High turnover in LTAC's?

Specialties LTAC

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August RN

6 Posts

An old discussion....

SE_BSN_RN, BSN

805 Posts

Specializes in LTC, Agency, HHC.
@CapeCodMermaid: I understand why what I wrote must have put you in a "defensive" mode. What I wrote was not meant to be hurtful towards any of the nurses that do LTC. It is, however, my objective experience. Although I apologize for offending you, or any other proud LTC nurses, it is my experience.

As far as what you said:

"And there wasn't much need for most nurses there (at the hospital) to think at all since the place was crawling with doctors. In LTC, it's you and your fellow nurses, and most of us have highly developed critical thinking skills."

If you had invested any significant amount of time in a hospital on the floor, you would realize that it is the bedside nurse, not so much the doctors, that know about the patients. The nurse is asked by the physician specific questions about the patients under her care in order for the best care to be given. Doctors are simply not there enough. They may spend a couple minutes (if that) with the patient while the nurse is there the whole 12 hours. Hospital nurses deal with unstable patients: that is why they are in the hospital in the first place: for both monitoring and treatment. If they were not predisposed to a decline in health status, they would not be inpatients in the first place. The hospital nurse collaborates with the physicians to address any aspect of the patient's care. In a nutshell, hospital nurses always "have a need to think" because people's lives can depend on it.

In contrast, LTC nurses can help or harm with their nursing practice as well. However, as we both know, LTC is not at all like the hospital. I already summed up most of my thoughts on my experience in LTC. I still stand by my position that a new grad needs to develop critical thinking which is achieved by learning what "normals" and "abnormals" are regarding their assessments. Yes, in LTC, a nurse cares for more people. This is the residents' home. They are stable. However, when their health status changes for the worse, it is the nurse's job to assess, and inform, the PCP of these changes. This was not happening at that facility.

I cared for all of the residents under my charge with the standards of care learned in the hospital setting. Also: They do not orient in the LTC like they do in the hospital. A new grad gets two weeks. An experienced nurse may get a day up to one week of orientation. In the hospital, a new grad gets up to 3 months training on the floor in addition to class training. An experienced nurse orients for a month.

I can only speak according to my experience. It was quite the eye opener. I shall leave it at that in an effort to keep what I am writing classy and not disrespectful.

What you said in your post was not objective: it was (is) your subjective opinion on hospital nurses. In contrast, my post was an objective post about LTC nursing. I did not even delve into half of what I saw (or heard) which was incongruent with safe nursing practice. With unsafe nursing practices, I stopped care at the bedside to protect the resident. With those many instances that were brought to my attention by another nurse, I told them to follow up first with the nurse and then management if necessary; otherwise, they would be just as guilty as the nurse who put their residents at risk by not following established nursing protocols (example: a nurse suctioning a trach with a dirty suction kit which had been stored in the resident's night stand or allowing the new grad to open the red container with sputum from the lower respiratory tract (from suctioning), emptying it at a sink or commode, because another LTC nurse told her that this was acceptable: putting herself and other people at risk of inhaling the contents). I can keep going but believe that I have made my point.

Like you, I am entitled to my opinion. I have respectfully stated it. I stand by my position. I respect your opinion even though I may not agree with you.

I have no experience in LTAC.....but I DO in LTC. I started there as a new grad LPN 8 years ago, because that's the only job I could find as a new nurse. And, now that I look back, I think ALL new grads should start in LTC....if they can't develop critical thinking skills there, perhaps they should find a new line of work! Critical thinking develops over time, and since most of these patients are stable, the nurse should be able to spot something abnormal, ask questions, and learn...I suppose you could do the same in acute care, but with a less sick patient, it should be easier to do. Or maybe my logic is flawed... If you can't learn to prioritize THERE....then definitely find a new line of work! If you can't manage meds for 20-30 people, along with charting, docs, families, other staff, management....seriously. I got a week of orientation, and learned to swim on my own. After that week, I had coworkers willing to help, and a DON who encouraged me, and didn't write me up for being late with meds, treatments, etc, etc. LTC has a bad reputation.....don't you wonder why?

In my experience, it has been the CNA's in LTC that don't know the parameters of BP's....

LTC is one of the best places to build assessment skills! Those little old ladies would love to sit and talk for as long as you could sit and talk!

Golly gee....look at that.....I hated LTC....but I have positive things to say....:yes:

Esme12, ASN, BSN, RN

1 Article; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

This thread is over a year old and about Long Term Acute Care (LTAC/H)hospitals a completely different animal then LTC

Specializes in SICU, trauma, neuro.

it's long termACUTE care :yes:

Junebug59, RN

217 Posts

Specializes in Main O.R. and CVOR.

OMGSH! you have just described the facility I started working at a month ago...... I hate my job. I am stuck here because I am in IPN. I made some mistakes in my past and have since paid the price three fold. now, I can only find a job in LTAC. I am on the sub acute unit. everything you describe fits. I am an RN. The LPN's just don't care and neither do the CNA's. there may be 2 LPN's that give a crap, but have no skills per se. I am a 30 year O.R. nurse, so there are no past nursing skills I can use except with PICC lines, etc..... maybe. it's so overwhelming. I just want to go back to the OR...... HELP ME GOD!

Esme12, ASN, BSN, RN

1 Article; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
OMGSH! you have just described the facility I started working at a month ago...... I hate my job. I am stuck here because I am in IPN. I made some mistakes in my past and have since paid the price three fold. now, I can only find a job in LTAC. I am on the sub acute unit. everything you describe fits. I am an RN. The LPN's just don't care and neither do the CNA's. there may be 2 LPN's that give a crap, but have no skills per se. I am a 30 year O.R. nurse, so there are no past nursing skills I can use except with PICC lines, etc..... maybe. it's so overwhelming. I just want to go back to the OR...... HELP ME GOD!

This kind of got off track. You are in LTC this is about Long Term Acute Care a different animal. Long Term Acute care is an acute care hospital with all patients having complex medical issues but have run out of days. These patients are transfused and have chest tubes. Most LTACH facilities have ICU's with lines and vents.

THere is a MD on duty in house they ahve x-ray and some have a lab. The nurse patient ratio is greater like 8-10 patients a nurse on nights. ICU is 3 to 1. They have drips and complex lines. But these are long term acute patients with multiple co-morbidities and complex hospital stays. I ahve seen halo traction. The ICU patients are vented and not necessarily trached.

Junebug59, RN

217 Posts

Specializes in Main O.R. and CVOR.

no, it's an sub acute care unit, not LTC. we have chest tubes, vents, post cabg pt's. we have an in house PA and a dr that come 2 times a week. no one stays longer than 100 days.

Esme12, ASN, BSN, RN

1 Article; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
no, it's an sub acute care unit, not LTC. we have chest tubes, vents, post cabg pt's. we have an in house PA and a dr that come 2 times a week. no one stays longer than 100 days.

Right but it is sub acute...an LTACH is accredited as acute care....like any other hospital. These patients are acute care. The MD is in house like any other hospitalist. They have intensive care units and manage critical care drips.

Long-Term Acute Care Hospitals (LTACHs) serve patients with complex medical needs who require longer hospital stays and highly specialized, expert care.

Most patients admitted to LTACHs arrive from traditional hospitals, referred to as acute care hospitals, with many patients admitted directly from a hospital's intensive care unit for the specialized programs of care offered. Many of these patients have medically complex conditions. For example, many patients are ventilator-dependent and need the continued level of treatment and care provided by a long-term acute care hospital, such as pulmonary and cardiac monitoring.

LTACHs differ from chronic care settings, such as skilled nursing facilities and sub-acute care settings. LTACHs focus on treating critically ill or high acuity patients in an intensive way, using individualized treatment programs and medical expertise geared towards the patient's illness and requirements.

http://medres.med.ucla.edu/Practices/Overview%20of%20Placement%20Options.pdf

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