Long term acute care inside hospital

Esme12, ASN, BSN, RN · Jan 4, 2012

Funny...I don't know of any LTACs in a general acute care setting. They are licensed as acute care facilities but are usually independent buildings. I really don't know if it is a reimbursement issue or just a documentation hassle with everything entailed in keeping the short term organized that they don't bother.

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 LLCs. 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.

The opportunity is there to learn a TON. The down side when they go to go for a short term acute care their experience is not counted as acute care in a critical care setting, Mostly due to the ignorance of the hospitals personel/interviewer.

After all this....why do you want to know? :)

Ms.RN · Jan 4, 2012

Thanks for your info Esme

I have worked in skilled nursing and subacute facilities and now I wanted to try an acute care. A nurse recruter set up a job interview with a nurse manager in long term acute care unit that is located inside the hospital. I thought long term acute unit is slower than med-surg unit because from what nurse recruiter told me patients stay average of 25 days. After hearing your description, it seems like this is more of a step down unit then med-surg unit. What types of IV drips do you administer to the patients? Is it like Nitroglycerin and other medications that are mostly given in cardiac unit? I dont suppose you give meds like Versed that are usually givin in ICU? I'm not feeling very confident about working in this kind of unit and my gut tells me this is not going to work out. Plus this hospital is located 6 hours from where I live so i dont even know if I should even try this job if its not going to work out. I'm still waiting to hear from a hospital that suits my skills little better but it has been over a month and they haven't called back yet. I don't know if its because this hospital was just bought by different company so they are putting a hold on hiring new people. What do you guys think?

onetiredmomma · Jan 4, 2012

If the nurse recruiter gave you the impression that LTAC is slower he/she is waaaay wrong. I worked at one as an agency nurse and everything the other poster said is true: not making enough progress to stay in acute care but too sick for LTC. My saving grace was that they don't give agency staff vent pts at this particular LTAC. This was a unit whose company leases a space in a hospital, staffing and policies are dictated by their parent company; they are totally independent of the hospital. I know it is hard getting work but how can you work 6 hours away from home? Do you have friends or famliy you will stay with? If you want to work for the other facility don't keep waiting to hear...call and remind them that you are interested and ask when you can expect to get an interview! Good luck to you

Esme12, ASN, BSN, RN · Jan 4, 2012

Thanks for your info Esme
I have worked in skilled nursing and subacute facilities and now I wanted to try an acute care. A nurse recruiter set up a job interview with a nurse manager in long term acute care unit that is located inside the hospital. I thought long term acute unit is slower than med-surg unit because from what nurse recruiter told me patients stay average of 25 days. After hearing your description, it seems like this is more of a step down unit then med-surg unit. What types of IV drips do you administer to the patients? Is it like Nitroglycerin and other medications that are mostly given in cardiac unit? I don't suppose you give meds like Versed that are usually given in ICU? I'm not feeling very confident about working in this kind of unit and my gut tells me this is not going to work out. Plus this hospital is located 6 hours from where I live so i don't even know if I should even try this job if its not going to work out. I'm still waiting to hear from a hospital that suits my skills little better but it has been over a month and they haven't called back yet. I don't know if its because this hospital was just bought by different company so they are putting a hold on hiring new people. What do you guys think?

On the monitored units and in ICU they are they same drips that are in the hospital. Versed, dopamine, nitro....

On the med surg part of LTAC it would depend. Some of the vented/trach patient can still receive IV sedation like versed...but only if vented and restless. You will see all those patients that don't do well in every hospital near by on one floor. The will ALL be sick.

You new description sounds more like a TCU....transitional care unit....then they aren't quite well enough for home but require more that a SNF can provide. Those units are different as a whole and are not the HIGH acuity of the LTAC. That unit probably will NOT have monitored patients and will be more like hips, knees that aren't quite ready to go home and don't need a SNF/LTC....so yes the pace may just be what the recruiter says.

How will you handle a 6 hour commute? Will you plan to bunch your days together and stay local or are you moving to the work. The other hospital if just bought is probably on a freeze until the new owners get a handle on things.......the freezes generally last a bout 6 months.

Good Luck!

Ms.RN · Jan 4, 2012

A nurse recruiter gave me some information about the unit and she told me they have vent patients, dialysis patients and patient who needs wound care. If I do take this job, I'll probably have to move close to the hospital. If I am confident if can handle this kind of unit, I'll definitely move but right now i'm not feeling confident at all. Do you think med-surg unit might be better than long term care unit?

HouTx, BSN, MSN, EdD · Jan 4, 2012

My organization has a subsidiary which operates LTACs within acute care hospitals. They lease the space (usually an entire floor) and everything is maintained separately from the 'host' facility. It is an arrangement that became very common as hospital census declined, and there was "extra space" available. Brings in extra revenue for the host and much less expensive for the LTAC also since they did not have to do any major structural renovations.

Everything is separate from the host facility. If a hospital employee wants to work prn in the LTAC (very common), they have to apply and be hired & oriented by the LTAC. Even though the LTAC may be sharing space with the host, there is no such thing as an 'automatic' admission. The process is exactly the same as if the patient was being transferred to an external LTAC. Everything is heavily regulated and scrutinized.

I have found that a lot of nurses prefer the LTAC because they have more time to get to know their patients since average stays are longer. Even though many patients have very high dependency needs, they are fairly stable overall and it's very nice to see the gradual improvement over time as they move towards recovery and rehab.

Esme12, ASN, BSN, RN · Jan 4, 2012

Then it is an LTAC.....but you will be very busy. These patients are sick and you will do it with less licensed staff than the short term med surg unit but will have PCA/CNA's. I think you can handle the unit and you will learn a ton. It really depends on your personality. Many nurses prefer the LTACs as they learn more complex patients and they get to know their patients because the length of stay is longer. Hospitals are hectic and these patients are in and out like assembly lines. Talk it over with friends and family....are they in support of you moving? You can do anything for a year but you will learnaton, the orientations are usually good. It's really a personal choice.

lenae · Jan 8, 2012

I graduated in May of this year and right after passing the boards in August I strated working at a LTAC facility inside a hospital. It's tough work, BUT you will learn so much.

I have never worked in a hospital before and I am getting through it. I see a huge turn around with nurses there, and I can see why. Once you get a year in there you can work just about anywhere, and most nurses leave as soon as they can.

Most of your patients are on vents, and/or are very very ill. You will have to get used to having your patients die, and the codes that come up when you least expect it.

Good luck to you, I know you can do it, you got this far in nursing!

leslie :-D · Jan 9, 2012

how long would your orientation be?

i understand your hesitation, esp where it'd involve relocating.

keep in mind, the nurse recruiter is going to try and downplay anything undesirable about the facility.

you can always ask what the turnover is like, how many pts you'd be assigned, and how many pts the aides would have.

this way, you could get a feel of what you're walking into.

and it'd be invaluable experience, for sure.

it's very natural to feel nervous.

just make sure you make an educated decision.

find out the facts, before assuming the worst.

much luck to you. :)

leslie

Been there,done that, ASN, RN · Jan 9, 2012

The sub-acute facility is just renting an area within the hospital.

It is BRUTAL work. These people are very ill. I had 6 patients, all complete care, 2 on ventilators and 20.. yes.. 20 dressing changes.

All that with an assistant stretched between 2 nurses.

I'm not afraid of hard work.. but that is not manageable.