What is working at a skilled nursing home like? New nurse needs advice.

[nurse1045, BSN]

I only have 3 months experience in med-surg. When I was on the med-surg unit I usually had 6 patients. It would take me a really long time to do med pass and assessments just for these 6 patients (for example, 8am-10:30 or 11am). I've heard that nurses working at nursing homes can have around 30 patients at a time. Is this true? I don't know how I would be able to complete med pass in a timely manner with that many patients. Do you have to do assessments every shift for these patients, too?

I'm also wondering how different skilled nursing is from med-surg in terms of families visiting, calling doctors and getting orders, and charting. The job I'm looking at also has 8 hours shifts instead of 12 hour shifts. There's 7am-3pm, 3pm-11pm, and 11pm-7am. Which one would be the best for a fairly new and unexperienced nurse like me?

Thank you to anyone who responds with advice!

[Davey Do]

Two of my LTC positions, as an LPN and then RN, have been on MNs. I orientated on days and eves and they are, to say the least, hetic.

I enjoyed MNs because they were slower and I felt like I could spend time with the residents when needed.

Good luck nurse1045!

 

[JBMmom, MSN, NP]

I did my first five years of nursing in long-term care. We had 60 patients in two long term units with two nurses- 30 patients each. We had 37 patients in the dementia unit with a charge nurse and a medication nurse 7am-8pm. We also had a 30 bed short-term rehab unit with a charge nurse and medication nurse 7am-8pm. 

I remember showing up for my first day of orientation and the nurse said. Do you want to do the med passes? I was working 3-11pm. There was a 4-6 pm med pass a 7-9 pm med pass and the treatments were done in between or after. Of the 30 patients on my regular unit about 25 were on the 4-6 med pass and 18-20 were on the HS med pass. The blood sugars were on the 4-6pm pass and most of the bp meds were on the HS pass. When there were new treatments added, I was sunk. 

It was hard work but I enjoyed it. Time management becomes a valuable skill. Assessments are very focused. Aides do vital signs, usually once a week for each patient unless they're currently being treat for a more acute illness. Weights are done monthly with shower day (shower day is weekly). I didn't happen to catch a few patients that "didn't look right" and ended up hospitalized for illnesses, but there's rarely full assessments. 

Patients that are Medicare patients require chart notes every shift and addition to any patients currently on antibiotics or with significant medication changes. There is sometimes a unit coordinator or supervisor that can enter orders from the doctor, but sometimes there's no one other than the nurse. Admissions are most common in the skilled nursing wing on second shift as patients are discharged from the hospital. 

I worked 3-11 and I liked that flow of work. The patients are up when you arrive and for the most part in bed when you're leaving. 11p-7a sometimes gives you more time to spend with patients and time to learn when looking through charts and notes, but since the staffing on nights is thinnest, one frequently incontinent patient, or one impulsive dementia patient can really eat up your whole night. Day shift has the busiest time, especially when patients are leaving the floor for recreation, physical therapy, family visits, etc. so that can throw off med passes and time management. There will be good and bad about every shift, just figure out what works with your life.

Good luck, LTC can be a great place to work!