Tips - moving from skilled nursing facility to hospital

[SamJS, BSN, RN]

Hi all,

Just made my first post a few minutes ago, and couldn’t refrain from my second already ?

Right now, I work for a skilled nursing facility on their short term rehab unit. Obviously the acuity is not the same as with a hospital, but for a rehab we are pretty acute on my unit. I have learned A LOT and am grateful for the certifications they have provided me (ACLS, IV cert, etc).

Staffing and administration are huge issues here. I know this is the case a lot of places, but my facility mgmt has no regard for accountability and correct almost nothing when it comes to staff behavior/errors/etc. On top of it, I work 11-7 and have a patient load of 14 short term rehab pts + 26 long term from the unit next to mine. It is hard and busy, but manageable. However, I am now looking to transition into a hospital to work toward my end goal of the ER. I got my experience, and now I need to get out.

I’m looking for any advice on moving into the hospital setting - how to land the job, any big “culture shocks” you experienced moving from STR/Skilled nursing to hospital, tips for getting in the swing of things, important things to review before starting... really anything you think might be helpful.

Thank you for any advice or input you have!!

Sam

[Jedrnurse, BSN, RN]

You may actually be in for a pleasant culture shock. Some sub-acute SNF patients are actually more "acute than sub" (so you've already had a taste of acute care), and in a hospital setting, you'll have access to more in-house support services.

And WAY fewer patients...

[egg122 NP, MSN, APRN]

Jedrnurse, BSN, RN is right. LTC and Sub-acute are now similar to many med-surg floors since they offer acute care services with IVF and IV medications. SNF nurses tend to also develop excellent assessment skills. On top of this, nurses have 15-40 patients in the SNFs! I have a lot of respect for LTC/sub-acute care nurses.

I think you won't have trouble on the inpatient side at all with time management, assessment and treatment. The hardest part may be adjusting to the EMR/documentation but this is also facility specific. Best of luck to you!

[JKL33]

Start applying!

Craft your resume and cover letter in a way that concisely gives them an idea of the prioritization and acuity you have been handling.

And in case you get an interview/offer: Don't sell yourself short on the amount of orientation you will need in the ED!

Good luck ~

[lovingtheunloved, ASN, RN]

I honestly had a LOT of trouble transitioning from LTC/sub-acute to the hospital. Mostly because our equipment at the SNF was ancient, we had to send everyone to the ER for every little thing so I didn’t get to treat the things I should have, and it was a huge culture shock. I eventually got my groove though! And who knows, it may just be me. I worked SNF for 7 years before coming to the hospital. We’ve had other SNF nurses who have done just fine. Good luck!