Skilled nursing in a hospital

[prinsessa]

I currently work on a skilled nursing unit at a LTC facility but I may have the opportunity to work at a skilled nursing unit in a hospital. Has anyone worked in skilled nursing in the hospital setting? I really like my skilled nursing unit but we have way too much to deal with. Besides passing meds for up to 25 patients we also have to make doctors appointments, schedule transportation, answer the phone, etc. I just feel like nurses are stretched way too thin in LTC. And then if I am the only RN on the floor I am responsible for doing all the IVs. The only thing keeping me here is my residents. When they tell me how much they missed me after I was off for a couple of days, I really feel like I am doing something right.

[CoffeeRTC, BSN, RN]

I've never worked on a hospital skilled care unit, but I think it would be a good opportunity. As long as you get more support (a unit clerk, etc) I would think it would be good experience and you would be in the hospital system so if you decide to go Med Surg or something like that, you might have more of a consideration from HR.

[debRN0417]

I worked on a skilled unit in the hospital. Most of the residents we cared for were 20 day short-stay Medicare recovering from hip or knee surgery. There were other residents there as well, but mostly orthopedics and it was rare that anyone stayed beyond the 20 days. I was the charge nurse and was responsible for meds, IV, calling docs, taking off orders, treatments, assessments, admissions, wound vacs, CPM machines ...and on, and on and on..... The majority of the residents were alert, oriented and pretty able to function, so that is why they were primarily short-stay. I had one LPN and 2 CNA's on the night shift and I usually did all the meds and treatments so that the staff were able to answer lights, get vitals, and do other things for the residents, and when I worked evenings, I had 2 LPN's and 3 CNA's. Usually our census was around 20-25. We also had what was called a "neuro-rehab section, seperate from the skilled (but on the same unit), where we had stroke patients, who were mostly heavy care- usually 5 or 6 residents. On night shift, I was charge over that unit as well sometimes, and would have an LPN down there who would do meds and treatments, but we all banded together and made rounds on the whole unit so no one was stuck having to do things alone. Sometimes I was fortunate to have another RN who would do charge on that end but we still combined forces to work together on the entire unit. I can't say that it was any different from a LTC Skilled facility, except that because it was in the hospital, there were doctors coming and going all the time (sometimes good-sometimes a pain), and you had access to immediate lab, x-ray, respiratory, and pharmacy. One thing about it, was that the staffing was good. I mean the staff rarely called off so we always had full staffing. The hospital paid more, but that is the nature of the beast...overall the work-load was the same as on the skilled unit in the nursing facility, but the nursing facility has a tendency to have the longer stays, and more complicated residents because of underlying dementia or other co-morbidities that make them have to stay longer. In the hospital, though, there are often more involved treatments that are not done at LTC skilled facilities, however that is changing. We also had State inspections every year as well as Joint Commission. Yes, there was a unit clerk on days and evenings (part-time evenings she left at 7) but none on nights.

[classicdame, MSN, EdD]

OUr Skilled unit is a lot like what DebRN1417 describes. Not long term care. We are now getting some post-CABG patients who need skilled care but not long term care and have used up their acute hospital days on insurance. Depends on acuity, but some only stay a few days.

[prinsessa]

Thanks....that is kind of what I figured it would be. One thing about LTC is that it takes so long to get anything done. It can take several days to get a new admit's meds in. If we need a stat lab it can take 4 or more hours for the phlebotomist to come and then another 4 or more hours for the results. The CNAs don't do any vitals or accuchecks. No one answers the phone besides the nurses. And then the hospital will send us patients who aren't stable enough for LTC and we have to send them right back. I would prefer it if the doctors would come in more often. We never see some of the doctor's at our facility. A couple have got in trouble for not coming in for several months to do progress notes on a patient. And then we have 50 (ok maybe not that many) supervisors walking around who don't seem to know what is going on with the residents until something goes wrong. I'm just getting fed up with LTC because so much is expected of us but it seems like we have no support. People are getting "kicked out" of the hospital sooner and sooner. Something needs to change in LTC because I think the patients really deserve better!