass, I was also in charge of call ins. There were several occasions that my CNA did not show up so I had to wear that hat too. I was also the nurse for the dining room. I had to pass out clothing protectors and drinks. As the RN I had to initiate the plan of care on any new admissions perform the initial assessment. I would also have to touch base with my other nurses to see if they needed anything. Many of the LPNs I supervised were great they didn't need much from me. I had to draw from central lines, and help set up an IV pump mostly skills. If anybody showed up during this crazy circus on the weekend and wanted a tour I had to show them around. All this for a few dollars less than I make at the hospital, no thank you. I had 2 years experience as an LPN before I started charging and a Registered Nurse. Maybe if you are hired on with a better call in policy. Find out what your duties are before you take the job. Best of luck.

From what I was told, it will be meds, treatments and paperwork, paperwork, paperwork. So, judging from what I'm hearing here, that sounds about right. :rolleyes:

starletRN · Apr 7, 2010

You have a lot more patients. They are chronically ill, most have dementia. The families can be harder to deal with than the residents. You are not paid hospital money and won't be. You don't do much "sexy" stuff, but as an RN a lot of paperwork to meet regulations. You are more removed from bedside care as ADLs are done by aides. Depending on your position you bang out meds and treatments. All freaking day.
Charge at night means you will have your own patients plus, since you have an RN license, will be taking charge of any "events" such as falls, sending someone to the hospital, etc.

Thank you. I feel like the more I'm prepared the less culture shock I'll have when I start. Right now I'm on a med-surg/oncology unit at a hospital and with the terminally ill patients we have we deal a lot with families. And they can be more demanding than the patients. Most of the time I completely understand where they are coming from. Some I still want to throttle. But that completely depends on the day I'm having. LOL Seriously, though, I think 99.5% of the patients we get are elderly and have some form of dementia. In some ways that gives me some experience I can take into LTC. But I can also see how it will be a different ball game all together.

TonyaM73, ASN, RN · Apr 19, 2010

I went straight from school to LTC as an RN. In school we are taught assess, assess, assess. In LTC, you don't have much time for that. I count myself lucky if I have the time to do a head to toe on at least one of my patients. It is all about meds, treatments and paperwork. You get through one round of meds (say your 5pms) basically to get going on the next round at 9pm. I can keep up with 20 patients, but when we are short and you have 30 patients, it is all I can do to get through the meds and treatments for day or evening shift. Then you have to stay after for all of the paperwork and GOD forbid that anything go south with anyone of them or you have admissions, then you are behind on everything and good luck catching up. I don't know how LTC nurses do this for years on end. I know that I am new and that some of this stuff will get fast with more experience, but I keep stressing about all of the things that I didn't get done or the fact that I don't know exactly what is going on with my patients if I have floated to another cart. You just don't have time to look into every singe chart before you start your med pass. :eek:

starletRN · May 7, 2010

I went straight from school to LTC as an RN. In school we are taught assess, assess, assess. In LTC, you don't have much time for that. I count myself lucky if I have the time to do a head to toe on at least one of my patients. It is all about meds, treatments and paperwork. You get through one round of meds (say your 5pms) basically to get going on the next round at 9pm. I can keep up with 20 patients, but when we are short and you have 30 patients, it is all I can do to get through the meds and treatments for day or evening shift. Then you have to stay after for all of the paperwork and GOD forbid that anything go south with anyone of them or you have admissions, then you are behind on everything and good luck catching up. I don't know how LTC nurses do this for years on end. I know that I am new and that some of this stuff will get fast with more experience, but I keep stressing about all of the things that I didn't get done or the fact that I don't know exactly what is going on with my patients if I have floated to another cart. You just don't have time to look into every singe chart before you start your med pass.

I just started LTC and I'm feeling the same way. It was a shock after being in med/surg for a year and improving my assessment skills to come to LTC where assessments seem to only be done on the sick folks and new admissions. Also, it would be great to get faster at the med pass. But I thought that might get better as I get to know the patients. I'm still technically in orientation right now.