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.
Trust me guys. It's not that great. I literally spent 3 hours tonight having the same conversation over and over and over again with a resident who was SunDowning big time. At the very least it gives me the opportunity to practice (and re practice) my communication skills.
We have pts who sundown in the hospital too. There are very few fields of nursing where you can escape sundowning.
I have nothing but respect for ltc nurses. They are the kings and queens of time-management and problem-solving. As much as I ***** about med-surg, having six or seven pts can't be as challenging as having 20+ patients with fewer resources.
With the aging population, LTC is the wave of the future.
You are lucky to be so well staffed! I worked long term care in a local nursing home where I was the sole nurse with a med aid and 3-4 cnas for up to 50 residents. We started out two nurses but went down to one for approximately 18 months. When I complained that it was too much I was told "we're trying to hire more nurses". I trained 3 or 4 nurses that didn't stay. It was a mess.
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.
Hppy
This is why I don't want to go back the passive aggressive behavior of truthfully being over worked and underpaid as well as appreciated...
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.
I thought they still had to chart a daily assessment on them.
Still, it's scary. A lot of times we'll get report that "we just changed shifts" about a patient not breathing.
Specializes in LTC,Hospice/palliative care,acute care.
I thought they still had to chart a daily assessment on them.
Still, it's scary. A lot of times we'll get report that "we just changed shifts" about a patient not breathing.
It's not uncommon to find someone has died when you are making rounds at shift change.Most of them are old with multiple co-morbidities.They die any hour of the day or night.We try to educate the resident and their loved ones regarding code status often with no result .
There are no requirements in my state for charting on a stable LTC resident.Each facility has protocols to follow for a change in condition or a "skilled' resident
I think that perception had changed with time. Most RNs I know refuse to work in LTC because of the horrific conditions and lack of ratios or any kind of support. I was an LVN and left my LTC job after 5 months because i was it on swing or night shift and I was not comfortable with that much responsibility as a new nurse. LTC is viewed as one of the worst jobs by many nurses because its very hard, not because it's "easy" or "doesn't take skill." Anyone who does think that is very mistaken.
Many forget that LTC is a specialty and requires a great deal of skill be become successful within it. I laugh when other nurses look down on the job that I have within LTC because I have seen nurses from all specialties, such as ER, ICU, and Med- Surg, that can not hang and complete the amount of work we have to do within the setting. There has been many days and nights that I have had to use my critical thinking skills to deal with a change in condition of a patient because the MD thinks the patient is okay. I love what I do and my patients do too. Majority of the negative vision of LTC nurse comes from the unknown about what we do. I job shadowed in the hospital one day just to see what all fuse was about and many of the Med- surg nurses could not believe the amount of work we do in LTC. Yes I draw my BUN/ Creatinine for my Vanc patients as well as spin them. It took me a long time to come to terms with the fact that LTC is were I belong. This is after a job in Med- Surg and Surgical Trauma. I plan to specialize in geriatrics and make LTC a place to be for our patients as well as for us.
So are nursing home LVNS/LPNS. Often times it's the LVNS critical thinking skills that the nursing home patients have to depend on. They are the doctor's eyes and ears.
I just saw this post featured on Facebook. I am SO FREAKNG ANGRY that OP's biases are being represented as held by the majority of nurses. I objected to this thread from the start and requested that moderators remove the objectionable title, to no avail.
Thanks for nothing, OP. Actually, worse than nothing. Thanks for casting a negative shade over us all.
I have been an LPN in a nursing home for my whole career. My Instructor told us in school that if we wanted to learn to be real nurses, we start out in a nursing home. We would learn all aspects of care and she was right. I did wound care, respiratory care, diabetic, psych, I did charge nursing, and PT, we did everything you can think of and more...including end of life care. I was looked down by nurses outside of the nursing home and told we didn't know what real nurses knew. I did CPR, and worked with codes on a daily basis. When a patient crashed for no obvious reason, we knew they would do it before they started....I saw RNs come and go...they couldn't take the heat. When you get a good nurse who sticks it out...whether RN or LPN...they know their stuff.
Not a job I want, but I have never thought it was an easy or not a real rn or Lpn job. But honestly..... The real heros of ltc are the nursing assistants. Most valuable but under appreciated job there is
ThePrincessBride, MSN, RN, NP
1 Article; 2,594 Posts
We have pts who sundown in the hospital too. There are very few fields of nursing where you can escape sundowning.
I have nothing but respect for ltc nurses. They are the kings and queens of time-management and problem-solving. As much as I ***** about med-surg, having six or seven pts can't be as challenging as having 20+ patients with fewer resources.
With the aging population, LTC is the wave of the future.