Oswin

So... long story short, I'm taking over my LTC facility's restorative program as of... last week. I'm not certified, my DON is and she's been helping me some but she's really busy. I've been given one day a week for this. I just can't figure out the best way to do this. This is complicated by having an... experienced DON who hasn't really had much computer training, so I'm not sure what's actually required to be used vs just what she's comfortable with? She gave me a functional assessment sheet out of the restorative binder and said those need to be done around their quarterly ARD (and any status changes), then also summed up in a progress note. Then that I need to keep the interventions the computer updated, care plan updated with current goals and interventions, progress note monthly, make up paper binders for the CNAs for each hallway so they know where the restorative care plans are. Attend the med B meetings and review and update goals. My biggest issue is coming these functional assessments and the computer vs paper charting. I feel like I'm wasting time duplicating everything when I should be spending more of my limited hours focusing on assessing the program in action and updating goals. The CNA computer charting auto populates over to the MDSes for our MDS coordinator with how much assistance they're charting for ADLs and it seems like it's a lot of duplication (though the functional assessment is more detailed, can they button a button, for example) it just makes me wonder if filling out this actual functional assessment sheet is required? Of course I want to actually do the assessment myself not just go off the CNA charting, but just filling out this functional assessment sheet is taking up SO much of my time for each person. I'm not sure why I couldn't just progress note the differences between this and the MDS since I have to progress note it again anyway? You other restorative nurses out there... what does your work flow look like? If you could talk me through your day, that would actually really help me feel more comfortable. Do you run your restorative programs with paper or on the computer? Any general advice you'd give a new restorative nurse? (other than attend a certification class, work won't pay for one right now since we've got a certified nurse in the building. yay budget cuts.) Thanks!

Your first death, especially unexpected ones, are so hard. Most of all through what you typed, I'm sorry you didn't have the support of another more experienced nurse to reassure you in your actions. I can't imagine what I would have done without that for my first (few) abrupt declines. It's hard to say without knowing his background and baseline, but the using his call light and not able to express his needs and drooling makes me think it MAY have been consistent with a series of strokes. Regardless of the exact cause... He was 99 with health issues. You were alerted of a problem, you assessed the resident, you tried to call a more experienced nurse for help which you didn't receive. You talked to him, held his hand, and comforted him. You elevated his HOB (so many people forget this crucial step when people are struggling). You then followed his advance directive. 15 minutes is not a lot of time, especially in LTC when you can't call a rapid response team to be there in a minute for help. That he was gone that quickly suggests to me that there was nothing you could have done at that point, and it was probably just his time.

Warning, rant ahead. I'm upset by a couple of recent experiences. 1. So I was running into the store before work the other day and was wearing scrubs. While I'm putting things in my car this middle-aged man at a nearby car asks if I'm a nurse. I said yes, and he asked what kind of nurse I was. Before I could answer he continues, with a big smile on his face, "are you saving lives in the ER? Or little babies in the NICU?" I responded, "Actually I'm a long-term-care nurse." The smile instantly vanished and he looked down at the parking lot, and mumbled, "oh... well... that's important, too." I just responded with a smile and said "Yes, I know it is." And he quickly left without making eye contact again. #2 I'm at a party and I'm introduced to another nurse. She looks really excited to talk to me, tells me that works medsurg. I give her the slightly more detailed answer of my facility is primarily LTC with a rehab to home wing. "Oh..." as she looks down at the floor, suddenly looking evasive with that barely perceptible facial cringe I've grown to expect when I say what I do, "excuse me, I need to say hi to a friend." she says as she slips away and I don't see her again for the rest of the night. ~ ~ ~ What is with this perception that LTC nurses are less important, less skilled, or do less valuable work than hospital nurses? The perception in my nursing class was essentially that you only went into LTC if you couldn't get a hospital job, and then it was only for short term experience to get a "real" (hospital) nursing job. Don't get me wrong, we don't use all the clinical skills that are needed in the hospital. I mean, I had to watch a video on central line dressing changes before doing one the other day, just because we don't get them often and I hadn't done one in four years. But we have our own set of skills that are needed to do our job, and not everyone can do it! We (in my facility) manage the care of up to 35 different people at once, supervising 3-4 CNAs, and there are only two nurses on the floor at a time, and on night shift only one nurse. We have to know each resident's routine (because they don't stay in their rooms), how/when they take their meds, their individual quirks, their general health history/skin issues and treatments. We also have to know which CNA will need reminders or more direction on tasks, and have to be watching our CNAs and other residents who might be wandering or getting into things while we pass pills, do treatments, and assess our residents. This is all often interrupted by a multitude of phone calls and faxes, and cnas complaining about other cnas and their assignments in general, door alarms and wanderguard alarms, and talking to family, etc. The ability to multitask, stay organized, and prioritize is vital. We get to take care of the same people every day, sometimes for years. We get to know them and their individual needs. We get to know their families and names of their grandkids. We know that the first sign that Mrs. Jones has a UTI is repeated fits of anger at the staff, and if we don't address it promptly she'll quickly go septic before she ever has any urinary complaints. We know that Mr. Smith will stop his PT early and refuse to continue if we don't get him a pain pill before he goes. We know that if Mrs. Jacobs doesn't complain about taking her medicine there's something wrong. Our doctors might go two months without seeing someone if they don't have a major change, so it's on us to watch vitals and skin tone and call/fax the doctor to ask for things. Our assessment skills and attention to detail have to be good because elderly persons tend to go bad fast if a problem's not picked up early, and with our patient ratios we don't get much time with them to spot issues. Our prioritization skills have to be excellent because if three of our people start going south at once, there's only one other nurse in the building to help (and any of her 35 patients might be having issues, too.) If my coworker is an LPN and someone needs an IV or stat labs (and she's not certified) and I can't get it, there's no one else to try unless someone volunteers to come in during their time off to try it. So that means I have to drop everything else and go try until I get it, because I'm not letting my inability to draw a lab be the reason someone has to leave their home to go to the hospital. Don't get me wrong, you critical care nurses are bada**. But LTC is also a challenging and important nursing specialty, just in a different way. We're still taking care of people who can't take care of themselves. But instead of working to get someone through something that went wrong, Our focus is providing day to day care to people who've lost the ability to do it themselves. We work to preserve dignity in life and death. We work to encourage someone's highest possible functioning in life, and support and care and advocate for them in death. We reposition them to protect their skin when they can't anymore, and chart bedside while holding someone's hand so they don't die alone. We also sing and dance and laugh and have impromptu mini engagement parties when one of the dementia patients comes up all exciting saying her beau just proposed to her. We see our residents more than their families and in some cases we're the closest thing to family they have. We're necessary for society because the simple fact is that it's incredibly difficult to care for an elderly parent/grandparent and many people are unable to do it safely, especially if there's a dementia component. I used to be an ER tech. I've been infuriated by nursing home residents that came in soiled and unkempt. But I've also had residents who got up in the middle of the night because they had to pee, tried to hurry to the toilet, then fell in their hurry, smacking their head on the dresser and breaking their hip and obtaining several skin tears, and then becoming incontinent - and then struggling around in pain and covering themselves in blood from the skin tears. I've then made the decision to send them out soiled because my priority then shifted to getting them assessed for serious injury and pain control. Undressing and turning someone who's screaming in pain because of a likely broken hip that hasn't been x-rayed yet, who has no pain meds onboard, in order to clean them up is not something I'm going to do. I am sorry for the times I've had to send someone out in a state of disarray, because I want my residents to look and feel their best! But sometimes things happen. There are bad nurses in every specialty and every location, but there are also good nurses who are doing their best, too. Can we just... respect each others specialties? If all nurses were hospital nurses there would be so many neglected people in the community. LTC needs more good nurses, not just people who can't get a hospital job, but skilled, observant nurses who want to care for others. There are bad homes, just like there are bad units in the hospital. But as a concept, it's a vital part of the community and people shouldn't be looking down on it! ----- TL;DR Annoyed with people looking down on me for working in a nursing home. LTC is a challenging specialty, too, in its own way. Let's change the conversation. What do you love about working LTC?

Thanks for the responses, everyone. Let me clarify a few details that you've brought up. We alternate being charge nurse when I work with her, per the scheduler. There are only 2 nurses in the facility on 2nd shift, and the scheduler assigns charge nurse status. This is actually part of my problem... I'm concerned this nurse is genuinely incompetent (and that's not something I say easily about a fellow nurse...), not just lazy. I believe she assessed a resident who was having a stroke and didn't notice the symptoms, and is unable to prioritize breathing issues over her med pass... it seems like in her brain, the med pass trumps anything other than chest pain, no matter how many times I try to gently nudge her toward ABCs. When that resident was satting at 78% I told her about it afterwards, since it was HER patient... and she actually replied "Well, thanks for taking care of it, but he would have been fine until I finished my med pass." (And yes, I did tell that to the DON, too.) I hate being charge over her because I know that ultimately the responsibility of her actions then fall onto me... and I don't trust her. I've only been a nurse for a couple years, I guess I've been fortunate not to have encountered this before, but I don't care for it!! lol. Sorry, I guess I didn't explain as well as I thought I did. It's completely natural for the CNAs to report issues they see to the nurses, it's part of their job, even. These are multiple CNAs over months who reported problems to the other nurse, and when the other nurse said she was too busy to address them, or ignored the issue, they brought it to me because they were worried about the resident. The CNAs have reported this to our DON, and I have reported my assessment results as well as my conversations with this other nurse to our DON....the bigger issue is that the DON doesn't care because she doesn't have staff to replace her. And I have no control over that, of course... as frustrating as it is. I don't think this is the issue in this case, though that's generally good advice. Also, I always ask them if they've reported the problem to that residents' nurse first, before I go see the patient (unless it's an emergency, of course). The CNAs may not be trained to assess, but they spend so much more time than we do with the patients one on one... they know when someone's not acting right. Thanks for those that suggested bringing her with to assess the patient. I think I might start paging her to the patient's room when the CNAs bring something to me and it seems to be serious, and see how that goes.

I am worried about one of my fellow nurses. Primarily, I am worried about her ability to care for her residents appropriately. On multiple occasions I've been told of an issue that was reported to her that she didn't investigate (residents with new pain, behavior changes, abnormal vital signs, difficulty breathing...) about the only thing that gets her attention is chest pain or a fall, it seems. I remember once a CNA told her a resident was SOB and was out of oxygen during a meal. She was doing a med pass and told him he'd have to wait until she was done passing pills... They came and got me and his pulse ox was 78%... I refilled his oxygen; she was no where in sight. Another time she presumably assessed someone the CNA said wasn't acting right and came to the determination that the resident was tired. The CNA came and got me a while later when the resident still wasn't acting right and the resident had new hemiparesis, new slurred speech, and was very lethargic. This is two of numerous incidents. I've talked to her a couple times about these things.. that breathing trumps med passes, the importance of assessing and investigating complaints, etc. But nothing's changed. I spoke to my DON about it, not because I want to tell on my coworkers, but I'm concerned about the safety of the residents in the building. She told me it was my word against hers (CNAs dont' count because they're not qualified to judge a nurse's job), and basically as long as she shows up for her shifts, gives her meds on time, and doesn't kill anyone they're not interested in pursuing it. Every time I work with her, I get overwhelmed. I feel like I have to keep an eye on her, and care for her residents on top of my own and it's REALLY stressing me out and making me not want to go into work. I know this isn't an unusual issue in LTC... any tips on dealing with it?

I'm also in IL. Things vary vastly in the state... how close you are to chicago, etc. I work in a very low acuity religious-based facility. We very occasionally do IVs, have no trachs, no vents, no g-tubes, one colostomy and have discharged a couple residents to other facilities for being seriously violent toward staff. 1. What size is your LTC facility? I.E. Maximum capacity for residents. 110, we're at 70% currently. This includes our skilled unit and our shelter care which has 20 beds. 2. What is the nursing to patient ratio? We have 3 nurses on day shift, and now run with 2 on evenings and nights. When our census increases we'll return to 3 nurses on evenings, which is our standard. 3. What is the CNA to patient ratio? Our absolute minimum # of CNAs is 5 on 1-2 shift and 2 on night shift, which only happens when we have multiple call offs and no one to mandate. Typically we have 8-10 on day shift (including a shower aid and a rehab aid) 6-7 on 2nd shift and 3 on night shift with our current census. 4. Do you feel you are able to provide quality nursing care to your residents? Not always, but most of the time I'm able to give them individualized attention if needed. 5. Is your facility doing computer charting? Yes 6. Are you subject to mandated overtime? Yes 7. How long have you been nursing in the LTC setting? Nearly 2 years 8. Do you feel that you are able to keep your various residents safe? When things aren't going absolutely insane, yes 9. Does your LTC home have a mixture of residents? I.E. Rehab to home, typical geriatric, psych, homeless otherwise? Yes 10. What is your hourly wage (ballpark) and do you feel you are underpaid for the work you are doing? I make $22.60 as an RN. I'm the lowest paid RN in the facility. We Have a $1 shift differential for evenings/nights, and $2 differential for weekends, double time on holidays. 11. What state are you practicing in? Illinois

I've been working in LTC for a while and know what you mean. There are some pills that I will give at different times. However, I NEVER recommend a new grad do this, especially at a facility i'm not familiar with. Reasons being: 1. chances are they don't know all the meds they're giving. It's unfortunate, but it's true. Plus, I can almost guarantee they don't know potential interactions that could occur by giving pills at the wrong time. If all someone gets at HS is a daily lisinopril or something, I'd ask someone more knowledgable (DON/MD or whoever's approval you need for your facility's policy) about moving it to be with another med pass to simplify things for everyone, including the resident. If you approach the DON about this from the angle that the residents go to sleep early and don't like to be woken for meds that don't need to be given at that time, they tend to be more interested in changing it (in my experience, anyway) 2. Some DONs are more strict about that stuff than others. As a new nurse to the facility, people are going to be watching her. I've known people in some facilities who were fired to giving meds at the wrong times instead of requesting the orders to be changed. 3. If state comes in and she never learned how to do her med pass per the orders, she's going to be even more flustered and more likely to make a mistake which could really hurt her and the facility. Give yourself time, OP. You will get faster and more efficient as you learn your residents and your meds!

In my experience, the tolerance does go away with time. But it re-develops more quickly in people who've built it up before. Not sure I fully understand that one, but I've seen it in multiple people, including myself.

ALWAYS read back telephone order to the doctor to make sure you got it down right. This is legally required, and if it irritates them, too bad Maybe you could put it on speaker with another nurse listening. Or when you answer the phone and realize it's a doctor say "this is _______, I'm a new nurse, would you mind speaking slowly so I can make sure I have the orders down right" before they start rattling them off As for the med pass... try to organize based on those residents. Pay attention to who goes to meals early and try to get them first. If there are neb treatments to give during a meal... do them before the meal, or get them going right before the med pass, even. That IS something that will come with time as you learn the residents' routines. And you'll get faster as you learn everyone's meds, too. Write down the supplies you don't have and take it to your manager so s/he can try to order more of it. An unfortunate thing I've learned (at least in my facility) is that many nurses don't apply creams but chart that they did - even when it was never ordered... check to see if they were ordered even if they've been charted as given, and if they haven't - order them. If they're available and you can't find them, ask how they're organized. If there's not an organization system, ask if you can stay late one night on the clock and develop one! (just make sure you write it out so everyone else can follow it, too, lol.)

First off ::hugs:: New jobs can be so stressful. I've been working at my LTC job for 2 years and I still ask questions daily and ask for clarification on things... and I'm one of the trainers! No one knows everything, and usually from school we don't get the the experience of taking care of 30+ people at once... regardless of acuity!! If you really aren't feelings safe to be alone, ask for some more orientation. Tell your boss you don't feel safe yet, remind her it's your first job out of nursing school, and first time in LTC - tell her you feel unsafe and why and what you'd like to work on with your preceptor in additional orientation. When I started as a new nurse in LTC, I had a full month of orientation. I know that 12 shifts seems like a lot compared to what others have said for LTC, but if you've never worked in one before, it's really not. Especially for a new nurse. At the least, I'd ask for a second nurse to be with you when taking doctor's orders. Also: I'd try to take a few minutes on a break (i know, I know... what's that) to write down what's tripping you up the most and study up on it on your days off. Do you know the meds you're giving? If not, write down the most common ones you're giving and look them up. Start with 5, and build from that. Write them out as flash cards and go over them like you did in school. Review your key "troublesome" residents' careplans... what's careplanned to do for that alzheimer's resident when she gets violent? Then chart the behavior, how you addressed it, and if it was effective. Ask your boss if you guys have the Interact Care Paths, if not, maybe they can look into getting them. They're useful tools that provide helpful flow charts for what to do if your patient is exhibiting _______________. They can be a pain to find and follow in an time-sensitive situation, but are useful tools if they can be organized appropriately. (example: http://www.med-pass.com/media/pdf/MP5660PS-4_sp.pdf) Review: Your facility's standing orders s/s sepsis (elderly people may not run a fever, or may have an elevated temp from their baseline which can be within normal) s/s UTI in elderly persons (may include behavioral changes, shivering, chattering teeth or other odd symptoms) what to do and what symptoms to watch for after a head injury s/s and assessments you need to do people for CHF and COPD what to do for chest pain Generally speaking: if someone's acting out of the ordinary > ask them what's wrong and assess any complaints. If they're diabetic, check a blood sugar. If they're on oxygen, check a pusle ox and oxygen connections/settings. if they're not able to give you any complaints do a quick visual assessment > facial/body symmetry, breathing rate/quality, skin color, etc. > fully assess any abnormalities or do a quick head to toe. Get vitals on anyone acting weird just in case. If nothing else came up in assessment, consider a urine dip unless your facility has stricter policies on them. Get organized!! I have a shift sheet for each hall set saved on our computers. At the beginning of my shift I edit it for any changes and print it out. Mine is half a sheet of paper with 2 columns and has: People who need accuchecks with a space for the result people on oxygen, space for pulse ox and their o2 orders Assessments needed: people on ABT and med a. Then I add the names of anyone that was having issues passed on in report Treatments due monthly summary then a big space for "To Do:" that I update through my shift so I don't forget things. If you're not sure about your charting, ask. Charting is important for the facility getting paid if it's not strictly private pay facility. They'll want to help you with that! Hope something in here helped... remember, if you get overwhelmed pause and take a deep breath before proceeding!

Because I want to know what the law is on the matter.

I'm in Illinois. What state are you in?

Ok, I'm a bit confused about this whole mandated reporter thing. I understand that as a nurse I'm required to report suspected elder/child abuse. However, is that only the case when if it's encountered while I'm on the clock at work? Or am I legally required to report it in any situation? Morals and ethics aside, I'm strictly wondering about the legality.

I'm not entirely sure what my face looked like when I realized what he was saying, but I really tried!! lol. But I definitely took an extra long shower that night!

It happens, yeah. Especially when the bedpan is full. But if it's happening EVERY time you might want to examine your "technique". Try pushing down on the edge closest to you while the pt rolls the other way to keep it level. Also, when you get them on the bed pan, make sure their thighs aren't touching before they "go", and if their orders allow, sit them up a bit!! Urine will run right down the thighs if they're touching and make a mess.

I always cleaned the plastic ones, except in rare cases where it was just too much effort. At my facility the pt got charged for each bedpan, so we tried to be conscientious of that, and they do cost the facility money. But sometimes... when they get that super pasty rank poop that you have to spend 10+ minutes scrubbing to keep the bedpan from stinking up the whole room... you just have to let it go and start over!

So I'm working as a tech in a hospital and we get this pt. He was in his 40's, and one of those patients who came in just... covered in dirt and old clothes and matted hair. and you can just sense something is "off" with them. So I get report that he's bed bound and incontinent. A&Ox3, Used his call light appropriately when he needs to be cleaned up, and having diarrhea so he's going a lot. (But it's like.. diarrhea with some chunks in it, not pure liquid. ) So he hits his call light and says he had a bm, i go in to clean him up and am met with a horrific sight. He had apparently gone a while ago... and been playing it. He pulled the pad out from under him stuck his hands in it, picked up chunks and threw them across the room. Drew smiley faces on the wall in stool. Wrote "Hi! :-)" on the wall. Shoved some towels between his legs to sop up some poop then flung them in different places in the room. He had a semi-private room with no roommate so there was some room to fling poop, and boy did he fling that poop. So anyway, I suck up my "what-on-earth-face" and put on the blank professional face and clean him up first. He doesn't say a word to me the whole time. Then I quietly get some towels and bleach wipes and start tackling the room. I'd had my back turned and was scrubbing (now partially dried) poop off the floor when I hear him mutter something, so I turn around and he's intently watching me clean up the mess he made. And masturbating. I'm trying to keep my face professional when I realize that he's mumbling "CLEAN my mess. Oh yeah." At that point I silently bagged up the towels, left the room, closed the door, and instructed the clerk to please page housekeeping, rofl.

Do you have sources for that, newhospicern? If I go in there with what Esme posted, she's just going to say "we're not a hospital, this isn't applicable" and ignore it.

Ok, here's where I"m having trouble... I want to make sure all my ducks are in a row before I approach her about this. One of those says hospital, and I'm not working in a hospital. Another that I found seemed to only pertain to state facilities. We do accept medicare/medicaid residents, but we are a faith-based non-governmental organization, so I don't know for sure if it applies?

To be clear, she wasn't trying to make me stay for 24 hours, just saying that she legally could, which I can't fathom can be true....?!

I work in a LTC facility,and like most we have some severe staffing issues. It's my first job as an RN,and I'm not sure what's ok and what isn't.... Normally when a nurse calls off, I volunteer to stay over, at least for part of the shift because I don't mind, but today I was on 3 in a row, sick, \got 2 admits, and I was just done. Well, the other nurses with me were already on doubles and couldn't stay anyway. I called our DON and said I could stay for a 12, but couldn't do a 16, it wasn't safe, I was going to fall asleep. She told me the standard line, that I had to stay, if I left they'd get me for abandonment and I'd be fired. She went on to say that the only law on the subject was that I had to have at least 24 hours in 1 week off work, and beyond that, I was required to stay as long as necessary until sufficient staff came in to replace me. So, since I'm part time, I could be mandated for 24 hours straight and it be legal, so long as I was allowed my meal breaks. I understand that part of working in healthcare means that we may have to work overtime, but this is just insane... and I can't fathom that it's legal! There has to be some limit to how long an employer can force you to work beyond your scheduled hours in one day... but I'm having trouble finding info on that from a credible source... Can anyone give me some guidance? :-/

First, let me say that you're not alone! I've been looking for a job for over a year and just now found one. It sounds like you're doing everything right, just keep at it and don't lose hope. In the meantime, try applying for cna jobs rather than just non-nursing jobs. That'll get you into the healthcare setting and might get you first in line if a nursing position opens up at that facility. As others have mentioned, a lot of nursing homes don't advertise open positions well - make sure you're calling them regularly. You can also try an employment agency, and make sure you're on linkedin, monster, etc. I'd also suggest calling places you're interested in working and asking if they accept volunteers, and if you get in as a volunteer some place, work your butt off. That gets you familiar with the facility, makes new connections, and shows the managers first-hand that you're a hard worker. Even if you can't get a job there it looks good on your resume and says "I'm so serious about working in healthcare that I"ll even do it for free." Ask your clinical instructor from school or a former employer to write a short letter of recommendation and attach it to your resume. DON'T give up! As for the loans, just call them. You're far from the only person in that position in today's economy and they can extend your deference easily, or if you're able to pay some you can probably get on an extended graduated plan for minimal payments right now. Good luck :-)

3 days! That sounds terrifying. Thanks for the reassurance. What does ATB mean? :-/

Ok, so I graduated from nursing school in December of 2011, and had to take some time off. I'd been applying for nursing jobs since august 2012 with no luck, but I was just offered a job at a nursing home on nights. I know nursing homes tend to have kind of a bad rap, and I'm really kind of freaking out about the idea, but I'm scared that if I turn it down I'll never get a job as a nurse, so I'm going to take it... However, I have NO idea what to expect at a nursing home job; I've never worked in one, and we didn't do any clinicals in long term care. I've been reading through ltc threads on here to try to get an idea, but they mostly just have made me panic more, lol. So here's what the manager told me in the interview... it's a 5 star nursing home. They have 120 beds total, but 20 are "shelter", so they're pretty much independent, and they only have 96 filled right now. When I asked about acuity she said "we sometimes have residents with IVs", and there's one hallway that's dementia, with 12 beds. On nights they keep 2 nurses (rn or lpn) and 5 cnas. And their orientation is 2 weeks on days, and then 2 shifts on nights, which seems really short to me, but I'll try it and see where I'm at before asking for more. I worked as a tech for 4 years which taught me a lot of organization and time management, but as a nursing student I never had more than 8 patients at a time. Obviously a nursing home is different from a hospital, but the idea of being responsible for close to 50 people is seriously freaking me out... I'm going through my old nclex study books to try and brush up on things before I start, but does anyone have any advice(In general or on specific things I should brush up on before I start)? Can anyone give me a basic idea of what a shift might be like in this type of facility? Thanks...

Some background... So I have an ADN, and am unable to find a job. I graduated in December of 2011, and took/passed by boards for the first time in August of 2012. I waited because we were going to move to another state but since it wasn't set in stone I didn't want to register for a license in that state and have it not work out, and then when that all fell apart it took me a bit to get a date nearby. So anyway, I"ve been applying for jobs since we moved in January and been rejected for over 50 applications, from doctor's offices to night shift nursing home jobs. It seems like everyone wants experience and I just can't get any So I"m considering going back to school to get a BSN to see if that helps me find a job, because... I just really want to be a nurse. Between my husband and I, we're already over 70k in debt from student loans, so I'm very conscious of the tuition cost. I'm a bit overwhelmed looking at all the online programs, and confused by all the accreditation and such. I've been looking at the The University of Louisiana at Lafayette, and they think I can get into the October session if I start the process now. But I don't know much about programs of this type, what to look for, what questions I need to ask, etc. And this program seems much cheaper than others of its type, which concerns me... Does anyone have any advice on looking for rn-bsn programs? And, while I know no one can predict the future... do you think it's likely this would help me get a job? Or is it more likely that I"ll just end up another ___ grand in debt, further from nclex with no experience, and even more unemployable? Any advice would be appreciated.