Staff RNs in LTC

snowfreeze, BSN, RN · Jul 23, 2004

I work LTC and find that my skills are used often. I work as a staff RN and I supervise in a 325 bed facility. LTC is much more than it was 8 or 10 years ago. The med/surg floor I worked on when I got out of school looks a lot like the sub-acute unit I work on now. My critical care skills are used often when we receive an admission that should never have left the hospital, the head trauma that starts to seize, the femur fracture that shows signs of PE, post-op whatevers that become septic in less than 24 hours of admission. You name it, we get it...after only a few days in an acute facility because insurance won't pay for a hospital stay.

CoffeeRTC, BSN, RN · Jul 23, 2004

Hi! I am new to this board. Are there any staff RNs out there in LTC? I live in FL. There have been so many changes recently and turnover at our facility...I am the only staff RN on 3 to 11...anyone else out there feeling this isolation..get along great with the staff, but other websites post you lose your clinical skills in LTC...and RNs should only be administrators in LTC...

Don't listen to those who say we don't use our skills in LTC. A nurse in LTC is a jack (or Jane) of all trades. We use our nursing skills plus. What size facility do you work in? Im in a 50 bed and we have 1 RN and 1 LPN with 3-4 cnas on 3-11. This seems like the norm for my area in PA. Keep reading these boards...they are great.

tiroka03, LPN · Jul 23, 2004

I too work in a subacute facility, as a LPN. We have RN's. Most refuse to asses when an emergency arises. The last time I needed ones expertise, I called over where he was breaking for the last 2 hours.

A person had fallen and it was obvious the hip was displaced. Upon calling the RN, I heard the background conversation. Why should I have to go over there? Can't she handle it herself? Ohhh, groan and moan, tell her to handle it.

It was a particularly busy time and we were short staffed that night. The RN was directly told to stay on this unit the whole night, but didn't. Shouldn't have had to call, he should have been there.

Our particular problem is this. We are staffed according to census. A rn is considered staff. But, the RN says, I am only there for when my expertise is needed. So the LPN does the job of both staff.

So, while the LPN is doing the work of two, the RN is reading magazines, and I mean that literally. They say, I can't get involved in anything, like giving a pain pill, or God forbid a bedpan., because something might come up requiring their expertise. How could they possibly leave in the middle of giving a pill to go to an emergency. The bottom line is the RN in my facility understands that the buck stops with the LPN. If the work isn't done, it's the LPN's fault and not the RN so why care?

If I sound a little frustrated, it's because I am. I would much rather the facility would give me anothe nurse's aide, not an RN

Destinystar · Jul 23, 2004

The scary part when you are the only licensed nurse in a facility is when you have emergencies like when someone codes, has to go to the hospital, etc. Then you have to stop what you are doing and follow up. Could put giving medications on time way behind. Especially worrysome when pts. need something as time sensitive as insulin. Or when they are in serious pain and left to suffer. In LTC only RN's can be DON's and MDS coordinators, give meds in an IV. I have a license in FL and worked out there for 6 months. Found out it was a right to work state and employees period did not have all the protection that they do in my home state of California. FL is a VERY litiginous state, the families are law suit happy and the state that regulates nursing home licenses is very strict. I improved my organizational, management and assessment skills in LTC, but I did not develop my skills for acute care hospital things. Depends on what your interests are. The turn over rate in LTC in FL is enough to make anyones head spin. YOU R NOT ALONE!!! Glad to hear you notice that somethings is not quite right. :rolleyes:

Hi! I am new to this board. Are there any staff RNs out there in LTC? I live in FL. There have been so many changes recently and turnover at our facility...I am the only staff RN on 3 to 11...anyone else out there feeling this isolation..get along great with the staff, but other websites post you lose your clinical skills in LTC...and RNs should only be administrators in LTC...

smk1, LPN · Jul 23, 2004

I too work in a subacute facility, as a LPN. We have RN's. Most refuse to asses when an emergency arises. The last time I needed ones expertise, I called over where he was breaking for the last 2 hours.
A person had fallen and it was obvious the hip was displaced. Upon calling the RN, I heard the background conversation. Why should I have to go over there? Can't she handle it herself? Ohhh, groan and moan, tell her to handle it.
It was a particularly busy time and we were short staffed that night. The RN was directly told to stay on this unit the whole night, but didn't. Shouldn't have had to call, he should have been there.
Our particular problem is this. We are staffed according to census. A rn is considered staff. But, the RN says, I am only there for when my expertise is needed. So the LPN does the job of both staff.
So, while the LPN is doing the work of two, the RN is reading magazines, and I mean that literally. They say, I can't get involved in anything, like giving a pain pill, or God forbid a bedpan., because something might come up requiring their expertise. How could they possibly leave in the middle of giving a pill to go to an emergency. The bottom line is the RN in my facility understands that the buck stops with the LPN. If the work isn't done, it's the LPN's fault and not the RN so why care?
If I sound a little frustrated, it's because I am. I would much rather the facility would give me anothe nurse's aide, not an RN

sounds like a move is in order! No way would i put up with doing the job of 2 nurses just because one prefers to sit and lounge all shift. get that resume dusted off. :)

leslie :-D · Jul 24, 2004

I too work in a subacute facility, as a LPN. We have RN's. Most refuse to asses when an emergency arises. The last time I needed ones expertise, I called over where he was breaking for the last 2 hours.
A person had fallen and it was obvious the hip was displaced. Upon calling the RN, I heard the background conversation. Why should I have to go over there? Can't she handle it herself? Ohhh, groan and moan, tell her to handle it.
It was a particularly busy time and we were short staffed that night. The RN was directly told to stay on this unit the whole night, but didn't. Shouldn't have had to call, he should have been there.
Our particular problem is this. We are staffed according to census. A rn is considered staff. But, the RN says, I am only there for when my expertise is needed. So the LPN does the job of both staff.
So, while the LPN is doing the work of two, the RN is reading magazines, and I mean that literally. They say, I can't get involved in anything, like giving a pain pill, or God forbid a bedpan., because something might come up requiring their expertise. How could they possibly leave in the middle of giving a pill to go to an emergency. The bottom line is the RN in my facility understands that the buck stops with the LPN. If the work isn't done, it's the LPN's fault and not the RN so why care?
If I sound a little frustrated, it's because I am. I would much rather the facility would give me anothe nurse's aide, not an RN

i find your situation deplorable and unconscionable. you deserve much more respect than what you're receiving. please, consider working elsewhere and wherever you interview, find out about duties of rn vs. lpn and other staffing issues. much luck to you gardenpath.

leslie

leslie :-D · Jul 24, 2004

Hi! I am new to this board. Are there any staff RNs out there in LTC? I live in FL. There have been so many changes recently and turnover at our facility...I am the only staff RN on 3 to 11...anyone else out there feeling this isolation..get along great with the staff, but other websites post you lose your clinical skills in LTC...and RNs should only be administrators in LTC...

you use your assessment skills, organizational/time mgmt and critical thinking skills alot in this environment. since there are not mds on the floor, you are their eyes and ears. you need to observe very subtle changes in condition since elderly seldom present with your typcial s/s until it's very advanced.

furthermore, there are many that are a dnh or managed by an hmo, both implying acute care at the facility. it's a totally different environment but equally as vital.

are there any lpns on with you? how many cna's and how many beds? on 3-11, after 8pm it tends to settle a bit. people continue to be uninformed about ltc facilities and picture nsg. as glorified babysitters. those who work there know that many have returned to acute care because of the hard work it entails.

with that said, there are indeed horrifically managed facilities and grossly understaffed. if you and your workers cannot be a team, the entire environment suffers. wishing you peace.

leslie

Dixiedi · Jul 24, 2004

I too work in a subacute facility, as a LPN. We have RN's. Most refuse to asses when an emergency arises. The last time I needed ones expertise, I called over where he was breaking for the last 2 hours.
A person had fallen and it was obvious the hip was displaced. Upon calling the RN, I heard the background conversation. Why should I have to go over there? Can't she handle it herself? Ohhh, groan and moan, tell her to handle it.
It was a particularly busy time and we were short staffed that night. The RN was directly told to stay on this unit the whole night, but didn't. Shouldn't have had to call, he should have been there.
Our particular problem is this. We are staffed according to census. A rn is considered staff. But, the RN says, I am only there for when my expertise is needed. So the LPN does the job of both staff.
So, while the LPN is doing the work of two, the RN is reading magazines, and I mean that literally. They say, I can't get involved in anything, like giving a pain pill, or God forbid a bedpan., because something might come up requiring their expertise. How could they possibly leave in the middle of giving a pill to go to an emergency. The bottom line is the RN in my facility understands that the buck stops with the LPN. If the work isn't done, it's the LPN's fault and not the RN so why care?
If I sound a little frustrated, it's because I am. I would much rather the facility would give me anothe nurse's aide, not an RN

It is deplorable when a nurse refuses, to assist another nurse. I wonder where he/she got the idea they had all that much expertise? LOL

Hang in there, this RN won't last. He/she is one of those who came out of school thinking they know everything, that kind never lasts. He/she will be long gone and you will still be there to continue to provide great nursing care to your pts. The next nurse will very likely be great and you'll forget about this one and "un"fondly remember him/her as you read a thread like this sometime in the future.

Kayzee · Jul 27, 2004

Hi! I am new to this board. Are there any staff RNs out there in LTC? I live in FL. There have been so many changes recently and turnover at our facility...I am the only staff RN on 3 to 11...anyone else out there feeling this isolation..get along great with the staff, but other websites post you lose your clinical skills in LTC...and RNs should only be administrators in LTC...

I am moving to Ft. Myers area the end of the week and am an RN. I have always loved geristrics. May I ask where you work? I have always enjoyed the one on one with the residaents and wouldn't care for adm. I don't believe you lose all skills. You become very good at assesment of pt. You get to know these pts, and you will know if something is not right. Give yourself more credit. Elderlt pts have so much to share and are so appreciative, keep up the good work. Don't listen to everyone else and do what you like best. Thay need you. K.Z.

Kayzee · Jul 27, 2004

Hi! I am new to this board. Are there any staff RNs out there in LTC? I live in FL. There have been so many changes recently and turnover at our facility...I am the only staff RN on 3 to 11...anyone else out there feeling this isolation..get along great with the staff, but other websites post you lose your clinical skills in LTC...and RNs should only be administrators in LTC...

I am moving to Ft. Myers area the end of the week and am an RN. I have always loved geristrics. May I ask where you work? I have always enjoyed the one on one with the residaents and wouldn't care for adm. I don't believe you lose all skills. You become very good at assesment of pt. You get to know these pts, and you will know if something is not right. Give yourself more credit. Elderly pts have so much to share and are so appreciative, keep up the good work. Don't listen to everyone else and do what you like best. Thay need you. K.Z.

DG5 · Jul 27, 2004

I can't understand the mindset of that RN you work with. These kinds of nurses need to get one big wake up call. I am an RN in an LTC facility, with an LPN and 2-3 CNA's for 37 beds. The LPN and I work together very closely, we have our own autonomy, but respect each other's roles. If someone falls or there is some kind of emergency, we are there together to work it all out. I find the LPN as an invaluable team member. She always feels free to bounce things off of me and vice versa. I know some RN's at other facilities think the opposite way- they feel that the LPN is a threat and don't let them do the things they should be doing, the RN wants all the control. Why is it so difficult to hit on the happy medium?