Role of an RN in long term care facility

NOADLS · Oct 28, 2015

I know every facility is different, but generally speaking, what is the role of an RN in a long term care facility? I was just offered a job in a LTC facility, and I go in on Monday to start getting processed into the system. During the interview I was so nervous that it completely slipped my mind to ask specific job details. I will ask specifics on Monday, but I'm just curious now. I did a clinical rotation at a ltc facility during school and, from what I saw, it was mostly the LPNs and CNAs running the show. I only saw an RN every now and then. Not to imply that they didn't do anything or have any purpose, but I just didn't see them much. I'll be working a 11pm-7am night shift, and I assume most of the residents will be asleep during the majority of my shift, so I don't really know what I'll be doing, lol.

If you're in a spot like mine, you'll have it easy. Maybe an hour's worth of work at most.

I used to bring my laptop to work and play candycrush which eventually got boring, so I enrolled for my NP and do my coursework at work.

It will largely depend on whether or not you'll have nurses working underneath you and management's attitude towards workload distribution.

Nurse_CrystalRN · Oct 28, 2015

Since I'm enrolling in a program to finish my BSN in the next couple months, I'll have plenty of course work to keep me busy through a boring night shift I'll also occasionally be covering for a 3pm-11pm shift, and even then I can't imagine having much to do. Maybe help pass out any evening meds, do some charting, and then have nothing to do after everyone goes to bed?

NOADLS · Oct 28, 2015

Since I'm enrolling in a program to finish my BSN in the next couple months, I'll have plenty of course work to keep me busy through a boring night shift I'll also occasionally be covering for a 3pm-11pm shift, and even then I can't imagine having much to do. Maybe help pass out any evening meds, do some charting, and then have nothing to do after everyone goes to bed?

Typically you will have one of two scenarios.

1) You are in charge. You will look after the sick patients while the floor nurse will be passing meds. You might have some other duties like performance evaluations after being employed for a certain period of time. One of the more dreaded things that can happen is an admission. This will eat up a good chunk of your downtime.

2) You are the floor nurse. Your primary duty will be passing meds and performing treatments (ie. dressings). This means that downtime will be limited to the last few hours of the shift.

You could also be a floor nurse and in charge at the same time. I've seen some posters on here tell me that this typically means you'll have a lot more on your hands. I've been in this spot a few times and it is still doable.

mtjoanna · Oct 28, 2015

I work nights at a LTC in a small town with a typical census of 45-50. I'm the only nurse in the building from 1800-0600 which means that I cannot clock-out for a break. Ideally, there are 3 CNAs on the open unit and 1 in the SCU (special care/dementia care) until 2200 when the noc shift arrives and ideally I have 2 CNAs on the open unit and 1 in the SCU. On nights when I'm fully staffed, I pass meds and deal with emergencies (falls and such) between 1800 and 2130 or 2200 depending on how many emergencies occur (sometimes they don't!).

Then I start on the treatments--wound care, perform and chart rehab assessments, Foley catheter changes, admissions or readmissions (such as from a hospital visit post surgery), etc. Typically, I then check in and then order medications for the entire facility, enter rehab orders, double check (and often fix) computer orders; daily charting, once a week do weekly charting on my assigned residents, behavior charting, check for labs and appointments the next day and prepare the paperwork for all, monthly order checks, clean and stock the med and treatment carts and do daily paperwork (daily assignments and such).

On nights like last night when I have a CNA call in 20 minutes before her shift, I also spend time helping the remaining CNA with rounds, help get a resident showered and a room cleaned after an explosive BM, break up altercations in the SCU between the new male resident and the aggressive alcohol-dementia resident that is certain that he is in charge of the unit, cover the floor while open unit takes lunch and then cover the SCU while that whiny, dramatic CNA takes a break.

It has been a long time since I have had time to read a book during my shift and am usually eating lunch at the desk while I work. I do try to stop long enough to enjoy a cup of my favorite coffee at least once a night.

BrandonLPN, LPN · Oct 28, 2015

Pretty much what everyone else said.

The key here is knowing whether they're hiring you as a floor nurse or as some sort of unit manager.

If you're being hired as a floor nurse, your role at the facility won't really differ from the other nurses on the floor, including the LPNs. You'll spend most of your time passing meds, changing dressings and assessing sick residents as needed. The vast majority of your day will be bedside nursing tasks followed by charting on those tasks.

If you're hired as something more along the lines of a unit manager, you won't normally deal with the day to day meds or treatments, you'll be putting out fires, attending meetings, auditing charts, following up on falls and on new admit paperwork. It's not so much a bedside role as the floor nurses, obviously.

And it should be added that you shouldn't assume a "charge nurse" job title indicates you'll be more of the unit manager type of nurse. In the vast majority of nursing homes ALL nurses (again, including LPN) are "charge" nurse by virtue of being the only nurse down their hall. Theres usually some sort of clear distinction with floor nurses being called "charge nurses" and unit managers being called "clinical delivery supervisors" or whatever the mot du jour is.

TheCommuter, BSN, RN · Oct 29, 2015

I once worked as an RN in LTC. Since I worked for a very profit-driven company (read: the big 'K'), I was the night supervisor as well as a floor nurse. I was responsible for supervising the LVNs and CNAs as well as administering medications and treatments to my group of residents.