Transition to Nursing Home

mazy · Jan 12, 2012

Can I ask why you are considering that kind of career move? I'd get a better sense of what the pros and cons might be for that kind of transition.

CoffeeRTC, BSN, RN · Jan 12, 2012

Pros and Cons will be different for each person.

Depending on the shift and type of center expect to be busy for the most part. We have alot of rehab patients and for a 50 bed place we average 2 or so admits a day some days none for a few days then we might get slammed with 2-4. It varies. The stays are shorter now since alot of our residents are rehabing and going home or to a personal care. We see alot of hips and knees too. Wound care and cardiac patients that are in for some cardiac teaching and therapy.

For those 50 residents we will have 2-3 nurses on staff. 2 that do the meds/ treatments and one nurse that is the charge or desk...makes appointments/ arrangements, deals with doctor calls and orders, rounds with the doc, calls family/ pharmacy and starts on admits/ discharges etc. When we have 3...it is doable.

Time4dilaudidyet · Jan 13, 2012

I really like getting to know my patients. Starting with an 8 patient assignment every night, mostly high acuity, Im not afforded the luxury of really getting to any of my patients. I was told by an LPN on my floor that worked at a SNF, that I would have more of an opportunity to know my patients.

Time4dilaudidyet · Jan 13, 2012

I'm a little concerned with reports of RNs getting a 20-25 patient assignment every night. How does 1 RN accomplish all the required duties of patient care, (charting, assessments, med passes, dsg changes, etc.) without risking his/hers license every night? Just asking, I'm unfamiliar with this area of patient care.

exit96 · Jan 13, 2012

Been an LPN at a LTC facility for about 8 months. I am taking my RN-NCLEX in one week and can't wait to get into a hospital. I do like the nursing home, I do love the population of elderly folks. I work noc so I get in there at 6:30p, pass meds and do treatments to approx 24 residents, then inherit another 30 residents at 11p until 7a. What I have grown tired of already is the fact that, on a perfect shift, when absolutely nothing goes wrong, you have no "behaviors" to deal with, you have all the meds you need in your cart/facility, etc it can be pretty nice. I am per diem so I work different halls, and last night i was on "the worst hall" and had the best shift ever!!! It is the least desired hall with lots of behaviors, demanding residents/families etc. I DO feel like my license is at risk working there. Just way too demanding. I AM a very efficient/ hard working guy, so this is not the issue. The "under-staffing" in LTC is true. My terminology for what I do is "Olympic Med Passing." THAT is the main focus, like it or not. If by chance I have to do other nursing skills, such as assessing a declining resident and then calling the physician it just gets in the way of getting the meds passed and the treatments done. I want to do assessments, call doctors and such. Good luck in your transition. I can't wait for my transition to acute care :-)

nurseprnRN, BSN, RN · Jan 13, 2012

i have to interject something here. this repeated drumbeat about "risking your license" is waaaay overstated. my state nursing association (and probably yours too) has a monthly newsletter with ceus, news, and other nifty features. it also includes a list of people who have had their licenses lifted, suspended, or restricted. the charges for these things are on the order of felony (theft, fraud), narcotics diversion, working under the influence, gross negligence (and this does not include "my floor is waaay to busy," but big or willful and intentional bad things like giving a 1000-fold overdose because of miscalculation, completely omitting an entire med pass, or giving medications without a medical plan of care), and the like. ordinary errors in practice (unless they include the above) are not usually cause for action against your license. stand down.

for what it's worth, there's a whole thread on this exaggerated fear elsewhere on an.

exit96 · Jan 13, 2012

Well, do you work in LTC GrnTea? I guess perhaps you are right, in a sense but are missing the point in another. But maybe I could express it in this way: with the under-staffing and having way too many patients if someone (God forbid) would need attention other than cramming pudding in their mouth and running to the next resident, I guess we need to slow down and just let everyone get ticked off. When I go in I want to be efficient, on time with meds etc...so maybe it isn't exactly "risking my license" but it could turn into that in a blink of an eye. I think you know what I mean. Just trying to point out that LTC sucks because of this dynamic. The normal shift, in my experience goes something like this: get report, see who needs m.o.m., look at new orders, labs etc, start passing meds, while doing this the usual chorus of voices are saying; "so and so in special care is wound up, they need their ativan, and so and so is having a hypertensive crisis, then come and look at so and so's bottom, so and so wants their pain meds and the daughter is in the room and is mad, doctor so and so is on the phone, 33-1 is wanting to go to bed and she wants her meds NOW, oops looks like the nurse before me "forget" to replenish the med cart again so I have to run to the med room, and I have to look for x-med in the backup box for the meds that ran out and didn't show up yet, hurry up now and pass those meds, 32-2 refuses to use the call light and ignores her alarms and she just fell yesterday so keep a close eye on her because the aides are over stretched also, a handful of residents have to take their meds a certain way (not out of necessity but just because they have an attitude and want to keep you in the room out of spite), telephone, "wow I better hurry up so I can get to my treatments before people fall asleep ( you know we aren't supposed to wake people up when they finally get to sleep), and so on. If this isn't a "risky" situation then what is?? There is a difference between multi-tasking and getting your orifice handed to you. I DO float to different units, so if I was full-time and had my own assigned unit everyday efficiency would increase. Your point is "taken" and your info valid. Thanks

Time4dilaudidyet · Jan 13, 2012

Wow! I have some serious soul searching to do. I have an interview with Sable Palms Monday. Based on your experience, do you have any advice on what type of questions I should ask of them to help me make an informed decision as to whether or not to accept a position there.

Time4dilaudidyet · Jan 13, 2012

BTW, good luck on your NCLEX.

Morainey, BSN, RN · Jan 13, 2012

Well, do you work in LTC GrnTea? I guess perhaps you are right, in a sense but are missing the point in another. But maybe I could express it in this way: with the under-staffing and having way too many patients if someone (God forbid) would need attention other than cramming pudding in their mouth and running to the next resident, I guess we need to slow down and just let everyone get ticked off. When I go in I want to be efficient, on time with meds etc...so maybe it isn't exactly "risking my license" but it could turn into that in a blink of an eye. I think you know what I mean. Just trying to point out that LTC sucks because of this dynamic. The normal shift, in my experience goes something like this: get report, see who needs m.o.m., look at new orders, labs etc, start passing meds, while doing this the usual chorus of voices are saying; "so and so in special care is wound up, they need their ativan, and so and so is having a hypertensive crisis, then come and look at so and so's bottom, so and so wants their pain meds and the daughter is in the room and is mad, doctor so and so is on the phone, 33-1 is wanting to go to bed and she wants her meds NOW, oops looks like the nurse before me "forget" to replenish the med cart again so I have to run to the med room, and I have to look for x-med in the backup box for the meds that ran out and didn't show up yet, hurry up now and pass those meds, 32-2 refuses to use the call light and ignores her alarms and she just fell yesterday so keep a close eye on her because the aides are over stretched also, a handful of residents have to take their meds a certain way (not out of necessity but just because they have an attitude and want to keep you in the room out of spite), telephone, "wow I better hurry up so I can get to my treatments before people fall asleep ( you know we aren't supposed to wake people up when they finally get to sleep), and so on. If this isn't a "risky" situation then what is?? There is a difference between multi-tasking and getting your orifice handed to you. I DO float to different units, so if I was full-time and had my own assigned unit everyday efficiency would increase. Your point is "taken" and your info valid. Thanks

Posts like this make me so happy I don't work in LTC.

rnlately · Jan 14, 2012

Been an LPN at a LTC facility for about 8 months. I am taking my RN-NCLEX in one week and can't wait to get into a hospital. I do like the nursing home, I do love the population of elderly folks. I work noc so I get in there at 6:30p, pass meds and do treatments to approx 24 residents, then inherit another 30 residents at 11p until 7a. What I have grown tired of already is the fact that, on a perfect shift, when absolutely nothing goes wrong, you have no "behaviors" to deal with, you have all the meds you need in your cart/facility, etc it can be pretty nice. I am per diem so I work different halls, and last night i was on "the worst hall" and had the best shift ever!!! It is the least desired hall with lots of behaviors, demanding residents/families etc. I DO feel like my license is at risk working there. Just way too demanding. I AM a very efficient/ hard working guy, so this is not the issue. The "under-staffing" in LTC is true. My terminology for what I do is "Olympic Med Passing." THAT is the main focus, like it or not. If by chance I have to do other nursing skills, such as assessing a declining resident and then calling the physician it just gets in the way of getting the meds passed and the treatments done. I want to do assessments, call doctors and such. Good luck in your transition. I can't wait for my transition to acute care :-)

I worked LTC for little over 3 years and then transitioned to acute care. The routine you state is spot on and routine that I followed when I worked there and not only that once you know each resident you can anticipate their needs and streamline your time. I also worked per diem but I floated so much that I knew each and every resident in the 100 bed facility. My transition to acute care wasn't as rocky as I thought it would be and you seem like you are going to do just fine.