RN responsibilities in LTC

cjmjmom · Jun 9, 2008

You would need to check with the particular institution to really know what they would expect from you. However from what I know about supervising in a LTC facility, the RN supervisor is responsible for the entire "house", all patients and is the person whom the LPN's report to and depend on for critical thinking decisions.

My opinion about would a "new grad" fit this position is no UNLESS the new grad has a history of being a really seasoned LPN with a varied background, not just LTC.

cjmjmom · Jun 9, 2008

Oh yea, forgot to add something...When the facility is short a LPN it is usually expected that the RN supervisor either finds a replacement or IS the replacement along with supervising the rest of the "house". Remember, it is your license on the line.

2006RNCS · Jun 9, 2008

I have been there and done that. An RN, like the previous poster said, is responsible for all patients and all staff when he/she is on duty. I had the job of RN supervisor in a LTC facility for almost 5 months on third shift. I loved the job, but if an LPN called out, I had to fill in, plus be house supervisor. On 5 different occasions, I had to work an entire wing by myself and be supervisor, and that meant caring for 70 patients, and being supervisor and responsible for all employees on the shift, and 179 residents total in the facility. I made really good money, but I never slept right during the day, and I never knew what to expect when I went in.

Your LTC facility may be different. Where I worked, the DON took all call outs, and between the DON and staffing, the call outs were not communicated very well, so we would show up to work with no one else there to help. More than one nurse walked out, creating abandonment of her patients. That was the terrible part to me.

Please think really long and hard. If you get a year or two under your belt, and you go to work for a good LTC facility, then that is wonderful. Just be wary, because what you are told is normally not the reality of the job.:heartbeat:heartbeat

RNfromMN, BSN, RN · Jun 9, 2008

I'm also curious about this topic.

I'm a new grad & was just hired to work part-time in LTC. When I asked my manager what exactly my new responsibilities would be, she only told me that it would be my job to "cross all her i-s & dot all her t-s". :confused: She also told me that the place was fully staffed with LPNs & CNAs. Oh, & that it would be my responsibility to make the call on whether or not a resident should go to the hospital - but that their policy is to send residents out to the hospital even if they get the smallest of skin tears.

**BTW, it wasn't until after I was hired for this position that I became aware that LTC isn't necessarily the best place for a new grad. I had always assumed that the only 2 possibilities for new grads were LTC & staff nurse on a MedSurg floor. Had I known so many experienced nurses felt this way about new grads in LTC, I probably would have pursued the hospital route a little harder.

2006RNCS · Jun 9, 2008

I'm also curious about this topic.
I'm a new grad & was just hired to work part-time in LTC. When I asked my manager what exactly my new responsibilities would be, she only told me that it would be my job to "cross all her i-s & dot all her t-s". She also told me that the place was fully staffed with LPNs & CNAs. Oh, & that it would be my responsibility to make the call on whether or not a resident should go to the hospital - but that their policy is to send residents out to the hospital even if they get the smallest of skin tears.
**BTW, it wasn't until after I was hired for this position that I became aware that LTC isn't necessarily the best place for a new grad. I had always assumed that the only 2 possibilities for new grads were LTC & staff nurse on a MedSurg floor. Had I known so many experienced nurses felt this way about new grads in LTC, I probably would have pursued the hospital route a little harder.

I hope I didn't discourage you. I received a lot of conflicting info. from my former DON. She told me that the facility was well staffed, and that I would work a med cart very seldom, but it was almost the norm that I worked the med cart, in addition to paperwork, compliance rounds, transfers of patients, admissions, etc., and the staffing was terrible, and the call outs on third shift were awful.

We didn't send skin tears to the hospital, unless they were terrible, and there was another injury. I have really good assessment skills, with a critical care background, so I guided the LPN's in the decision to transfer pts. out. Some LPN's wanted me to assess and make the decision, others did it on their own (which I don't approve of), and the one's who did the transfer with my input, were the ones I loved!!! So many had so much more experience than me, but just needed validation that it was the right thing to send a pt out. Some nurses work great under pressure, and some crumble. I stay really calm throughout the crisis, and breath a HUGE sigh of relief afteward. If you have great assessment skills, and can remain calm and clear headed in a crisis, you will have no problem. If not, it will come with time. You know way more than you think.

You'll probably be fine. Is it day, evening, or night shift?

Good Luck!!! LTC needs really good, special nurses. Hope you love it.:heartbeat:heartbeat:heartbeat

RNfromMN, BSN, RN · Jun 10, 2008

I hope I didn't discourage you. Good Luck!!! LTC needs really good, special nurses. Hope you love it.:heartbeat:heartbeat:heartbeat

Hope I didn't come off ultra-defensive:chair:. I'm not discouraged yet...but after doing some research here on AN, I'm a bit more apprehensive about starting the job than I was before. We'll see how it goes...before I started my CNA job, my cousin (who's a nurse) told me that I would absolutely hate it, then when I got my 1st job as a CNA, several people told me I would absolutely hate the company that I worked for - it all worked out in the end. I got lucky - it ended up being a natural fit for me. I'm sooo hoping the same rings true with this position.

Not sure what my hours will be yet - will keep you guys posted, though :)

LadyJRN1 · Jun 10, 2008

Working in a nursing home is exhausting! Dealing with the families who won't or can't take care of their loved ones at home then they criticze you for what you are doing, The LPNs are jealous of the RN supervisor who has this enormous responsibility on her shoulder with a DON who doesn't support you. If an LPN doesn't show up for work you are supposed to pass meds and be the supervisor. Dont do it - you will be burned out in three months guaranteed!

Chloe'sinNYNow · Jun 10, 2008

Jessica,

I see you have 4 yrs experience. Are you a new grad RN? I am less than a yr off boards w/ 2 diff hosp experiences behind me. I'm interviewing at a N.H. Wed. I feel and have been told that I will be a better fit there.

BTW, I am also apprehensive after readng many posts on these boards. But if you read beyond just one thread, there is affirmation as well.

Good luck to us both!

Chloe

RN-BSN, BA

SuesquatchRN, BSN, RN · Jun 10, 2008

Boy, I love all of the generalizations about LPN's and aides.

And where I worked the often only person who could make the decision was an LPN because there was, in accordance with law, not always an RN in the facility. But, did you know, even we lowly LPN's are capable of enough critical thinking to say, "Whoa, that ain't right" and call the doctor.

LadyJRN1 · Jun 10, 2008

Boy, I love all of the generalizations about LPN's and aides.
And where I worked the often only person who could make the decision was an LPN because there was, in accordance with law, not always an RN in the facility. But, did you know, even we lowly LPN's are capable of enough critical thinking to say, "Whoa, that ain't right" and call the doctor.

Yes, I am afraid to say that LPN's and nurses aides in LTC are at the bottom of the food tree and my experiences with them have not been positive. Where I worked in LTC, these two catagories of workers have caused more interpersonal conflicts and issues between RN's and staff that people lost their jobs over it. I hate to say it, but LPN's and nurses aides will never be what RN's are but wish to be, and this is why they are not nice people in the working environment. Funny, I was an LPN before I became an RN and still to this day, I have never tried to cause trouble for any other nurse and this I am proud of. I have a high standard of ethics for myself and wish no grief on anyone else. :yeah:

calliesue · Jun 10, 2008

LadyJRN1

Maybe your problem with lvns and cnas stems from your own poor attitude? If you deal with people like you post about them you will definitely have problems with people who you are supposed to supervise. No one likes to be talked down to .

:argue:If you were generalizing about a race , or gender like you are about lvns you would be getting flamed all over the place.