Offered "ADON2" if I'll stay...what do I do?

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I recently posted about my plight about leaving the nursing home and going to work at an extended care hospital.

The idea was that I would get hospital experience (which I've never had) but I've been told by some that LTAC will not be hospital experience even if they call themselves a hospital (???)

The nursing home has been trying to get me to stay, and I was recently told the ADON wanted to cut her hours and they would like to put me in her position when she is not there (a couple of days a week.) I went in today and she showed me some of the ropes and all, but I still don't feel very useful, though I don't know if that would improve as I learned more about what she does. I don't want to just be there shuffling papers so I can have a job. I still am not quite sure about what the future would hold for me at the nursing home. I'm planning to start a FNP program soon and the DON (who is planning to go through the same program) keeps telling me I have a much better opportunity there and they will work with me while I'm in school which is something "that hospital" won't do (but how do they know?)

Anyway, it has come down to the wire. I am supposed to start orientation at the hospital Monday, but if I'm going to stay at the nursing home...anyway, I need to make a decision soon. I understand I won't need hospital experience to become a FNP (I'm thinking I would like to start out with primary care, maybe stay doing that for my whole career).

I need your help. The anxiety is eating my brain.

Nursing home pros:

It's a familiar environment

I like the people I work with, I love the patients

They (right now) are willing to be flexible with my schedule

slow pace (much of the time)

NH cons:

four 8 hr shifts a week (instead of 3 12's like at the hospital)

working the floor is boring

afraid I'll be a pencil pusher

pace is too slow (much of the time)

LTAC hospital: I don't know what the sam hill to expect...

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Specializes in ICU.

LTAC hospitals are ACUTE CARE. I cannot stress that enough. They are NOT nursing homes. Although some people think they are, until you work at a good LTAC, you just won't know what to expect.

LTAC's are acute care, but the average stay is somewhere around 28 days. Sometimes longer, sometimes shorter. Most LTAC's even have ICU's. REAL ICU's.

The difference in the patient population is that in the LTAC patients need acute care longer. They are too sick to go home, to sick to go to rehab, too sick to go to the nursing home. LTAC's have a lot of rehab services, but there is still acute care going on.

Whoever told you that an LTAC hospital is like a nursing home is dead wrong.

Add on: LTAC is definitely acute care experience.

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I say go for the new experience and try the LTAC because you don't sound completely happy where you currently are. Can you ask someone at the LTAC if they work with employees who want to further their education?

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Whoever told you that an LTAC hospital is like a nursing home is dead wrong.

Add on: LTAC is definitely acute care experience.

They told me this over on the SRNA forum.

To hear some of them tell it, they know it all...

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Specializes in ICU.

I have several years experience in LTAC ICU. Granted it is a LITTLE bit different than a regular hospital, it is still acute care, and it is still a hospital. Insurance companies would rather have their patients transferred to an LTAC than leaving them in the regular acute care hospital because of a few factors, mainly..

cost.

Then there is the rehabilitation factor. An LTAC is more equipped with atleast starting the rehab process. A regular hospital does not go into rehab. You are discharged as soon as possible, and if you need more care, more IV antibiotic therapy for whatever reason, ie pneumonia, UTI,, etc... then you get transferred to an LTAC where you can get your acute treatment while getting rehab, PT and OT, wound care, and swallow eval's... nutritional consults etc....

Even critical care patients are transferred to LTAC's. Short term and long term ventilator patients,, septic patients... A large percentage of the patients are going to be sick for a long long time, but they're not ready to give up. In the ICU we see a lot, and I mean A LOT of old people that have been in the nursing home for years,,, all four extremeties contracted,,, peg tube, RAGING stage four sacral wounds,, on ventilators and the family is not ready to give up. They are full codes. So, we run the full load of tests and give whatever vasopressin or critical care treatment that is indicated.

The end result is,, you will get acute care experience, and if you are not fullfilled at your current job,, you may end up being miserable! Just do what you think is right... You may find your niche in LTAC. :)

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Specializes in ICU.
They told me this over on the SRNA forum.

To hear some of them tell it, they know it all...

What is the srna forum? Just curious

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Specializes in Home Care, Primary care NP, QI, Nsg Adm.

Given the trends of an aging society, long term care will continue to grow offering excellent long term career prospects in nursing, nursing management and as a nurse practitioner. I learned from these threads how intensive LTC care is and from what I am reading it seems like a good environment for older nurses (like myself) who may not want the acute care hospital environment but same type of care on what sounds like a more controlled environment. I would consider the option for myself.

As an NP I would definitely encourage the NP path. I enjoyed past clinical practice and now as a DON, that background is excellent, especially in developing nursing practice in Saudi where I currently work.

Advanced practice has many practice options as well.

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What is the srna forum? Just curious

Student Registered Nurse Anesthetist.

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Specializes in Maternal - Child Health.

Just one word of caution from someone who has been there, done that, and didn't last long:

Please insist on a formal job description of the ADON position as well as a formal interview with your potential superiors.

I had worked in a hospital for only a brief time when a management position opened up. It was offered to me without a formal interview process, and I unwisely took it. Had I known how the upper level management of this facility worked, how dysfunctional and out of touch it was, I would never have taken that job.

So I suggest that you schedule a formal panel interview with all of the involved parties and discuss the position, expectations, hours, benefits, the whole 9 yards. Remember, an interview is as important to you as it is to them. You need to meet your new working group and decide if you will fit in.

Good luck!

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This is a nursing home in a small town where I've worked 9 years. I will be working 4 days a week and 8 hours a day. The idea is that I will "help" the ADON because she will be cutting her hours to get more time off. This means I would be in the office 2 days and probably working the floor the other 2 days.

I will be paid hourly, the same as I am now, and my yearly review is almost due, so I will probably get a dollar raise, or something like that.

I won't come out ahead financially if I go to the hospital, but I don't want to miss out on a good learning opportunity, either. If I stay at the nursing home I will be able to spend more time with my kids...I can't take worrying about it anymore.

Both places have offered me a day shift position, too, and that isn't common in a hospital, nor a nursing home.

My stomach hurts.

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Specializes in Maternal - Child Health.

Jo,

Does the nursing home have adequate staffing to take you off the floor 2 days/week and allow you the "office" time that you expect to complete you ADON duties, or is there a possibility that you will end up working 4 days on the floor, and still have paperwork to do on top of that?

The reason I ask is this: in the position that I accepted, I was supposed to have 80% management time and do staffing 20% of the time. We were so short staffed, that I ended up working 8 hours per day as staff, and 4 hours per day doing management duties. I was salary, so I didn't get paid for that, which was bad enough, but working 5 12-hour shifts per week was even worse.

I just want to caution you not to end up in a similar situation. If the DON plans to cut her hours back regardless of staffing, you might find yourself burning the candle at both ends. Something to clarify before taking the job.

I'm sorry this is turning out to be so stressful for you!

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Specializes in ICU, nutrition.

Ah, yes the SRNAs...

They probably meant that working in a LTAC ICU is not the kind of experience that's needed for a CRNA program. I've never worked in a LTAC ICU so I can't say for sure, but they're probably right. The best ICU experience is probably CVICU or SICU. You do more hemodynamic monitoring on open hearts than probably any other critically ill patients.

But you're not going to CRNA school, right?

I think the LTAC would probably be a better experience if you are planning on being a FNP. Yes, familiarity is nice, but you want to do what's best for your future, right?

And nursing management is thankless anyway, much less when you are management half the time and then a floor nurse the other half.

Good luck, whatever you decide.

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