New grad starting LTAC job next week - advice?

  1. 0
    I'm a career changer, leaving the computer field where I've been for almost 20 years and starting my first RN job at an LTAC on Monday.

    Any advice for the newbie? I'm super excited, and a little anxious about this career move, but it was an opportunity I couldn't pass up.
  2. 17 Comments so far...

  3. 0
    Sorry I can't offer any advice, but I'm pretty much in the same boat and I'd love to hear how it's going. I'm a career changer too, new grad, and have a good feeling I will get an offer from an LTAC next week. PM me if you like
  4. 6
    In an LTAC/LATCH(Long Term Acute Care Hospital)...organization is key. You will learn a TON. Does the LTAC where you work have the ICU? LTAC's are full of very acute patients, all the medically complex/complicated course/unusual illness patient are collected under one roof. Staffing can be an issue......take what they are going to offer you and learn.

    LTAC's are a unique combination of very sick patients in a LTC setting. These people are the SICKEST of the sick AND they have had complicated hospital course. A 4:1 ratio may not seem like very much but in an ICU setting in an LTAC are the failure to weans so you will have 4 vented patients. Most will have multiple lines including PA Catheter's/Swan , including pressors and IV's.

    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 LTAC. These patients are the ICU patients that remain critically ill but have run out of "paid days" on insurance/medicare. You will see a ton of stuff.......everyone else's failure to discharge home. Open hearts with complicated post op courses, trauma's with Halo traction, many unique disease process with complicated recoveries, open wounds, chest tubes, vac dressings, wound irrigation's. You will give TPN, blood, do labs...your IV skill will make you valuable to them. These patients are mostly full codes and every attempt is made to get them home.....but with a fraction of the nursing staff in an acute care setting.

    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.

    You will gain a TON of experience and at least they do have great orientations. I wish you every bit of good fortune and luck in your new journey. If you have any other questions about and LTAC....PM me.:heartbeat

    You will learn a TON and LTAC's are willing to teach. Organization is key.

    Here are some brain sheets.
    brain sheets.......here are a few.

    ntp medsurg.doc 1 patient float.doc‎
    5 pt. shift.doc‎
    finalgraduateshiftreport.doc‎
    horshiftsheet.doc‎
    report sheet.doc‎
    day sheet 2 doc.doc

    critical thinking flow sheet for nursing students
    student clinical report sheet for one patient

    I have made some for nursing students and some other an members (Daytonite) have made these for others.....adapt them way you want. I hope they help

    GOOD LUCK!!!!
    sassynerd, mso819, sunshyne17, and 3 others like this.
  5. 2
    Esme, thanks for the encouragement and the info. I'd already scavenged the forums and pulled down the brain sheets and am currently trying to figure out the right "flow" for me.

    I wasn't sure when I posted before because they'd said one thing in my interview and something else in the offer letter, but the job is actually for ICU at the LTAC. I've worked 3 shifts with one of the preceptors now, plus a week of orientation stuff. I can already tell I'm going to learn a LOT here.

    I also think from everything I've read that I'm very lucky in which facility I'm working. Our ICU has 5 beds so one RN takes 3 and one RN takes 2. We don't have a patient care tech, but we do have an RT there all the time. So the ratio is not crazy like some places I've heard. And you're right the patients are total care and so far all the ones I've seen are on vents, so there's a lot for me to learn. They do seem committed to a lengthy and involved orientation/training process for me, and only asked me to be willing to commit to a year which I had no problem with. I'm hoping to start my BSN bridge this fall online and if that happens I'm not likely to look to move until I finish that as changing jobs is stressful and I've learned that stress and school don't complement each other well.

    I'm sure I'll have lots of questions as I move through this process. I'm incredibly grateful for the opportunity, and am already digging in to further my knowledge and figure out how to get the most out of my orientation.
    Esme12 and Clovery like this.
  6. 2
    Thanks for the info. I got the job at a Kindred LTAC. Really excited to start my orientation in a couple weeks. I think I've read every thread in this LTAC forum
    Esme12 and NevadaFighter like this.
  7. 1
    Yay, Clovery!! Sent you a PM.
    Clovery likes this.
  8. 1
    Congrats, Clovery!
    Clovery likes this.
  9. 0
    thanks!
  10. 1
    Esme12....a lot of great info you posted here. I just recently switched from hospital setting to LTAC and am really liking it. I'm getting ready to apply to NP school and this job is perfect.
    Esme12 likes this.
  11. 1
    Quote from Esme12
    In an LTAC/LATCH(Long Term Acute Care Hospital)...organization is key. You will learn a TON. Does the LTAC where you work have the ICU? LTAC's are full of very acute patients, all the medically complex/complicated course/unusual illness patient are collected under one roof. Staffing can be an issue......take what they are going to offer you and learn.

    LTAC's are a unique combination of very sick patients in a LTC setting. These people are the SICKEST of the sick AND they have had complicated hospital course. A 4:1 ratio may not seem like very much but in an ICU setting in an LTAC are the failure to weans so you will have 4 vented patients. Most will have multiple lines including PA Catheter's/Swan , including pressors and IV's.

    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 LTAC. These patients are the ICU patients that remain critically ill but have run out of "paid days" on insurance/medicare. You will see a ton of stuff.......everyone else's failure to discharge home. Open hearts with complicated post op courses, trauma's with Halo traction, many unique disease process with complicated recoveries, open wounds, chest tubes, vac dressings, wound irrigation's. You will give TPN, blood, do labs...your IV skill will make you valuable to them. These patients are mostly full codes and every attempt is made to get them home.....but with a fraction of the nursing staff in an acute care setting.

    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.

    You will gain a TON of experience and at least they do have great orientations. I wish you every bit of good fortune and luck in your new journey. If you have any other questions about and LTAC....PM me.:heartbeat

    You will learn a TON and LTAC's are willing to teach. Organization is key.

    Here are some brain sheets.
    brain sheets.......here are a few.

    ntp medsurg.doc 1 patient float.doc‎
    5 pt. shift.doc‎
    finalgraduateshiftreport.doc‎
    horshiftsheet.doc‎
    report sheet.doc‎
    day sheet 2 doc.doc

    critical thinking flow sheet for nursing students
    student clinical report sheet for one patient

    I have made some for nursing students and some other an members (Daytonite) have made these for others.....adapt them way you want. I hope they help

    GOOD LUCK!!!!
    Esme,

    This is great advice. I know this thread is old, but I stumbled upon it looking for ideas....I am considering a position in a LTACH....but I don't know if it would be a good first step. I am a new RN, but have been a LPN for some time before getting my RN.....so I am not considered a "new grad".

    Do hospitals consider LTACH experience acute care, or LTC? Eventually I want to work in a hospital to get acute care experience, but of course I can't get in anywhere. New RN, and all that.
    Esme12 likes this.


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