Starting in a nursing home?

Nurses General Nursing


Has anyone out there started out in a nursing home right after graduating? If yes did you feel that it gave you a base to work on or no?

Specializes in Hospice, Critical Care.

I graduated in 1995 when there were no jobs to be had in hospitals. I started working an nursing home the offered intermediate care. From there I moved to another nursing home that offered skilled care. After 18 months in nsg homes, I got a Med-Surg job. Nothing prepares you for med-surg except med-surg :). While it gave me experience in delegating staff and scheduling staff, it did not provide much in the way of time management (in relation to med-surg needs) and dealing with physicians. It did give me experience in dealing with families and the elderly. But med-surg was a big difference and a great learning experience. I appreciate my time in LTC and feel it gives me a better perspective when we get nursing home patients in the hospital.

Specializes in CCU, Geriatrics, Critical Care, Tele.

I also graduated in 1995 and no hospitals were taking new grads. I was pumped up as a new grad, and to be quite honest, didn’t want to work in LTC, I didn’t believe that it was real "nursing" like a hospital. I really wanted to get into a hospital right away, because I wanted to work in Critical Care. Anyways, I took a job a nursing home and I learned more than I ever imagined I would. But at the same time, there where moments when you felt like all you did was pass meds to 35 pts twice a shift, a higher paid medical assistant. At times, I didn’t even feel that I was using my nursing skills and thought that I was going to forget a lot of what I learned. But every job has it's peaks and valleys. Some of the best nurses I worked with at the NH were LPNs and they were amazing nurses, I learned so much from them as a new grad. They knew there pts so well, there assessment skills where amazing, they picked up on the smallest symptoms early before they became problems. It was a wonderful learning experience and some of my best memories of nursing are from the NH and the elderly pts that you get to know so well. Although my heart was still in critical care, I found my NH experience quite valuable and I do not regret it one bit. After about 1.5 yrs, I did move on to the hospital setting and eventually into CCU, Which I enjoyed greatly as well. Good Luck in what ever decision you make.

[ June 08, 2001: Message edited by: bshort ]

Hi burger. Where did you graduate from? I just graduated from URI in Dec. I'm starting out in the hospital, but we have a couple of orientees who have worked primarily in LTC, and it sounds as though they think the hospital is a better learning experience. If developing skills and effeciency is what you want to do, and as someone else said, dealing c/ physicians, then it would be a better idea to start out in med-surg. If there are pros for you to start out in LTC that outweigh these things, then go with that. Good luck.

I just graduated last dec. with my ADN and my lpn 1 year before that, I also have started in a nursing home. Every day I wonder if i am doing the right thing. I worry that i will lose certain skills, but feel that when i am ready to leave that i should be able to pick them up when and if i go to acute care setting. I do feel my areas will be psychiatric or hospice nursing.

I am learning a great deal in the nursing home though and do love dealing with the elderly and their families.

I graduated in 1996 and no hospital wanted a new grad. So, I too went to the nursing home. It depends on what type of home you work in. In mine, I practiced skills such as, IV, TPN, GT and NG tubes, Ventilators, Suctioning, wound care with the VAC dressing, Peritoneal Dialysis and many other skills. So, when I finally went to the local hospital to do agency, I was not as lost as I thought I would be. The skills I am practicing now that I didn't before are Heparin Dripps and Critical Cardiac Drips, fresh cardiac catheter patients etc......the acuity is higher and the turnover of patients is faster, but the paper work and work load are ten times better in the hospital. I am having a blast getting the new skills at the hospitals. This is a decision you have to make. good luck.

If anyone is reading this, please read the previous posts. The majority are saying they started in LTC-Long Term Care/NH-Nursing Homes because there were not any openings for (LPN or RN). So they had no choice but work in nursing homes. For some nurses, they found their "calling", for most, they were just waiting for the "real", glamorous nursing job. This was my story too. I said I would never work in a nursing home. I took a job in a local nursing home to be close to my home, my kids, etc. As an RN, I had done surgery, med/surg, home health, psych, but I found that LTC/nursing homes were where the real nurses worked. It's a shame that nursing homes are the last place that "nurses" want to work. I thought I was a good "nurse" but I couldn't stick it out. The best nurses I know are LTC/NH nurses, whether they are RN, LPN or CNA. They have guts, stamina, compassion and just the will to walk through those doors.

I started out in the nursing home... I didnt really like it, but, I did learn alot... mostly one thing though... SPEED! 2 medpasses to 57 pts a shift... you learn to go fast!

I started there because I was considered too young to start up at the hospital... (the hosp will not employ nurses under 19YO... I'm the youngest ever hired, after a partictularly good review by my old DON)

It was a good job... I did what I had to do... learned what I had to learn... I learned how to be a staff nurse, a charge nurse... a code runner... a referee, a bouncer... a boss, an underling...

it really was fufulling....



I graduated in 1996 and I deliberately chose to work LTC. I wanted to work with the same patients for a while and get to know them both sick and well so that I could learn how someone lived with COPD for instance. I worked on the Medicare section so most of the patients were post acute. I also wanted to learn various illnesses in person to supplement my textbook learning. LTC can be very challenging. One thing that scared me was that all immediate decisions were made by myself because the MDs were at the hospital, so I had to assess the patients, then pass them information over the phone. I was the only RN on my shift. Skills are really needed LTC, how many nurses out there can start an IV on a dehydrated 96 yr old? Working the medicare section requires lots of technical skills; I have used IVs, wound vac, TPN, central lines, surgical dressings(sterile), suctioning, neurochecks etc. And your assessing skills need to be top notch. Basically, anything goes. I also find that skills return very quickly, you don't lose them, you may need to refresh and keep current. I get a professional journal, and do occassonal research, I also seek further education opportunites in order to maintian my level of practice.

I have not regreted starting that way.

I worked in LTC for 5 years after working Neuro ICU. Let me tell you I got severe culture shock. :D However as to skills, I kept my skills and enhanced them. I learned to juggle more than 2 patients, I learned to prioritize more, I learned to function without a physician right there. And I learned that LTC work is very different from hospital work. As the previous poster noted, putting in an IV on a dehydrated 96 year old patient is quite a challange. I can now put an IV into just about anyone. Frustrating end of LTC. Lack of staffing and resources. I work in a hospital setting now, feel my skills and abilities were enhanced by working in LTC in many regards, but would not return to that setting because I got tired of working with almost nothing for staff and resources for my patients. One of the great benefits of working in LTC is that you quickly get over the idea that RNs are automaticly better skilled than LPNs. Thank God for the LPN with many, many years of nursing how took me under her wing when I started my first LTC job. I think otherwise they would have shown me the door there. That switching from ICU to LTC was difficult to say the least. I went into LTC because I needed a day job, and couldn't get one at the hospital. I think it is interesting to note that all of the people who went into LTC note that is was because they couldn't get a hospital job as a new grad, 5-6 years ago. What has changed so much in that short amount of time that have the hospitals crying for nurses, new grad or not? Screwed themselves didn't they?

I chose to begin my career as an RN 3 years ago in LTC. I am constantly amazed that, even today, so many have the misconception that if you want to be a "REAL" nurse, you work in a hospital, and that LTC is for those poor souls who just couldn't cut it. I have noticed that 'hospital nurses' who come to work with us usually don't stay long... they just can't keep up!

I work 7p-7a in a 102 bed center, with a night staff of 3 nurses and 5 CNT's. 2/3 of our beds are skilled, and we care for patients of varying acuity, from terminal CA to post-surgical pts who are with us for rehab. We handle wound care,drains, decub care, IV's, TPN, GT's, NGT's, ventilators, PCA, portacaths, PICC's, TLC's, suctioning, peritoneal dialysis, and respiratory care. We care for pts who suffer from alzheimers, CVA's, heart disease, respiratory diseases, and the end results of diabetes. We provide end-of-life care, rehabilitation, psychological, emotional and spiritual support for those who have given us all so much, but so often are left alone when they can no longer 'keep up' with the rest of the world. We are diplomats, managers, nutritionists, plumbers, mechanics, detectives, engineers, and surrogate family members.

We have 24-7 access to our MD's, but they frequently rely on our assessment skills and knowledge of our patients when they make their treatment decisions.

True the paperwork will kill you. Government Regs will drive you NUTS. But when I go to work, my patients greet me with a smile and a hug, and their familes aren't afraid to leave them and go home for the night--we know each other, and they know I will care for their loved ones like they were my own....because they are. And even after my worst night, I can still honestly say, "I LOVE MY JOB!"


I justed wanted to thank everyone that responded.Times have changed in the last couple of years and getting a hospital job is very easy... I was even offered position in critical care units. I just really enjoyed my LTC rotation and wondered if that was where I should go before entering my first love Psych! You have all helped so much, but I guess what I really need to do is decide whats right for me at this time!! Good Lord I am soooo overwhelmed and confused, I don't know where to begin! :eek:

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