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.