Please tell me I'm not crazy...

[mrf0609]

Hello,

I had posted a few weeks ago about not being able to find a job being a new LPN. Everyone wanted 1 yrs experience. I was getting desperate and spent 8 hr days going around applying everywhere I could think of. I had a few home health agencys very interested in me, but without money I was not going to be able to pay for my backround check, fingerprints, physical.... Was starting to get really nervous, this is my second career and I have never had a problem getting a job.

Well.... I finally got a call from the hospital I have always said I wanted to work for. It is one of the few that hire LPN's in the area. I am starting school in Nov to get my RN - BSN - prereqs 1st, and the job offer shifted from nights to days(although the pay is less, it fits into my life a bit better). I went and interviewed and was offered the job on the spot. I was so excited! I never really discussed money at all. Then I get a phone call to set up orientation - Monday, and she says "you do know the positon pays $13.68?" I look at it as if I really want to work in the hospital long term and will get a great education here. I have not had a job thru school and have lived basically on nothing for so long that something is better than nothing. It has moved so fast... getting the offer, accepting, doing the paperwork, starting monday. This is the way it is supposed to be - graduate one week, start work the following? I start school in November again and can defer my student loans hopefully till I am a RN ( who knows how high they will be, but if I die owing...) I have a young son and have been so blessed to have the support of many people around me. I have a few people I have to repay a few thousand dollars to. This is where my fear comes along. Did I do the right thing? I have talked with some friends at school and they have job offers at $20 - $23.00/hr. I am not doing this for the money and many people have told me that it has happened the way it is supposed to and the money will come eventually. After my 8 wks of orientation, I can work overtime, so I am hoping I can at least boost my salary that way. They say no raises until 1 yr, I am afraid of how little it will be.

Please tell me I am doing the right thing. I was ok with it until I filled out all the paperwork and was leaving and got a huge pit in my stomach.

Thanks so much in advance

Oh yea - I am REALLY grateful to have gotten a job, please do not take this the wrong way!

[Blackheartednurse]

What are the kidding or what? No way...

[scoochy]

Acuity in hospital is way higher and requires a much different skill set. LTC isn't much more than giving meds, doing tons of paperwork and supervising unregulated staff.

I worked in an acute care setting (ICU & PACU) for over 25 years before I "called it quits." I have been working in LTC for the last 1.5 years; it certainly is a lot more than giving meds, doing tons of paperwork, and supervising unregulated staff. Time management is a valued skill in LTC; many have not been able to grasp this skill. Try admitting 2 residents, no unit secretary, passing meds to 25 residents, a resident fall, and sending a resident out to the ER who was a full code and had a cardiac arrest in the LTC facility. This occurred two weeks ago on the 3-11 shift, on one unit. We have no free-floating supervisor. This is the epitome of time management.

Having cared for "fresh" open heart patients, multiple traumas, heart transplants, liver transplants, etc.., I can say that caring for this acute patient set is "easier" than working in a LTC facility.

[NurseKatie08, MSN]

Acuity in hospital is way higher and requires a much different skill set. LTC isn't much more than giving meds, doing tons of paperwork and supervising unregulated staff.

I don't know where you're from, but as an RN in a subacute/long term facility I only make about 1-2 dollars less than some of my peers from nursing school who work in major Boston hospitals. A new grad LPN at my facility would only make a bit less than I did as a new grad RN.

Evidentally you haven't worked in my kind of LTC. I'm working on a busy subacute rehab floor that takes patients from major Boston hospitals daily....do you think they just magically get better and all their chronic co-morbidities go away the moment you discharge them?

Acuity shouldn't (and isn't at least where I'm from) be a major determining factor in the pay of nursing staff.

[kcochrane]

I worked in an acute care setting (ICU & PACU) for over 25 years before I "called it quits." I have been working in LTC for the last 1.5 years; it certainly is a lot more than giving meds, doing tons of paperwork, and supervising unregulated staff. Time management is a valued skill in LTC; many have not been able to grasp this skill. Try admitting 2 residents, no unit secretary, passing meds to 25 residents, a resident fall, and sending a resident out to the ER who was a full code and had a cardiac arrest in the LTC facility. This occurred two weeks ago on the 3-11 shift, on one unit. We have no free-floating supervisor. This is the epitome of time management.

Having cared for "fresh" open heart patients, multiple traumas, heart transplants, liver transplants, etc.., I can say that caring for this acute patient set is "easier" than working in a LTC facility.

I totally agree. I've worked both and find that acute care is much easier for me.

[emnicams]

Agreed... I work in LTC (on a skilled unit) and my stress level at work is ten times as high as when I worked ICU-stepdown with art lines, chest tubes, post-ops etc. I only changed jobs due to needing 8 hour shifts.

[jkaee]

To try to keep this from turning into a LTC vs hospital nurse debate, in my area LTC nurses make a bit more than hospital nursing. It was a major reason why, when I moved to this area, I chose LTC. I just couldn't afford the pay cut.

As others have said, you got your foot in the door, you'll be earning a paycheck AND experience (and any amount of experience in any setting is good) and you'll be able to support yourself and your family with careful planning. Nothing crazy about that.

ALL nurses, in EVERY setting, have skills they develop. There is no "easy" nursing job.

[Michigan]

So LTC nurses make more than hospital nurses?

That is just so many ways backwards.

????? Backwards, why??? Not meaning to flame or cause tension, but that comment IMO is so wrong. Have you ever worked LTC? Yes, LTC nurses deal with many of the same issues as a nurse in a hospital, plus many no hospital ever deals with.

I've worked both and home care also, and trust me LTC is very stressful, you must be spot on with assessments, ever watch an elder go down hill in less than an hour? And don't even get me started on families and all the state regs.

I took almost a $3.00 hour pay cut for my LTC (yes, perks for my job- no weekends, holidays or call).

[belgarion]

Agreed... I work in LTC (on a skilled unit) and my stress level at work is ten times as high as when I worked ICU-stepdown with art lines, chest tubes, post-ops etc. I only changed jobs due to needing 8 hour shifts.

Add in the additional fact that due to Medicare and insurance pushing acute care patients out the door as fast as they can, LTCs are getting patients back from hospitals who would have never been discharged 20 years ago.

[OttawaRPN]

Yes, I've worked LTC and was admittedly bored to pieces, not from lack of work to do, but by watching all my hard earned, valuable skills go down the toilet with the poop. Yeah, I had to be reasonably good with my assessment skills and time management skills but nobody ever got discharged from my LTC unless they were climbing the stairway to Heaven. The majority were elderly and circling the drain, ready to meet Jesus a long time ago, but family refuses to let them die. Maybe the odd excitement of a tunneling fistula or stage 4 decubiti or inserting a PEG tube, but otherwise I barely saw each resident for more than 2 mins with all the 40+ I had to give meds too, dangerous unregulated staff I had to chase after and overwhelming amounts of paperwork management was hot on your orifice to complete in a timely manner.

But the big thing that got me was the lack of autonomy and decision making abilities. Anytime I tried to advocate for something, in the best interest of my resident, there was always someone above me that would veto any decision or order or plan of treatment, or whatever, just because they could. In hospital, I am my patient's primary nurse from start of shift to finish. My CHF patient has SOB, worsening congested cough and 2+ pitting edema to ankles bilat and I feel needs an increase in his Lasix? I call the md/on-call and get an order so I can diurese my patient before he dies. In LTC, many have died while waiting for management to get their thumbs out of their a$$ deciding what they want done.

So yeah, you bet I expect to be paid more being someone's nurse than management's b!tch.

[skittlebear]

No, actually it is LTC/nursing homes where they have received the higher offers. I just think I will get much better experience in the hospital, if I want to change it will be easier to go somewhere else rather than getting a job in LTC and trying to change later on. Am just trying to do the right thing. I have ALWAYS gotten everything I need, and I know to be careful what you wish for. I just hope that wishing for this job was the right thing.

I think you are making a great decision and are not crazy! You will be gaining TONS of experience in the hospital setting. That will be great to put on your resume and you will get more job opportunities in the future because of it. It's even better if you are planning on furthering your education and getting your RN. I would stick there for at least a year if you can afford to. :heartbeat

[jkaee]

But the big thing that got me was the lack of autonomy and decision making abilities. Anytime I tried to advocate for something, in the best interest of my resident, there was always someone above me that would veto any decision or order or plan of treatment, or whatever, just because they could. In hospital, I am my patient's primary nurse from start of shift to finish. My CHF patient has SOB, worsening congested cough and 2+ pitting edema to ankles bilat and I feel needs an increase in his Lasix? I call the md/on-call and get an order so I can diurese my patient before he dies. In LTC, many have died while waiting for management to get their thumbs out of their a$$ deciding what they want done.

So yeah, you bet I expect to be paid more being someone's nurse than management's b!tch.

I guess it just depends on where you work, because I've felt much more autonomous in this LTC facility than I ever did in the hospital. I've also never felt like a "b!tch", and I had the ultimate say on what was or was not done for my patients, NOT management. I regret that you were made to feel that way. Unfortunately, all it takes is one experience to ruin it for someone.

But please don't lump all LTC's together...that is not how it is in every facility.

[CrunchRN, ADN, RN]

Get the experience if you can live on that rate of pay. One year from now you will have many more choices becuase of that experience......