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.
As a CNA and then a phlebotomist in clinicals I witnessed how hard LTC nurses have it. I give credit because I can't do it. Being a CNA to Alzheimer's and dementia patients is hard enough.
Last night was prime example of how rough it can be for a LTC RN. I was doing the admit assessment/paperwork for a new admit when one of the LPNs comes to me and tells me that our resident with a chronic nose bleed (that's we've been trying to stop for about 5 hours now) is starting to gag on the blood draining down his throat. Less than 30 seconds later another LPN comes to grab me because another resident's SaO2 suddened dropped and they are significantly SOB while on O2 and sitting in the wheelchair. Not to mention I'm trying to manage comfort cares for a gentleman at the other end of the building who is finally dying (it's been a terribly long process for this person) from CHF/COPD. Then a resident falls while attempting to self-ambulate. Plus it is time for me to administer a resident's IV antibiotic via PICC line. I'm the sole RN in the building. Let me tell you that a RN can get stretched pretty thin at times in those conditions.
As a CNA and then a phlebotomist in clinicals I witnessed how hard LTC nurses have it. I give credit because I can't do it. Being a CNA to Alzheimer's and dementia patients is hard enough.
I say this to any student: what if you have to do it? No one is guaranteed a position anywhere. Even if your classes are paid for by your employer, they can cut you loose if they don't have a position for you. Have seen it often in the last 5 years.
I was just trying to start a conversation and admit I was in error. Man some of you people are touchy. No wonder people get so Offended on social media.
I hate to tell you but in my class of 70 RNs I'd argue that 95+% looked down on LTC nursing. The community I live in, I'd argue that statistic is the same. Like it or not, the vast majority DO look down on the job and don't feel it is "real" nursing.
Now that they've worked a little, wonder if they've learned to be a little less judgmental about their peers and the many different types of nursing care.
So, will freely admit that I am one of the judgmental ones.
When it warrants it.
SNF sends out a patient who is combative, fell, AMS...I don't care. I just hope that I get the correct paperwork from the SNF (because I've been there, I've seen the files, I get how it can be confused and I try to at least let them know that "hey, you sent me Mr. Kidney, but I have some stuff from Mr. Renal here...looks like his official DNR. What would you like me to do with it?")
I get a patient who has no history of dementia or other organic brain disease that had EMS called for a sudden onset of crushing chest pain, and tells me "no, I was just watching TV. I have a little cough, but I've had that for years...no, my chest never hurt." I tend to raise my eyebrows and start thinking about how they're going to get home.
I get a patient who has gone so far beyond septic that we're having trouble getting a central line placed because they are that hypotensive, the sacral pressure ulcer is unstageable with nothing in the paperwork or report about it, and they're about ten minutes away from being in irreversible shock after getting a report that "they were up and walking around just before all this happened?" I judge the hell out of that place and the people working there who sent along a chart that says that skin is clean, dry, and intact. (Same with foleys that are full of pus with a report saying that there isn't even one.)
Of course, every specialty out there will have people who judge it. It's the nature of being human.
Family member just transferred this week in to LTC. So, now 2 family members there. The charge nurses (I'm assuming, NOADLS position, the floor RN???) are amazing in both places. They are very kind to visiting family members, will stop and answer questions and seem to know the patients and their quirks.
They work their butts off. The LPNs, RNs and CNAs are always available. Both the places are spotless.
I have never thought of Nurses in Nursing homes as anything other. As an LVN(38 yrs) who has worked about 7 of mine in Nursing Homes I know that they look for very versatile nurses. A little background: I have worked every unit from ICU- Tele and all in between for many years. I would try anything, learn anything(ICU-cold turkey). I did all of this for many years. Now I stick to Med/surg basically if in a hospital. Mostly because I haven't worked some of these since early 2000 and now because only RN's. In a Nursing home you have to have critical thinking in many areas and know when and what to do. When you have a nurse that can do that she will be that great Nurse. Yes Hospital Nurses look down on many but that is where confidence comes in + I have been in a hospital for about 28 yrs of Nursing. It's not all about the Nurse tho. It is alot about taking care of 35+ residents. In many cases it's more. Hospital Nurses have no desire to do that. One thing hospital nurse hate is sending them when not really necessary. I have seen this many times. It makes the Nurse look bad...I have received them in the hospital for this......One case really stood out for me. I personally called the NH Nurse for this one. Asked several ? and came to this conclusion. " Resident wouldn't eat"....Short version. To hospital, every invasive test available to do. Pt then came to hospital ate every meal well for her. BMs good etc.. for 3 days. Bottom line with so many NH residence is they get sick of the food and nothing sounds good..My experience is this happens with many of them. I won't give you the full scoop but I spoke with daughter and when I came back the next day she had returned to the Home. Many hospital Nurses can transit to a NH but they can not do so to a Hospital. That's one reason they won't hire a Nurse to a hospital if only in LTC.(Generalization not an absolute for those who have). I have known some very good RN,LVN's who do great in NH setting.
Specializes in LTC,Hospice/palliative care,acute care.
A successful LTC charge nurse has to be an excellent manager AND clinician.That nurse is responsible for every department directly impacting the residents.
Hey everyone! Just a quick question and trying to get some insight.
I work in an LTC in Texas and recently, the administrator decided to post a note above the time clock. The note stated that all nurses are to punch out for a 1 hour lunch. Problem for me is, I work 16 hours shifts (2-10/10-6) and I have no one to relieve me. I am the only nurse in the building with just 2 CNAs'. The other shifts during the week and weekend have proper relief for their break and meal times. I however do not.
I worked 34 hrs this past weekend, and missed the meeting where the administrator supposedly stated " for the good of the patient, health and welfare." I am not allowed an uninterrupted break? What would the state or Txbon say about me being off the clock without relief of staff?
KThurmond
636 Posts
As a CNA and then a phlebotomist in clinicals I witnessed how hard LTC nurses have it. I give credit because I can't do it. Being a CNA to Alzheimer's and dementia patients is hard enough.