I just quit today after two weeks. I thought I was lucky enough to land a job at a SNF/subacute place nearby. After the first week, I was in for a rude awakening.
I had only 5 days of orientation in a 98 bed facility and was labeled charge nurse. Half the place is LTC, the other half subacute. 1st and 2nd shift have 3 nurses--usually 1RN and 3 LVN; 3rd shift usually has 2LVNs. Once I was on my own, passing meds to about 35 pts (in the LTC side) pretty much took me my entire shift. It was overwhelming and frustrating. On top of that, since I was an RN, I was responsible to hang IVs for all IV pts, no matter what side. I barely had time to document, and little to no time to assess the pts. As a friend had said, it felt like an assembly line--and that's how I felt I was treating the pts. There was no time to chat, no time to care, no time to critically think. Many of the staff members actually work on their OWN time (i.e. Not getting paid!) to chart, since many of them are afraid to get too much overtime since Administration will question them about it and may affect their performance review.
Many of my co workers were trying to convince me to stay, saying that it'll get better, that everything will become routine. But why is it that they are still taking more than their shift to do their work? It's simple: it's understaffed.
I brought all my issues up to the DON. All she said to me was, "I told you it's a lot of work and that it's a lot of patients. It wasn't going to be easy." Of course I didn't expect the work to be "easy", but I explained to her that there was no amount of training that could help me provide quality patient care if there is no time given to do that. She said she would like to hire more nurses, but Administration apparently doesn't want to hire anymore for any one shift. She just didn't seem to care too much.
I just had to vent and bring this up to all you new grads. I know I'm not the only that experienced this since I spoke and heard about a few people that experienced the same thing. I just want to give you some advice if you're looking into LTC or SNF. Some things I wish I had done before hand:
You may not see everything that goes on behind the scenes with this, but at least it's a good overview of the place. It's better than making any judgements based on how nice the building looks upfront or the nice painting and furniture in the reception area.
3) Ask the DON a lot of questions.
How many beds? As a new grad RN what are the job responsibilities? The job description? Expectations? Number of patients in your care? What is used for documentation/charting?
4)If you do commit, remember to buy some malpractice insurance (I guess that goes for any place you work at, but especially at a high liability job)
I hope this will be of some help to someone out there considering a job in a nursing home. I understand that many of us are still looking for a hospital job, but the pickings are few and far between. I haven't given up hope in finding that job, or even finding a job at another, better LTC facility in the mean time, but these are just some things to consider... Hopefully it'll save you from being burnt out or at least some tears.
When the **** hits the fan, they don't care if you are the doctor at the facility! Somebody has got to take the fall!!! This is why I left long term care for good 4 years ago. I called the doctor from a LTC facility and identified myself and before I could tell him what the problem was, HE RUDELY STATED FOR ME NOT TO CALL HIM AND HE HUNG UP!!!! I reported this to management that night and their response was, "oh he does that". Well for me, that was NOT acceptable and they told me that they were not going to do anything about it. So when I clocked out the next morning, that was the last that they saw of my ***! I love geriatrics and the elderly but I cannot work there because I cannot sit back and watch **** like that continue to happen day after day. I returned to my agency hospital assignments and have been doing SOLELY med/surg ever since!!!!! These elderly folks need care and I go above and beyond for them WHEN they come into the hospital because with the everday situations that those folks are subjected to because mgmt doesn't give a flying u-know-what, they WILL be coming into the hospital!!!! I applaud nursing home nurses everyday for sticking around when some of us just couldn't take it anymore when it came to dealing with mgmt's neglect of these defenseless history makers!!!
OMG - I feel as if someone is writing my memoir. Put "Gizmo44" as the poster and all would fit my experience. I went through the same thing only as a new grad LPN. I got my license in Aug.08 & started PRN in LTC. I asked if it was doable for a new nurse to do PRN and was told yes. I needed a job so I took it. Training was 3 days-1 day in each unit, I got 5 days because I asked for additional time since I would be floating. It was so unorganized - took over 3 weeks mind you to get my 5 days in. My title was Charge Nurse which I thought strange because I didn't feel as if I knew enough to be in charge of anything. I should have listened to my instincts when experienced nurses were complaining about the work load. I saw so many corners get cut I couldn't believe what I was seeing. Was told this is how it is in the real world. By the time I was on my own, it was almost 2 months before I got a shift. I had nearly 40 residents of all acuity levels, had j-tubes, treatments, blood sugars/insulins, supervised meal time-including recording nutrition/fluid intake, Supervised 2 CNAs in my unit, lucky if we had a 3rd that floated, had a killer med pass-most got them crushed or floated-felt like I was doing nothing but passing meds. We had a 2 hour window to pass to everyone and I hate to admit it but I couldn't do it in that time period. Not do it to policy & procedures - then I found out hardly anyone did. The person who trained me on this unit didn't crack open the med/treatment books. Said she had everyone's meds/treatments memorized. Charted on her med pass/treatments at the the end of her shift. I never had time to assess anyone for changes, have a conversation with anyone, I barely got the required assessments in as it was. Speaking of assessments, during a training shift, I as given a stack of assessment forms that needed filled out on some of my residents. I thought, I didn't assess anyone, I can't fill this out, I don't even know anyone's name. The response I got was sure you can you saw everyone today. I said to myself this is nuts but said outloud that I did not do any assessments, don't know the people or their condition, so I would not feel comfortable charting on them.
Then, when I was at my lowest, wondering how can I do this, why is it like this, why am I so slow, I found out that it was common for people to clock out at the scheduled time and work off clock to finish their paperwork or charting. I was shocked at how wrong that was. For one thing, it puts you at risk if anything happens to you (slip/fall, etc) because Workman's comp will NOT cover anything that happens off the clock. But it was common practice among nurses because OT wasn't allowed.
Now, I did not go into nursing thinking it would be easy, on the contrary. I wanted to work hard, be challenged, help people, and learn new things. I did not want to sit behind a desk staring at a computer all day anymore. I was bored & needed a change. Through my experience I decided to achieve this the best thing would be continue to get my RN to broaden my opportunities. But due to the economy, no one wants to hire new nurses whether LPN or RN. The more I learn about this subject the more I wonder about my decision - as a result I am also looking into other areas of healthcare like surgery tech or RT. I also do not believe there is really a nursing shortage. There is, however, a shortage of nurses wanting to work so short-staffed, putting themselves & health, their patients, and licenses on the line. I bet if they took a poll of everyone who ever held a nursing license, they would find enough people to satisfy the need. Also, if they polled the people with or without a current license to find out why they weren't working in the field I bet it would be somewhere a long the lines of working conditions.
I, for one, will not accept the status quo so anyone who says suck it up & deal with it, is wrong. The thing we must remember is that residents in LTC are someone's mother/father or husband/wife or sister/brother. Would you want your's to be treated like this?
With this bad job market the rehabilitation centers I went are not hiring new graduates either. They are only looking for per diem experienced. How sad! On one side I think I might be lucky get a job in any place, on the other side I don't feel like going there for long term. Am also afraid got stuck in rehab if that is my first nursing job.
I just want ot remind everyone that not "all" SNF's are terrible. I am the DON of a SNF, and staff at a much higher rate than what those of you have listed. I feel blessed to have wonderful LPN's and RN's working for our facility. I have hired new grads in the past and am very clear on the challenges that they will face once hired, most stay. I would never consider letting a new hire start working on their own without at least a month of full time orientation to the floor. If it is a new grad, it may take longer, each individual is different. Myself, the ADOn and the nurse managers are always available to assist when needed, and yes, i have come in during the night and weekends. I start my day at 5:30 AM and go until 4:00PM so I can see the staff on all shifts.
Please don't give up hope on LTC, the elderly need us.
The funny part is that I graduated in 95' with a BSN, had worked as a tech for 2 years and couldn't find a job back then either-they wouldn't accept new grads! The conditions you describe aren't just at nursing homes, they are at hospitals also. I can't count all the times I've been in that same situation over the years. There are some better situations but a lot are like that. Hospitals are businesses and a business is out to make money which means less overhead. They could care less about the pt. and the workers, they just want to make money. Funny thing is, you never see the CEO running like a banschee!!!If you ever wonder why there is a shortage of nurses, this is why. I remember in 92' hearing an LPN telling me she was overworked and under payed and she was dead right. School isn't an accurate description of nursing at all-you never hear about the conditions you mentioned just the good stuff and what you see on T.V.:angryfireI recently got out of nursing, started my own company and am much happier. No more threats of being written for BS, no more bedpans, no more admitting 2-3 pt's at the same time, no more MD's blaming you for something they did and writing you up, no more 12 hr. shifts turning into 13,14,15 hr. shifts. I hope you find that happiness! Good luck.
If everybody knows that this job is stressful per sé...If we are working short all the time...If the corporations are not paying enough......If we can be fired for any reason (Policy is observed or not depending also of your relationship with the "Bosses")...if we don't have administrative incentives since administrations change almost yearly and they usually prefer bringing somebody from outside known by them than promote the older employees...If the state during a survey follows a nurse and in order to have a good evaluation. it takes 20 min to give meds. through a GT to one patient, and another 20 min to take care of a patient with a trach., and 15 min to give Bp meds. and insulin to a third one (doing every thing "by the book"), and they already know that the nurse has an assignment of 30+ patients (so is impossible to finish med pass, if we follow state regulations, in 2 hours) but in their survey conclusions all that is not even mentioned...if we work 9-10 hours taking no break and the next day we are called to the office because we didn't leave on time...If we have to take care of Labs., Pharmx, invissible doctors, Doctor's telephone orders, family members, dining room, even the door; with little or no help ...If in the Nursing Homes & Rehab Centers, the acute level of care is higher every day...if the level of knowledge of the DONs is lower every day because in order to get out of the floor they accept less money that the fine prepared nurses......How in the world do we not have enough nurses in FL?? !!!
I am also a new grad, LPN in 2008. I am lucky in that I get to work in a
hospital. I did not want to go to SNF becuase of the same things I am hearing here. I think in the SNF's and the hospitals we have to many patients. Well, in the hospital some areas may be ok with 5 pt's but I get floated often to a surgical floor that has 20 beds , usually only 3 nurses and NO PCT most days.
On Monday I worked on that floor and I really, really wanted to quit!
I just want ot remind everyone that not "all" SNF's are terrible. I am the DON of a SNF, and staff at a much higher rate than what those of you have listed. I feel blessed to have wonderful LPN's and RN's working for our facility. I have hired new grads in the past and am very clear on the challenges that they will face once hired, most stay. I would never consider letting a new hire start working on their own without at least a month of full time orientation to the floor. If it is a new grad, it may take longer, each individual is different. Myself, the ADOn and the nurse managers are always available to assist when needed, and yes, i have come in during the night and weekends. I start my day at 5:30 AM and go until 4:00PM so I can see the staff on all shifts.
Please don't give up hope on LTC, the elderly need us.
Noc4senuf,
This sounds like a situation that I would love. Its overwhelming enough just starting a new job out of nursing school...anywhere for that matter. But to feel like you're just thrown into it, like I was, is another thing all together. In 3 shifts you're just getting your feet wet with the facility (finding the bathroom, learning how clock in, where is the back up stock kept, not to mention learning faces & names-of residents AND staff) I mentioned my experiences to RN friends of mine and they seemed shocked. One said, her unit required 4 months of full time orientation for new hires regardless of the shift they were hired for and more if they need it.
You obviously really care for your staff and their development and it shows.
Thanks for the advice - I'm so sorry you had to go through that! Wow, it makes you think twice before either working in a nursing home or putting someone you love in one.
hi everyone. would you believe that this is the picture of govt. hospitals here in the Philippines? nurses are no longer seen caring but documenting! more hours spent on transcribing mds orders than bedside care! nurses as they say in these places get jaded. there is no such thing as tx communication. patience is a very rare commodity. staff nurses are impatient. hot headed towards mds., patents, sos, expecially to student nurses. when i was a student and saw an ideal staff nurse,(by ideal i mean someone who cared and departed even for a short while from the charts/kardex) it was a miracle. but then again, can you blame them? when you have 80-100 pt in your ward and only 2 auxiliaries with you? and the 80 by they way is a light load already...but i salute them for choosing to serve our indigents. it is really not an easy task, that's why they say nursing is a vocation.
Good advice, but unfortunately I've found pretty much the same conditions in every SNF I've ever worked for. the only exception was one that didn't accept medicare...so the $ were spent on staff to care for the patients instead of additional staff to fill out all the feds paperwork & stay compliant with all their rules. (for a facility the size of the one you described, there's usually 2 or 3 licensed staff dealing with nothing but medicare stuff &are out of patient care completely)
I hope you find that happiness! Good luck.
ladside, BSN, MSN, LPN, RN
162 Posts
When the **** hits the fan, they don't care if you are the doctor at the facility! Somebody has got to take the fall!!! This is why I left long term care for good 4 years ago. I called the doctor from a LTC facility and identified myself and before I could tell him what the problem was, HE RUDELY STATED FOR ME NOT TO CALL HIM AND HE HUNG UP!!!! I reported this to management that night and their response was, "oh he does that". Well for me, that was NOT acceptable and they told me that they were not going to do anything about it. So when I clocked out the next morning, that was the last that they saw of my ***! I love geriatrics and the elderly but I cannot work there because I cannot sit back and watch **** like that continue to happen day after day. I returned to my agency hospital assignments and have been doing SOLELY med/surg ever since!!!!! These elderly folks need care and I go above and beyond for them WHEN they come into the hospital because with the everday situations that those folks are subjected to because mgmt doesn't give a flying u-know-what, they WILL be coming into the hospital!!!! I applaud nursing home nurses everyday for sticking around when some of us just couldn't take it anymore when it came to dealing with mgmt's neglect of these defenseless history makers!!!