Anything positive about working in an LTAC??

  1. 2
    Hi all,

    I'm a new nurse (less than 1 year experience) and I have an interview at an LTAC today. I don't have any experience with this level of care--my background is at a Transplant PCU and honestly, I'm stressed out since my patients are constantly going down the tubes on my shifts. My typical patient load may include treating a hyperglycemic patient (blood sugar over 600), a post op day 1 transplant patient, and another patient on a cardiac drip with sporadic chest pain. I'm a bit freaked out with the safety risks for each of these patients and realized that I'm in over my head as a new nurse. I want to transition to Med/Surg but unfortunately, my lack of experience has made it difficult for me to find work. I applied for this LTAC position since it was listed as a Med/Surge level of care and they were the first and only place that has responded to my application in the past 2 months.

    After researching the general discussions and this board in particular, I haven't seen many positive comments about being an RN in an LTAC. My question is for you seasoned LTAC RNs, what is it that you like about LTAC and what motivates you to remain in your facility?

    Thanks in advance!
    JustBeachyNurse and Meriwhen like this.
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  3. 14 Comments so far...

  4. 0
    Moved to our new LTAC specialty forum to elicit further response.
  5. 4
    In an LTAC/LATCH(Long Term Acute Care Hospital)...organization is key. You will learn a TON. Does the LTAC where you work have the ICU? LTAC's are full of very acute patients, all the medically complex/complicated course/unusual illness patient are collected under one roof. Staffing can be an issue......take what they are going to offer you and learn.

    LTAC's are a unique combination of very sick patients in a LTC setting. These people are the SICKEST of the sick AND they have had complicated hospital course. A 4:1 ratio may not seem like very much but in an ICU setting in an LTAC are the failure to weans so you will have 4 vented patients. Most will have multiple lines including PA Catheter's/Swan , including pressors and IV's.

    Any LTAC I have seen or worked in is a tough environment. These patients are SICK!!! They have just "run out" of acute days and are sent to the LTAC. These patients are the ICU patients that remain critically ill but have run out of "paid days" on insurance/medicare. You will see a ton of stuff.......everyone else's failure to discharge home. Open hearts with complicated post op courses, trauma's with Halo traction, many unique disease process with complicated recoveries, open wounds, chest tubes, vac dressings, wound irrigation's. You will give TPN, blood, do labs...your IV skill will make you valuable to them. These patients are mostly full codes and every attempt is made to get them home.....but with a fraction of the nursing staff in an acute care setting.

    The LTAC I am familiar with had an ICU and these patients were not DNR's, they were vented, with lines and drips. They are a collection of the most medically complex patients that have suffered complications and rough hospital courses due to comorbidities. The floor patients can be vented, multi lumen lines, feeding tubes, IVF, antibiotics with complicated wounds still receiving aggressive treatment to get them well enough to got to a rehab, SNF or home.

    The nurses perform like any other "acute care nurse" and more "acute care" nurses and hospitals/administrators need to respect what these nurses do with little to NO help. They process labs, drugs, give blood, pass meds. I have seen HALO traction many times on the elderly who have fallen. There are a ton of young trauma victims that are not doing well as well as the complicated open hearts on telemetry. They will seen neurological diseases like ALS and weird meningitis like listeria.

    Any nurse will work very hard....I think a new grad who is bright and a go getter with a thirst for knowledge and confidence is a good candidate. They usually have extensive orientation programs and are will to invest i the nurses education....but you will work very hard. The patient load is double...example most ICU patients are 1:1's or 2:1's when they leave the hospital....they are 3:1, 4:1 at the LTAC.

    You will gain a TON of experience and at least they do have great orientations. I wish you every bit of good fortune and luck in your new journey. If you have any other questions about and LTAC....PM me.:heartbeat

    You will learn a TON and LTAC's are willing to teach. Organization is key.

    Here are some brain sheets.
    brain sheets.......here are a few.

    ntp medsurg.doc 1 patient float.doc‎
    5 pt. shift.doc‎
    finalgraduateshiftreport.doc‎
    horshiftsheet.doc‎
    report sheet.doc‎
    day sheet 2 doc.doc

    critical thinking flow sheet for nursing students
    student clinical report sheet for one patient

    I have made some for nursing students and some other an members (Daytonite) have made these for others.....adapt them way you want. I hope they help

    GOOD LUCK!!!!
    KimberlyRN89, Enthused RN, VickyRN, and 1 other like this.
  6. 0
    explore the forum.
  7. 0
    Thanks Esme12! Your response filled in a lot of blanks for me about LTACS. And thanks for the brains too!
  8. 1
    I worked LTAC for 2.5 years. The positive is that you DO get to know these patients pretty well as opposed to regular med/surg where patients come and go pretty quickly. You will learn alot for sure. Just do your best to keep a balance in your life. Especially with nurse to patient staffing ratios what they are these days. Burn out can catch up to you quickly!
    Esme12 likes this.
  9. 3
    I loved working with the residents in LTAC. They will truly be thankful for everything and anything you do for them. I liked the relationships I built with my resident and their family. I thoroughly enjoyed it, and even though it is hard work I would do it again if I had to, probably night shift though.
    WhereIsMyCallBell, ElSea, and Esme12 like this.
  10. 1
    I no long work LTAC but you will never forget the patients and families. You will learn so much. Hopefully find a co-worker who loves to teach new nurses and you will do fine. Good luck and God Bless you.
    faeriefaceRN likes this.
  11. 1
    I've been practicing in an LTACH for 2 1/2 years. Prior to that, I had 1 year med/surg experience, 2 years acute psych experience and about 9 months on a rehab (PT/OT) floor. ER/ICU experience is preferred at my hospital, but I was hired anyway. I've learned a lot. I am now confident in my care of a ventilator patient as well as a patient on critical drips. We see a lot of people die. The sickest of the sick come to our hospital and it's a joy when someone recovers...but there is a lot more of the other end of it in LTACH. The hardest part is when you realize a patient isn't going to make it and the family is fighting over what to do. Or, the family realizes this isn't what the patient would want (vent/tube feeding/drips), but the doctors and case managers are arguing over keeping the patient on life support and filling the family with false hope. THAT is what I struggle with. It's hard to keep your mouth shut, but unfortunately, LTACHs want to make money and are largely funded by Medicare/Medicaid patients that have strict rules about how many days a patient is required to be "in house" to qualify for reimbursement. It's not pretty...

    BUT...I pray about it a lot. I feel I do make a difference, even if in small ways...for the patients and their families. I really do like my job, even if it's crazy busy and I don't agree with the decisions that my facility and the physicians make sometimes. I feel you run into that almost everywhere because of how insurance companies manipulate things.

    If you do end up working there...you'll learn a lot. Hopefully you'll end up with a good group of nurses that will help you. That was key for me. I LOVE the nurses I work with. Many of them have a couple decades of experience on me, but still answer questions and work as a TEAM to make it bearable. It's hard work. But at this point in my career, it's where I plan to stay for a while.
    KimberlyRN89 likes this.
  12. 0
    Quote from nulife4good
    Thanks Esme12! Your response filled in a lot of blanks for me about LTACS. And thanks for the brains too!
    You're welcome!


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