As someone who's been a charge nurse in a nursing home for some time now (as first RN job) I must admit that I was wrong and many on here have been wrong as well.
The position is looked down upon but I can assure you there is a lot of critical thinking, decision making and responsibility in that position. As the lone RN in charge of 8-10 Aides, 3 LPN and 65-70 residents it is a huge task and responsibility. Not to mention when things go south for a resident, you might as well be a nurse in the rain forest or Kenya (as far as supplies are concerned). All you have is your critical thinking skills.
My opinion of nursing home nursing? It's unsaaaafe. I think they should have more nurses. I don't know how they safely do it. If you have 15 residents, how often can you check on them? How often can you really assess them? 15? Shift starts at 7? What kind of assessment can you get in that time frame?
I have been a nurse for 7 months now. Late bloomer...I'm 53. Wanted to work in a hospital but all are magnet hospitals around here and want bsns. Not sure if I'll continue and do that. Anyway got a job in ltc. Many nights I have 26 patients and sometimes like last night I work a split shift on our rehab floor and then went down and finished my shift on the ltc side. Don't feel that I'm getting to practice some skills like iv starts but I definitely get a lesson in time management each night I work. It's hard work and not the best pay. I am constantly being called to work extra shifts to which I usually say no. It's too dang hard on my body plus we're so short staffed bc low pay and working conditions that I feel I'm part of the problem if I help to fill in their shift gaps bc they can't keep anybody due to the aforementioned reasons. Don't know where I'll end up but I had to get my foot in the door and get some experience.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
LTC is heart-breaking. If you are like me, you love the residents. You care deeply for them like your own family. But decent care of them is out of your grasp because as an LPN/RN, you are assigned an entire hall of anywhere from 25-40 residents or more and by the time you are done with your med passes, you are on to treatments, wound care, etc. You spend your entire shift trying like hell to prevent falls and other problems. You WANT desperately to connect and care for each one but time and staffing constraints will never let you do that.
So you either resign yourself to these impossible conditions and harden a bit or you (like me) move on because you can't stand it anymore.
I have nothing but respect and admiration for LTC staff , from nurses, to aides, dietary, you name it. It's one of the hardest, and often, thankless, but most important jobs in the business.
Specializes in Oncology; medical specialty website.
I have been a CNA, EMT & LVN, in the RN program currently. I've been a LVN for over a decade and have worked for a magnet hospital in the ER/MedSurg/GI/L&D, a inpatient hospice, surgery center, a wound care center and also a quite a few SNFs. I've always held more than one job so I've gotten around the neighborhood a bit.
I can give the OP this credit, I have come across nurses, FD paramedics and MDs who feel SNF nurses are less competent and less of a nurse. I've also had the wonderful privilege of training a new hire or new grad RNs who have issues with a LVN being the charge nurse or my being a LVN and training them or think they are "too good" for this work. Heck I am more than happy to hop on that cart and good F'ing luck on that desk sweet cheeks, 99-149 patients, 3-6 LVNs and a bazillion CNAs. If you are going to act superior to me since you are from a hospital, then why should I help you when you are snubbing your nose at me? End of shift my tushy is out that door on time for once and that nurse is asking if I am going to help. NOPE! And I straight tell them it's karma and a clearly needed life lesson that I'm not clicking out and spending my personal time helping do their work. Which btw is super common here, you aren't finished at the end of your shift? Well then click out and finish
It is very rare I come across these kind of people by I've also seen RNs give incompetent report to FD paramedics so not sure I can always blame some of them for their feelings. They asked one nurse how long she had been doing CPR and she told them she first got her CPR card in 1988. Eek!
I love working in the SNF and around here that's where the better pay is, I also make more than a new grad RN does though so lol it's all kinda wacky here. I absolutely HATE the ER. I can't stand the floor in L&D, desk I'm great but beside with some of the ignorant selfish choices it just bugs me and makes me bitter. I love seeing how much all my effort really has an effect on my patients and it warms my heart to see these patients celebrating some of their life accomplishments and hearing all of their stories. Before the RN program I was a Case Manager, I have SLE&RA so working in a SNF just is not feasible for me for long term career but I would love to be a Case Manager at a SNF or subacute. I'm dreading having to get my experience in the hospital on the floor and am hoping for a quick transition to CM/UR or maybe the NICU. I love the NICU. All of the fields I love involve patients who are there longer term that the 24-72hrs.
It takes a special kind of nurse to deal with some of the craptastic work conditions SNFs have. But it also takes a special kind of nurse to deal with all those patients that come into the ER and into the wound clinics. It takes a special kind of nurse to do each of the different fields.
Nurses should not work off the clock...ever. If a problem comes up when someone is working off the clock, it can leave the nurse and the facility open to major legal issues.
As far as the CPR comment? I can see how one could blurt out a dumb answer with all of that adrenaline running and the excitement of the moment.
LTC is heart-breaking. If you are like me, you love the residents. You care deeply for them like your own family. But decent care of them is out of your grasp because as an LPN/RN, you are assigned an entire hall of anywhere from 25-40 residents or more and by the time you are done with your med passes, you are on to treatments, wound care, etc. You spend your entire shift trying like hell to prevent falls and other problems. You WANT desperately to connect and care for each one but time and staffing constraints will never let you do that.
I don't see how you can possibly keep them all straight. I don't care how healthy they might be, this kind of ratio would give me regular anxiety nightmares. I really don't know how even super nurse could truly feel "safe" about this kind of assignment!
My opinion of nursing home nursing? It's unsaaaafe. I think they should have more nurses. I don't know how they safely do it. If you have 15 residents, how often can you check on them? How often can you really assess them? 15? Shift starts at 7? What kind of assessment can you get in that time frame?
LTC residents typically don't need hourly checks or regular (daily) physical assessments. If they do, they probably shouldn't be in LTC. I'm referring to ICF-classified residents, not skilled Medicare folks.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I don't see how you can possibly keep them all straight. I don't care how healthy they might be, this kind of ratio would give me regular anxiety nightmares. I really don't know how even super nurse could truly feel "safe" about this kind of assignment!
I didn't. That's why I left. It was impossible to do everything needed/expected and I was burning out fast.
Specializes in Psych, Addictions, SOL (Student of Life).
I don't see how you can possibly keep them all straight. I don't care how healthy they might be, this kind of ratio would give me regular anxiety nightmares. I really don't know how even super nurse could truly feel "safe" about this kind of assignment!
It's not so bad when all the residents are stable long term residents as you get to know them and their quirks and idiosyncrasies. But lately we are getting more and more complex medical patients some post-op at 3 to 4 days that take more time and effort to assess and take care of. as for staffing goes that's not going to change until they are no longer regulated by the state and move into being regulated by JACHO. As it is the law at least in California set's and extremely low reimbursement rate and minimum safe staffing based on the number of nursing hours a resident needs (in their opinion) It's a sort of complex math formula and often left to the interpretation of the DON. I often have to split my focus between high and lower acuity residents. Still I do have a pretty good team on my shift. I treat all my co-workers with respect for the part they play in the process, CNA, LPN, are all invaluable to the process and we usually don't get hung up on the LVN charge nurse title. I just have one that likes to throw that around and act like she knows it all. She also makes a lot of mistakes. When someone comes in asks who's in charge she will say "that's me" then if it's something she can't handle she comes running for me. As much as I want to say "It's your baby you rock it." I won't compromise resident safety that way. PS. I never ever work off the clock for the following reasons: I don't work for free! I have my son's prep school tuition now and college tuition in the future to look forward to. It's HIPAA violation. It's also a violation of several employment laws. I made all this very clear the first time I was asked to work off the clock. My OT is not excessive but it does occur.
My opinion of nursing home nursing? It's unsaaaafe. I think they should have more nurses. I don't know how they safely do it. If you have 15 residents, how often can you check on them? How often can you really assess them? 15? Shift starts at 7? What kind of assessment can you get in that time frame?
Way more than 15 residents is the norm. Depending on the shift it's more like 25-50. But we don't do assessments on all of them, or even very many of them. Only medicare pay require a quick daily assessment, and we split up these so not one shift gets them all. Unless there is a change of condition we are monitoring there is no need for assessments every shift, or even every day.
This is a little different of course for our short term rehab unit, with more acute issues the assessments are much more frequent, however the census on that unit is also much lower.
Specializes in LTC,Hospice/palliative care,acute care.
Many do. Many think the LTC position is the bottom of the barrel and is a job of last resort. Myself included. I now know I was wrong. Even though the pay and working conditions in this area are the bottom of the barrel.
That's changing around here.....Our admin is striving for 5 stars with BSN unit managers and as many RN charge ourselves we can find.....
Many do. Many think the LTC position is the bottom of the barrel and is a job of last resort. Myself included. I now know I was wrong. Even though the pay and working conditions in this area are the bottom of the barrel.
While I agree that many do look down on nurses that work in LTC, the environment and pay is not always bottom of the barrel. In my area, I was offered $5/hr more for LTC than hospital as a new grad RN.
applesxoranges, BSN, RN
2,242 Posts
My opinion of nursing home nursing? It's unsaaaafe. I think they should have more nurses. I don't know how they safely do it. If you have 15 residents, how often can you check on them? How often can you really assess them? 15? Shift starts at 7? What kind of assessment can you get in that time frame?