New RN needs advice on skilled/sub-acute rehab/LTC nursing

[Novisnurse]

I have just accepted a job as a RN in a sub-acute rehab/skilled/LTC facility. I was told I could have up to 20-25 patients at times and I would be supervisor over LPNs and CNAs. I am overwhelmed with the amount of paperwork I am responsible for and also having to take care of my share of the patients. I know it is possible cause it is being done now by others. I want some advice on how to organize myself, so I can properly delegate to others and prioritize my care. I know once I get the hang of things that it should even out, but right now I could use all the advice I can get.

Also I have been told not to stay in Rehab/LTC too long or a hospital will not recognize my experience for med-surg units. Will somebody tell me the truth?????

[emmalou*]

Hi

I'm in Australia so I'm not sure if my experience will help you.

I worked in acute settings in hospitals as an RN for 10 years then decided to do my masters degree (in another discipline). I worked as team leader RN in a nursing home (aged care setting) for 2 years while I was at college. I found the paperwork and amount of patients I was responsible for very overwhelming at first however it didn't take me long to get into a routine. Because it was a very different setting than I was used to, I took lots of notes and used the task list as a guide every day, and asked questions of the other RNs, and recognised the value of the assistant nurses as their knowledge of the patients was excellent.

All in all I learned a lot in this setting; I learned how to deal with challenging patients; how to manage/run a team; I learned the value of 'old school' nursing, as in the importance of personal care of people who are vulnerable - there is nothing worse than seeing someone with dementia with their skirt up around the knees or with food on their face or with messy hair/dirty glasses and I got a lot of satisfaction out of seeing patients who presented well; I got to know the patients and their families really well and felt valued because of this; I learned that my workplace was the patients' home and to respect that; I learned how to make executive decisions and to perform procedures on my own.

As far as acute settings not recognising this type of nursing - here in Australia that mentality has been around for ever and it's largely inaccurate. Most hospitals are happy to have people with any nursing experience. However, in saying that, you need to value your job before you can sell yourself to prospective employers. Nurses working in long term care are highly skilled and working in a speciality which here in Australia anyway (not sure about the US) has a severe deficit in experienced nurses.

I found this type of nursing to be a privilege; that patients allowed me into their lives and their home to look after them. It can be frustrating and challenging in so many ways, but in so many ways its also a really lovely field to work in for a while.

I hope this helps.