LTC - Subacute vs speciality hospital, vs nursing home vs rehab?

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    I'm a new ADN in New Jersey. I graduated in June 2009, got my license in Sept. I don't have any prior work experience in health care field. I've been looking for jobs, mainly in hospitals and so far no good. As you all know, it's extremely hard for new graduates to find a hospital jobs in New Jersey. I regret not started applying earlier. I'm lucky that I still have a non-nursing full-time job to fall back on. Paying bills is not a problem. But I cannot just keep doing something else and let my nursing license get stale.

    My ultimate goal is to work in an RN pool for a major hospital, that means I can work in Med-surg, ICU, ER, L&D. etc. I really enjoy doing different things.

    Given the current job market for new graduate in NJ, and the market is just getting tougher for me as the new graduates will rush in in December. I know sooner or later I may either have to move out of the state, or start looking at LTC. My understanding is: if I have to start in LTC, sub-acute or shot-term nursing home stay is a good place to start. Assisted living is the last place I should look at.

    I've seen some specialty hospitals, are they the same as subacute care? although these special hospitals in NJ do not seem to hire either. I am also thinking about applying for specialty hospitals in PA.

    I've also seen some recruiting events for Nursing and Rehab centers. These Nursing and Rehab centers are affiliated with the same major health care system, which have some real good hospitals. Is it better to start in a rehab center like this? so chances of moving to the affiliated hospital will be bigger, compared to an independent nursing home chain?

    For Rehab center, vs long-term subacute care, is that long-term subacute care is much better? Seems more iv skills, wound change, G-tube, tache-care used in long-term subacute care. Am I right? If so, I'll probably concentrate on looking for a subactue facility first.

    My classmate who worked in a nursing home for many years as a LPN told me to try to get a hospital job, and not to work in a Nursing home, she said nursing home sucks.

    Another option is home care. I know a foreign language, which may place me on some kind of distant advantage in looking for a home care job in new york city. But I heard home care experience do not really count. So it's may be better to start with long-term subacute?

    The order would be:
    Specialty Hospital > Long -term Acute Care > Short-term subacute care > Nursing Home > Rehab > Home Health Care > Assisted Living.

    Is my order right? Any suggestions? Greatly appreciate.

    Another possibility is to move to a State like Texas, look for a hospital job there. Get one year med-surg experience, then come back to NJ. I'm single, owe no houses, but my friends are all in NJ, and I'm very comfortable with the climate and the living here. Careerwise, does it really make a such a big difference starting in a hospital vs starting in a LTC? I'm not sure if it is worth the moving out for one year.

    Any suggestions, greatly appreciate it.
    Last edit by TheCommuter on Oct 6, '09 : Reason: cross-posting/duplicate threads
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  3. 10 Comments so far...

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    I work in a long term care facility, on the sub-acute unit...maybe this is what you are trying to say when you say "long term subacute"....not sure what you are referring to.

    Anyhow...we deal with primarily geriatric patients (very occasionally we'll get someone s/p a TKR or THR in their 50s or so, but they usually are only there a few days) for short term rehab secondary to a number of problems--just to give an idea, diagnoses I've recently dealt with include a R TKR, T12 compression fx, sciatica pain, s/p perforated duodenal ulcer, aspiration PNA/esophagel ca on j tube fdgs, chf & copd exacerbations, C Diff colitis, MRSA, VRE and a C4 incomplete spinal cord injury....nevermind the multiple comorbities that these pts have--htn, diabetes, etc etc... I am responsible for an 8 bed "team" of patients...currently I have 7 patients, and 4/7 are diabetic.

    We get wound vacs, IV antibiotics/hydration, PICC lines, J or G tubes, complicated dressing changes...you name it. I feel that I've developed great assessment skills during my first year as a nurse in this setting...you really have to be sharp and know your patient's baseline...sometimes you pick up on very subtle signs that someone is going south...

    Feel free to ask any questions about what my floor is like to work on--I hope my message has helped some!
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    I'm a little confused by your wording too. I work in a LTC, which has a subacute (also known as transitional care, or rehab) wing. In the last few months, we have had pts. with new brain shunts, compression fractures, liver and pancreas transplant, PVD wound care requiring a wound vac, a new trach pt., a TBI, an aortic valve replacement, diabetic ulcer, several complicated lower extremity breaks, a shoulder fracture, hepatic encephlapathy (moved to LTC), and a pt. who the hospital had no clue what was wrong with, so they sent her to us for rehab and recovery, while monitoring her labs to try and figure out what's going on. We've also had older pts. recovering from pneumonia, COPD excerbations, a younger man (50's) who required ongoing skilled nursing for burn rehab...I could go on and on. It's a lot of variety, and while technically the pts. are stable....well, when you get labs back with K+ of 8.3, or pts. with a PT/INR that's critical...yeah, there are some assessment skills and critical thinking that need to happen ASAP.

    As is true in all areas of nursing, your own mileage may very. Facilities are different too. I've been in LTC's that I would never work in. Some people absolutely hate this type of nursing.

    LTC is a bit different too, but there is something to be said about having a long term relationship with your pts. and their families. Also, not all LTC's have a subacute service. Mine has PT/OT/Speech available on site, thus we take a wide variety of pts.
    summerrose_10 likes this.
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    Well Im also from NJ and have bene experiencing the same thing as you. I graduated in May and passed my boards in September. I can not relocate. Im married and have a house. So I have applied to DE, NJ , PA hospitals. I applied to a LTC facility that is a mile from my home back in July. Interviewed once. They hired me yesterday. I have been applying to hospitals like crazy and have gotten nothing. I also had an interview for home care for a pediatric agency but that was more than an hour ride from my home. At this point because of where the market is at and the fact that about 70% of my class does not have a job yet with more people coming into the market Im going with the LTC facility. It will give me some experience till at least I can get hired at a hospital. It is not perfect but in this economy I think we need to take what we can get. I like the order you are looking in but I would apply to all categories and see where you get a bite at. I dont know if it helped but I can tell you I have been applying everywhere in all categories and this is where Im ending up at.
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    MH24, Congratulations on getting your first job!

    It's scary that in December more graduates will be in the market, and the job market looks just going to get worse in the near future.

    I already started the transfer of the license to the state of Texas. I may have to visit there to look for jobs. As long as I can get in the hospital door. I've been through other professions. Know how hard it is to jump to a better field once you stuck in the wrong area at the beginning. People started with acute care/med-surg, they can come back easily find a job in a LTC, but not the other way. Kind of not fair for the unfortunate ones, but it is how society works.
    Moonstar94 likes this.
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    I worked at a large nursing home for 2 years that had a subacute rehab unit. During my 9 months on the subacute rehab unit, I typically had 15 patients on day shift and 30 patients on night shift.

    On the subacute rehab unit where I worked, we dealt with a lot of central lines, IV antibiotics, CPM machines, feeding tubes, suture removal, surgical staple removal, complicated wound care, ostomy appliances, diabetic management, casts, braces, splints, cervical halos, and so forth. Most of my patients had recently underwent surgical procedures such as laminectomies, knee and hip arthroplasties, kyphoplasties, CABGs, hysterectomies, limb amputations, colectomies, thromboembolectomies, and abdominal aortic aneurysm repairs.

    The non-surgical (medical) patients were admitted for recovery from CVAs, acute MIs, debility, cancer, fractures, status post pneumonia, deconditioned states, failure to thrive, status post falls, contusions, and generalized weakness.

    You will bust your buns in nursing home subacute rehab, but it will provide a unique learning experience.
  9. 0
    Sorry for the confusion. I guess I do not quite understand the industry well. Your information is very helpful. Thanks.

    Quote from SunnyAndrsn
    I'm a little confused by your wording too. I work in a LTC, which has a subacute (also known as transitional care, or rehab) wing. In the last few months, we have had pts. with new brain shunts, compression fractures, liver and pancreas transplant, PVD wound care requiring a wound vac, a new trach pt., a TBI, an aortic valve replacement, diabetic ulcer, several complicated lower extremity breaks, a shoulder fracture, hepatic encephlapathy (moved to LTC), and a pt. who the hospital had no clue what was wrong with, so they sent her to us for rehab and recovery, while monitoring her labs to try and figure out what's going on. We've also had older pts. recovering from pneumonia, COPD excerbations, a younger man (50's) who required ongoing skilled nursing for burn rehab...I could go on and on. It's a lot of variety, and while technically the pts. are stable....well, when you get labs back with K+ of 8.3, or pts. with a PT/INR that's critical...yeah, there are some assessment skills and critical thinking that need to happen ASAP.

    As is true in all areas of nursing, your own mileage may very. Facilities are different too. I've been in LTC's that I would never work in. Some people absolutely hate this type of nursing.

    LTC is a bit different too, but there is something to be said about having a long term relationship with your pts. and their families. Also, not all LTC's have a subacute service. Mine has PT/OT/Speech available on site, thus we take a wide variety of pts.
  10. 0
    Quote from TheCommuter
    I worked at a large nursing home for 2 years that had a subacute rehab unit. During my 9 months on the subacute rehab unit, I typically had 15 patients on day shift and 30 patients on night shift.

    On the subacute rehab unit where I worked, we dealt with a lot of central lines, IV antibiotics, CPM machines, feeding tubes, suture removal, surgical staple removal, complicated wound care, ostomy appliances, diabetic management, casts, braces, splints, cervical halos, and so forth. Most of my patients had recently underwent surgical procedures such as laminectomies, knee and hip arthroplasties, kyphoplasties, CABGs, hysterectomies, limb amputations, colectomies, thromboembolectomies, and abdominal aortic aneurysm repairs.

    The non-surgical (medical) patients were admitted for recovery from CVAs, acute MIs, debility, cancer, fractures, status post pneumonia, deconditioned states, failure to thrive, status post falls, contusions, and generalized weakness.

    You will bust your buns in nursing home subacute rehab, but it will provide a unique learning experience.
    Thanks for the information, Good to know so much to learn in subacute rehab.
  11. 3
    During nursing school, it was a given.... get a job on a med/surge floor. It will give you experience in all things. However, after working in LTC/sub acute step down unit from acute care hospital, I question that advise.
    In a subacute care unit, you will learn more assesment skills then in any unit. In a hospital, you have the doctor, who will round on your pt. daily. In LTC/subacute step down unit,...your lucky to get the doctor to come once monthly.
    As NurseKatie08 says. she has 7pts., 4 who are diabetic. Imagine, needing BS before meal/after meal and covering for CHO's., along with... as SunnyAndrsn says.. brain shunts, liver and pancreas transplants, new traches and as TheCommuter says, 15 pts on days, 30 pts on nights, dealing with central lines, IV abx, CPM machines, feeding tubes, TPN, wound vacs, suture removal, colostomy/illeostomy care, bariatrics, hip ORIF, and just about any other thing you where introduced to in nursing school.
    Not only will your assessment skills be fine tuned, your time management skills will be second to none

    It amazes me, the ignorance on this site, of what LTC/subacute care really is. You all have to realize, geriatric care is where we are all heading (remember the baby boomers). heartbeatheartbeat
  12. 0
    Quote from purplehockeymom
    During nursing school, it was a given.... get a job on a med/surge floor. It will give you experience in all things. However, after working in LTC/sub acute step down unit from acute care hospital, I question that advise.
    In a subacute care unit, you will learn more assesment skills then in any unit. In a hospital, you have the doctor, who will round on your pt. daily. In LTC/subacute step down unit,...your lucky to get the doctor to come once monthly.
    As NurseKatie08 says. she has 7pts., 4 who are diabetic. Imagine, needing BS before meal/after meal and covering for CHO's., along with... as SunnyAndrsn says.. brain shunts, liver and pancreas transplants, new traches and as TheCommuter says, 15 pts on days, 30 pts on nights, dealing with central lines, IV abx, CPM machines, feeding tubes, TPN, wound vacs, suture removal, colostomy/illeostomy care, bariatrics, hip ORIF, and just about any other thing you where introduced to in nursing school.
    Not only will your assessment skills be fine tuned, your time management skills will be second to none

    It amazes me, the ignorance on this site, of what LTC/subacute care really is. You all have to realize, geriatric care is where we are all heading (remember the baby boomers). heartbeatheartbeat
    Thanks for posting this. I begin my subacute rotation at a LTC tomorrow morning and wasn't sure what to expect. Oh, dear, I think I'm going to be busy! I hope my experience is a good one. I've been assigned to care for 7 patients, 2/7 have blood sugar checks and 1 has a G-tube. That's about all I know for now. A wee bit nervous since up to now, I've only cared for 1-2 pts...pray I serve them well. My patient's deserve quality care.

    Take care!


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