High turnover in LTAC's? - page 2

I was wondering if there is a high turnover in long term actue care and if so why?... Read More

  1. Visit  nursingilove profile page
    1
    ESME12,
    Thank you for explaining that. I understand much better.
    Esme12 likes this.
  2. Visit  Esme12 profile page
    1
    This is still a thread about LTAC's Long Term Acute care. A TOTALLY different entity from LTC Long term care. These patients are sick. These nurses have a highly developed sense of critical thinking. These facilities have intensive care units, telemetry units, and have minor surgical procedures performed at these facilities as well.

    Nurses/hospitals in general need to become better informed about the LTAC culture/environment for this is a growing industry as healthcare moves forward. These are acute care patients with long term complications. These nurses care for acutely ill, multiple complication patients. These patients are considered "heavy patients" at the acute care hospital. Here you have an entire facility full of these "heavy patients". I took the job as a supervisor at an LTAC to help out a friend....besides how hard could a nursing home be?

    Boy was I wrong!!!!! I was schooled pretty quicly that I needed an education myself.

    OP......You will work very hard. You will learn a TON!!!! The turn over is so great becasue it's a tough job.....these patients are sick. They are short staffed. Burn out is high. But these facilities are willing to teach you and train you. Learn what you can from them.
    Last edit by Esme12 on Aug 5, '12
    BuckyBadgerRN likes this.
  3. Visit  Kasandra profile page
    0
    @Esme12: I was responding to a post from CapeCodMermaid. I realized a couple posts back that LTAC is totally different from LTC. I even said this as well a couple posts back. I do not see you "scolding" CapeCodMermaid about posting about LTC. I do not plan on posting anything else on this thread.
  4. Visit  Esme12 profile page
    1
    Quote from Kasandra
    @Esme12: I was responding to a post from Cape Cod Mermaid. I realized a couple posts back that LTAC is totally different from LTC. I even said this as well a couple posts back. I do not see you "scolding" Cape Cod Mermaid about posting about LTC. I do not plan on posting anything else on this thread.
    I am not scolding....I will remove quoting you for maybe that helped in your thinking I was scolding you. I am just clarifying for there is a misconception,by many, about the LTAC. I was one as well. I sincerely apologize if you felt I was scolding for that is Never my intention.

    I wish you the best.
    BuckyBadgerRN likes this.
  5. Visit  Kasandra profile page
    1
    @Esme12: No worries. I apologize if I came off snippity. I realize that what I have written in inappropriate, really, for this thread. However, I was stating my position on nursing which does differ somewhat from CapeCodMermaid's. I did not know what LTAC was until I read this thread. I am glad to have stumbled across it. I did not know that such places existed outside of the hospital. Ok: Now I will stop posting on this thread! I did not want to leave you hanging, Esme12!
    Esme12 likes this.
  6. Visit  Esme12 profile page
    0
    Quote from Kasandra
    @Esme12: No worries. I apologize if I came off snippity. I realize that what I have written in inappropriate, really, for this thread. However, I was stating my position on nursing which does differ somewhat from CapeCodMermaid's. I did not know what LTAC was until I read this thread. I am glad to have stumbled across it. I did not know that such places existed outside of the hospital. Ok: Now I will stop posting on this thread! I did not want to leave you hanging, Esme12!
    ...all good
  7. Visit  BrandonLPN profile page
    0
    I think Cape Cod Mermaid's point was that in LTC we have far less support than nurses in acute settings. As someone who worked in a hospital and now in a nursing home, I agree. We have to rely more on our assessments than hospital nurses do. A hospital nurse can get blood work, ABG, UA, xray, respiratory therapist or even a phys/PA assessment very quickly. In LTC not so much. All the "diagnostic" tools we have at our disposal are a vitals machine a glucometer and maybe a bladder scaner.

    We are actually much more independent in our practice than our hospital counterparts. Our jobs don't revolve as much around following the doctors orders. We have FAR more standing orders, based solely on nursing judgement. It amazes me that a hospital RN can't give Tylenol to a febrile pt w/o calling a dr first. Where I work a RN can even initiate IV fluids on a resident who's clearly dehydrated per standing order.
  8. Visit  CapeCodMermaid profile page
    2
    Gee...I was 'scolded' and didn't even realize it.I know the difference between LTAC and LTC/SNF levels of care. And I know the difference between subjective and objective. It bothers me when anyone makes a blanket and often incorrect statement about nurses who work in long term care.
    BuckyBadgerRN and SleeepyRN like this.
  9. Visit  Esme12 profile page
    0
    I think the OP question was answered about the turnover rate in LTAC's. We are all nurses and we all follow physician's orders and we all experience varying degrees of autonomy depending of off shift physician coverage.

    Will close.....for staff discussion
  10. Visit  NRSKarenRN profile page
    0
    Due to multiple requests, we have opened a new forum: Long Term Acute Care (LTAC/LTACH)
    and moved thread here.

    Come and visit to see all the chatter about LTAC
  11. Visit  AngiereeRN profile page
    1
    I currently work in a LTACH (Long Term Acute Care Hospital), completely different from Long Term Care. As someone said before the patients are very sick, many are total care. Lots of vents, trachs, wound vacs, feeding tubes, central lines, telemetry, etc. I started there as a new grad and have been here for a over a year. I have learned sooo much! A float nurse once told me that if you can work in an LTACH you can work anywhere. There is a high turnover rate where I work. Many nurses start here as new grads and after a year or two move on to specialty areas. That's the main reason nurses here leave. CNA's often leave because the work is very difficult physically. Our team work is great, we nurse always pitch in and help, there is no task that is beneath us but it's still hard because they have anywhere from 10-15 patients a shift. Overall this has been a very valuable experience, it hasn't been easy but I'm grateful for all I have learned. One more thing, our patients and their families are with us for an extended period of time so we do get quite attached, it can be difficult when they pass away.
    KimberlyRN89 likes this.
  12. Visit  mschrisRN profile page
    1
    Quote from Esme12
    Working at a a LTAC will give any nurse experience beyond belief. Unfortunately.....Hospitals still view them as "nursing homes" due to their lack of understanding of what an LTAC is....even though they send the patients they failed to get home. So a nurse who has worked at an LTAC has more selling to do about her experience than other nurses in acute care.
    I'm a new grad working in LTAC and I can't agree with this more...everything Esme said is spot on. I have gotten tons of experience with "chronically, critically ill patients." These pts are basically the ones that have survived major traumatic insult who, 20 years ago...some even 5-10 years ago, would not have. They come to us with multiple active disease processes, many of them (somewhere between 50% to 70% in our LTAC) with antibiotic resistant bacterial infections. They have chronic wounds, both DQs and surgical. One shift that I worked, I had a patient that was a longtime anorexic who had developed pneumonia and been hospitalized in ICU. The patient was discharged to us for wound care and nutritional monitoring. The patient 13 pressure related wounds from the weeks spent in the ICU at the critical care hospital. Lately, we've had a rash of abdominal wounds; massive ones, with huge wound vac sites...some of them with ostomies exiting the abdominal wall through the wound bed. It's challenging; stress is HIGH, time is short, and supplies can be near impossible. And as Esme said, many hospitals still assume that LTACs are LTCs, *EVEN THOUGH* they're discharging their most ill patients to us! That means when you're ready to move on you really have to push that you know your stuff and that you have the multitude of experience that you have. You *have to* "sell it." It's not for the faint of heart or the slow learner. They won't hand hold, but they will teach. Be prepared to ask questions.
    Last edit by mschrisRN on Sep 5, '12 : Reason: wording
    Esme12 likes this.
  13. Visit  P-medic2RN profile page
    0
    my pt. load is 55-60 with 3 CNA's. i'm running as soon as i can.

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