SNF questions to ask

What does SNF mean?

What does SNF mean?

Oh sorry.

"Skilled Nursing Facility"

My first question for you is, if you are an RN, why are you working in a SNF? Why put your license on the line to be responsible for 25+ patients? Why are you not looking for a positopn in a hospital where you will be responsible for only 5-7 patients and you will learn so much more and utilize the skills you learn in school.

The reason I ask these questions is because I am a LPN currently in school to get my RN and my last job was this summer (which I quit during orientation) was at a SNF and I had 20+ patients (some with alzheimer's) and I realized why was I putting my license on the line to be the sole caretaker for these people? And trust me, you get NO help from the CNAs. Don't get me wrong, I know someone must care for the geriatric community, but as a new grad as yourself, I would not start out at such a stressful place with so much responsibility. Just so you know, I have 13 years experience, 4 of them being med-surg.

Just my thoughts........................

1) How long is your orientation?

2) Will you be responsible for Treatments & Meds

3) How many aides are on the floor?

4) Acuity of patients

My first question for you is, if you are an RN, why are you working in a SNF? Why put your license on the line to be responsible for 25+ patients? Why are you not looking for a positopn in a hospital where you will be responsible for only 5-7 patients and you will learn so much more and utilize the skills you learn in school.

The reason I ask these questions is because I am a LPN currently in school to get my RN and my last job was this summer (which I quit during orientation) was at a SNF and I had 20+ patients (some with alzheimer's) and I realized why was I putting my license on the line to be the sole caretaker for these people? And trust me, you get NO help from the CNAs. Don't get me wrong, I know someone must care for the geriatric community, but as a new grad as yourself, I would not start out at such a stressful place with so much responsibility. Just so you know, I have 13 years experience, 4 of them being med-surg.

Just my thoughts........................

I would start out at hospital.. if I could! That is where I want to be but I live in San Diego. I have been applying for new grad positions since January of this year. I thought, okay maybe no one is hiring me because I don't have my license yet. I got my license in June. It is almost September and I still have not found a new grad position in a hospital. There are very FEW new grad positions available if any. I have applied to over 100+ RN hospital positions but they all require experience. Something I do not have. I can't be picky at this point. I understand that taking care of 25+ patients is difficult. That's why I created this thread. I want to know what questions to ask so I can make sure I at least know a little about what I'm getting myself into.

Questions may change depending on what shift you're working. But, you'll want to know the typical setup of the floor staffing ie; LPNs and CNAs. Also, how many other RNs will be on the floor. Who will be training you? Extra duties? I did a travel assignment in Cali not to long ago, and noted RNs had to oversee a lot of stuff w/ the LPNs & CNAs. Ask about documentation, and what if any papers you will have to sign off on. That's my two cents for right now...

FYI: keep your eyes open, while my LTC experience has been good, a lot of non kosher things can happen...but even a hospital can be crappy enough to lose your license in...

My first question for you is, if you are an RN, why are you working in a SNF? Why put your license on the line to be responsible for 25+ patients? Why are you not looking for a positopn in a hospital where you will be responsible for only 5-7 patients and you will learn so much more and utilize the skills you learn in school.

The reason I ask these questions is because I am a LPN currently in school to get my RN and my last job was this summer (which I quit during orientation) was at a SNF and I had 20+ patients (some with alzheimer's) and I realized why was I putting my license on the line to be the sole caretaker for these people? And trust me, you get NO help from the CNAs. Don't get me wrong, I know someone must care for the geriatric community, but as a new grad as yourself, I would not start out at such a stressful place with so much responsibility. Just so you know, I have 13 years experience, 4 of them being med-surg.

Just my thoughts........................

Not all skilled nursing facilities are the same. Sure, if its the run of the mill geriatric facility, I would agree with you. But there are facilites where you can learn great skills. A rehab or respiratory floor is great for learning skills and learning how to prioritize. But I do agree that the number of residents that you are responsible for can create an unsafe environment.

To the op:

I would ask:

How many residents do I have on a typical day?

Is there a treatment nurse or do you have to do the med pass and treatments?

If I'm in charge, how many will I have under me? And what other duties might I have in addition to being charge. For example many times on the weekend, our RN was not only charge, but she had to do a med pass.

How often is the floor shorted staffed?

Do you have to float and on average how many times?

My first question for you is, if you are an RN, why are you working in a SNF? Why put your license on the line to be responsible for 25+ patients? Why are you not looking for a positopn in a hospital where you will be responsible for only 5-7 patients and you will learn so much more and utilize the skills you learn in school.

The reason I ask these questions is because I am a LPN currently in school to get my RN and my last job was this summer (which I quit during orientation) was at a SNF and I had 20+ patients (some with alzheimer's) and I realized why was I putting my license on the line to be the sole caretaker for these people? And trust me, you get NO help from the CNAs. Don't get me wrong, I know someone must care for the geriatric community, but as a new grad as yourself, I would not start out at such a stressful place with so much responsibility. Just so you know, I have 13 years experience, 4 of them being med-surg.

Just my thoughts........................

I am an RN. Most of my staff nurses are RNs. Just because you couldn't hack it in a SNF is no reason to put down an entire industry. People here love to say "you'll lose your license". It is very difficult for any nurse who is following standard practice to lose a license. I had 30 patients when I was a floor nurse on a very busy sub acute unit. I had central lines, TPN, trachs, gtubes...I learned more working there for a year than I did when I worked at the hospital on a med surg floor. SNFs need good nurses who can think on their feet and use the skills they learned in school. I love to hire new grads...I train them the right way and so far 95% of the new grads I've hired have turned into excellent nurses.

And...if your CNAs aren't helping you out, then the problem is yours. The licensed person is supposed to supervise the CNAs so don't blame them if YOU can't do your job.

Our long term care wings at my facility have 24 residents each. These residents for the AM med pass have an average of 8 medications each. Some have more, some have less. Like I said, 8 is an average :-)

I think a two week orientation would be great. I had 2-3 days on each wing, so a total of about 6-9 days, IIRC. The hardest thing by far is learning the residents. Once you learn the med pass for the shift you'll be working, the rest will come. The treatments, the paperwork, the policies and procedures take longer to learn, IMO, but WILL eventually come.

It took me several months before I didn't get nervous going into work, and about 6 months into things I was really feeling comfortable. Now that I've been there over a year and a half, I wonder what I was so nervous about, LOL! Then I started at a local hospital, and I've got those nerves all over again.

Good luck, I'm trying to think of other questions:

1. Does the facility utilize hospice cares?

2. Does the facility use a gerontologist/NP who makes facility rounds (We have an MD/NP team, I love them!)

3. Examples of facility standing orders?

4. Computer training?

5. How many CNAs/resident ratio?

6. Expectations for supervision by the RNs?

7. Follow up to #6: Chain of command and management team?

8. Continuing education/opprotunities/availability?

9. Is there Wound care nurse? Rehab/PT/OT? Restorative programs for residents?

10. Ask about policies r/t resident's change of condition: We have a "manual" we're supposed to follow, including needing three symptoms for reporting UTIs in order to obtain a UA/UC.

11. Follow up to #10: Typical communication with treating MDs is done by....we fax our MD's unless it's urgent, then we call their clinic.

Ask to see a sample of their report sheet and/or treatment sheets, this will give you an idea of the cares provided.

Good luck!

I started out in a SNF, and I'm still there. Several reasons for this:

1. Current job market--in my area, LPNs are no longer hired for med/surg

2. Huge layoffs just before I graduated at all the major hospitals

3. Local home health agencies (as an LPN) didn't have insurance benefits.

As frustrated as I've been at times, overall my facility has a pretty supportive management team. Also, overall, there is NO WAY I could do my job without my fabulous CNAs. They rock!

Yes, there are some that I prefer not to work with, that I feel like I spend a lot of time just getting them to do their job. However, their are others that run circles around me and are fantastic are reporting any issue with the residents to me ASAP.

My first question for you is, if you are an RN, why are you working in a SNF? Why put your license on the line to be responsible for 25+ patients? Why are you not looking for a positopn in a hospital where you will be responsible for only 5-7 patients and you will learn so much more and utilize the skills you learn in school.

The reason I ask these questions is because I am a LPN currently in school to get my RN and my last job was this summer (which I quit during orientation) was at a SNF and I had 20+ patients (some with alzheimer's) and I realized why was I putting my license on the line to be the sole caretaker for these people? And trust me, you get NO help from the CNAs. Don't get me wrong, I know someone must care for the geriatric community, but as a new grad as yourself, I would not start out at such a stressful place with so much responsibility. Just so you know, I have 13 years experience, 4 of them being med-surg.

Just my thoughts........................

Thank you everyone for your comments and advice/questions.

Reading all the negative things about certain facilities and the current job market can get really discouraging but reading the positives is great because it reinforces the fact that it's possible.

Mlok,

Thanks for starting this thread and to the experienced SNF nurses----thanks for the info and your encouragement!! I am also applying to SNFs. I passed NCLEX in October and the hospitals in my area are not planning to hire new grads for some time.

Most of all I want to start my nursing career---whether that's in a SNF, a hospital, a clinic,etc. And I want to keep this roof over my head. The debt from unemployment keeps growing like a virus.

We didn't put in all that time, energy, money, etc. into nursing school to sit around and wait for the economy to change. I changed careers and went to nursing school to help take care of people, young or old. I realize that if one of these SNFs hires me I will most likely feel lost and overwhelmed by the number of patients and all of their needs. But if it's a decent place and I can adapt to the ratio then I look forward to that feeling of connecting with patients again...I hope to work in a hospital eventually but I'm starting to believe that being flexible is really important right now.

Mlok, did you start working at a SNF? If yes, how's it going?