Should I go to a hospital or SNF to gain more experience and skills?

FlameHeart, CNA · Nov 13, 2021

I'm not a Nurse, but currently a California Certified Nurse Aide.

Before I became a CNA, a few years ago I worked in Home Health Care in Hawaii as a Home Health Care Aide that didn't require me to have any license or registration. The company I worked for just required I have my CPR and First Aide Certifications.

I did that for 2 years and I loved that, but God was calling me to do more and so now I aim to become a Registered Nurse.

CNA School was good, but my eyes have recently become open to what it means to be a CNA for most places hiring.

I worked for 5 days in a Post Acute Facility some might call it a Long Term Care Facility or Skilled Nursing Facility or Nursing Home.

4 Days were orientation where I didn't have my own Patients and the 5th day I finally had my own Patients: 8 + 1 another CNA had abandoned. 3 were mostly independent. 5 needed their diapers changed.

I only changed 2 diapers while trying to meet everyone else's needs to. The only reason they all got changed was, because 1 LVN, 1 PT, and 2 other CNAs helped me. An 8 hour shift turned into 10 hours. This shift started in the morning.

1 of my patients the LVN showed me had developed a skin issue because they were not changed soon enough.

I realized things would be worse and even though I might have help (not always) I couldn't do this job on my own that I signed up for.

So I quit.

I did alot more research after that and realized that that facility for AM shift gave 9 patients per CNA which is the lowest amount I have yet to learn any facility give.

On average Hospitals give 12-15 patients per 1 CNA (these are sicker to and require more care) and Nursing Homes can give the same amount or even higher depending on your shift: Overnight shift gets about 2x the amount of Morning shift and Late Afternoon to Early Evening Shift get somewhere inbetween.

It's an entirely different world and mindset and focus than Home Health Care.

Inpatient Care outside of Home Health Care is all about numbers and money. They give every Health Caregiver from Doctors to Nurses to Nurses Aides far more patients than they can realistically give full proper quality care to.

It's simple logical business ethics that put profits first and product quality last. However in this case the product is Health Care. The less staff you have the less you have to pay, plus the more patients you have the more money you make, and this equation equals maximum profits.

The results are alot of patients who are not having all their needs met, they are mostly kept barely alive and largely ignored the rest of the time. There are often some patients who lay in their own feces and urine regularly simply because their CNA does not have the time to change them. Patients who do get changed are often ignored because other than feeding, changing diapers, bathing, and keeping them breathing CNAs just don't have the time to do much else.

I would say based off my research in terms of equating amount of patients with difficulty, Home Health is Easiest, Outpatient Clinics are Harder, Hospitals are Much Harder, and Nursing Homes or Post Acute Facilities are the Hardest.

The Health Care was broken by evil business administration that puts profits first and Health Care last. Doctors sometimes kill themselves, Nurses sometimes quit, and CNAs have borderline PTSD.

Read God's Hotel by Doctor Victoria Sweet to open your eyes to how things used to be and how things are now to see the sheer horror that is American Modern Health Care Administration.

This is the world you're going into as you leave Home Health Care and go into Hospital or Skilled Nursing Facility work.

Tread lightly.

I don't know much about what Nurses go through, but to give you an idea: in the Post Acute Facility I worked at a Nurse was the manager of the entire facility, we did have I think at least 1 Doctor on site, which had over 100 patients while LVNS each got 1 hallway: each hallway had about 5 or more rooms on each side, each room had usually 3 patients in it, that's 30 or more patients per LVN.

They seemed often busy doing charting and other paperwork or non-direct hands Nursing while the other times they simply gave Medications. If they were nice and made the time they might help change a diaper. We had dedicated Woundcare Nurses and Physical Therapists so a general LVN didn't do those things I think.

FlameHeart, CNA · Nov 14, 2021

You have to look at this from a realistic point of view:

You're used to caring for 1 Patient for 12 Hours right?

That means they were probably very acute needing skilled Nursing for a long time per day.

That gives you alot of experience working 1 on 1 with acute patients.

In most in patient places you will be given 5 or more patients and you'll not have time to do everything for them all so some Nurses hate it because they feel they didn't go to school just to be pill pushers as they mostly just give medications.

Depending on the unit, you could also assist in the OR, be a Wound Care Nurse, work in the chaos and fast paced and sometimes deadly world of ER, or you could go into the careful slow quiet extremely detailed and sometimes intense world of 1-2 patient ICU.

If you want to develop your skills from a Facility point of view and you can handle that your patients might die once in awhile: I extremely recommend applying for the Intensive Care Units in Hospitals.

ICUs are unique from all other parts of any hospital because Nurses are usually given 1-2 patients each. This is where patients go once they are stable enough to not immediately die transferred from the Emergency Room often without much info gathered by the Nurses working the ER because they often simply don't have the time to get any other info than what is needed to keep them alive in that moment.

The patients are stable but often not well enough to speak or walk as they may be often times be sedated (something to keep in mind if you value talking to your patients, they may be able to hear you but they often won't be able to talk back to you or communicate but remember even patients in comas may be able to hear you). They often have lots of tubes in them all over their bodies and are hooked up to all kinds of electronic machines.

This environment is not a rushed one, but the complete opposite of The ER. Simce Nurses often get 1 or 2 patients they may have their own often used Rooms that they setup before the patient gets there. Nurses here have more control more so than anywhere else in the Hospital because unlike most other places that split the medical from the ADL care giving Nurses charge ovet Medical Care and us CNAs over ADLs, here in the ICU Nurses sometimes don't even HAVE CNAs so Nurses may do NEARLY EVERYTHING for their patients including turning them, bathing them, changing their diapers if they have one or emptying their bags, doing wound care, and administering medications.

However there is far more interactions with other Health Care Professionals than there is with the patient themselves at least when it comes to actual talking. They will sometimes bring Student Doctors in to watch and learn if your hospital is a teaching Hospital. Of course the family will visit the patient, highly emotional at times. Depending on your shift and the availability of your Doctor you may have standing orders given so you don't need a Doctors written order to give certain medications if you know how to recognize when the patient needs them.

You have to almost constantly monitor the patient, because keep in mind that something going wrong with their condition can lead them Coding really fast, which means while it won't happen as often as THE ER you'll have to be prepared to give Emergency Care and bring this person back from the edge of death if you can.

And everything has to charted hourly or every 2 hours leading to alot of paperwork for each patient, this is why Nurses have to at least be present from even ADL changes they MIGHT have a CNA DO that they must SEE and CHART.

While I have never worked in a ICU, based on my research it seems to me to be the closest I could get to resemble Home Health Care in a Hospital.

This is quiet, calm, careful, calculated, slow, extremely detailed and analyzed, occasionally fast, and sometimes highly emotional environment. The hours Nurses may CHOOSE are 12 Hour shifts because they may like having that much time to do all they need to to give care to the patient. Patients may be in the ICU anywhere from a days to weeks or even a month.

However, if a family can afford it sometimes similar work can be done at home for a patient. Which is something I want to look into as a future RN who prefers the restaurant Healthcare that is Home Health Care as opposed to the fastfood Healthcare that is Hospital and Nursing Homes.

vince_reads, BSN, LVN, RN · Nov 14, 2021

Stay where you are for now. Ask questions from nurses who work at a SNF, or hospital before deciding to work in another environment. Ask them in person.

I know someone who used to be LPN/LVN here in California at a home health agency. Once she passed NCLEX-RN, she stayed at home health because she's used to it.

Do what's best for you, not what others think you should do.