Anyone Familiar with Extended Care Hospitals?

caringchic · Mar 5, 2009

OMG I could tell you some stories to make your hair stand on end.. I worked at two different facilities, one as a staff RN and one as a traveler.. both places are not facilities that I would recommend to a new nurse or probably not even my worst enemy. The companies running both were ok, good benefits and the management not terrible. It is the concept that I was uncomfortable with. Just the name "acute long term care" hospitals aka LTAC.... means sick people w/ no where to go but hopefully to rehab enough to go to rehab or to get poor enough to be eligible for other insurance options. My experience was because they have hospital in the name JCAHO rules apply, so we were expected to run our own codes. That was fun I have ACLS, done codes previously, except.. this certain place had no docs except by phone, no lab, no RX, no x-ray, no RT who could intubate and I was prohibited from doing so per facility protocol... and 911 was a no go d/t us being a "hospital" we were expected to run our own stuff. Did I mention that I was the charge, w/ one LPN, one RT, one CNA and a tele monitor for my staff.. ICU pts, and M/S pts anywhere from 8-16 on any given shift. My experience taught me alot...run, Forrest, RUN!!!! :) For me it was not something I felt comfortable in, I need to know that I have the tools to do my job and do it well. I dont like feeling helpless especially under pressure, so I ran fast. Maybe others find it very rewarding.

Jo Dirt · Mar 6, 2009

What you're describing doesn't sound like what I'm talking about. There are doctors and RTs and plenty of nurses and such, though I'm sure it's no picnic, either. The extended care hospital is directly connected to the main hospital, you don't even realize you are in another hospital until they tell you. If anyone is familiar with Baptist Med Center in Little Rock they will know what I'm talking about.

mscsrjhm · Mar 6, 2009

I was just hired on at a hospital that has an extended care hospital. Basically, it is like an extension of the ICU. I was told there are cameras over each bed and experienced critical care nurses in control rooms watching the patients and monitoring them on telemetry monitors. I was told they can do assessments on each patient and the cameras even measure pupil size. And they can talk with and communicate with patients and us.

Never heard of nurses watching cameras. Wouldn't they be more helpful on the floor?

Seriously, you are walking into some rough @#$%. Extended care can be very tough. Why do you think they are training you on night shift? Team nursing- you and an LPN, for 8 patients. Doesn't sound bad, except these patients are all high acuity. These patients are commonly referred to as "train wrecks".

Caringchic is absolutely correct.

Lots of caffeine, deep breaths, carry candy for needed sugar, and remember that healthcare, as we know it, is still in it's infancy.

Break a leg.

mykrosphere · Mar 6, 2009

i work in an ltac now and dont really mind it.

the nurses i work with are mostly knowledgeable and the NAs are great.

we have a house doc who stays the night in case we need anything.

nurse to patient ratio lately has been 1:5

the job is not so bad compared to my last job in a nursing home which took vent patients.

tapj28 · Mar 6, 2009

Dear GoLytely,

From the situation you describe, for sure you will get some of the best experience as a nurse if you can manage to hold on to your license long enough to make it count. In the current economic climate in which we live, please be sure to secure a 'certain' next job before you leave this. Give it about six months if you can stick it out that long...but be sure to secure another confirmed job before you leave. Also, it will serve you will to give at least two weeks notice. Take good care, I hope our wisdom will be of use to you.

Jo Dirt · Mar 6, 2009

No! You're supposed to tell me what a wonderful position I'm about to go into! Not that I was lead to my doom like a lamb at the slaughterhouse!

You know what happened? When I talked to the recruiter on the phone she was talking about med surg and they even have day shift openings, la la la.. Seeing as the nursing home cut my hours and I really wanted to come home to Arkansas I went over there on a rail. I came for the initial interview. This pretty woman who was super nice interviewed me and made a phone call. Then, an older matronly-looking woman came down to the main floor to escort me to the next step. I asked where we were going and she said, Extended Care.

It's all coming back to me like a dream in slow motion now. All the people I was introduced to, now their welcoming words and smiles seem demonic, and you know how they talk very calmly and their eyes linger on you even when they're turning away? They told me God sent me to them...what's next? Poison Kool-Aid? Now all those old folks crumpled up in those beds on ventilators seem like a part of a bad nightmare.

And they have an open-door visiting policy!

I never liked that song Hotel California but it seems like that is where I'm going.

It all makes sense now. It went from the lure of med surg to Hell! I'm supposed to go for my physical soon, how do I get out now?!

Jo Dirt · Mar 6, 2009

Dear GoLytely,
From the situation you describe, for sure you will get some of the best experience as a nurse if you can manage to hold on to your license long enough to make it count. In the current economic climate in which we live, please be sure to secure a 'certain' next job before you leave this. Give it about six months if you can stick it out that long...but be sure to secure another confirmed job before you leave. Also, it will serve you will to give at least two weeks notice. Take good care, I hope our wisdom will be of use to you.

What do you mean hold onto my license?

Jo Dirt · Mar 6, 2009

Never heard of nurses watching cameras. Wouldn't they be more helpful on the floor?
Seriously, you are walking into some rough @#$%. Extended care can be very tough. Why do you think they are training you on night shift? Team nursing- you and an LPN, for 8 patients. Doesn't sound bad, except these patients are all high acuity. These patients are commonly referred to as "train wrecks".
Caringchic is absolutely correct.
Lots of caffeine, deep breaths, carry candy for needed sugar, and remember that healthcare, as we know it, is still in it's infancy.
Break a leg.

You don't know about the cameras???

The all knowing eye? Big Brother?

And they can even measure the size of your pupils!

Naturally, me and the LPN would be the ones out there like robots with the "experienced" RNs monitoring the tele monitors and deciding what needs to be done for each patient. I saw them with my own eyes. They sit behind monitors and can see the patient and I guess I would be the schmuck running from room to room.

I'm not a night shift person and I sure can't take this kind of deal. They promised me a day spot when I was comfortable in my position.

Yea right.

When I met the nurses, even the ones who have to do the dirty work, they were smiling and acted happy...what were they hiding?

I'm starting to feel more nervous and neurotic than before I posted this.

whipping girl in 07, RN · Mar 6, 2009

I have a good friend who works in a LTAC in another state and she loves it. It's on the 8th and 9th floor of a real hospital, though, not a freestanding facility.

A new LTAC opened in our town last year. So far I've not been impressed with what I've seen. We've sent patients over there and they've had to come back for whatever reason, and they were dirty, getting pressure ulcers, and generally not well cared for. A lot of the families have complained. I hope they are complaining to the state as well.

So I'm not really sure what to think of LTACs at this point.

I worked in an ICU with cameras and remote nurses. They did not do very much that I could see. We had to call an 800 number when we admitted and discharged a patient. They would turn on the camera once a shift and look at the patient, monitor what was on the bedside monitors, labs, etc. We still cared for the patients as we always did. It seemed like a huge waste to me, but I could see how they could get the staff used to it, then say, OK now you can take one or two more patients because you have the electronic monitoring. They had not done that yet when I quit but it wouldn't surprise me if they did in the future. Of course, at the rate nurses were leaving that unit, I will not know anyone to ask pretty soon!

Take a deep breath, try not to be nervous and neurotic. Just take the job and then try to get a different one. I'm originally from Arkansas. PM me if you want to talk about facilities. Maybe I can help or get you in touch with someone who can.

lpn2icu · Mar 6, 2009

OMG I could tell you some stories to make your hair stand on end.. I worked at two different facilities, one as a staff RN and one as a traveler.. both places are not facilities that I would recommend to a new nurse or probably not even my worst enemy. The companies running both were ok, good benefits and the management not terrible. It is the concept that I was uncomfortable with. Just the name "acute long term care" hospitals aka LTAC.... means sick people w/ no where to go but hopefully to rehab enough to go to rehab or to get poor enough to be eligible for other insurance options. My experience was because they have hospital in the name JCAHO rules apply, so we were expected to run our own codes. That was fun I have ACLS, done codes previously, except.. this certain place had no docs except by phone, no lab, no RX, no x-ray, no RT who could intubate and I was prohibited from doing so per facility protocol... and 911 was a no go d/t us being a "hospital" we were expected to run our own stuff. Did I mention that I was the charge, w/ one LPN, one RT, one CNA and a tele monitor for my staff.. ICU pts, and M/S pts anywhere from 8-16 on any given shift. My experience taught me alot...run, Forrest, RUN!!!! :) For me it was not something I felt comfortable in, I need to know that I have the tools to do my job and do it well. I dont like feeling helpless especially under pressure, so I ran fast. Maybe others find it very rewarding.

It sounds like one of those scary stories by Stephen King....No medical doctors/Resp Therapists on the unit! :coollook:

The only thing I would do is to resign as soon as possible!!!

tapj28 · Mar 6, 2009

Hi GoLytely,

The statement, "manage to hold onto your license"...meant it sounds like from the facility description, you may be presented with some instances where it (your license) may be at risk.

BTW...I couldn't help it - I enjoyed your last post...you are funny!! You could write a book about this experience, and I believe nurses would buy it...because many of us may relate to what you describe so clearly (and to me, humorously) of the job interview to the unit tour. ["It's all coming back to me like a dream in slow motion now. All the people I was introduced to, now their welcoming words and smiles seem demonic, and you know how they talk very calmly and their eyes linger on you even when they're turning away? They told me God sent me to them...what's next? Poison Kool-Aid? Now all those old folks crumpled up in those beds on ventilators seem like a part of a bad nightmare."]

I tried, but perhaps have been of no help to you in this. Please forgive me if what I've said contributed to your nervousness. It does sound like whipping girl may be able to offer you the best help right now. Take care friend.