transition from hospice to LTC

[Aunt Slappy]

I was a CNA for four years, part of that time in a hospital telemetry unit, most in inpatient hospice. I went to school while working full time at that job, and became a hospice nurse once I was licensed. I have finished almost a year, and a couple months ago picked up a pool job at a local LTC that focuses on veterans (not VA). The LTC offered me full time, and due to some issues going on with my current employer, I accepted it and gave my notice. I also wanted to get off night shift, and this position is 8 hour days starting at 0600. It fits with my kids' school schedule, and I have a 16 year old who just got his license and can drive his siblings to school for me now, so me being gone early 5 days a week like that isn't much of an issue anymore. I am so looking forward to sleeping at night like a normal person again.

I already know that the pace and patient load are totally different, but this facility seems to me to be well-run and well-staffed. From what I have seen as a pool nurse, the teamwork is good and the CNAs are an impressive group, giving the nurses the support they need to focus on nurse-only tasks and taking good care of the residents.

So, I guess my question is......what challenges might I face that I'm not seeing coming? I already know the med passes are huge and I gave more insulins and tube feedings in one day there than in my entire time as a hospice nurse. Obviously, while I want comfort for my patients, the focus is on maintenance, improvement, and for some things even cure in a way that's not present in hospice care.

Fire away. I want to know what might smack me upside the head that I'm not expecting.

[amoLucia]

Am just catching this post a couple days late. To OP - just know that LTC is more highly regulated than the other healthcare fields.

It will seem like EVERYTHING in LTC has a regulation to regulate it. Am NOT joking!!! So there is most usually a reason WHY something is done (or NOT DONE) a certain way because of some regulation.

Now on a more micro level - time management will be a concern as well as family interactions, interdisciplinary & interdept relations and role development.

You will quickly see how your time management is so critical with juggling your heavy workload in a timely fashion. 'Nuff said!

But family interactions also SIGNIFICANTLY drive care provision. 'If the family ain't happy, the facility prob won't be either'. REALLY! You're not dealing with just one family, but many. And you'll soon find out that families tend to 'pack together'. And those blasted satisfaction scores ... !

There's freq a lot of fragile egos and 'turf' war possibilities. BUT ... it sounds like there's some good teamwork & management where you're at. That is terrific!

Another thing. As a licensed nurse, you will most likely be responsible for 'supervising' or 'monitoring' the care provided by CNAs. Not a task relished by many new to the concept of overseeing others. Like it becomes difficult when you have to depend on the CNA to empty a foley for you to do the I&O, but it's not being done. That makes YOUR job tough when YOU'RE scrutinized by the PTB. It's YOUR job to 'deal with it'.

Just some things to keep in mind. Good luck with your new endeavors.