Umm...again, how many weeks of orientation?

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    I had the opportunity to take a critical care RN position at a LTAC (long term acute care) hospital. The nurse manager gave me pause when she told me that I would get 2 weeks of orientation. Hunh? Eventhough I am an experienced telemetry RN (6 years), I was a little put off by such a short orientation for changing from my specialty to such a high acuity specialty. Two of my colleagues told me that I should have taken it but to me that would have been putting my license and more importantly, patients in jeopardy due to my inexperience.

    If you were me, would you have taken the position?
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  3. 16 Comments so far...

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    I agree with you: 2 weeks is not enough time. They must be very desperate to have staff on the floor, and not at all concerned for their staff or patients. Definitely not somewhere I'd want to work.
    jrsRN07 likes this.
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    2 weeks is definitely not enough! We just got a veteran tele RN new to our CT ICU-- they put her on the same training program as everyone else (new grads, and new to ICU RNS): 2 weeks pre-class, 4 weeks in-class, and 4 weeks post-class training. At the previous hospital I work at, it's also 10 weeks total. In both cases they give you an additional 2 weeks if needed (per preceptor recommendation). 2 weeks is crazy, even if you are an amazing nurse who learns quickly def. not enough. I'm surprised the manager would even consider such a short orientation-- very unsafe for you and your future patients! 2 weeks is for experienced ICU RN's on a new ICU if anything.
    jrsRN07 likes this.
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    Maybe there are regional differences, but in my area LTAC's aren't ICU's. I would agree that 2 weeks is way to short to go from tele/progressive care to ICU, but going from tele/progressive care to an LTAC is going to be a pretty smooth transition, particularly if you've done stable trached patients on vents.
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    Quote from MunoRN
    Maybe there are regional differences, but in my area LTAC's aren't ICU's. I would agree that 2 weeks is way to short to go from tele/progressive care to ICU, but going from tele/progressive care to an LTAC is going to be a pretty smooth transition, particularly if you've done stable trached patients on vents.
    If the OP only worked tele, then it is doubtful she is familiar with vents, titrating drips, a-lines, or other critical care skills used in most LTAC facilities. LTAC's are not just nursing homes, these pts typically come from in-pt ICU and will need long term ICU type care.
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    Quote from ChristineN
    If the OP only worked tele, then it is doubtful she is familiar with vents, titrating drips, a-lines, or other critical care skills used in most LTAC facilities. LTAC's are not just nursing homes, these pts typically come from in-pt ICU and will need long term ICU type care.
    "Tele" is sort of a non-specific term, but it typically refers to a progressive care unit. These units do drips, and sometimes even stable vents (same as LTACs), if not, then 2 weeks should be plenty if the only thing you haven't done is vents. None of the LTACs in my state take art lines, pressors, or drips other than non-titrated drips other than those you would also typically find on a tele unit. They will take non-titrated milrinone or remodulin, although you'll find those outside outside of ICU's in hospitals as well.
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    It depends on the LTACH. I supervised at an LTACH that got complex post CABG with PA/art lines and drips. So it really depends.

    Hummm....2 weeks. If it is a hard core where I supervised I would work the unit versus the floor........at least the most patient nurse ratio was 3-4.......I where 8-10 medically complex vented patients with extensive drsgs/care are common on the floor.

    If it is just vented heavy tele patients...you should be ok...the nurses are usually good to each other and they have an in house MD and respiratory to help with the vents. But LTACHS are hard jobs...you will learn a TON....but you will work very hard. Burn out is high turn over is high as well.
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    moved to LTACH for best response
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    From reading here, it seems that LTACs vary greatly in terms of the acuity of the patients. I'm a new grad and 3 weeks into my orientation in a tele/med-surg LTAC unit, and a couple of times we (my preceptor and I) were pulled to the ICU. The vented patients (about 75% of the census) made me nervous until I spent the day with a Respiratory Therapist. That helped immensely and I am now comfortable with the ventilators and suctioning patients. RT is always there, so they usually respond to the vent alarms. The med pass is easy enough, after I was shown a couple of times how to give meds through a PEG tube. I feel comfortable enough with telemetry and I'm always asking the tele tech questions. The only thing I still feel very unsure about is wound care, especially with the complex wounds we get. I'm going to ask for a day with the wound care nurse. Right now I feel comfortable taking on 2 patients with minimal assistance from my preceptor. We've had one code so far and I was able to contribute.

    Even for an experienced nurse 2 weeks does seem rather short. How many patients would you typically have? For the nurses who have been working at my facility for years, 5 is overwhelming. 4 is comfortable but you're strapped for time. 3 or less and you're able to get everything done and spend some time with them.

    If I were you, I probably would have taken the position if the only concern is can you safely care for the patients. BUT... it seems like LTACs in general are not very desirable places to work. It's hard work and the patient loads are high. Nearly everyone is on contact precautions so you spent half your time sweating in a blue plastic gown. It's heartbreaking to see these 80-90 yr old people who mouth for you to stop, grimace in pain with every turn & IV stick, yet their POA insists on them being a full code and continuing all treatments. You get great experience, which is why I'm there, and no one else is hiring new grads. But if I had nursing experience already, I doubt I'd choose to work at an LTAC. I'm already thinking about where I'd like to work after I get my year or so of experience. So maybe you made a wise choice.
    whslee01 likes this.
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    Quote from Clovery
    ...It's heartbreaking to see these 80-90 yr old people who mouth for you to stop, grimace in pain with every turn & IV stick, yet their POA insists on them being a full code and continuing all treatments. You get great experience, which is why I'm there, and no one else is hiring new grads. But if I had nursing experience already, I doubt I'd choose to work at an LTAC. I'm already thinking about where I'd like to work after I get my year or so of experience. So maybe you made a wise choice.
    I could have written this myself, you put it perfectly.


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