RN considering LTC

suebird3 · Jun 7, 2006

Hi! My Facility has 120 patients; 2 nurses split the Facility, 60 and 60. That is NOT saying YOU will have that many patients, though! My place is non-Medicare. You would be responsible for med pass, TX (if there is no TX nurse), taking orders, GT feeders, and of course....charting.

It IS do-able. Yes, I whoop and holler at times, but it comes with the territory. No, wouldn't trade the job, either. Nothing beats giving a "rezzie" a sucker, and hearing them say "Yum! Thank"...even if you did get an earful from said "rezzie"!

And interruptions ARE somewhat the "norm". Makes for an interesting shift.......

Suebird

Nascar nurse, ASN, RN · Jun 7, 2006

You will love it or hate it. Seems that rarely anyone is neutral. Lots of hard work and LOTS of regs! As far as losing your skills, I'm sure you may lose some, but on our skilled units we have several at any time on IV ABT, wound vacs, extensive wound care, tube feedings, trachs every now and then, multiple diabetics, CPM machines...etc. You will definately learn time management and organization if you don't already have that mastered and that should be a HUGE advantage anywhere you go in the future. Can't hurt to try! Good luck

weetziebat · Jun 7, 2006

I currently work Assisted Living and, in my many years as a nurse, have worked in other LTC facilities as well. Personally, I hate long term care.

The residents are wonderful, but for nurses you get too caught up in all the meds, treatments, answering phones, taking and sending faxes, arguing with the pharmacy, having to work OT cause everyone seems to call in a lot and, in general, not having any time to spend with the residents cause there are too many regs, and far too much paperwork.

No one seems to care if the residents are cared for as long as the paperwork is done.

This has been my experience, and for a new grad, I'd say stick to the hospital. Considering your well documented illness, perhaps your present unit will be understanding. I mean, why fire someone who was really ill from a job where you were doing well and loved it. I'd stop by and talk with them and find out where you stand before looking at other options.

Good luck and let us know how it turns out.

Daytonite, BSN, RN · Jun 7, 2006

as an rn you will most likely be put on the medicare wing. you know those patients that got discharged from the hospital that everyone felt weren't ready to be discharged? guess where most of them go? medicare wings in ltc facilities. most of the places i worked tried to get the medicare patients that were recovering from hip and knee replacements that mostly needed physical therapy as they are easier to take care of. however, when i worked medicare wings i had patients who were on peritoneal dialysis, had picc or hickman lines and needed iv antibiotics and blood drawn, people who had extensive dressing changes for infected wounds (often mrsa) and decubitus ulcers, g-tubes and tube feedings, c-diff diarrhea from all the antibiotics they had in the hospital and all kinds of cardiac and lung problems. there were a lot of orders for labwork and medication changes that had to be done. i was constantly calling doctors to notify them of lab or x-ray results, changes in patient conditions or asking for medication changes. specific things have to be charted to prove they are providing skilled nursing care to these patients so medicare pays the facility. so, i had to know exactly what was qualifying each patient for his or her medicare stay at the facility. i worked closely with the mds nurse because she had to file the first mds report to medicare within 15 days of the patient's admission and knew exactly what was making the patient eligible for this medicare benefit. because the facility is paid one lump sum for these patients and they have to pay for all the patient's needs from this money, these facilities are usually very tight about the supplies and medications these patients use with leftovers being returned to suppliers for credit after the patients are discharged. most facilities who handle large amounts of medicare patients will have one or two rns who have been trained to know precisely what qualifies a person for medicare skilled coverage and what doesn't. if medicare ends up denying the facility payment for some reason, it is the facility who eats the loss, not the patient. so, the facilities who take in medicare patients are very vigilant of what is going on with these patients.

i don't want to scare you, but i've always been a bit of a workaholic and worked plenty of med/surg and stepdown. i've never worked harder than when i worked medicare wings in nursing homes. they were very exhausting for someone like me who followed up on every phone call to a doctor, signed off and made sure every telephone order i wrote was carried through, notified the patient's family of order changes and that every patient got charted on very thoroughly (head to toe assessment). i generally had 12 to 14 patients to care for. cnas did the basic nursing care, but i had plenty to keep me busy. it's likely you won't see many doctor's. most of your contact with doctors is by fax messaging or talking with their office nurses. in addition to all that you will most likely also be responsible for passing all the medications and doing all the treatment on these patients.

aandersonrn · Jun 7, 2006

I have worked in long term care as a housekeeper, then CNA and then through school as a LPN and RN. I absolutely love it, as a nurse manager we are small enough that I know every nurse and their children who sometimes come to visit our residents. And when my allergy to latex progressed and I was going to have to change jobs to a hospital for a safer enviornment, the LTC agreed to make the switch. I was exstatic, I did not want to work in a hospital. Yes sometimes it hurts when you have known a resident and seen them every day for years and then they pass away. But at least you knew them and you can share stories with the vetrans. Like remember the day she pulled the fire alarm and when you saw her she was just clapping her hands and smiling and all the rucus. Those all 60 residents are the reason that I am still there. Interuptions are just the norm you just make a lot of lists. I hope you come over to the geriatric side

catlady, BSN, RN · Jun 7, 2006

Sadly, on a subacute unit, it's like being on med-surg---except you have 20 or 30 patients. The last unit I worked, the nurses routinely were there 10 to 12 hours every day for their 8 hour shift, just to try to get everything done. And not everything got done. A lot depends on how much support is there. If you're doing it all--and some places expect you to do it all--you'll drown.

I have plenty of LTC experience and certification in gerontology and I'm going back to acute care. Less stressful...

2real · Oct 19, 2006

Can someone please give me the job description for ltc DON ? I have been asked to interview and consider this position. While in a Hospital HR dept, applying for another , totally unrelated position. I have 23 yrs of rn experience. Varied alot for awhile, but settled into ER medicine for 15 or more years. I mentioned that I am intent on returning for bsn asap, and feel qualified to teach, or manage the newbies coming in. But I'm not sure which road I want to go. l figure it out in school , which way to go. Then , possibly on toMasters if bsn isn't too much BS!

They tell me I am qualified through my many years of experience and good practice. And that I would have an opportunity to both teach staff , and manage staff. Then I will be experienced when I graduate, and can choose best direction for myself then! Is this do-able? Learning DON position and going to accelerated rn-bsn program? I don't completely understand the job description. Why does there seem to be such a huge turnover of DON's and ADON's in LTC?

I'm afraid this will possibly hurt my career rather than help it?Where does an older(48) nurse go to retire from the stress and aggravation of ER when they're MAXED OUT? I'm also interviewing for PAT 20 hrs a wk . And ENDO lab 20 hrs a week at my present job where I work in ER. TheyHave great tuition reinbursement. Will the DON job be well over 40/week, and if so, do you get comped later for it? I still want to have a life, but I want good monety too! What are you DON's opinions on your job satisfaction, and life balance?

banditrn · Oct 19, 2006

I've worked nites in LTC for about 6 months, after years in a hospital. I've seen our day nurses job, and I wouldn't have it. Seriously. They work her like a dog, and she's looking for something else. It will be a shame, too, because she's a darn good nurse.

I don't believe all places are like this one - we get no support from administration, and a lot of the nurses are ready to leave. The part time day nurse just quit, and the other nite nurse is as fed up as I am. I'm going to interview for another job today.

The bad thing is, that I've grown so fond of some of the residents there - I'm torn, because I don't want to feel like I'm abandoning them.

banditrn · Oct 19, 2006

Sorry, I feel like I didn't answer any of your questions before, so I'm going to add some more.

I worked for some of the best nurse managers over the years - and a couple of the worst!!

The best ones got out among the 'people' and knew what was going on - the worst sat in her office, made policy without any knowledge of how things really worked.

The DON we have now is a young girl who seems to think this all some kind of game - she seems to know a lot about the rules and regs for medicare and such, which I don't. But she is totally non-supportive of staff - her typical answer is 'just deal with it'.

This home will accept ANYONE without thought to whether the staff can handle them or not - and we've had some doozies in the past 6 months.

Right now we have a trach patient - it's an old trach, and we were told that the patient does most of the care herself - 'just might need a little assistance'. Right!! She's confused, and pretty much total care - whenever you go into her room, you can pretty much plan on spending an hour.

We have NO P&P in place for trach cares, and none of the supplies that I was familiar with at the hospital. I finally took the catheter and soaked it in soapy water the other nite to clean it. They were telling them to just rinse it with tap water after they were done with it.

And we always have the other 36 patients to care for. Nope, it's not low stress.

Cowboys_RN, BSN · Oct 19, 2006

I came here to post a similar question. My heart is in gero as I have always volunteered in LTCs and love my gero pts. I'm in my 3rd semester and my instructor is recommending I go to work at a place right by my house after I graduate. It's a "continuing care retirement community", it's independent living to assisted living to skilled nursing. Every time I mention I'm interested in gero to a med-surg nurse they tell me I'm crazy. They said it's all paperwork and care planning. I know I don't want to work in acute care, but wouldn't be happy doing all paperwork and not spending any time with my pts either. The only other units that have clicked so far are postpartum and OR. I'm trying to figure out what the role of the RN is in assisted living or skilled nursing. In all the LTCs I've been in here in CA the LVNs do all the meds. I haven't been able to figure out the RN role.

santhony44, MSN, RN, NP · Oct 19, 2006

Ask if you can come in for a day and job shadow to see what the job is like. That might help you make up your mind.

If you do end up losing the job you're in due to your health, reassure prospective employers that your health is now good (it will be, when you get over the pneumonia). They are going to want to know that your health problems are not chronic and are unlikely to cause you to lose work time in the future. You don't necessarily have to tell them exactly what you've had if you don't wish to, just explain that you had two unrelated back-to-back acute problems that are unlikely to recur. (I know after being treated for hyperthyroidism you may end up hypothyroid but that's not something that usually causes people to miss work).

Also, before you take a job an hour away consider how much commute time that involves. It's ten hours a week, and you need to think about being away from your family that much longer. (That's besides the cost of gas and wear and tear on your car).

Good luck to you!