New RN interested in LTC

RN1989 · Apr 17, 2008

Yes there is some level of responsibility since you are the RN even if there is an LPN "in charge" of the floor. The same would go if you were working somewhere on the floor and had 10 years of experience as a nurse and the charge nurse only had 2 years of experience. If you saw something that the charge nurse did, and the charge nurse had a lower degree level or less experience than you, if you did not step in and assist the charge to make the correct decision, technically you could be held responsible. Just because someone has the title of "charge nurse" this does not mean that the other nurses would not be held accountable if they saw the charge was making a wrong decision and they did nothing. Something that MANY nurses seem to forget since they haven't been sued.....yet.

JB2007, ASN, RN · Apr 17, 2008

I only worked as a RN for 5 months on a tele unit. Then I went to LTC and I have been there a year now. Like you, I felt that LTC would be a good fit right out of school. However, I had several of my instructors tell me that it would be a mistake to start out in LTC. They were wrong. Most days I enjoy my job and I have gained many skills very quickly.

I am not charge nurse and yes at this time I have a LPN that is my unit supervisor. Personally, I would not want to be a unit manager for at least a couple of more years. When you are in management you have to take a lot of crap off of everybody (upper management, floor nurses, CNAs, residents and their families). Many days it is enough to keep up with my 30 resident's meds, tx, doctor's orders, ect.

If you feel that LTC is a right fit for you do not let anyone tell you not to go into this part of nursing. We need more caring and intellegent RNs and LPNs.

CoffeeRTC, BSN, RN · Apr 17, 2008

You are going to get a bunch of varied responses.

I started out in LTC right out of college. Been doing it for almost 13 yrs. Many different positions and opportunites and you will utilize different skills. Not all LTCs are alike. Some are more skilled than others, some utilize LPNs and RNs differently.

For the most part...if the LPN is charge..they will be in charge. You may have to step in as the RN, but often times there will be another RN in the building too (DON, ADON, RNAC) Like a PP stated...the RN will be the one ultimately responsible.

Sooo...try it if you want. Being a just a staff nurse and getting your feet wet is the best way. If you would like to be a super...go for it, but as another PP stated...its nice not to be the one in charge and let someone else deal with those sticky situations.

Now....as far as it hurting your chances of getting a different job. I don't think so. This summer, I think I'd like to try acute care..med surg. First I'd like to try agency in LTCs and then move on.

LPN01112005 · Apr 18, 2008

There are opportunities for RN's in LTC other than being the medication nurse. So, once you've gotten the hang of LTC, you could move into another position such as ADON, Unit Manager or MDS Coordinator or Wound Coordinator.

I went to LTC fresh out of school, then went to the hospital med surg unit. Ultimately, I returned to LTC primarily because I missed the meaningful relationships that can be developed with the residents in LTC. Although, I did enjoy the hospital and I did get the opportunity to perfect skills, gain IV certification, Learn basic cardiac dysrhythmia interpretation, and advance cardiac life support. All of those were opportunites that had not been available to me in LTC. So, my hospital experience was very valuable and made me a more valuable and skilled to my employers.

I am now the Wound Care Coordinator at my facility. A position that was previously held by an RN. I supervise one LPN and two CNA tx aids. When I was the Unit Charge Nurse I supervised 6 CNA's. One of our Unit managers is an RN, the other an LPN. We also have an RN RAI Manager and an LPN MDS coordinator. Our DON is of course an RN. The evening supervisor is an RN, as is the weekend supervisor.

I report directly to the DON. The Unit Managers report directly to the DON, however, the LPN medicaton nurses and Charge Nurses report to the Unit Manager. There is some opportunity for an RN medication nurse to report to an LPN Unit manager. Seems like the lines could get skewed a bit. However, at my facility, there really doesn't seem to be any hierarchy in the RN vs. LPN department like you see in some hospitals. I, personally am made to feel like a lateral collegue to the other administrative nurses, whether they be LPN or RN, and honestly, I treat the LPN tx nurse and the LPN charge and medication nurses and the CNA's for the most part the same as I'm treated....like a collegue. We all have important tasks to do. Mine happens to involve a lot of paper work and not as much hands on direct care, but we are all a part of the same team.

I know that technically any RN in the facility has the ability to be called the manager on duty or whatever and be the "responsible" nurse in the facility, because in every state, LPN's work under the supervision of an RN. But, on a day to day basis, the RN's don't run around "supervising" the LPN's, just because they can. I mean, the RAI Coordinator, with whom I work closely for documentation purposes, doesn't consider herself my superior. I work with her daily, and I don't think she's ever reminded me that she is the RN.

I hope I haven't confused you, or made you feel like I think that RN's should in some instances be "under" the LPN because that was not my intent. I meant to convey that in some LTC settings, there isn't that much emphasis put on what your credentials are as long as your are capable of doing your job.

LTC is stressful, staffing is ALWAYS at issue. I recently had to work the floor as a CNA due to call outs. I'm telling you, THAT is the toughest job in the world. I honestly could not handle it. LOL. But, it is also very, very rewarding. So much more rewarding than the hospital was for me.

sistasoul · Apr 18, 2008

Thank you to all who have replied. I appreciate it and will keep these words handy as I make my decision. I still have 3 weeks to get through.

Peace and Grace

Heather