Working in LTC. New Grad.

Ruby Vee, BSN · Oct 6, 2016

If you're a new grad six months out of school, you are not losing skills. You never had them to begin with. What you ARE doing is learning the skills necessary to succeed in long term care, and those a very valuable skills indeed. You're learning time management, prioritize toon, how to talk to patients, family members and physicians, how to make quick, focused assessments and when to listen to that niggling little voice in the back of your head that something just isn't right. You can't learn those skills in six months; it takes about two years. My advice -- and I doubt you'll like this -- is to stay put for another year and a half. Over a forty year career, it's such a tiny speck of time and it's an investment in learning skills, in your career, and in your development as a nurse.

It sounds as though you need to invest a little time and energy in cultivating your workplace relationships. You have nothing positive to say about your colleagues, and unfortunately that says more about YOU than it does about THEM. Please don't believe that the stress will be less in Med/Surg, Telemetry or ED. It won't. It will be different stress and there will be more urgency.

AmmyRN · Oct 7, 2016

Mainly posting to follow because this is interesting. I just got a job for the same shift at a SNF. I start Monday. Wondering how it will effect me as a nurse, but being new nurses we have to realize that being new is a disadvantage. We should be excited to learn and get experience no matter where we are. There is something to gain with every situation.

Try having a more open mind and positive attitude. I know it's hard sometimes, as I'm a sensitive person. But the more good vibes you project, the more will come back.

Good luck!

NuGuyNurse2b · Oct 7, 2016

in my area, even LTC jobs for new grads are scarce. our market is oversaturated. your best bet in getting into a hospital is connections. you need to know someone who will give your name to a manager, who will check with HR to pick your resume out of the 3 phone books high pile of other applicants.

TheCommuter, BSN, RN · Oct 7, 2016

I think that a large number of newer nurses make a big deal about 'losing their skills.' I also think these procedural nursing skills are overrated. I also happen to think people place the hospital setting on an undeserved pedestal.

I am currently sitting at home in my robe while participating in a telephonic meeting. I work from home...no poopy smells, dressing changes, fungating wounds, lines, drips, beeping IV machines, rounding doctors, or annoying family members to deal with.

The hospital setting is overrated. Meanwhile, nurses line up to work (read: bust their butts) at the hospital while the more pleasant nursing positions go unfilled. By the way, my LTC experience was the springboard to the career that I have today.

AmmyRN · Oct 9, 2016

I think that a large number of newer nurses make a big deal about 'losing their skills.' I also think these procedural nursing skills are overrated. I also happen to think people place the hospital setting on an undeserved pedestal.
I am currently sitting at home in my robe while participating in a telephonic meeting. I work from home...no poopy smells, dressing changes, fungating wounds, lines, drips, beeping IV machines, rounding doctors, or annoying family members to deal with.
The hospital setting is overrated. Meanwhile, nurses line up to work (read: bust their butts) at the hospital while the more pleasant nursing positions go unfilled. By the way, my LTC experience was the springboard to the career that I have today.

Dear lord, please tell me what you do so I can head down that path! Lol

caffeinatednurse, BSN, RN · Oct 9, 2016

I just started working in LTC (a large facility with several levels of care). Lately, I've been working in the short term rehab unit until I come off orientation.

Let me tell you: there is no shortage of skills. I have a higher ratio of residents than the med surg unit I used to work on, and they're much sicker than they were at the hospital. Many have cancer, are recovering from total joint replacements, receiving palliative or hospice care, are total care, have tubes/drains/wounds that have to be monitored each shift. Nevermind the LARGE med pass twice per shift (it really does take practice to do that safely), the never ending assessments, sending people out to the ED and dealing with admissions. Tending to family members and their questions, arguing with the pharmacy and trying to get in contact with the on call doc are all part of the package, too. Plus charting progress notes (by hand), completing Medicare charting, checking behind the CNAs to make sure they've completed their charting, and anything else that needs to be done.

I came from such a floor that you're describing. I lasted 4 months, primarily because I almost never had a CNA to help me (I was frequently told that I was my own CNA for the night), the hospital laid off the nurse educators (our go to resource on the unit when we had questions) not long after I started work, and the culture of the work environment. Keep in mind that I had anywhere from 6 to 9 patients at one time, 75% of which would be total care and possibly even nonverbal. The staff nurses I worked with were generally unhelpful and often told me that if I couldn't handle the load, I should get out of nursing. The only "skills" I obtained were hanging bags of IV fluids and antibiotics, doing bladder scans (to see if the pt needed a catheter), and arguing with grumpy doctors who didn't like being woken up at 2 AM. And arguing with the pharmacy - some things are the same, wherever you go. I don't miss hearing IV pumps ringing in my ears when I get home from work, though.

I never started IVs, performed blood draws, did wound care or saw blood other than that which was coming out of a fresh JP drain. I was an automated machine: assessment, meds, charting, repeat x 9. We had specialized nursing teams for IVs and wound care. If I drew blood for labs, it was out of a PICC line.

My experience in LTC has been just the opposite. Is the facility I work for perfect? No. Far from it - everywhere you work will have issues. There's people who love drama, people who clearly don't like me, but it's easy to avoid them since most of them don't work on my shift. But there's plenty of experienced nurses around to ask questions when things go south, and showing an ounce of respect and humbleness goes a long way in that regard. I have nursing supervisors who regularly check in on me to see if I need help with anything. (If I'm drowning, they usually just jump in and start doing something.) The CNAs usually are pretty good about doing their job, which makes my job much easier.

I use the knowledge I gained from my short stent at the hospital to form nursing judgments, but I'm thankful every day that I'm not there. It really is no place for anyone who doesn't have at least 1-2 years of prior nursing experience under their belt.

My advice? Stay where you are. Even if you're bored to tears, you're learning and gaining experience. Try to get to know your coworkers, at least on a professional level. Everyone in LTC has a speciality, if you just ask them. After being there for at least a year, then you can look at other places to work and will have a better chance at landing a hospital job.

TheCommuter, BSN, RN · Oct 9, 2016

Dear lord, please tell me what you do so I can head down that path! Lol

I am an RN case manager who is employed by one of the large insurance companies that you have probably heard of.

AmmyRN · Oct 9, 2016

I am an RN case manager who is employed by one of the large insurance companies that you have probably heard of.

happy case management (manager?) week!

Kystudentrn · Oct 12, 2016

I can only speak for my area. LTC gets a bad rap. My instructors in nursing school never really even spoke about that environment. It was very much implied that if you couldn't get a job in an acute setting then you could try LTC. It was viewed as a last ditch effort for employment.