Should I take this position?

[luvmydogs84]

Hello, I may sound like a broken record but I've seen so many threads about new grads not being able to find jobs. I just graduated in May, took NCLEX mid July, and received my license mid August. I started applying to hospitals around my area as soon as I found out I passed NCLEX, so since mid July. I know it hasn't been all that long yet, but I have heard nothing. I know someone who has worked at a particular nursing home/rehab center for at least 10 years, she's an LPN, and she has gotten ahold of me to see if I'd be interested in a position at her facility (she said her administrator wanted her to ask me). I was very grateful for that but at the same time I thought it was a little sketchy because the administrator was seeking me out and not the other way around. Well I decided to go in for the interview. Everything went well, everyone was very nice, the facility was clean, and now I'm considering taking the job. My rationale is that I'm scared if I wait any longer for a hospital to call that I'll be waiting for months and months like I read so many other people doing on here. Advice from friends and family have been to take it and work there for several months or so until I hear from a hospital, any experience is better than no experience.

My question is do you think I would be making the right decision? The administrator said orientation is about 3 weeks or so, depending on what I may need (which seems very short), she would send me to an IV class, and I would be orienting with an RN and LPN. My biggest concern is that she said usually the facility has 3 nurses in the building per shift. 115 bed facility. I asked her how many RN's on each shift she said at least 1 or 2. And I would be working as a floor nurse. Well if it's only one on my shift then that would be me, by myself, with 2 LPNs (I'm assuming AFTER my orientation). This is what scares me about taking the job. Isn't that a little scary to have a new grad as the only RN? My gut says yes but the LPNs I would be with have years and years of experience. Does that matter? What is the usual staffing at a nursing home as far as RN's go..is it usually just one? I hear alot of new grad RN's starting in LTC so I'm wondering if it's the same. What would you do? I don't think a new grad by herself (being the only RN I mean) is a good idea, but then again I have no experience with this so I just need some advice from you all. I would really like to take the job but I do not want to risk my license. Thanks.

[Zookeeper3]

please know, many in your shoes have done just that, it was hard and they did and became excellent nurses. I've never done it... I personally envy those nurses because I won't... it's crazy as a new grad it's too much and run away. You don't need it that much.

Now, reality, those whom have done so can hopefully give you guidance... I say "hell no" I'll eat mac and cheese.

[mazy]

Everything sounded absolutely amazingly wonderful until you mentioned the staffing ratios. Three weeks of orientation is fantastic for LTC...I got 3 days as a new LPN grad, the first day the unit manager handed me a patient chart and told me to read it because "that's the way we do things here," and the next two of those days the charge nurse told me to work the cart by myself and come to her if I had any questions. Then she disappeared.

I ended up staying two years -- learned a ton but was so stressed out I felt like something was trying to claw it's way out of my stomach, ala "Aliens." I think I still suffer from some low grade form of PTSD.

Are you saying that there are only 3 nurses in the building for 115 patients? Are there different units with 3 nurses taking care of a smaller amount of patients or is this really 3 nurses and an entire building of 115 patients?Is this on all shifts or just for night shift. Night shift I can see happening, but during the day that's not enough...well, a lot of places do it but it's not adequate.

If it's an skilled unit nursing ratio I would say run, run, run, do not pass go, do not collect two hundred dollars. If it's LTC it's still pretty bad and I would have some serious concerns.

What is the CNA staffing like? If you have that few nurses you are going to need the help of a lot of CNAs.

I'm also not clear on something, are you an RN or an LPN? I got the impression that you are an RN, but not understanding why you would need IV classes.

It sounds like a very difficult but all too common work environment for LTC. But the reality is that hospital jobs are hard to come by and if you hold out for that you might be unemployed for a long time. Ultimately, it's your decision. Are there any other possibilities in your area? What kind of support system do you have financially?

I wish I could offer better answers.

[TonyaM73, ASN, RN]

I agree with the above. The staffing ratios are too high. If you have med techs passing the meds, then maybe, but to medicate around 40 patients during the day and still stay within your 2 hours for a med pass, I would say that is near impossible even for the more experienced nurses. As a brand new grad, it is totally impossible. I was in the same position last year when I graduated. I started at a LTC with rehab. The ratio was 30-1 for LTC and 20-1 for the rehab side. Even with that it is very difficult to get everything done especially when/if you have someone going down hill or you have an incident or an admission. If is really is 40-1 with no med tech....I would run far and fast!!!

[luvmydogs84]

Thanks for the replies. I'm an RN. According to the administrator she said about 3 nurses per shift. I'm going to clarify that once more with them because I do believe that is a little ridiculous, and scary. But the whole building is not skilled, just one part of it. It is a nursing home AND rehabilitation center. I looked at the Dept. of Public Health website and it says this facility has 1 DON, 6 RN's, 9 LPN's, and 24 CNA's employed. BUT that was last reported in 2006...

[realitycheck1]

LTC with skilled and rehab patients is he worst nightmare job in nursing for floor nurses and aides. It's where you would be exploited the most. The secret is that such facilities open skilled and rehab floors within nursing homes, but still operate as nursing homes as far as patient-to-nurse ratio. In a rehab/skilled hospital the ratio is 6-8: 1nurse, perhaps up to 12 - the most. But when the LTC are hiding under the nursing home ratios, but actually doing post acute rehab (with nursing home ratio) - I believe it is exploitation of nurses. I am talking from experience and would never ever work in LTC again, and would not recommend to anyone.

I couldn't sleep well for 2 years while working there. During the 12-hr day shift I was working a rehab floor of 24 patients (4 hours of a morning med. pass, being constantly interrupted by all kinds of phone calls from families, labs, other facilities, constant admissions of new residents, discharges, charting, incidents, emergencies). Often I felt as I was a doctor, instead of an RN, because doctors were coming 1-2 times a week, and it was up to me - the well-being of my patients. Too much? The unit managers were there, and seeing nurses running like crazy for work to be done - they were giving us more to go. They were having a good time, talking, relaxing, laughing, and trying to find faults with is. Often I felt as I was in a frontline war zone - from the stress, responsibilities and the enormous workload --- working in a skilled/rehab nursing floor of an LTC facility.

As the government cuts $ in healthcare reimbursement - the exploitation of nurses and aides increases, as facilities are trying to profit, stay in business by working us very dangerously short staffed. You can try, you may have a better luck and will gain experience. But it also can be your worst nightmare, especially at the present time.

[mazy]

I looked at the Dept. of Public Health website and it says this facility has 1 DON, 6 RN's, 9 LPN's, and 24 CNA's employed. BUT that was last reported in 2006...

The Dept of Public Health website will also have a full listing of all complaints and occurances for that facility and you can get a sense of all the issues and problems that are going on there.

But from what others are saying it does sound like a very bad situation -- without even knowing any of that.

[luvmydogs84]

Ok I have a correction- I spoke with the lady and she said they haven't had over 100 beds in YEARS. I got the 115 bed from the Dept. of Public Health website which has not been updated since 2006. So hopefully (if anyone even sees this)....does that make it any better for me? She said there are 3 units- side 1 has up to 36 pts, side 2 has up to 38, and side 3 which i'm assuming is the skilled unit has up to 20 pts (only 11 pts currently though). I would be assigned to one side each shift. BUT, I would still be the only RN...which scares me since I'm a new grad. Hopefully everything happens for a reason and I make the right decision. Sorry for the confusion and thanks again for everyone's thoughtful replies.

[wanderinrn]

My first job as a new RN was in a large LTC facility. I applied for a position posted for RN with 2 yrs exp for a 'sub-acute' unit that was just getting up and going there. I was told (while being interviewed for the positoin by an LPN) that since I had no exp and this was sub-acute unit & was 'new to them, too', they really wanted RN's with exp. BUT, they would like to offer me a position as House Supervisor....midnights no less, where I would be the ONLY RN in the building, of 100 + patients, well over, in fact. Anyway, to make a long story short, I took the position, as I was in rather dire straits financially. It was SO stressful. I remember sitting in the parking lot and feeling so nervous I was nauseous, and just praying I would be able to do what I needed to do and have the knowledge, etc to handle whatever would come up. Within 6 months I was the NURSE MANAGER on the sub-acute unit, and all 3 of my team leaders, day, eve, night, were new grads! I ended up being there 18 months, but was so consumed with paper work, and the only way I was getting any skills was just by going out on the floor and 'helping' the LPNs and CNA's which the DON and ADON frowned upon if they learned of it. 'You have staff to do that'. Oh, forgot to say, too, that my primary 'preceptor' (and I use the term loosely) was an elderly LPN who was known to sneak off and sleep in med recs! On the other hand, I had several seasoned LPNs that were of much help to me! Good luck whatever you choose to do.

[nursynurseRN]

I would take the first job offered to me if I had no job. You can wait and see maybe if someone else will call. Take the offer and run. If something comes later if you absolutely hate it there then take. Give it a chane. Its a great way to get your feet wet. Just don't get stuck if its not where you want to be. GOOD LUCK

[tex-anna]

Just something to think about... I have been a nurse for 17 years. After about 5 years I did work a LTAC unit that was much better staffed than the one you are considering. Are you handing them your license on a silver platter. Will you go home everyday feeling that you did the best job you could? Or will you feel like you could have done more given appropriate support from your facility? I am afraid that in this situation you will see a high rate of infection and staff burn-out. These situations lead to bad habits b/c you tend to cut corners to get things done. How would that make you feel about your care? Just some thoughts. Hang in there. There are good jobs out there for new grads. Have you considered re-locating?

[RNASHLEY]

I don't have a whole lot of time to reply as I have got to get my little one to bed but I can tell you that i just graduated in May and took Nclex in June and have applied EVERYWHERE. If I were in your situation and you can afford not to take the job and keep looking than do that. However, all jobs regardless of what they are will help you gain experience to get a better job in the future. If it were me, because I need the money and the experience...I would take the job.