New RN in LTC...is that a good idea?

Specialties Geriatric

Published

So I graduated in December 2007 and received my Rn license in Feb 2008. What a joyous time...til I realized there were no jobs! Then I found out that I was expecting twins in the middle of job searching. So I've been a stay at home mom/ job hunter! So I recently got hired, finally as an RN at an LTC and I was so thrilled I didn't know what to do with myself! Then reality hit...orientation 4 days...training 5 days then on the floor on pm's by myself....30 patients and 3 c.n.a's. Ummm excuse me? Repeat that again? I agreed to what now? I couldn't sleep....I tossed and turned thinking about the harm I could cause as a new nurse without proper training. My license is worth a lot....and I want to be a good nurse, in a good comfortable setting....but I need the money and have kids to care for. It was a hard decision but I resigned after only 7 days of work....crazy huh since "beggars can't be choosers" but....there are so many things to be careful with in LTC. Meds, lots of them, 30 patients, being interupted in the middle of med pass can cause serious med errors and there were always interruptions. You have to do damn near everything.....like ordering meds for patients from an outside pharmacy and if you forgot all hell would break loose. Rounders, weeklies, ordering supplies, stock meds, charting on 30 patients, plus directing cna's, dealing with stressed out family members who are in pain from the decline of their family member. They facility ran out of gloves...huh? Is that not something you need an abundance of in a medical facility? The CNA's walked around chit chatting half the time and the nurses copy and pasted there charting on patients...meaning they never took the time to assess their patients. Another thing disturbing was the amount of nursing negligence that I saw...nurses giving parenteral medications with no gloves, not giving the correct amount of medications and not assessing their patients! It was a wake up call to say the least, and i'm not saying that all ltcs are like this. But there were some awesome hard working nurses that put on a smile and did their job the best that they could...God bless them.:redpinkhe Oh and the other thing about ltcs...highly regulated by the state because they have a lot of medicare pts....what does that mean....the state is always there inspecting the facility. The funny thing is that the state comes all the time yet manages not to see all the eroneous mistakes! ***! It was a really hard decision and I cried about it, I'm still having a hard time with it. Part of me says that I have standards and safety is a big concern. The other part of me wishes I could have stuck around, sucked it up....for my kids future. UUHHH! But really good critical thinking skills are needed in LTC, don't think you're just passing meds...I think a solid background of acute care is needed too be an LTC nurse because of the level of independence that is given to you. Plus you are also filling a surpervisory roll. So I'm sad that I gave up this opportunity but really...should a new nurse be put in a situation of taking care of 30 pts?

Good Luck to you all who are looking for a job...i'm back on that saddle again!:nurse:

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M5nurse....a lot of us have the same story! It's unfortunate that hospitals look down upon RN's with LTC as their only experience. I also graduated in May 09, and the only jobs that I have been able to get are in SNF's. If you don't have at least 1 year of acute-care experience, then they don't want to hire you. I say, if you can work in a SNF with 25-30 patients, 9 med per person average, make a good assessment in a matter of minutes, take orders from the MD and carry them out, and deal with family members, then working in a hospital setting is a piece of cake! It should be required that all RN's get experience first in LTC! Anyway....hang in there. It'll pay off soon! :nurse:

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Specializes in chemical dependency detox/psych.

To be honest, it sounded a lot like my experience, but not as bad. I had 34 residents and it switched every couple of days (big facility), so I didn't even get a chance to get to know them. Also, I had 2 aids. I hated it and left as soon as I could. I was given a hall on day 2 and told to "have at 'er"....yeah, right. As for a new nurse being put in charge of 30 patients, that's the way that LTC seems to work. It sucks.

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Specializes in Mental Health Nursing.

Its doable. You have to find a system that works for you. 7 days isn't even enough time to get to know the residents. Once you know the residents and get used to their meds and all the paperwork then your good to go. I see good nurses, who started out as a new grad in LTC, administering meds to 30+ patients the proper way in an hour and a half's time; they do their treatments, assessments, documation, orders, etc on time and leave when they're suppose to. It's doable.

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I see good nurses, who started out as a new grad in LTC, administering meds to 30+ patients the proper way in an hour and a half's time; they do their treatments, assessments, documation, orders, etc on time and leave when they're suppose to.

How long did it take before they got to that point? How many weeks or months were they taking >2hr to pass meds and leaving late most days?

And meds to 30+ patients "in the proper way" in 1.5 hr? Seriously? That's less than 3 min/patients. I'm guessing that means that the nurse knows all the patients well enough to never check names, the nurse knows these patients' meds backwards and forwards already and only briefly skims the MAR for changes, the nurse knows all the meds by sight and doesn't triple check the name on the packaging, the nurse has almost no patients with difficulty swallowing or meds via G-tube, the nurse always knows where to find each patient, etc.

Also, pre-pouring and signing off on the meds en masse (eg after the entire pass), which are verboten in nursing school, are often considered "the proper way" in LTC - though rarely admitted outright. At least that's the only way I figure it can be done.

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Don't get discouraged. It sounds like you did the right thing for yourself and the residents. I had to walk away from my first position as well because I was not comfortable with being the only nurse in my facility (LTAC) after 4 weeks on the job. This website helped me find a wonderful job www.hospitaljobsonline.com. Good luck and be proud you put yourself and your license before your paycheck.

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I think you made the right decision. Too many nurses are taking chances with their license. The probability of making a med error is huge in the conditions you had to work under, everday. I graduated nursing school nearly six years ago, never worked as a RN, I don't feel confident to enter the field without a refresher course, I owe that to my future patients. I congratulate you on your decision to protect yourself, your patients and your license. Putting food on the table is one thing, but having to go to jail and your license revoked is a whole other situation. Your children needs their mommy; it's best you work in a hospital where there is more staff. or at least a nursing home with more staff. Best of luck!

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Wow, it sounded like what I have experience. However, they only gave me 3 days of orientation. On the 3rd day, the nurse who was suppose to orient me didn't show up so I ended up by myself at the other end of the hallway with 30+ patients and 3 CNAs. It was a horrible night. I ended up going home 2 hours late because of the long med pass. I actually got the hang of working nights because I planned my shift accordingly. Timing when I can sit down & chart, and doing med pass early so I can finish on time to give my report. However, things got screwed when they put me on days.

I would have probably stayed at this facility if the DON put me working night shift, but she needed me on days so I tried it for 2 days until I decided to let it go. I could barely catch up with all the med pass and by the time i'm done, I still need to chart with so little time left before my shift ends. Also, trying to figure out who is the patient if they're not in their bed to give their countless medication and giving you a hard time at the same time is so difficult if you have more than 30 patients to pass meds in the morning. I got help from the CNAs but they are not always around at my side. Plus calling me because for a phone call in the middle of my med pass! I can't just leave all those meds I prepared in the cart because someone might steal it. I thought this is it . I tried it for a total of 5 days. My health and happiness is important than risking my license and losing my sanity at this facility. Besides, they didn't even have health insurance when I started working there. Next time, if the last resort for me is working in LTC, I will carefully investigate.

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Specializes in Gerontology, Med surg, Home Health.
How long did it take before they got to that point? How many weeks or months were they taking >2hr to pass meds and leaving late most days?

And meds to 30+ patients "in the proper way" in 1.5 hr? Seriously? That's less than 3 min/patients. I'm guessing that means that the nurse knows all the patients well enough to never check names, the nurse knows these patients' meds backwards and forwards already and only briefly skims the MAR for changes, the nurse knows all the meds by sight and doesn't triple check the name on the packaging, the nurse has almost no patients with difficulty swallowing or meds via G-tube, the nurse always knows where to find each patient, etc.

Also, pre-pouring and signing off on the meds en masse (eg after the entire pass), which are verboten in nursing school, are often considered "the proper way" in LTC - though rarely admitted outright. At least that's the only way I figure it can be done.

Pre-pouring is NOT allowed or considered the proper way anywhere. Signing the meds off en mass will get you fired if you work for me. There is a right way and a wrong way and those two are the wrong way.

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Nothing wrong with LTC as a first job. My first year was in LTC, the next 16 in ICU.

What you "should" learn in LTC, is prioritization. No, everything is not important.

Always lead by example wherever you work, don't get into personal work ethics battles.

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