Which one is more stressful: med-surg or LTC

[ijuanabhappy, ASN, RN]

I just started a job at a LTC and do not want to go back. I'm an inexperienced RN and got hired on to do weekends only; two sixteen hour shifts back to back. I absolutely love the residents but this job for a relatively new grad seems dangerous to me. I only got three days of following someone around before I started on my own. It was crazy. I had a hall of 30 patients on my own. All weekend I didn't even get around to the mountains of paperwork because number one I didn't have a moment to sit down and number two, I didn't know how to do the paperwork. There were so many things going on at once and I didn't know what to do.

There was a patient actively in the dying process, a lady needing an immediate suppository while her overbearing family was following me around, asking when I would tend to her. I was drawing up insulin while this all occurred. For most of the night I had to keep a close eye on a lady who kept getting up and walking with her IV pole despite being dizzy and told she would fall. I went in to check on her and she was standing by her bed with her head hanging down. As soon as I walked behind her, her whole body weight collapsed on me and with one arm I lowered her to the floor and tried to keep the IV pole from falling with the other. The IV pole bonked me on the forehead, but I managed to keep her from hitting anything as I lowered her to the floor. I called out the hall for help and not a peep from anyone. The other nurses were in their own halls which were far away. No paperwork got completed this night and I felt so completely stressed and scattered. I was asked to pronounce someone's death since I was the only RN in the building. I told them I didn't know the protocol and could someone direct me.. (didn't realize it was as simple as feeling for pulse, listening to heart with stethoscope and calling a time)... but I got major attitude that I am an RN and should have learned this in school.

I interviewed today for a med-surg position at a hospital. I have read on this forum that LTC is less stressful than the hospital. After this weekend, if med-surg is more stressful than what I experienced... maybe I am just not cut out for nursing.

[Katie5]

Go to med-surg.Thank me later:D

[christinacub]

Okay that sounds like a night mare! Honestly, 30 patients??? I was thinking about LTC but this talked my right out of it. I can't believe no one came to help and you hit your head and could have hurt yourself catching the dizzy lady. 16 hour shifts? really??? That's nuts

[optimist]

Having done both, In my opinion they are equally stressfull, only different stressors in each setting. In MS, you have acutely ill pts that may require multiple calls to the doc over the course of a shift.The families can be just as overbearing.You're constantly assessing for minor changes that could be life-threatening and may have multiple admissions/discharges at one time. In LTC, you have to work with fewer resources (including staff). There is no doctor in the house to evaluate a deteriorating pt, the on-call will rely solely on your assessment skills.As the only RN in the building your coworkers will rely on you to perform certain tasks they arent qualified for (pronouncing,etc). So there is no easy answer, they are both stressfull. I would suggest trying out MS and see how you like it. You may realize that the pace of LTC is more suited for you. I went from LTC to MS and right back to LTC. I preferred getting to know my pts and the routines of LTC over the hectic bustle of MS. Best of luck to you!

[wooh, BSN, RN]

Yeah, different stressors. I think there are very few nurse jobs that aren't stressful, they just all have different things to stress about. :)

[Karl Farmer]

My last LTC job- I started weekend doubles. First day I counted 80 meds that were not in the carts, meaning not being given, either. I spent hours calling pharmacy for refills, doctors for refill orders, etc. I documented every single med that was not available to be given, in one way or another. Monday- five nurses were fired from that unit, and I was suspended for 'not calling the DON at home to tell him about this problem', regardless that I had informed the supervisor, doctors, patients, and on and on. I quit, and haven't worked in nursing since. Three years and counting! You will not be backed for anything- they pass inspection by saying 'We got rid of the nurse that was out of compliance', and that stuff. That first day I had 22 patients, 3 discharges, 3 falls, and 4 admits (and again, 80 meds not available). All in 16 hours. So- pick your poison- I've worked in 80 SNFs, in 3 states, they are all the same.

[Karl Farmer]

BTW- the place I refer to, in 11 months, I first worked day shift. When I saw nurses walk out routinely, I started a count, out of curiosity. Before I left- 105 LPNs came and went, 98 CNAs, about 20 RNs, 4 DONs, 4ADMs, 5 kitchen managers, untold kitchen staffers, and several other department heads. This is a 110 bed place with only two units!

[JB2007, ASN, RN]

I find Med -Surg less stressful by far. I got better training, there is a Dr in house, there is the charge nurse and a house supervisor. There are at least 2 to 3 other nurses with years of med-surg experience that I can call and run things by if one of my pts are not doing well. I can call a rapid response if my pt has a change in condition and I think something needs done right away.

In the nursing home alot of the time it was up to me if it was the weekend and no supervisors were there. If one of my residents were going down hill I would have to call the family and get permission for the resident to go to the hospital (because we all know every family member is a medical expert) and then call the doctor, get the order, fill out a mountain of paperwork, call the EMS, and wait for the EMS. In the mean time I would just pray that 98 year old full code did not code on me because that is truely sad doing CPR on these frail old people that the family refuses to let go peacefully despite the fact that the resident has repeatedly stated that they wanted to die.

That is only one of the many, many stressers in LTC. On the plus side you did get to know the residents and their families much better. That could be both positive and negative. However, the pace is not slower in any way shape or form. In LTC I was ALWAYS leaving late...ALWAYS. On the Med-Surg unit I usually leave within a 1/2 an hour of the time that I was suppose to get off.

[tyvin, BSN, RN]

Having done both (and then some) I will say they are both stressful and depending on where you work IMO LTC gets the booby prize for more stressful. Med-surg is more of an organized stress where as in LTC you are oriented for 3 days and then set out to sink or swim; literally thrown to the wolves. You learn a different type of chaos.

The one thing that you will learn in LTC is time management skills. If you don't learn how to utilize your time effectively you will go down fast. On the up side when you do get your med-surg job you will almost think it's funny to watch the other nurses running around all crazy because they have 8 patients. Then you can reminisce about the time you set up a CBI, did trach care, irrigated a wound, changed an ostomy wafer, suctioned the DNR and did an admission all at the same time well almost but anyone who has worked in LTC knows what I'm talking about.

LTC will teach an internal calm when amid the ruckus and pandemonium inherent with LTC you will breath and know you have developed what is now know as "LTC Super Hero Syndrome!" which gives you the ability to scale the halls faster then a speeding bullet, chart faster then a locomotive, able to leap and dispense 800 pills in a single bound, disguised as a mild mannered nurse fighting the unending battle for job security, safe nurse/patient ratios, fair pay and the American way.

Hurrahhhhhhh!

[LuvMyGamecocks]

I, too, agree that they have their own stressors. But, having 5 months in LTC (doing nothing but Admissions/Discharges on a TCU and LTC unit) versus a year and a half on a telemetry PCU floor in a cardiac hospital, I understand the "LTC Super Hero" reference.

Our RNs have 28 pts...but we have me to do Admissions/Discharges, a wound care nurse doing all treatments, an MD inhouse 5 days/week and a NP inhouse on weekends. I'm told we're lucky!

[TonyaM73, ASN, RN]

OH MY! Try the med/surg! I worked in LTC with Rehab for 10 months. It was absolutley horrible! I got the same three days of training and then put in charge of 30 dementia patients. None had arm bands on to figure out who was who. (You had pictures in the MAR that were years old!!) I stuck it out for that long because the hospital was not hiring new nurses, but when I was thought to have experience, I cut and ran. It is not SAFE for a brand new nurse to only get 3 days of training on the floor!

In the hospital I got 6 weeks of training after the two weeks of general training! It was wonderful! I hit the halls running after that much time of training and have really enjoyed it ever since. I have now been in the hospital as long as I was at the LTC center and I can't believe the difference in my outlook. Get out if you can and if you can't make the most of it and at all costs protect your licence!!!

[Karl Farmer]

LTC is hell, and from what they say with the budget cuts, I'd suggest running for the HILLS. Strange though- I recently discovered that SNFs were created by the feds to keep them out of expensive hospitals- and THAT explains why, even though the government 'inspects' them, the same abuse and hellish situations continue year after year. It's the fox guarding the henhouse.