LTAC ? Good or Bad?

  1. I am a new grad and was offered a job in LTAC for $30/Hr with a 6:1 nurse pt ratio (no vents-they are in our ICU). As a new grad I am having a hard time finding a job and it's this or LTC ... Do hospitals frown on this sort of experience? Also, how does this job compare to a med/surge position in the hospital? I know what type of patients we have and they have a lot of issues AND I know I will be very busy. Is there anything in particular I should prepare for? How is job satisfaction in this specialty? I am excited, but nervous at the same time.
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    About krstxn

    Joined: Oct '09; Posts: 44; Likes: 11


  3. by   BluegrassRN
    I don't know..that seems like a somewhat high ratio. Is there an aide to help on the floor? Is this a day or night position (flame me if you wish, but I work nights and I do think it is easier to take a bit higher of a load on nights)?

    As far as "would it be frowned upon", honestly, you get out of a job what you put into it. I think it would be great experience, and maybe you would really like it and stay there for quite some time.

    I think the job market stinks right now, it's difficult for new grads to find anything, you need to have a job, and a job has been offered to you. Sounds like a good deal!

    Worse case scenario, it's awful. You quit and look for another job. Best case scenario, it's awesome, you love it, and you stay there forever, completely satisfied and positively blissful. Probably it's going to be somewhere in between, but you won't know until you try it!
  4. by   krstxn
    Thanks for responding! It is a day shift position and we will have aids--whether the aid really helps or not is another question

    I am very happy to have landed a job, just curious as to what I will be walking in to !! How much charting is there in LTAC? Anyone know? Is the environment "intense" and "crazy running around like a chicken with your head cut off busy" like the hospital? Or is it a more managable busy? Do you get report each day or is it different since they will be there 25-35 days? I am assuming it is physically exhausting with all the lifting and such...
  5. by   BluegrassRN
    Okay, one more response from me, and then I'll stop, because I've never worked LTAC and I have no idea what I'm talking about.

    It seems like it would be pretty heavy, but also pretty rewarding. I love when I come back to work and all my patients I already know, because I've had them the past two nights (most of the time....). That would be a great advantage, working in LTAC. It seems like it would still be acute experience, you'd learn time management, you'd learn a lot of treatments, and you get very comfy with multitasking. I think it sounds like a great beginning.

    Good luck to you, whatever you decide. I know it's a hard market right now; I really feel for you newbies. You have it rough.
  6. by   d'cm
    I worked LTACH for a couple of years. If the patients actually meet admission criteria, 6 patients would be heavy for ANY nurse. I never saw a new grad but I agree w/ BluegrassRN, if they are willing to give you a chance go for it.
  7. by   daves
    I've done LTAC with Select for years. The acronym says it all. You tend to deal with medically or surgically complex patients that arrive with a host of ailments. We are never their first hospital - sometimes their third, even.
    They frequently end up at LTAC because their initial hospitals cannot or will not deal with them anymore. Their complexity can be as great as anything I ever seen in any ICU.
    One more "interesting" aspect you get to deal with is the family. Some almost literally move in to "help" out on day to day care.
    I couldn't imagine most new grads settling in nicely without a fair amount of day shift support.
    What saves us is an amazingly strong Resp therapy dept. Good CNAs are always a plus like anywhere.
    Good luck - its good experience if you can manage the pace.
  8. by   bunsterj
    Here is a link to the type of patients one would find in LTAC: LifeCare Hospitals - Long Term Acute Care (LTAC) for the Medically Complex Patient
    I don't think a hospital would "frown on" that sort of experience. It would be very diverse and complex.
  9. by   lnt3
    krstxn I myself was a new grad this past December and took a position within an LTAC and honestly I'm very pleased with my decision. I've learned more than I could've ever imagined. I've worked both the Med-Surg and ICU side of the LTAC floor so at times we do have vent patients. It is a 6:1 ratio on the med surg side and 3:1 on ICU.

    It's hard to say how busy you'll be. Somedays will be more relaxed than others and some days you run like crazy but I think that's the case with any nursing position.

    As far as report goes, it is of course easier if you've had the patients before because they are there for such an extended time period. If not, then a quick history of why the pt is here and their history is given just to give you a general picture.

    It is a lot of work because these pts have so much going on but it is extremely rewarding at the same time. For instance, getting to hear a pt talk for the first time in months after finally having their trach capped. I've been lucky to have a great amount of support from the staff. Everyone has been very nice and willing to help out. And the level of teamwork on the floor is amazing. I'm not sure how I would make it through the day without the help from the rest of the staff.

    It is a feasible floor for a new grad to work on in my opinion. However, be willing to do a lot of work and put a lot of effort into learning. Good luck!!
  10. by   FLMom3
    I recently got a job with Select after being a stay @ home mom for 3 yrs. I have a lot of PCU experience, but the 5:1 ratio (some vents) makes me a little concerned... and some shifts you cover LPNs. Most of the nurses look like they're running around like crazy. The CNA's seem good so far.
    Krstxn, Good luck to you as a new grad, I'm sure you'll have some tough days, but you will learn a ton.
    Daves: how do you like Select. I'm not too sure about it yet.
  11. by   zia238
    I have been reading through tons of messages regarding LTAC's and I was very happy when I read your message. I am a recent BSN graduate in the Philadelphia area and the market for new nurses is extremely tough right now. I am interested in critical care nursing and have an interview with an LTAC facility next week. Some people have told me that this isn't "real critical care experience" or that it's not going to help me get into any hospitals ICU floor.... Since you are experienced in this field would you be able to help answer some of my concerns?
    I believe that LTAC nurses are doing critical care.... right?
    If I wanted to work at a large city hospital would my LTAC skills prepare me for an ICU floor?
    And is the pay different at LTAC's than Hospitals?
    If you or anyone else could help me I would really appreciate it Thank you!
  12. by   daves
    LTACs, like any other hospital or hospital type, vary greatly from town to town. Your patient ratio is probably going to be twice that of an average ICU, but less than on Tele. And thats about right - its sort of a cross between the two. What saves you is the one "easy" patient that you hope to have.
    Patients tend to be there a long time; weeks certainly. Many come on a pre-approved 30-day insurance authorization. That means every one gets pretty familiar with them sooner than later. As I made assignments daily, it became a matter of matching total acuity with nurse capabilities.
    Covering LPNs is certainly a consideration. For one thing, some LPNs can act practically independant, almost as an RN. Other LPNs - not so much. As far as new nurses on a busy and high acuity LTAC, the most hopeful thing I would point out is you would get a lot of experience a whole lot sooner than on MedSurg.
    And like any other first job in this biz, the most important thing is to learn how to prioritize, make fast assesssments, and ask smart questions (before you get into trouble).
  13. by   zia238
    Thank You!
  14. by   grandmawrinkle
    I'm an ICU nurse. I've never worked in a LTACH but my two cents is this:

    The patients we send to LTACHs are the ones we can't get better in a finite amount of time and we need to get them out of our ICU to free up beds. These patients are too sick for the ward or even the stepdown -- most of the ones we send won't wean from the ventilator, and we don't have progressive care or vent weaning beds at my facility. They are also otherwise medically complex with other issues to monitor/treat.

    I personally think that this would be excellent experience for a new grad that wants to get into an acute care hospital eventually -- really, it's the next best thing. I think most of your patients will be higher acuity than med/surg patients in the hospital, actually. You'll be getting patients that are somewhere between the ICU and the regular floor as far as level of care required. I think from there, you'd walk right into a med/surg floor and think it was easy, and if you'll be trained into vents, it would be a fairly easy transition into a hospital ICU as well.

    I think this is a good move for you, and would take it. You are going to be tired and overworked, but hopefully it will pay off with a hospital position for you after a period of time. Good luck!