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RN's average day in LTC


Hi Everyone!

As I get closer to graduation, I am beginning to question what setting I want to work in. I was wondering if you could tell me what the average evening and night (since I'll be working either evenings or pm's when I graduate) shifts are like for an RN working in LTC. Thanks in advance!


Evenings and nights in LTC will give you an opportunity to hone your assessment skills. The RN is the highest ranking medical personnell on duty on eves and nites. You will pass meds, do treatments, solve the problems for all the staff and all the residents, police the breaks, and assess those residents who present a change in condition. The shift RN in a long term care facility is the eyes and ears for the MD. It's a lot of responsibility, but such a great professional growth opportunity.


Has 18 years experience.

Depends on where you and how the facility utilizes the LPN role. I worked LTC for three years. The only meds the RN's did were narcotics and insulins after the LPN did the BGM and gave the RN a report. The RN was more of a supervisor job. Dealing with lab reports and late doctors calls, family issues, pronouncement of death. I never saw an RN with a patient assignment and the only wound care they did was on fresh wounds. The LPN did the shift care and reported any changes in condition. Our facility did not accept anyone with IVs and blood transfusions were not permitted in LTC.

My best advice is to find out what duties they expect you to perform, how long your orientation is.

Evenings/nights were a better time for newer, less experienced RN's as the days were hectic.

At my LTC the floor LPN's and RN's do the same job. Pass out pills and do Tx's and assessments on lot's of resident's. You essentially work your *** off all shift. When you think you are finally finished and almost ready to go home it doesn't happen. Five minutes before you are ready to give report and go home your CNA will say " The resident just fell and is on the floor." You then get stuck with a whole bunch of new paperwork to do-calling the doctor,notifying the family, etc. etc. etc. :angryfire

renerian, BSN, RN

Specializes in MS Home Health.

I would love to work in a SNF but am so afraid of the horror stories I hear from nearly everyone. I don't have a W wonder nurse on my chest/big smile.

renerian :uhoh21:


Has 18 years experience.

We don't have wonder nurse badges. Usually the families footprints on our backs and the caremanagers footprints on our chests!

renerian, BSN, RN

Specializes in MS Home Health.

Have you worked in LTC for very long?



Has 18 years experience.

Did 3 years and am never going back!

renerian, BSN, RN

Specializes in MS Home Health.

That bad huh? Is anyone hanging around that likes it?



Has 18 years experience.

I liked it just couldn't take the verbal, physical abuse anymore. I really miss some of my residents. I just wish management would be more supportive of their staff.

Abuse of staff in Active treatment is not tolerated. In LTC its always "the resident has dementia" "how did you approach the resident" "the family wants it done this way". Had to explain to one care manager that if the resident brought their bed from home how did it meet the health and safety guidelines for staff, would Workers comp cover my back injury.

Too many care managers are scared that the family will take Mum or Dad away and they will have empty beds. Trust me they don't want to take their relative home.

CoffeeRTC, BSN, RN

Has 25 years experience.

Okay...lets not scare the OP. I think your question was about the average shift...sometimes there is no average. I work every other weekend 3-11 shift. No administration and more lax atmosphere. :rolleyes:. We have 48 residents and normally 4 CNAs with one RN (me) and an LPN. In PA the LPNS are allowed to get verbal orders, so that lessens the load. Here is my routine

3 pm ---report and make assignments and vital sign list (sometimes the CNAs will do it for them selves)

3:30---eye ball all my residents, start blood sugar checks and meds, do mini assessments as needed while passing meds

5 pm---check vitals, chart, make calls to docs

monitor dinner trays, feed as needed (I hate feeding!)

6:30 or pm take a lunch break (I've been getting my time in!)

7-----chart, start some treatments

7:30- 8pm---start 9 pm meds, assessments, treatments

10pm--finish meds, charting and restock the med and treatment carts...

This is basic. Admissions and emergencies and replacing call offs really throw this around. I also take a short 15 minute break ot pump since I'm still nursing.

YOu have to give LTC some time for adjusting....if you don't like it....get out fast!

I am a RN and have been working full time for about 8 1/2 years. I have done acute care as in med/surg, LTC, Sub-acute, Rehab, and NICU, and now I am at a 115 SNF. I work with Many LVN's in California.

We work 12 hour shifts. In my case, I specifically didn't want the RN superviosor position (EOW and for fill in). I just have that flaw of wanting to please everyone and it's not possible.

Anyway, my advice to any new RN grad would be to really get to know your nurses. I'm ashamed to say that I supervise two RN's on days and 3-4 LVN's at any given time. One of the RN's is very thorough and a good nurse.

The other RN is basically non-motivated in regards to customer service and nursing practice altogether. I have followed my LVN's enough time that I can say with certainty that I have the BEST LVN's out there. Their assessment skills, documentation, and attention to detail are incredible. They are much more qualified than the RN I have to suppervise.

Bottom line, don't assume that the RN with years of experience working next to you is qualified because he/she has the letters RN behind their name. And, be VERY VERY good to your CNA's regardless of what setting you work. They truly are your best friend, your eyes, ears, and you will rely on what they tell you. Don't just ramble off orders of what you need (other than an emergency), but explain the reason why behind what you are doing. Teaching a CNA and encouraging them to go on to become a nurse is wonderful and I don't mean asking them to do things out of their scope of practice. You'll get much more cooperation with a CNA that comes to know that you are competant and that they can also trust you to take them seriously. I've seen nurses that just run them to the ground, treat them poorly and as if they are dumb. One example was that I had a patient that was seen by me about 1 hour earlier for meds. She seemed just fine. The CNA approached me and said "hey, there's something wrong with this patient, she's not acting like herself". Knowing my CNA, and that she knew this person very well, and that she found it necessary to let me know there was a change from the patients baseline, caused me to reassess the patient and take action. As it turned out, the patient was in the early stages of stroke and this CNA probably saved this patient from further decline because of early intervention.

Just some great words of advice and I'm sure that there are other nurses out there that share the same experiences. Other staff you work with aren't grunts, but your co-workers and dedicated health care providers. Treat all like you would want to be treated...from the housekeeper all the way up to the CEO. You will not go wrong and find yourself enjoying your work in that you've given the best care possible.

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