I will be applying to a couple SNFs in my city. What questions should I ask during an interview?
These are questions I have come up with...
How long is orientation?
How many patient's does an RN usually care for during their shift?
Other questions you think I should be asking will be greatly appreciated!
I am a new grad. If offered a position do you think it's okay if I ask to have the same patients for a couple weeks until I get the hang of the facility? I've heard that RNs usually get 25+ patients and I honestly do not know what a lot medications are, so I'm sure it will take me quite awhile to look them up. At least if I had the same patients, I would eventually remember what each of them are for and who can and can't swallow their meds.
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?
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?
I started working at a SNF since last month and just recently got off orientation. My orientation was 12 days. Med pass and doing treatments are easy. I find that being the charge nurse is the most difficult for me because I recently graduated and have never had experience being in charge of anyone. Also the paperwork involved with being charge nurse is a lot for me to handle. I still don't know where a lot of things are. Fortunately, everyone I work with is very friendly and nurturing. They try to help me when they can. But everyone is very busy because there are usually only 4 nurses (5 if I'm lucky) during my shift. Med pass can be difficult but I've kind of made my own routine.
I do rounds before I start, then I have a little notebook with rooms that need me to set up a new GT feeding and blood sugar checks. I do the 1600 medications and as I go through the medication book I flag the papers in the medication folder that need 2100 medications and put them back in the folder when I am through. After I have given a medication, I turn the resident's medication card over so I know I finished that one. There are days when I finish on time... and there really bad days when I stay over. The latest I have stayed was 2 hours.... that was the day I was charge nurse.
Good luck :) If you have any questions feel free to PM me.
I will be applying to a couple SNFs in my city. What questions should I ask during an interview?
These are questions I have come up with...
How long is orientation?
How many patient's does an RN usually care for during their shift?
Other questions you think I should be asking will be greatly appreciated!
I am a new grad. If offered a position do you think it's okay if I ask to have the same patients for a couple weeks until I get the hang of the facility? I've heard that RNs usually get 25+ patients and I honestly do not know what a lot medications are, so I'm sure it will take me quite awhile to look them up. At least if I had the same patients, I would eventually remember what each of them are for and who can and can't swallow their meds.
Every SNF is different. When I first graduated from RN school I was hired as a nursing supervisor in a SNF. It was not a hard job, but it required more responsibility than I wanted at the time. I would have taken a med-pass job over supervison of staff at anytime then, even though the average wing had about 28 residents on it, but I had been an LPN first, so med-pass was something that I was used to. Remember though once you work in a SNF for a while you become familiar with the patients and the medications that they use, so what may start out as a difficult med-pass in the beginning will eventually become a piece of cake. Moreover if you are going to be doing med-pass I would ask to be oriented on all of the wings, so that you can familarize yourself with all of the patients. This is a good way to learn the patients and the different meds that they take.
2. What paper work does the charge nurse do that the others don't??
A charge nurse is just a nurse, LVN/RN, that has someone working for them. Typicaly if you have a CNA working for you then you are a charge nurse. That term "charge nurse" is totaly over rated and over used. When the family walks in to talk to Grandmas nurse, they like to see your name with "Charge Nurse" behind it. Any nurse in a SNF/LTC working on the floor with CNAs is a charge nurse. If you are sitting in the office or MDS then you are not.
I have never seen a SNF/LTC where the RNs and LVNs didn't do the exact same job except here in Calif. LVNs can start IVs but can't start IV meds or blood. LVNs let the nearest RN know when IV meds are scheduled. We work along side each other and work for the DON, not each other. Our MDS as well as our Assistant DON are both LVNs with alot of experience. So much for the great difference in ablilties and skills between RNs and LVNs everyone talks about in school.(uh oh, i am probobly going to get along reply listing the differences)
As far as people that have no experience supervising don't worry about it. The CNAs already know their jobs. Take about 20 minutes and talk to your DSD about what CNAs are supposed to do and you will be all set. (it is your job to know your cnas job). Also remember when you started school and had to learn the CNA work before nursing? It is pretty simple and straight forward.
I just have to add one more comment. If you can make it in a SNF you can make it in any hospital. Med surg, Tele or PCCU is NOTHING compared to SNF as far as stress, work load or responsibility.
I hope so...I have never felt like such a failure on a daily basis in a new job...a new grad...32 patients---combo of the transfers from the local hospital, the rehab patients, and the long term, severe dementia combative spitting-meds-out patients. No V/S machines, taking BPs, HRs, manually.
Here's what I was told about the LVN/RN dynamic from the mean ADON today:
"You must be embarassed because you're a RN and you don't know as much as the LVNs."
I didn't respond and I left since my shift was over. But it makes no sense!! Of course I don't know as much as experienced LVNs. I"m a new grad and of course they knew that when they hired me.
It's sooo frustrating and exhausting everyday. And if there are any discussions about work or patients or anything the nurses aren't speaking English so I don't know what they're saying. That heightens the feeling of isolation.
Everyday I think about quitting...and then I think about all the debt I have from school and not working while I was in school full time...so I tell myself that I'll stick it out and learn more. And then the next day I go to work and around 10:30 when I'm asked "still doing meds?" I think again "Why am I here??!!"
Today my preceptor for the day came to the cart as I was finally finishing the morning meds and brought up the topic of finishing late..."the state says we only have a 2 hr. window to give the 09:00 medications so after 10:00 is too late." This from a nurse who I have never seen take BP!! But documents it on the MAR. And I replied: "I know the guidelines. But I'm going to take the BP before I give BP meds." That was the end of our discussion.
I really appreciate the helpful hints and words of encouragement (plus moral support) I find here. I made excel sheets of the patients and I know that helped me today.
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........................
Wow that was encouraging! I've worked in both settings; and acute care with only 5 patients a shift is no easier than a SNF. Not everyone is cut out for LTC it takes time to learn common drugs, time management, communication skills and delegation. There are just as many lazy CNA/RN in the hospital so please think before you generalize everyone. Good luck to the OP, I agree with all the previous posters questions to ask.
P.S. Your CNA's are your eyes/ears in LTC so they are a TREMENDOUS help to the nurses.
I share your experience. I too have started on my own 2 weeks ago and cried my very first day. At night, I am the only RN in charge of 63 patients and have witnessed RN/LVN's falsify BPs and HRs before giving antihypertensives and Digoxin. I bought myself a digital BP monitor and will use that when I need but the DON says that they are inaccurate. I say if you use them correctly, they shouldn't be and if it's some rediculously high BP, use the manual ones. Thank you all for sharing your story :bowingpur , I can go in tonight with a little piece of mind.
I've worked in SNF/LTC for about 14 yrs now. I love it!!
but with that said, just know that it is a completely different world than a hospital floor. It's not better, it's not worse...it's just different.
In a hospital, all your regulations are governed by joint commission. In LTC, Medicare governs your regulations. This makes both jobs completely different.
Yes, it's true that you will have lots of patients. Over the years, I've cared for as little as 10 and as many as 48. (don't panic! the 48 pts job was working in an ICF facility, no acute care at all, but i loved it). The first year is the worst. Not only are you trying to learn to be a nurse, but you are trying to get the hang of your job, honing your assessment skills and learning to be a manager as well.
A lot to try to learn, so give yourself a break! Many of us nurses are codependent types that think if we dont take care of everyone perfectly, we arent doing a good job, lol. We make it hard on ourselves dont we? lol
Instead, take a deep breath and concentrate on one thing at a time! Even if that is concentrating on that one patient you are caring for right then. Just rememeber, enter every room with a smile and make that patient feel as if they are your only patient for those few moments you are with them, even tho you feel your world is falling apart. learn to do that and you got the rest of it aced because your patients will love you and when they love you, they will forgive lots. like when you are working hard and running behind and meds are late, lol.
concentrate more on learning your job, your assessment skills and getting the hang of SNF instead of trying to be some super manager that has to tell everyone what to do because you are the RN. why do i say that? it seems when we graduate, we become 1 of 2 types...we are either scared to death and dont know what we are doing and admit it, or we are knowitalls that THINK we know everything when we know nothing. me? i was a knowitall that drove my coworkers insane! dont be like me, lol. it took me a few years to realize i didnt know anything and needed to learn.
there is a ton of paperwork in SNF. and yes, much of it is redundant and ridiculous at times but alas...that is our lot. WE know it's time consuming for nothing but all we can do is whine about it while we do it, lol.
learning to chart under medicare guidelines is NOTHING like you learned in school. in the hospital, we chart in a sort of positive way, "the patient did this, he can do that" type stuff. in SNF/LTC, we chart the complete opposite. "the patient can't do this without assistance, can't do that without assistance".
why? because that's how we get paid. we have to show in our documentation daily the level of assistance our patients need. the more assistance they need, the more medicare will pay us. therefore, our job is to chart what they cant do rather than what they can. learn this and your bosses will love you no matter where you go.
we've had tons of threads on how, as nurses, we eat our young. boy do we ever in SNF! try not to let the catty nurses that love to point out what you don't know and say things like "i bet you are embarrassed.." get to you. they are just showing their true selves. ignore them and go on. i like to just smile at them while thinking "oh bite me, would ya?" and off i go about my business.
i dont know what it is about us nurses, especially in SNF, but a new nurse, RN or LPN, has to "prove" themselves to the other nurses. Until the other nurses figure out you know what you are doing and will last in SNF, many will treat you like a red headed step child. just remember, there are always nurses willing to help a new nurse. find those nurses and stick with them and let the other crap just roll off your back.
and remember HALT. if you are feeling totally overwhelmed, stop and think "am i Hungry, Angry, Lonely or Tired??" and go take a 5 minute break! even if it means you go sit in the bathroom for 5 minutes. if you find yourself getting stressed at all, walk away from the floor for just a few minutes and you will be able to come back with a clear head. it took me many years to learn this. it's something i now do many times a day and i try to teach to my nurses, especially the new nurses because it's so easy to get overwhelmed for any of us. things will be going along great and all the sudden all heck breaks loose and you are standing there like "wth happened? " .
Thank you, thank you SouthernBeegirl for your advice and encouragement. It helps a ton!! Nothing like Southern hospitality! I will try my best to not be so hard on myself at work and make a list of things I've learned so far. And what you wrote about taking a 5 min. break...I will take that to heart. I realize that the final hour I'm passing meds to the last of the 32 patients my pace slows a lot because I"m literally running on fumes. The prioritization skills I can learn in this SNF will help me there but also anywhere I would think. When five patients are asking for something at the same time I realize why the NCLEX had soooo many prioritization questions. And thanks for the insight on Medicare charting. I know I need to learn a lot about charting.
SMUgrad---we're going thru the same newbie experiences and for me it really helps to have the support on this thread. Let's all keep in touch!
you won't believe how much better you feel if you just walk away for a few minutes. even when you are feeling like you dont have time to stop, that is exactly when you need to take a little "mind" break. you wouldnt believe how many times i go in the bathroom and just close my eyes and meditate for a few minutes. i also do this when i get mad too so i wont overreact. it's easy to feel too overwhelmed to even take a lunch. but dont do that! you HAVE to go eat. if you dont take care of yourself, you can't take care of anyone else.
dont get caught up in the facility gossip and crap like that. just keep your nose down and concentrate on your job.
prioritizing is going to help you most. i also carry a notebook of some kind around with me at all times. i call it my brain. no way can you remember everything you need to do, need to chart, etc. WRITE IT DOWN! i do that and as i complete each thing i mark that sucker off my list. when my list is all marked off, i can go home
your CNAs can really help you too. be specific with them so that they can help you, like for instance, tell them "i need the VS by "acertaintime". let them know up front what you need. dont let them run over you though. CNAs ALWAYS push new nurses to see what they can get away with. i even did it when i was a CNA too, lol. (i actually used to torment my charge nurses just for the heck of it, lol). they are your eyes and ears to your patients. but remember, what they think is an emergency, you might not think is an emergency. listen to what they have to say and then assess for yourself.
i'd also say to run by with your supervisor before calling a doctor on something. during my first couple years on the floor, i would call the doc at all hours day or night for things that could have waited until they were awake. i had one doc threaten to kill me, lol. let your supervisor guide you.
and dont be like i was. i resented the fact that i had a supervisor. after all, i was an RN! ( i was the kind of new nurse all nurses HATE to work with). the supervisor is not there to second guess you! she is there to coordinate care for all the patients, handle staffing, family problems, etc. she will also be one of your best resources to do your job.
take your time, take a deep breath, get to know your patients and you will love SNF!
and dont pay any attention to the people that say LTC nurses arent "real" nurses. you will do every skill imaginable while working in SNF except for acute care monitoring and giving blood. it's a great place to hone your skills. dont be afraid, do anything and everything you can. if it's not your patient, ask if you can watch.
dont worry that you won't know anything either. you will be amazed at the information your brain actually retained from nursing school. sometimes i still find myself amazed at knowing the answer to a question that someone asks, lol. it's like "where did THAT come from?".
and above all, do things (charting, skills, etc) the way you KNOW they are to be done, NOT the way people you work with may do them. remember that old saying "if your friends jump off a bridge will you jump too?". even if people say "thats the way we do it here" and you know it to be wrong, dont try to tell them they are wrong, just worry about YOU doing the right thing. if you keep doing the next right thing always, you will do a great job!
and always remember....chart with a lawyer in mind! i always look at my notes and ask myself how a lawyer could rip me apart for leaving things out and try to include those details. it's inevitable in this day of suehappy people that we all will be in depositions and court rooms defending our care. make sure you start off with great documentation because you will be on that stand alone. no matter who you work for, they will always throw you to the wolves to defend themselves. so always keep that in mind when you chart.
910hope
30 Posts
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?