Updated: Jun 13, 2022
Published Jun 10, 2022
I’m a CNA. I only have hospital experience (Tele-Step Down) but have been away from the hospital since 2019. I decided I want to go back into healthcare and applied to a nursing/rehab facility with a big sign on bonus. I’m freaking out because my orientation is on Monday and I’m already having all sorts of awful feelings about this. So much has happened in healthcare since I’ve been away and hearing about people losing their licenses has me afraid to go back. My goal is to apply to nursing school sometime next year. I thought getting back into the field would be a good start. How do you all manage to cover your butt in a nursing home facility? Should I tell the facility that I’ve declined the offer? I have no long term experience and I’m terrified! A part of me thinks it could be a good learning experience but the other part has my stomach in knots and says run…
Michelle Csergei, BSN, RN
While I am not a CNA, I have worked as a nurse in skilled/rehab/LTC for about 7 years. Nursing homes have been hit hard during this pandemic and they are the most regulated type of healthcare facility. It's a different world then it was a few years ago. I know the patient load can be high at times, but a lot of this depends on the facility you work in and how much support you get from your team. A lot of people love working in long term care because they can get to know their patients and have some more routine to their day. A lot more residents need more assist on LTC than when I first started. So there are a lot of people that need lifts or 2 person assists. I used to work the skilled unit because I liked the different challenges and seeing people improve and move on. Your patients tend to be more mobile so you will do things like help them walk. You also work more with other departments such as Rehab and social services. There is a lot more opportunities to help patients with therapy and exercises so it tends to be busy. Most places have 8 hr shifts, so that can be a bonus if you prefer that to a 12 hr shift. I think too many places have raised wages to be more comparable to hospital pay.
I personally believe every RN/ LPN should start as an CNA as it gives you an understanding of the essential work other people on your team are doing are doing and it really helps with your initial basic skills.
I worked in LTC a million years ago when I was a student. The first facility was awful, the worst and had me considering dropping out of school. The second was amazing and to this day one of the best jobs I have ever had. I would say give the job a try. If it is awful, resign and look for something else. If it is good or great, perfect!
Sign on bonuses always make me a little wary. Be sure to ask for a written copy of exactly how / when the bonus will be paid and conditions that are tied to it. Do not let anyone tell you some nonsense that there isn't a written policy or you wouldn't have to pay it back if you left before X months/ years. I have heard both of these recently. If they do try to feed you this have them confirm it in writing (email) that you are not required to pay it back if you leave and keep a copy of that.
These days I always make a copy of all HR documents I sign during hiring/ orientation - holiday requirements, policy on calling in sick (punitive policy) notice to resign and anything related to the bonus and I can promise you paperwork will magically appear once you have accepted the job and are filling in a mountain of other bits of paper. For some reason I have never understood, these policies are routinely quoted at you but written copies of them are surprisingly elusive after the first day. There are plenty of free apps for you phone that will convert photos into a PDF, have one downloaded and ready to go.
Best of Luck!
Been there,done that, ASN, RN
Ask to shadow for a day. Should tell you everything you need to know.
What about the job scares you? We all know it’s different strokes different folks. Try for yourself it may be new and different or could be completely dragging sadly most of those places in California are outdated never had any work done on the properties needing repairs a complete makeover and we see a rush of wealthy doctors who have come in groups massive wealth like those week long wedding wealth and buy the nursing homes go around the unions to not pay and drag them down they are pulling out all the money and sadly it called some word that’s very insppropriate leave that to ask you is that OK or not? I don’t see anything wrong with it but again I’m not the one who put in the hours u know. It’s better places that provide quality care. If your just getting some experience and building your skills and maybe to get familiar to chart and do vitals like faster why not however use the help your back is your money and if that goes out your done
research the owners for yourself
A huge sign-on bonus should be a red flag, if other local employers are not offering the same. It doesn't necessarily mean it is a terrible place to work but I would ask questions and try to talk to a CNA who works there before taking the job. Is your goal to work in LTC once you become a nurse? If not, I would avoid being swayed by the sign-on bonus (unless you really need cash fast) and try to get a job in whatever setting you eventually want to work in as an RN. Long-term goals are more important!
As far as being freaked out, I would try not to worry too much. If you really hate it there, you can just quit and give back the sign-on bonus. As a CNA, you're not licensed anyway (you're certified), which means you have pretty much zero liability - everything you do falls under the supervision of a licensed care provider.
Personally, I would never work in a SNF. They are notorious for having horrible working conditions and super unsafe staffing. Plus they are just kind of depressing... if you're interested in LTC, maybe consider assisted living? I did that for several months in a memory care/assisted living facility before nursing school and actually really enjoyed getting to know the patients there.
kbrn2002, ADN, RN
Working in an LTC is all about the facility, the management and the staff. If it's good it can be a great place to work. If it's bad it can be a terrible experience.
There's really no way to 100% know what kind of experience this facility will give you unless you try it out. My advice since you've already accepted the position and have your start date soon go ahead and try it out. Give it at least a couple of weeks, that'll give you a good enough idea of how the place is run to know if it's worth sticking with.
If you decide it's not for you, go ahead and quit. No harm, no foul as I would imagine they don't pay out the sign on bonus immediately anyway. No need to feel guilty either if you decide to leave. Turnover in all areas of health care is fairly high and LTC may have the worst turnover rates of any health care job. A decision to leave wouldn't have any kind of negative impact on future opportunities as long as you give proper notice.
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