High turnover in LTAC's?

  1. 0
    I was wondering if there is a high turnover in long term actue care and if so why?

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  2. 43 Comments...

  3. 1
    Are you new to nursing? If so, I would recommend against starting out in LTC. This is why: I have been a nurse for two years. I spent most of that time on the floor in the hospital setting before switching things up with LTC. This is what I have seen:

    I have encountered the predominant majority of RNs and LPNs in LTC not to be critical thinkers. They do not know the vitals for their residents before administering b/p meds, do not assess, and even give meds they have no idea about because "they are too busy". The month that I did LTC, I had within one week two people that I had to send out when I assumed my shift at 2200: One which was hypotensive with a 80s systolic with frequent liquid diarrhea and emesis and another g.i. bleeder with three large, tarry stools that showed the classic presenting s/s of a g.i. bleeder. For the exception of my assessments, no one had assessed these two. On the former, no one had taken vitals on her since January of this year. I, however, took vitals on those people who did not appear well or who were on any cardiac meds because that is a safe standard of care. For the latter, while getting report on my 36 residents, the LPN happened to mention one tarry stool. No mention of an assessment of the resident. She said she had called the PCP, informed him of the one bm, and was told to do a H&H on the resident the following day. When I spoke with the CNAs from the LPN's offgoing shift, I was told that the resident had three large, tarry bm's. I always assess first, and noted all the textbook s/s of a g/i. bleeder. Regardless, I was sending both residents out.

    Lack of supplies is another issue. You will run out of things important for the nursing care you provide.

    No training. In the hospital, you will receive never ending training. In LTC (at least where I was), training was non-existent. There was a high turnover. A RN was usually there from a couple days to 2 weeks at the most because of the bad care environment. I was an overachiever: I was there for a month, and am going back to the hospital to stay with a new job.

    Another thing that I detested: Paper charting. Too much paperwork! Double, quadruple charting for the same thing. Just ridiculous.

    To their credit, I did work with a couple good RNs and LPNs. However, out of the entire staff, I could only say this of 3 of my colleagues who were on point with their nursing care. The rest: not so much.

    In a hospital, you will see muliple pathophysiologies. You will grow so much as a nurse. In LTC, you take care of the same people every day who, for the most part, take the same meds every day. You do not develop your critical thinking as well as what you would in a hosptial.

    For those nurses in LTC: I do not mean to insult your profession. After a month of full time experience in a LTC, this is what I saw and what I know. If you can provide another point of view, please do. I, however, would not recommend any new nurse to go to LTC. However, if the new nurse really wants LTC, at least get some hospital experience so that you know your abnormal assessments so that you can get the residents help when they need it.
    Nurseknowsit likes this.
  4. 10
    LTAC is completely different from LTC. I would imagine LTACs have a high turnover because they deal with almost ICU level acuities mixed with med surg level ratios. And WAY less support. Many pts go straight from the ICU to a LTAC simply because their insurance ran out. Not because they are any less sick.
  5. 2
    @Brandon: Thanks for the clarification! I totally thought this post was about LTC. Oh well. Anyone who was wondering about LTC: Maybe my post will be of some help to them. Who knows!
    BrandonLPN and Esme12 like this.
  6. 0
    Kassandra.....The contribution is always appreciated.

    The LTAC has a big turn over rate for a lot of the same reasons but these facilities have an extremely high acuity. They are the sickest of the sick population in acute care that have failed to wean from vents or have had very complicated medically complex recoveries. These patients are too sick for LTC and home and have run out of hospital days/funding. Patients can be transferred from INtensive care units with vents, lines and drips. But the staffing is not as plentiful as acute care even though these patients are acute care patients.

    Marginal staffing for acuity and adequate pay. These forprofit companies usually have marginal supplies as well.

    There have been a few threads about this......... Google Search Results for LTAC esme12

    http://allnurses.com/massachusetts-n...ad-747659.html
  7. 1
    Quote from Kasandra
    @Brandon: Thanks for the clarification! I totally thought this post was about LTC. Oh well. Anyone who was wondering about LTC: Maybe my post will be of some help to them. Who knows!
    Don't worry about it. Very similar acronyms. The pluses of working in a LTAC are that they readily hire new grads, you would learn a lot and the pay is better than the hospitals. (from my research, I've never actually worked in one). I also think it will be a wave of the future. Hospitals just don't keep inpatients as long as they used to. I'd be interested to see LTAC get it's own page here. It doesn't really fit with LTC or ICU pages.....
    Esme12 likes this.
  8. 5
    I spent the first 9yrs of my nursing career in LTC/skilled... I cant speak for all LTC facilities obviously but I can tell you that I used my critical thinking skills everyday. I imagine it is up to the individual nurse how they practice. I learned more about prioritizing care and time management than I ever could of in a hospital setting.
    My props to you for actually trying out LTC to see how hard it actually is. Every time I sent one of my patients to acute I was talked to as if I was incompetent. I dont think acute care nurses actually know what goes on in LTC.
    I now work in dialysis, having left LTC because I was growing tired of the "do more with less" attitude . I wish more acute care nurses would come work in LTC, and see exactly what we do.
  9. 0
    Thank you for your replies, the feedback I'm getting is that you can't go wrong with the experience you get.
  10. 0
    Are you asking from becoming a DON/ADON? or staff?
  11. 3
    Wow...I got NO orientation or mentoring or anything else when I was a new nurse working in the hospital. And there wasn't much need for most nurses there 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.
    SE_BSN_RN, Selene006, and nikkicb2004 like this.


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