Severely burnt out. Nursing home vs. tele unit?

**CalicoKitty, BSN, MSN, RN** · Dec 18, 2018

Nursing homes have their own stressors. Patients and families may still be overbearing and rude, and they may feel "entitled" because they are "paying your salary". See if you can shadow for a day with a nurse there to see how the day can go. Get an idea of the nurse:patient ratio, patient acuity, etc.

bluegeegoo2, LPN · Dec 18, 2018

There is no shortage of mean-spirited, overbearing and demanding patients and families in LTC. Unfortunately, they are usually there for the long haul so you will have to deal with them 40 hrs a week, week after week until they move to another home, discharge or die. That can be a very long time.

There is way more to LTC then people unfamiliar with it think. It is absolutely not merely passing meds and keeping an eye on them. Every conceivable instance has a form and protocol attached to it. The paperwork is unreal. And there is no help with that. It's all you.

For instance, someone has a small, barely bleeding scratch. Nothing major, right? Wrong. Most facilities will require an incident report with a completed investigation as to the cause with interventions put in place to prevent a recurrence. In some buildings you care plan it as well. You will also have to fill out a skin sheet, notify the MD, receive and transcribe orders. Notify family and document all of the above.

Some families flip clean out over the most minor issues, so be prepared for plenty of butt chewing and accusations. "Why is Dad ALWAYS getting bruises and skin tears? WHAT ARE YOU PEOPLE DOING TO HIM?!!" I have heard that more times than I care to count. It gets old.

Question: Am I less of a nurse than you because I worked LTC? What makes you better? Or me less than? I'm truly not trying to be confrontational. I am asking you to explore your own feelings about LTC and attempt to resolve them before you get here. If you feel that, on any level, you are above a nursing home you will not do well here. I've seen many, many hospital nurses come to LTC thinking it would be easy, only to go back to the hospital environment in very short order.

Salary varies by location, of course. My last full-time LTC job paid me $32.50/hr weekend op. RN's generally make around $5 more an hr around here. It paid the bills.

I have had to excuse myself to the bathroom to cry many times in LTC. It can be overwhelming and heartbreaking. It's very difficult to tell the spouse/kids of a patient that you've had for months/years and have a great relationship with that their loved one has died. It's hard to sit there and hold their hand as they take their last breath. Especially the ones you've grown fond of.

All of that being said, there are many wonderful, awesome patients and families and it can be a very rewarding environment in which to work. It really depends on your attitude towards it.

One last thing. If you've carried depression symptoms since before becoming a nurse, I can't encourage you enough to seek help with that. A change of venue won't fix it.

Best of luck to you.

37changes, ASN, RN · Dec 18, 2018

Re: pay -- that depends on your area. Here, LTC pays better than the local hospital, for sure.

I'm a new grad with only experience in clinicals. But I can tell you that I am headed to the world of LTC with a pretty good idea of just exactly what I'm getting myself into ~ and "less stress" or "nicer family members" is not on the list of pros for me.

I have a deep respect for the nurses who care for this population day in and day out. I think it is a job where you are (generally) overworked, under-appreciated, short-staffed, and often subjected to unreasonable demands and expectations from management.

Spend some time reading through the LTC forum here. If you see all that I've seen, if you read through it all and still feel in your heart that it is the direction you want to go ~ then by all means, go for it. But please, don't head to LTC without a clear picture of what you are getting into. I don't believe you have that clear picture just yet. If you did, you would not even ask the question about being "less of an RN".

Been there,done that, ASN, RN · Dec 18, 2018

See the many threads here about the first year and view the First year of Nursing forum.

You have that golden year of experience. Stop crying and market yourself to a better position.

Moving to a nursing home would be .. out of the frying pan and into the fire.

You are going to apply to a nursing home, yet you ask us..what you will earn? Do your research and make a better place for yourself.

caliotter3 · Dec 18, 2018

Previous descriptions of the environment are very accurate. Just wanted to add that you are responsible even if you have, say, four assigned nursing assistants, and on any given shift three of the four spend their time hiding from the residents and hiding from you, instead of doing their jobs properly. I can assure you that you can't do your job as well as the jobs of the CNAs simultaneously. In every single LTC facility where I ever worked, administration would do absolutely nothing about insuring that high quality work was performed at that level. They just blamed the nurses. That won't go well for your attempt to decrease your own stress level.

esrun13 · Dec 19, 2018

I can confidently say I believe LTC would be more stressful than a hospital job. More patients, still tons of responsibility and families who are stressed out, still difficult politics and even less management support. If you want less stress, consider a doctor's office. It's busy and there's still a lot at stake, but ultimately it's less chaotic and patients and families are not (AS) high strung...therefore, you're unlikely to be, either. You have one year of experience in a hospital so at this point you have tons of options...go to a LTC if you're passionate about it, but definitely not because you think it will be less stressful.

Also, I agree with the previous poster regarding depression...prioritize your mental health or you'll never be able to fully function as the best nurse you can be, regardless of the setting

anewsns · Dec 20, 2018

I'm really sorry to hear you're going through this. I personally prefer tele to nursing home. I found families at the nursing home to be more overbearing and disrespectful and it really burned me to the ground. 28 pt Med pass is no joke. I was always there 1-2 hours late and never got a break. I got NO respect from administration or management, they don't care about you at all. I've heard this same story from ALL of the nurses who did LTC (different facilities.)

I do however recommend acute rehab. You get 6-8 patients and it tends to be a "happy" setting as everyone is improving quickly and planning to go home. You maintain your acute care skills too. It's acute care lite. I found that population was more upbeat, respectful , and thankful than nursing home. I disliked the rehab side of my nursing home due to culture so still always worked LTC side, though many prefer rehab side (13 low acuity patients). I could go on and on about why the LTC system in this country is absolutely disastrous. If I ever go back it's going to be with a vengeance and in a position to push for many changes.

I hate to discourage you but want to tell you the truth. Of course you may be a better fit than me in LTC. It's a different kind of stress.

does this make you less of an RN? That statement makes me cringe!!!!

the answer is no, it doesn't make you less of an RN- but a lot of people will look down on you. Your comment implies you're a person who looks down on LTC RNs- Be prepared to deal with people like yourself looking down on you.

Glycerine82, LPN · Dec 22, 2018

I've been an RN for one year.
I've been working on a cardiac tele floor for ten months.
I've been depressed and anxious about work ever since starting, and it hasn't improved. I deal with mean spirited patients and their over bearing families. I bend over backwards for my patients and I feel like they spit in my face each time.
I cry almost every day. Therefore, I've decided to apply at a private nursing home. I'm starting to think the hospital isn't meant for me. Does this make me less of an RN? Will I still earn enough to live?
I'm so stressed and depressed, it's unbelievable! I thought all of these miserable feelings would go away once I obtained my nursing degree.

There are many avenues in nursing and there are many types of nurses. Trying out different areas and eventually choosing one that fits you best does not make you (or anyone else) a better or worse nurse. Each area of nursing has it's own sets of complications and utilizes different parts of our skill sets and theory. Being a nurse in a SNF is not easy, it's also a total blast for some people (ahem - me). Others have a harder time with it and thats completely OK.

brandy1017, ASN, RN · Dec 22, 2018

I would look into finding a clinic job that would probably give you the best quality of life and less stress. The nurses I know that work in the clinics are the happiest and the worst thing they say is sometimes it is boring. Well boring is not stressful, right!