CVICU step down vs. LTACH

[Wedahayes]

I am a new grad and I just got offered 2 job positions. One is in a CVICU step down unit and another is in an LTACH. The LTACH is within a big hospital. I was wondering in your opinion which area would probably best benefit a new grad as far as getting great work experience?

[Okami_CCRN, BSN, RN]

I would go with the step-down unit.

[KatieMI, BSN, MSN, RN]

I would also go for CV step down. LTACHs ("acute", not rehab) usually have harsher enviroinment and sicker patients and require more experience to feel comfortable there.

[Nurse SMS, MSN, RN]

The CVICU Stepdown unit would be a better choice at your point in your career. LTACHs are great for getting allllllll kinds of experience and you would develop excellent assessment skills, learn to shoot from the hip for interventions that can deal with the lack of adequate supplies (frequently a problem in LTACHs) but LTACHs are a pretty harsh work environment and for reasons I do not understand they are not considered "acute care" experience by some others in the industry, which can make getting into another specialty more difficult. I did my preceptorship at the end of RN school at an LTACH and loved it. Serious respect for LTACH nurses. But as a new nurse, a stepdown unit would be a better option in my opinion.

[Wedahayes]

Thanks for the responses. At first I was leaning toward the LTACH because the interview went great and I enjoyed talking to the manager and even interviewed with some of the nursing staff. However, I do understand that LTACH pts are really sick and maybe I should stick with the stepdown unit for now.

[Nurse SMS, MSN, RN]

I will say this....culture is EVERYTHING when it comes to a work place. I would move mountains personally for a good fit work-wise. Life is miserable without that. It bears weighing in. You may want to shadow for a shift to see if it plays out across the board or if they just talk a good game when hiring....

[Wedahayes]

That's a great idea to shadow. It may just give me the REAL idea of how things actually play out.

[sugarwahine10]

Don't do LTACH unless you want the sickest long-term care patients(critical care nursing home patients basically)--majority will have trachs too (which is one of my few nursing tasks that makes me almost hurl at times). I very much respect nurses that can do LTACH, but I never could. I worked with a nurse that did PRN LTACH and even on our worst day in CTSICU she said LTACH patients were 50x worse! Definitely go for the CVICU--it will be critical care patients, but different patients majority of the time and a great learning opportunity!

[Wedahayes]

Thank you for the reply. Everybody I have spoken with about this says LTACH may not be a good fit for me as a new grad. I will have 4 or 5 patients a shift and 2 will definitely be on ventilators. Also, I don't have a very strong stomach when it comes to trachs either.

[quote name=sugarwahine10 B

SN,RN]Don't do LTACH unless you want the sickest long-term care patients(critical care nursing home patients basically)--majority will have trachs too (which is one of my few nursing tasks that makes me almost hurl at times). I very much respect nurses that can do LTACH, but I never could. I worked with a nurse that did PRN LTACH and even on our worst day in CTSICU she said LTACH patients were 50x worse! Definitely go for the CVICU--it will be critical care patients, but different patients majority of the time and a great learning opportunity!