Neener_RNBSN

I just have to say something here. To be honest, LTC gets a bad rap, but for no real reason other than the stigma! I graduated from a great BSN program at a respected university. When I had trouble finding a traditional acute care job due to the economy, I gave LTC/rehab a try. I fell in LOVE with it! I've been in practice at my current facility for 7.5 years. It's not something I had ever thought I'd be interested in, but I truly fell in love with my patients. You have so much autonomy in LTC, especially in smaller facilities. You're almost like a mini physician in a lot of ways--since the docs aren't there all the time, you learn what is important to focus on/report. You're almost like a case manager. You learn invaluable pharmaceutical skills. You learn to manage dozens of patients at a time. Contrary to what most people surmise, it's not just "popping pills." You have to learn to think outside the box, manage multiple critical cases at once, and be able to react to any unexpected situation in an instant. My LTC/rehab facility compensates very, very well for what we do. You get to build priceless relationships with the residents, who are so incredibly appreciative of what we do. Although originally it wasn't my dream job, I have learned so much that I can't even begin to describe. Like you, I have been told countless times that I am too good for my job or too smart...that I belong in acute care. But why? Only dumb nurses work in long term? Come on! Nursing is a versatile profession with a plethora of specialties...one specialty does NOT invalidate another! LTC is a unique specialty all its own. I don't care what anyone tells you, I've lived it. It's true. Don't you dare let anyone make you feel less than because you're not in an acute care setting. Although I am a bit burned out in my current position, it has nothing to do with LTC itself. It's just the culture of my current facility. I am looking into transitioning into subacute care, or a bigger, more intense skilled setting. Bottom line..if that is what you love, go for it! You will be rewarded many times over. I've known countless RNs from my facility who have transitioned to acute care and say, "Wow--it's so much easier!" We are used to managing 25-30 patients at a time. I will never regret my wonderful, intensive, 7.5 years in LTC/rehab regardless of where I go next. Best wishes and you can do it!!!

Thank you so much for the input. Very good idea. It's time to look out for myself.

Thank you! I think I truly knew the answer in my heart, but I didn't want to do anything rash or in the heat of a frustrated moment. For my own health I need to get out. I see that now. I appreciate you taking the time to respond.

I have been working in a SNF/LTC facility for 7 years. Due to a lot of recent changes, it has become almost unbearable. The work load is unbelievable. I'm a shift superviser but am also responsible for 26 patients--2 med passes, txs, etc. We have no unit clerk, so faxing/filing/other tasks like that are also my responsibility, and any staffing issues that may arise. After 7 years, I feel truly burned out! I love my patients and coworkers, but there is an inordinate amount of drama and nonsense. I work under an administrator who no longer cares because he is retiring. It seems he is trying to dump as much work as possible on us before he leaves. It's a mess. There are several grossly incompetent nurses and issues that the DON just won't address. The stress and anxiety is just about killing me. The problem is, due to my high anxiety I have a tremendous phobia of starting somewhere new. I turned down job offers twice at a great facility in my area just because I was so petrified to start all over again. My question is: should I suck it up and just quit? Normally I'd never leave a job without something else lined up, but I feel that due to the heavy toll this is taking on my mental health I may have to. Financially I would be able to take a couple months off, regroup, and find a new position. Recruiters call me all the time. Is this a bad idea? Will it look bad to prospective employers if I am not currently working, say, if I did take a few months off for a break? Alternately, I could transition to a pool position...that way I could stay on staff but not be working full time. Should I cut my hours to part time for now? I'm miserable. I dread going to work daily. I feel that so much gets dumped on me, and I'm constantly cleaning up after those who leave work undone, e.g. lab results that come in on my day off---never called in to the physician. There are a lot of issues like that. Any advice or words of wisdom would be sincerely appreciated. I feel lost right now.

Well I think first and foremost I'd say try not to become overwhelmed. LTC is different than acute care. You will have dozens of patients to keep track of with various conditions. In the beginning it will seem impossible, but I promise it does get better. Time management is key. Use a single sheet of paper to jot down any significant info. I use the left side of my paper for the med pass: I cross off the room numbers as I give the meds. I also have a section for any documentation I must complete that shift so I know whose vitals to grab or what specific assessments to make; my right side is a big "to do" list, i.e. call 14B's doc about PT/INR. The bottom center of the page I use to make a list of any wound care/Txs I must do on my shift. The trick is so have a single paper with all the info you need right in front of you in a clear and organized way. Having so many patients makes this imperative. Know that you must trust your gut, because nurses run the show in nursing homes. But be patient with yourself! New nurses need time to learn. Take care during your med pass to prevent errors. Take your time with documentation and remember it is a legal record! Be respectful to your CNAs but never let them take advantage of you (and believe me, they will try!). Immediately report suspected abuse or neglect to your supervisor. Don't ever tolerate CNAs who leave residents saturated or poorly cared for. When you get overwhelmed (and you will), remember that you are only human and can only do so much in the time you are allotted. Do the most important things first. Work as a team, offer to help your fellow nurses so that they'll help you when the time comes.Don't let hasty doctors try to rush you off the phone. When taking verbal telephone orders, make sure you verify by repeating the correct drug, dose, time, duration, etc. Most importantly, love your residents. The majority are so deeply appreciative of what we do. Have fun with them, sing and dance for them, joke around, whatever. But never ever degrade them by treating them like infants. Cognitively impaired residents deserve just as much dignity and respect as any other human being. Working in a nursing home is incredibly challenging, frustrating, and at times demoralizing. But it can also be tremendously rewarding. I started in a nsg home as a new grad and have learned a wealth of information since. I am a stronger and more independent nurse because of it. I've been charge nurse on a 28 bed unit since I was 22 years old. On my shift, I'm the only RN in the building and am responsible for any staffing or nursing care issues that crop up. I don't think I would have gotten all that supervisory experience as a staff nurse in a hospital! I truly wish you good luck. If you would like to further discuss this, message me. It's terrifying in the beginning, but you can do it! After all, you're a nurse.

Hi all...I could really use some words of wisdom. I graduated at the top of my class with a BSN in May 2009 and was an RN by August 09. Due to the horrible economy, I could not find a job (or even an interview), despite my high GPA and good resume. Most hospitals in my area (Philadelphia) were laying nurses off, had hiring freezes, or wanted 1 yr exp. It took me 8 months to find a part time job at a local nursing home. I have been working there since January 2010. Although I've learned a lot, I now feel it's time to move on. I need something full time, and I need more experience. My nursing home is 44 beds, 28 of which are my residents. I work 3 to 11 shift and spend a good deal of time passing po meds. We hardly ever have residents on IVs. I've had a few tube feeds, mostly bolus. I do a lot of wound care and have experience with pressure ulcers of course, but the good majority of my wounds now are skin tears. Every other shift someone falls or gets a skin tear and I have to fill out an incident report, which is time consuming. I am up to my ears in paperwork. Anyway, I need to move on. I want desperately to get a full time nursing job, but I'm terrified. I'd love to work in a hospital and get new grad treatment, with a preceptor and lots of training, but I don't think I can because I have a yr and a half experience. I am weak in many areas due to where I work, i.e. trachs, vents, etc., because I simply don't see them at my facility! And I haven't had much IV practice since I've been out of school for the same reason. I learned how to insert a Foley in school but I've never had to do it since because 11 to 7 shift is responsible for obtaining UA specimens. Although I'm smart, I feel I haven't been able to hone so many of my skills as a nurse because of where I work. My question is, if I get a job on a med-surg unit, will they expect me to know everything because on paper it says I have experience? Would I be able to have a preceptor? Would someone teach me the things I need to know, like trachs? I plan on sending out my resume this week. Am I no longer considered a new nurse, so will they throw me to the wolves? I took the nsg home job because it was all I could find...did I make a mistake? Help!

I work in a LTC facility and I have a resident with a stage III sacral ulcer. The order is to irrigate with wound cleanser, pack with calcium alginate rope, and cover with C/D/D once daily and PRN. Since this is still my first year as an RN, I'm still learning, and my question is this: Does the calcium alginate rope need to be soaked in NSS before packing? I have NOT been soaking it before packing. I was just surfing the internet and saw a question someone asked about soaking a different type of calcium alginate (the answer was no), and I thought, "OMG! Should I have been soaking it before packing?" I can't seem to find this answer anywhere! I work 3 to 11 shift, and when it comes to wound care, I'm pretty much on my own. I'm the charge nurse...the DON usually leaves shortly after my shift starts, and I don't do the wound care till around 7 pm. There is an LPN who works on the floor below me, but she is also a new grad and has even less experience than I do. Does anyone have experience with calcium alginate rope? Do you soak it or just pack it dry? This wound does not have much exudate. Of course, I can just ask at change of shift next time I work, but I want to know now if possible. Have I been doing it wrong???? (And of course, there are no directions on the box that the rope comes in!) Any input would be MUCH appreciated!

I work in a LTC facility and I have a resident with a stage III sacral ulcer. The order is to irrigate with wound cleanser, pack with calcium alginate rope, and cover with C/D/D once daily and PRN. Since this is still my first year as an RN, I'm still learning, and my question is this: Does the calcium alginate rope need to be soaked in NSS before packing? I have NOT been soaking it before packing. I was just surfing the internet and saw a question someone asked about soaking a different type of calcium alginate (the answer was no), and I thought, "OMG! Should I have been soaking it before packing?" I can't seem to find this answer anywhere! I work 3 to 11 shift, and when it comes to wound care, I'm pretty much on my own. I'm the charge nurse...the DON usually leaves shortly after my shift starts, and I don't do the wound care till around 7 pm. There is an LPN who works on the floor below me, but she is also a new grad and has even less experience than I do. Does anyone have experience with calcium alginate rope? Do you soak it or just pack it dry? This wound does not have much exudate. Of course, I can just ask at change of shift next time I work, but I want to know now if possible. Have I been doing it wrong???? (And of course, there are no directions on the box that the rope comes in!) Any input would be MUCH appreciated!

I'm sorry, I don't have anything helpful to add, but your post caught my attention. I would love to switch places with you! I currently work in LTC and am not crazy about it--I've been DYING to work in psych since I was in nursing school!!! Good luck, I hope you find what you're looking for.

You're right, SWS RN, I wasn't referring to Florida when I said I'd heard there were jobs in the South. I was told by a man who comes into the restaurant where I work--I believe he is from Georgia? He has family who are RNs there and knows someone in the HR department of a hospital. I don't know how reliable this information is, though, so don't quote me! :) I was also speaking with a career counselor over the weekend at the college I graduated from. She said I'd find more jobs if I was "willing to relocate," but she didn't have time to go into any detail. I just want to clarify that what I heard was through word of mouth, not from any research I did on my own. I'd love a great job, but I'm just not ready to relocate yet so I'm waiting it out! I also totally agree with you SWS RN about the media perpetuating that "recession-proof" garbage! More and more people are choosing nursing as their major in this tough economy, and it hasn't been getting any better. Many hospitals near me have hiring freezes and one huge hospital recently laid off hundreds of nurses! Most of the people I graduated with are STILL looking for jobs, and we have Bachelor's degrees. The only ones who are working in hospitals are the ones who got their foot in the door by working as aides while still in school. I really wish I had worked as an aide, but when I started school nursing jobs were plentiful and I was told by professors that this was not necessary. It really is a nightmare out there. Good luck to all of you, don't stop looking!!

My school has a very high NCLEX pass rate. Senior year we were required to take 2 semesters of a critical thinking course (which was essentially a course all about how to pass NCLEX). We were told repeatedly, "You should do 5,000-7,000 practice questions before you can sit comfortably for the NCLEX." They required us to submit proof of answering a minimum of 1,000 practice questions per semester. Most people did around 10,000 questions before sitting for the exam. A lot of people used the Lippincott books (I used the one by Silvestri). Let me tell you, I did NOWHERE NEAR 5,000 questions! I did maybe 500 during my senior year, then 2 weeks before my exam date, I did a few hundred more. I thought the NCLEX was very hard and I was positive I failed, but I passed. (I am a good test-taker, however, and I graduated with honors despite being a horrible studier and procrastinator.) My advice to you is this: QUESTIONS, QUESTIONS, QUESTIONS, and more QUESTIONS. It's not about going back and reading your text books--that would be crazy. Do lots of practice questions, memorize critical lab values (NCLEX loves those!) like H&H, K, ABGs, WBCs, therapeutic serum levels for Digoxin, Dilantin etc..and you're good to go. You may want to review med calculations too, but I didn't have a single calculation question. ALSO, USE TEST-TAKING STRATEGIES like process of elimination, opposite rule, etc. Even if you've never heard of the disease or drug that the question's asking about, you can often find the right answer by using test-taking skills. I think that's what really saved my behind on the boards. My test shut off at 75 questions and I thought I was done for, but I'm an RN now. YOU CAN DO IT!!!! Good luck.

I am a new RN and started working in a small nursing home in January. I HATE THE PAPERWORK! We are absolutely BOMBARDED with paperwork, 80% of which I don't even know how to fill out properly! I also hate the number of patients I have. I am new and very inexperienced, and I'm responsible for 25 people on day shift. If I work 11p-7a, I have to care for 46 people (ALONE, with 2 CNAs)! I often feel completely overwhelmed, have panic attacks, have to stay after my shift to finish paperwork, and leave completely exhausted and bawling my eyes out! All the nurses I work with are TERRIFIC, AMAZING people who always give me pep talks and help in any way they can. That's what I love. I just hate being a novice. I feel like I don't really know what I'm doing and I have a hard time giving meds to 20 people in a timely manner. Everyone tells me that they went through the same thing and it gets better over time, so I'm trying to stick it out. I'm actually considering going to a therapist to try to do something about this immense anxiety I feel whenever I have to work. It actually makes me feel like I can't function. I know I will love nursing once I actually feel comfortable and know what I'm doing...the question is, when??!?!?!?!

I went through the EXACT SAME THING! I graduated with a BSN in May 2009 and became an RN in August 2009. Since before I graduated, I applied to dozens and dozens of jobs--hospitals, nursing homes, assisted living facilities, doctor's offices...you name it, I applied to it! Even with a BS, everywhere told me they wanted at least 1 or 2 years of experience. I thought I could find a job at a nursing home easily--yeah right! The nursing homes I applied to were either not hiring or looking for experience. I was beginning to feel desperate and worried that I would forget everything I learned in school by the time I found a job. I went to visit my college's career center in October to talk to a career counselor. She advised me to "think outside the box." Nursing jobs are terribly hard to come by these days for new grads, so she gave me the following suggestions: -ANY job will do...even if you only work there once a month, at least you're doing SOMETHING with your license. -If you're willing to relocate, certain areas of the country are hiring new grads. I live in the Philly area, so getting a job around here is a nightmare. I was told that there are lots of jobs down South. -Try applying at healthcare clinics or rehab facilities -Look into the health clinics at some drugstores like CVS or Walgreens -Apply for government health agencies (like your state's health department). I hear the application process is long, but the pay is competitive -What about one-time type jobs, like giving immunizations? It's SOMETHING to put on your resume -Look into the Red Cross--I think they only take volunteers, but it looks better on your resume than nothing! -See if you can shadow a nurse. No, it's not paid, but it will keep you fresh, and you'll learn some useful things. She advised me to ALWAYS THINK OUTSIDE THE BOX. If the economy turns around in several months or a year from now, potential employers will hire the nurse who made use of their license (even if in a small way), NOT the person who did nothing since graduation. Finally, I was hired for a pool position by a small nursing home at the end of December and I started working in January 2010. So it basically took me 8 months to get a job. I was thrilled to learn that they pay their pool nurses $30/hr. The downside: I only work PRN. They call me when someone requests off or calls out. It can vary from several times a week to once a month. I am trying to look at the bright side because at least I have something to put on my resume--it's a step to getting a better job, and I AM getting nursing experience (though it's not full-time). It's not where I had imagined being right now, but it's something. Keep trying! It will work out. And don't worry about forgetting all the stuff you learned in school, trust me, your job will give you orientation time and it all comes flooding right back! Plus, most of the learning we do is on the job, not in school. GOOD LUCK! Someday we'll both have our dream jobs.