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I have spoken to my former instructors about what my job entails. They have given me their blessings to share my experiences with current nursing students. They can't speak from experience regarding the role of a nurse in a SNF/LTC in today's health care system. They recognize that patients are discharged from the hospital far earlier than in years past and know that the patients aren't ready to be released to home, but they missed the piece where they come to us. We get patients straight from the ICU-bypassing Med-Surg entirely. It's not necessarily the best option for the patient, but health insurance being what it is, it has become the trend. We are expected to deal with very acute patients without the benefit of a doctor in the building. Our medical director comes in twice a week and is reachable by phone most of the time, but we must pay close attention to the subtle nuances in behavior that cue us to major problems brewing. It can be very intense at times. The level of intensity is matched, however, by the laughter and singing and general amusement one enjoys on a daily basis.

Thanks for the great comments!

People don't realize many things until they are in a particular situation. I'm no longer concerned with whether I am perceived to be a "real nurse" by those who simply don't know. My residents and their family members know that I am a nurse, as does the medical director and the EMT's who respond in times of need. I have noticed that many of my peers in a variety of health care settings aren't satisfied because they compare themselves to some fictional super nurse. "I don't have a BSN, MSN." "I work in a rural hospital-big city hospital nurses get all the glory." You name the setting, you will find nurses who feel they aren't measuring up somehow. Here's the true test for me-does my patient know I am his/her nurse? Does he/she know that I will advocate for unmet needs? In the end, that's where it matters to me.

I love working in long term care. In nursing school, LTC was touted as being the least desirable job in nursing. Instructors warned students that assessment skills would be lost and future employment opportunities outside of LTC would be nil. When I proudly attained my first job as an RN, I was surprised at how many people, (lay persons as well as healthcare workers) responded apologetically when I told them my job was at a LTC/SNF. "Everybody has to start somewhere", and "You'll find something better, don't worry" were the typical comments, instead of "Congratulations!". After two-plus years in LTC, I still love it. While each day presents challenges, each day also brings joyous rewards. I am surrounded by people who have made amazing contributions to society throughout a lifetime. Their generation worked hard to help build our country into a land of promise. There are so many who sacrificed. Brilliant men and women from every walk of life. Women who stepped way outside of societal norms of the day to pursue master's and doctorate degrees. Men with full-ride scholarships who gave up that opportunity to serve in the armed forces. Talented authors, actors, musicians, engineers. The list is endless. So here they are. These amazing people who have given so much and lived so much and their greatest joy is that I greet them with a smile and a gentle touch on the shoulder and give them a few minutes out of my day. I am humbled to be among such greatness. I am a registered nurse. I choose to work in this specialty. I applaud all nurses in their chosen specialties. Be proud! By the way~my assessment skills are just fine!

Perfect! If you heed this advise, you will be a stellar nurse :)

My advice is always the same. Expect that it will take forever to accomplish your med passes in the beginning. Do not take short cuts. Trust that you will improve as you become more familiar with your job. You will learn to provide quality care while staying on task.

Some meds may form a precipitate when combined, possibly clogging the tubing. The facility where I work just completed a deficiency free survey. That's right, zero deficiencies! I invited the surveyors to observe me administering a feeding and med-pass via PEG tube. For set up, I marked each cup with designated med, crushed med individually, and returned it to medpass cup. I also marked each of two cups with 150 ml, and two with 60 ml indicator lines. I had a cup of lukewarm water ready to combine with each crushed med. Remember to have barriers on the bedside table. I used paper towels. Make sure the syringe, etc is properly dated. 1) Greet resident and ask whether they object to being observed 2) Place appropriate barrier (towel) on lap to catch spills 3) Listen for bowel tones, check placement, check residual, return residual 4) Proceed with feeding; our facility policy states 150 ml tepid water, then formula, followed by another 150 ml tepid water 5) Even though the tubing is clear of formula at this time, policy states to flush with 60ml water, followed by meds, one at a time, with 10ml water between each med. This resident had 7 meds. Then follow with another 60 ml water. Converse with the resident, as you should normally do anyway. Clean up as per policy. It seems llike it would take a while, but I do things the way I would do them if a surveyor were present, so it's easy. For this resident, crushing the meds individually probably took an extra minute or two compared to if I had crushed them all together. Hope this helps.

DSHS=Department of Social and Health Services-They are social workers who check on residents from time to time, particularly when the resident has a pending discharge to home. They ensure the resident received appropriate treatment during his/her stay and that the home is adequate to meet their needs. (In a tiny nut shell)

I asked for his ID and led him to the DON prior to the interview. It's always good to reiterate the importance of checking ID, so thanks!

This is still annoying me a couple of days after the incident so I'm venting. The other day a man showed up at the nurses's station, identified himself as DSHS personnel and asked to interview a resident who will be discharging home soon. No problem. The resident was interrupted while in the middle of PT. I had alerted the DSHS worker that this resident was aphagic, to which he replied, "Can he answer yes and no questions?" as he whisked him off and wheeled him into a corner where the usual questions ensued. I proceeded with my med pass and after some time, noticed that the worker, who had disappeared some time earlier, still hadn't returned. There sat our resident, in the corner-unable to propel himself backwards in the wheel chair. I approached the resident, asking him whether the gentleman had left. He shrugged. So, this government official who is responsible for ensuring the proper, dignifed, humane treatment of our residents, dumped this guy in the corner and left him without letting anybody know or communicating that he was indeed leaving. Just ironic. Do as I say, not as I do.

Monday-Awesome shirt and beautiful corsage+card of thanks Tuesday-Starbucks and donuts-also retractable ID card clip that says "Nurses Rock" Wednesday-Day off!(Coincidence) We shall see what Thurs and Fri will bring. Monday was plenty, really:)

I have found that songs with an easily recognized chorus go over well. "I've been workin' on the rail road", "Oh my Darling, Clementine" "My Bonnie lies over the ocean", "My country tis of thee", "Yankee Doodle" to name a few. I googled and went through lots of songs and printed them out, etc. The residents have a handful of favorites where they can chime in with the lyrics they remember. We hardly go into the second verses because it's no longer fun for them when they can't just sing along from memory.

Though not evidence-based, per se~ One poke= sore muscle, apply cool pack to affected area and give analgesic, if warranted. Two pokes=only if necessitated by dose. Second poke likely to elicit compounded discomfort due to patient tensing more in anticipation=more pain. Plus now you have two breaks in skin integrity-(though alcohol or cleanser of choice should minimize that risk, especially if you apply a little bandage). Conclusion? I'd "stick" with one stick.

I'm smiling because that's almost exactly what my husband said:) This guilt feeling is more associated with the residents than my employer.

I have worked in a SNF/LTC RN position for almost 6 months. I like my coworkers, like the residents, and have become more efficient in my job. The problem~I'm afraid for the future of geriatric nursing, and I'm afraid that if I don't make a move out of geri-care soon, I will be unable to get an interview in a different line of nursing. Our wages were just reduced, and we lost PTO days due to the impact of medicare reductions. I'm already at the very bottom of the scale for RN's. I feel guilty looking for another job and imagine how I would tell my employer. I'm a new nurse, but not a young nurse, which adds a bit of pressure. It would be easier if I hated my job. I'm trying to plan for the future. I'm interested in thoughts from colleagues. Thanks :)