The Low Down on Nursing Homes...Is It All That Bad?

Atheos · Sep 4, 2008

New grad considering working in nursing home. Pay is decent, hours are great...is it as bad as everyone says?

Really, it all depends on the nursing home. I've seen low pay, hellish nightmares and I've seen homes that I would live in myself that payed great and were excellent places to work.

The only advice I can give is investigate the home BEFORE you start working there.

SunnyAndrsn · Sep 4, 2008

Like an environment in nursing, it depends on a lot of factors: Co-workers, management, and of course support staff. CNA's can make or break your shift in a nursing home.

If you get an interview, you'll get a tour. Look, listen (not just to the person interviewing you) and SMELL. Listen to the way the staff interacts with each other, and how they talk to the residents. Watch the staff, how they interact with each other.

Overall, I like my job in long term care. We've had some personal issues, co-worker squabbles, and some CNAs make my nights very hard and long. But I love a lot of my residents and like most of them.

Some nights I feel like I spend 8 hours passing medications and doing nothing else. I've cried from the stress but those nights have been rare.

It's never, ever boring.

New grad considering working in nursing home. Pay is decent, hours are great...is it as bad as everyone says?

Mo_RN · Sep 4, 2008

I was told the nurses get around 17 patients--is that comparable with what you get? How do you prioritize and chart on 17 patients? :no:

SunnyAndrsn · Sep 4, 2008

I have 24 pts. I do not chart on everyone each night. There is a system in place for when vitals are done, usually once a week. For our hospice pts, it's typically only once a month--they have an order for "no routine vitals". Also, skin assessments are done once a week, on bath day.

Prioritizing takes time to learn with this many pts. Keep in mind that in LTC the pts. are considered stable, therefore, the cares and prioritization are different. My day goes something like this:

2-2:10, get report

2:10-2:30: print bowel reports so I can see who is on the bowel list (aka, who needs milk of magnesia and/or a supp.) Assess anyone who is having an accute problem, give needed report to CNAs, let them know what my expectations are (anyone who needs nails done, shaved, any changes for pts. needing repositioning, who I need I&O on, and who I'm watching for BMs)

2:10-3pm: Skin assessments (this is when eve. showers are done) and vitals, organize paperwork, and organize my med cart--make sure everything is stocked. Gather supplies/equipment for treatments.

3-5: pass meds and do the treatments I can. Get the vitals I can get during this time.

5-6: Help with supper, help clear the dining room and begin toileting residents who can't or won't wait until after supper is finished.

6-6:30 Break

6:30-8: Chart, finish treatments, sign the treatment book, make sure the treatments assigned to CNAs are done (teeth brushing, etc), make sure any extras assigned to CNAs are done (shaving, nail care, repositioning residents).

8-9/9:30: Evening med pass, this is pretty short.

9/9:30-10: finish charting, re-count my narcs, make sure my MAR is correctly signed, and tape report.

Somewhere between 2-3 I try and get a narc count done, our facility is really bad at this, and I have a hard time getting co-workers to count at the end of there shift...I've recently started getting my DON to count with me.

Hope this helps--of course this theoretical schedule goes to pot if there is an admission, or if anyone has a serious change of condition that necessitates me calling the MD, sending them to the hospital and/or requires frequent monitoring. This is where our facility is lucky, we have 4 nurses for 72 residents, so I always have another nurse I can go to for help.

I was told the nurses get around 17 patients--is that comparable with what you get? How do you prioritize and chart on 17 patients?

lexibear99, LPN · Sep 4, 2008

I work in a nursing home on 2nd shift. I typically have about 19 patients, of these 7 are full vitals, assessment and medicare charting every shift. The rest will vary, such as fall vital, admission vitals, or if someone is on a antibiotic they are T-P-R every shift. I have to say I have really good CNA'S and they really do make a difference. Before I was put on this hall permanetly I was down a hall where I had approx. 37 residents for med passes but no routine vitals or charting unless the waas a fall etc. It was alot more stressful because the CNA'S didn't work well together and you could never find one when you needed them. I never thought I would like to work in a nursing home and I swore i never would, I absolutely hated it the first could of weeks but it's not bad now and the pay is good and you become attached to the residents really quickly!:heartbeat

Mo_RN · Sep 4, 2008

Thanks for your responses--and taking the time to reply to me. From what I hear it sounds like it might work for me. How long was your orientation? :typing

1776patriot · Sep 4, 2008

Request to job shadow for a day. Even that can't tell you everything. They may put you with the nurse with the best situation. If you walk around and the place reeks of urine I would avoid it.

You don't want to put yourself in a situation where you are so crazy busy that you are signing for treatments and things that you have no way of doing. I've seen some places have several residents on 15 minute checks. There is no way a nurse can check on the whereabouts of residents every 15 minutes when the facility is large and you have 20+ residents. Management is just setting you up if something were to happen.

There are well managed Long term care places and those are usually private pay. I would seek one of those out. You get what you pay for people.

sophieblophie · Sep 4, 2008

I work as an aide in a nursing home, and I've been told by several of the more experienced RNs that new grads should not start out in long-term care and should work in a hospital environment for at least two years after nursing school to get a broader range of experience. It seems like mostly all our nurses do is pass meds most of the time, although there are pegg tubes and IVs to operate occasionally too. This isn't to say that LTC is a bad place to work, if you love enjoy working with the elderly and feel you have a passion for it, then go for it. There are some great nurses where I work that truly care for their residents and it shows in the work they do. However, there are also nurses at my nursing home that constantly complain about their jobs and seem like they are only there for the paycheck. I guess it's just about finding your niche.

CoffeeRTC, BSN, RN · Sep 4, 2008

Head on over to the LTC/ Geriatric forum....

kythe, LPN · Sep 4, 2008

Wow, you all have had some pretty good experiences in nursing homes. My first job was in one on a unit of 20 residents, and it was overwhelming. It was a facility that smelled like urine and body odor most of the time. I had more than one patient on a 15-minute watch due to behaviors, and this is literally impossible when there was only me and one aide most of the time. It seemed a set-up for trouble whenever something happened, which was frequently. I was writing incident reports for behaviors, accidents, and falls several times a week that should have been avoidable if we were well staffed.

Most of our residents were on government healthcare so they paid nothing, but the cost of care was about $5,000 month. As far as I'm concerned, they could live in a hotel for that price and get a better quality of care through room service than what they were provided. It's just that insurance doesn't pay for a hotel.

I didn't last there long, due to mutual feelings between me and the management. Through an agency, I have worked several shifts in other nursing homes which were much the same way, and some have as high as 1/50 nurse/patient ratios with two aides on the floor.

I'm glad I moved on to a different environment, though it is uplifting to know from this thread that there are some good skilled care facillities out there. :) As much as I complain about my experiences in nursing homes, I can't say I regret starting out there because it provides very good experience that can be taken anywhere else. There is no better place to learn time management and organization, med pass, wound care, and managing common conditions such as COPD, heart problems, diabetes, and dementia.

SchnauzersRock · Sep 4, 2008

I was told the nurses get around 17 patients--is that comparable with what you get? How do you prioritize and chart on 17 patients?

Try up to 28 patients to take care of. That's on top of all the skilled ones that must be charted on every shift, every day. That is one of the big draw backs of working where I work. I make great money, but the acuity can be overwhelming. Nursing homes aren't just for the old and infirm. The big push these days is to also offer rehab services. That is where the big bucks are. We have had patients as young as 15 years of age to way past 100 years old. Some are there just to live out their lives, some are there to get back their daily function so they can return home. Admission paperwork? A total nightmare. Lots of duplicate forms to fill out (thanks federal government!). Like passing meds? You'll become an expert pill pusher in no time. Scheduled med passes four times a day, and the non-stop prn narcotics. Hope you like doing wound vac changes, too. I know I make it sound horrible, and to tell you the truth, some days really are the absolutely worst, but some days are quite nice, and it all evens out. I wish the best of everything: the best co-workers, the best management, the best team players, the best patients, the best support. That is what it takes to make it in LTC.