kfostercma

I was feeling self-conscious about starting my first med-surg job at the age of 38 when most of my coworkers became nurses in their early 20s. Then I happened across this inspiring post. Thank you so much for this! In short, no you are not too old. You have an illustrious thirty years of experience behind you, and when I was in the AD RN program, the LPN students seemed to do better with the content than those of us who were not yet nurses. Don't sell yourself short! Imagine all of the skill and knowledge you have gained during your career--and how much more you know than a new grad RN. Additionally, it is becoming more common for middle aged and older adults returning to college for various reasons. Different profession, I know but I took an abnormal psychology class with a gentleman in his mid 50s who was pursuing a doctorate in clinical psychology. He might be in his mid 60s before he gets to practice! I extend my condolences for your loss, and wish you good fortune as you pursue your RN. You can do it!

I have been working in a "Greenhouse Model" nursing home for 3.5 years. Here is what I have observed: Intent: and in addition to promoting independence like any traditional long term care setting, elders are encouraged to garden, help with preschool/daycare, and even meal preparation. Reality: out of 20 patients (a light workload compared to other LTC settings), only a handful, 2-3 at a time might be capable of these activities. In 3.5 years I have never witnessed an elder stepping foot into the kitchen, let alone assist with meals. Intent: Shahbazim (nursing assistants with extra training, singular: Shahbaz) have a smaller workload (5:1 ratio as opposed to 10:1), but are expected to take on housekeeping and maintenance roles. Reality: out "Greenhouse" facility still has housekeeping because even at a 5:1 staff ratio it is difficult for our Shahbazim to keep up. Intent: Shahbazim to prepare meals to order in a home-like kitchen Reality: Professional chefs cooking meals just like any other nursing home, except without the benefit of an industrial kitchen. The single biggest complaint about our "Greenhouse" facility is the food. Our elders were made to expect home style cooking every day and got something quite different. Additionally, even if a person is admitted to our facility with a level of functioning which allows them to participate in all of the tasks intended for the Greenhouse model, they inevitably decline and choose not to move when their acuity level changes. Often, since management is under pressure to keep rooms filled, many of our new admits are total care patients. A few things to mention as a positive: our elders are generally on fewer anxiety medications than traditional institutional style nursing homes. The hallways are shorter (ten elders to a floor); and the shorter distances are less intimidating for a person who is barely ambulatory. With one aide for five elders, I do a lot less wound care than I did at my first nursing home which had one for ten. Older post, I know but I hope that helps!

For clarification: I do not have a carefree attitude towards my work performance, I feel quite privileged to be actively using my education and I show gratitude for that by always looking for ways to improve. I listed my mistakes/need for coaching in some areas to emphasize the point that I am not as talented as my clients seem to think.

I have been a nurse for three years now, all of my time has been spent in LTC I am the only white male nurse on the payroll at my facility--which is not terribly surprising. Even ten years ago the female to male nurse ratio was something like 15 to 20:1 with male nurses preferring to take administrative or research positions. Most of my coworkers are minorities and over half speak English as a second language; every single elder on my unit is US born and white. At the risk of sounding pretentious, most of my elders and their families love having me as their nurse. I do my best and am always looking for ways to improve but I am honestly having trouble discerning genuine praise from the relief of seeing a person who has the same skin color and presumably same cultural background as them. My annual review on the other hand was a testament to mediocrity. I of course received high marks in customer service but my performance with daily operations needs improving. I frequently forget to chart my weekly skin body audits on the same day as the shower (I always look, but if there is no skin deficit I tend to forget about it); I also sometimes fall behind with MDS assessments. I don't always get to my accuchecks before my elders start to eat and more than once I had to be coached on using SBAR format when communicating with providers. And then there are medication and treatment errors; there was this one time I used an Enluxtra dressing in place of a Xeroform dressing and ripped this guy's fistula open. There was so much blood this guy's room smelled like a slaughterhouse (he wasn't harmed at least). When I reported this to my nurse manager he bellowed something like "Jesus Christ! Those don't even sound alike, why did you do that?!" Despite all of this, my elders (even the guy mentioned above) think I am doing well but that appraisal is in sharp contrast with my annual review. No this isn't a humblebrag and no I don't have any white guilt. I think it is pretty clear that my elders treat me differently than my colleagues, but what do I do knowing this? All I have thought of so far is to make an effort to say "good job" and "thank you" to my coworkers in front of as many of the elders as I can, and whenever an elder tells me that I am their favorite nurse I have a knee-jerk reply: "that is very kind of you to say, but I like to think of us as a team" or some variation of that. Have any of you noticed any preferential treatment given to white males in the geriatric setting?

Yes, I agree with notanumber about positive reinforcement. Leadership 101: praise is cheap! Always say please and thank you. It is better to ask an aide to perform a task for an elder than it is to order it. My aides often tell me I am their favorite nurse to work with. To explain that, I need to tell you a little about myself: I made the mistake of not becoming a CNA before I became an RN. I was once a CMA but that really isn't the same thing, and not a single thing I learned as a CMA helped me transition to the professional RN role. You can imagine how lost I felt when I started working at my first nursing home! My father raised me to believe that a supervisor (I like to consider myself a coworker of my aides, but my credential also requires me to supervise) should never ask a subordinate to perform a task that the supervisor cannot or will not do. I have always been upfront with my aides in that I tell them that I never worked as an aide, and not knowing any better, I tell them that their job is probably harder than mine. One of my first goals was to earn the respect of my aides. Here is how I did it: #1: If I am in a room with an elder and they need a fresh cup of water or a new brief or something, I will do it myself. I want my aides to know I am not above performing tasks that are normally delegated to them. One exception I will make is showers. I will not give showers because it is too time consuming, but I do want my aides to know that I am not above changing soiled briefs. #2: Answer call lights, and encourage all staff (not just nursing) to do so. The aides will feel less burdened by having to handle ALL of the call lights themselves and you might be surprised how often people accidentally press the call button, or need something simple like a glass of water, or to check the time. Of course you should not expect a receptionist or a HUC to change a dirty brief, but if the call light is at least answered the elder knows that they have been heard. That goes a long way. Strive to have every call button answered in sixty seconds or less. Have you ever had to wait sixty seconds for something? That time really drags on, doesn't it? Now imagine waiting sixty seconds with a full bladder....yeah..... #3: If an elder is complaining...at great length...about something that is beyond your control, hear them! Even if you have implemented the nursing process to the best of your ability and the elder still finds things to complain about, you can at least accept that you cannot change the behavior, but it might surprise you how far you can get with them by simply lending an ear. You may notice that my suggestions are more focused on the elders that you care for than your staff. That is because the morale of my coworkers and I are directly linked to the happiness of the elders for whom we care. Keeping the elders and their families happy is within our best interest. I hope this helps!

I'll confess that LTC wasn't my first choice (AD RN here, working on my BSN), and I will grant that it is predictable, it can be boring on some days, upward mobility is limited unless you want to be a manager (no thank you!) and I am constantly keeping my eyes open for a way out. But to say LTC is lame stings a little. Reading the comments on this thread, I am reminded of some of the dismissive attitude I have had to endure from acute care nurses when I sometimes have to send my elders to the ER--and as a male nurse, I am shielded from a lot of their condescension! If you are unhappy now but are limited on prospects, here is what I suggest: if you are so good at your job that you finish your med pass, MDS assessments and clear all of your alerts that your electronic chart flags for your elders, check your facility policy on how to destroy controlled substances. If you as an RN can destroy narcotics with a second nurse to cosign for you, imagine how much time you will save counting narcs! When I started at my current job, I ended up cleaning out almost half of the narcotics that we had on hand since they no longer had orders. Counting narcs at change of shift became a cinch! Ask yourself if you are implementing the nursing process to your elders' full advantage. A major part of our job as LTC nurses is to optimize our elders' quality of life. For instance do you have an elder who could benefit from a different sized wheelchair? I recently came back from a vacation and had a new admit on my unit who was using a loaner wheelchair from our TCU. It was a standard sized wheelchair, and this gentleman was at least 6'6" tall when standing, also he was on hospice. Poor guy was using that little wheelchair for about four days before I collaborated with hospice to get him a high back wheelchair. It isn't always about money. That is why we are nurses and not physicians, right? If you aren't feeling challenged at your current job, I invite you to look for opportunities to shine. Your coworkers and your patients will love you for it.

I am an AD RN and managed to find a 0.8 FTE job in long term care right away, but working in my favor is my gender. I have been frustrated trying to find something more specialized, hospitals in the Minneapolis, St Paul area where I live are unwilling to consider a nurse who hasn't completed a BSN, and I have yet to even land an interview at a clinic. 2 years is long enough for me to know I don't want to spend my career in LTC.

I'm a white male nurse with 2 years of experience kind of coasting by with my privilege. When it got to the point where I started to question whether I was really doing well at my job or if my white maleness is responsible for my accomplishments, I asked some of my friends (not nurses).who are minorities what I should do. Most of them said I should use my position to praise my coworkers at all times. I know it sounds silly, but some of the elders I care for have started to trust my non-white colleagues. Perhaps you can challenge your coworkers who are white to compliment good work when they see it.

When I was in my early 20s I originally wanted to teach high-school science. But after my first college speech class I found I couldn't speak in front of crowds. Ten years later, I graduate from nursing school and have 2 years experience...my confidence is much MUCH improved....but to take a pay cut? Maybe when I start to burn out.

When I was in my early 20s I originally wanted to teach high-school science. But after my first college speech class I found I couldn't speak in front of crowds. Ten years later, I graduate from nursing school and have 2 years experience...my confidence is much MUCH improved....but to take a pay cut? Maybe when I start to burn out.

She went off sliding scale for a time but she ept spiking into the 300s after breakfast and her a1c was 9ish so she went back on. I wanted to increase lantus but MD disagreed with my approach.

I average one double shift per week at my LTC facility and often it is the day before a regular shift. I work days so it goes 0630 to 2300 and back at 0630. I rely on public transit and won't get home until midnight....but the tradeoff is that the next day sure feels shorter! I started drinking coffee in the mornings to manage the sleeplessness, and I can't cancel myself.

I have been working in LTC for as long as I have been a RN--about 1.5 years. I have worked in two facilities, and I have run into the same problem with my sliding scale diabetics--actually all of my diabetic elders--in that no matter what aides I have working with me, they will bring my diabetics to meals without informing me so I lose my opportunity for a pre-meal accucheck. I have tried updating the care plans, verbally instructing my aides at the start of my shift, and even posting a sign reading "Elder must be seen by nurse BEFORE meals" but it is still a daily struggle. I do have a good routine down for the floor I work, but my sliding scale elder does not always eat at the same time every day. Often she will rise at the start of my shift while I am taking report on a different floor (I work two floors with ten elders each). Does anyone else have this problem or do I just suck at managing my diabetics?

NurseGirl has a good point too, the burnout rate for LTC is high and one nursing home administrator once told me that there is an expected worse than usual shortage projected for the next fifteen years. It gets frustrating fast; I threw my smartphone (breaking it) once because of staffing frustrations. Normally I try not to let my aides see me angry. Oh and speaking of aides, treat them like equals and they will take care of you! That isn't to say that you should delegate stuff outside of their scope of practice--don't do that--but demonstrate to them that you are not above doing some of the things that are normally delegated to them. I do pericare, toilet elders and get my own weights on some days and my aides love me for it!

Yes, everything ltcnurse4u said is correct.

I only had seven days of orientation when I started my first nursing job 1.5 years ago. It wasn't enough....I am only an AD RN though. As for advice, just make sure you aren't afraid to give out PRN medications; I get irritated when I start my shift and I hear that "so-and-so" has been in pain all night/has been nauseated and vomiting all night, has diarrhea or whatever. Also, check your standing orders when an elder has pain or other symptoms but no PRNs ordered. Hope that helps! Kev

Hi guys! It did not take me long to find my first RN job; this may be because I was willing to work in LTC. Despite my personal record of a four week job search, I am having a major crisis of confidence! First of all, I was supposed to orient (work with an experienced nurse) for my first three days, but that was extended to five days, then seven because it was clear to them I was not ready. Now I have worked two full shifts outside of orientation, and I just feel so inadequate. I always leave work for the evening shift--always. I at least finish passing both rounds of medication for which I am responsible. But I have not yet left the evening nurse with a clean schedule. Everyone is telling me "you're doing great!" but I wonder if they are saying it to help me build confidence because I can tell you right now that I don't feel like I am doing "great." I have made incredibly poor decisions already, like my supervisor had to tell me to never leave meds in a patient's room--the kind of thing that I should have known from school, if not the darn NCLEX, right? I asked her what consequences I am facing for my actions (I am the kind of dude who owns my mistakes, and wants to deal with them head on so I can learn) and she said "well, just don't do it again." I don't want to give the impression that I regret becoming a nurse, because I love my job! I just wish I was better at it. I forgot how much I hate being new.... Any thoughts and suggestions would be awesome and appreciated!

Let us look at the concept of sin for a moment. I think the most basic understanding of the word, is that to "sin" means 'to do something bad.' I don't think religion is the best remedy for that, I really don't. Take killing for instance. I think we can all agree that killing is "something bad," a "sin." So...without a higher power watching over us with a promise of punishment if we ever kill someone, what stops us from killing? Law? Maybe. The legal system we have where I live, in the United States borrowed heavily from English Common Law, which was (please someone correct me if I am wrong, I am not well versed in British history) loosely based on the bible. With that in mind, one can argue that we need the bible to prevent people from killing or stealing from each other, a basis for a peaceful society. What if we lived in a world without religion though, what would stop people then? I think the answer is empathy. If there were no laws against killing, and we were reasonably certain there is no higher power watching over us, I would argue that rational human beings (that is those free of significant mental illness) still wouldn't kill people for personal gain--or just because they don't like each other. I honestly believe people wouldn't be able to bring themselves to do it, the weight of the wrongness of taking another life would weigh too heavily on most people. Personally, I trust human empathy (something we can see) to police our behavior over a supreme being (something we cannot see) promising punishment for crossing the line. You may point to serial killers, war mongers and other people who wage wonton destruction onto their fellow human beings as evidence that we need religion to prevent this from happening, but I don't think that is an honest argument. Most mass murderers and serial killers have something fundamentally wrong with them which allows them to do the horrific deeds that most of us can't imagine. The only exception I can think of is Heinrech Himmler...of him, one psychiatrist said he was "shockingly normal." But then, then deviations from normal data are pretty common when it comes to human behavior. I did my best to tone it down as you suggested, duskyjewel. How did I do?

Thanks, bud! Yeah, LTC isn't what I had envisioned when I started nursing school, but as an AD nurse the reality is that hospitals will not look at my resume if I don't have experience. My current RN supervisor (I am employed as a medical assistant at the moment) has told me that she learned a lot working in a nursing home which lends me some hope that will be a good experience for me. Thank you for your input, and congratz on being a semi-new grad!

Hi Everyone! I have accepted my first RN job yesterday! A surprise too, I found myself rambling at times when the interviewer asked "tell me about a time when...." questions, and I wore a bow tie with my suit--the next day several people told me that was a pretty stupid idea. I am having a real hard time believing my luck, I was prepared to run my job search for at least a year. Also, I heard it is uncommon for new grad RNs to land straight days as their first job--is that true? I am an associates degree RN. I think I can learn much from working in LTC while I pursue my BSN, but I have heard horror stories about nurses getting "stuck" in LTC. I think an article on this forum (I don't remember the title, but it listed 7 or so things to know about LTC nursing) said that other medical professionals don't value LTC RNs' experience which reinforces this idea. If that is true, is there a way to present LTC nursing in a positive light--I may want to work in a hospital some day. Other than that, I am excited to start my career. I want to extend a thanks to everyone who has supported me.

I will concede that my tone is harsh, but the number of abuses that I have endured at the hands of religious types has colored my perspective. Just because I don't believe in Hell doesn't make it any less hurtful for a person to tell me I am going there.

That's great advice. Thanks! I still won't identify myself as a nurse to my patients until I find an RN job though. The day that I told my boss that I passed my NCLEX she told me very specifically not to start performing things within the RN scope of practice.

Well, super congratz to you, RN. I passed on my first try too, and I was sure that I failed because the questions just kept coming. I too graduated in May and waited (probably a bit too long) to take the test. In the end, started the test at 8:15 am, took one break at the 2 hour time point--I don't even remember for how long--and left a few minutes before noon. I told everyone that I was going to hit the bar after the test but I ended up just going to my apartment and sleeping for five hours. Any number of questions past 150 is an endurance test. Good job! Celebrate.

You *should be concerned about a CMA identifying as a nurse. I am speaking as a CMA. One of the first thing they taught us in the CMA program is to never ever identify ourselves as nurses. My instructor added that if a patient (everyone who wears scrubs looks the same to a patient) ever refers to us as a nurse, we should politely correct them. Currently, I have passed my NCLEX and have earned my RN title, but I have not found an RN job. I still introduce myself to patients as a CMA. Why? Because I was hired as a CMA, and my scope of practice has not changed. Never ever let a CMA identify themselves as a nurse. Some of our skills overlap, some CMAs are more skilled at certain things than RNs, but the reality is that anyone with a clean criminal record can become a CMA. Becoming an RN requires a skill set that not everyone can handle. This is why nursing programs screen candidates so thoroughly despite an imminent projected nursing shortage.

YES! YES! YES! They speak of their faith at great length, even attributing it to their own success and the misfortunes of those who do not believe as they do; they are so sure their faith is the only "true" gospel on Earth--the very height of hubris. I remember my first month on the job. I mentioned to a coworker that "I'm glad I washed my scrubs before I watched [some scary movie] last night, or I might have been too scared to go into the basement." To which she replied "you don't need to worry about that, God will protect you." "No he won't, he doesn't exist." At this, she audibly gasped, and looked at me like I'd shot her dog. After gathering herself a moment, she said to me "you..don't say that!" Ever since, the bible thumping zealots at my job have been trying to "save" me. Thing is, I know more about their scriptures, their ceremonies and their sheep savior than they do--this is precisely why I am an atheist; there is an inverse relationship between knowledge and faith, why else would Adam and Eve be commanded not to eat of the Tree of Knowledge? I was raised in one of their watered-down collection of bible versus, indoctrination and rituals they call a religion and can carry on a reasonably intelligent discussion about it with them whenever I am confronted. I actually welcome these debates when we have downtime; there is nothing wrong with proselytizing.