Which job - Skilled Unit vs LTAC?

[mobl.rn]

I have been offered two jobs and I am not sure which one would be a better fit!

I am a new grad with a few months LTC experience and I would like to get more acute care experience.

The first job is at a 75 bed LTAC facility. FT nights. The base pay is a bit higher.

The second job is on a Skilled/Rehab Unit at a regional hospital. FT days. Benefits are better, but pay is less.

Patient ratios at both facilities are about 6:1.

Is there a big difference in the acuity of these patients? Would one provide better experiences than the other? Would a larger facility provide me with more advancement opportunities?

Any comments or opinions would be greatly appreciated!

[tammyfair]

I've worked both, LTAC for 1 1/2 years, and just started a new acute rehab job at a hospital now. I liked my LTAC experience, because I got to do MASSIVE amounts of cares. Think ventilators, g-tubes, trachs, wounds, wound vacs, tube feedings, etc etc etc.... but for the most part they were stable. The NP came by once or twice a week, the dr came by once a week, the WOC-RN came by once a week. At the acute rehab, they are slightly more acute, the dr is there every day, I do more IVs now, but less of the other cares and more toileting. It may be easier to transfer to a different unit in a few years because of having better/closer references. What it would come down to for me, would be the hours. Days is always busier and you will learn more than nights, nights you have less interaction with drs, pt/ot/st, managers, etc, but you will have more time with patients. You can always ask your interviewer what types of patients they get and their acuity.

[cute.as.a.callbutton]

I was a new grad in May and got my first job in a SNU at a regional hospital that has an Acute rehab unit on the other side of the hall. At first I was apprehensive about getting "stuck" in skilled nursing but that eneded up not being the case at all. We get pulled to the med surg floor all the time, and currently I pick shifts up in the ARU. I guess what Im trying to say is Im getting tons of experience being as Im in a hospital than what Id be getting if I was in a NH. Also, where Im from Hospitals do not honor NHs as Med Surg experience but the work I do on my SNU counts as med surg since it's in a hospital, something to think about if you ever want to advance to ER, ICU ect...

[born2circulateRN]

I'm a new graduate and I got an offer at an LTACH about 3 months ago. It was definitely not my first choice, but now I am very grateful to have gotten the experience I have. As the first poster stated, you will get tons of experience. At my place of employment, we have a higher and a lower level of acuity. The higher acuity (more like an ICU floor) patients are usually admitted for acute respiratory failure and mostly all are on ventilators. The ratio is 1:3-4. The lower level of acuity is like a med-surg floor with a ratio ranging from 1:5-6. You'll get patients for ventilator weaning, antibiotic therapy, pain management, complex wound care treatment- a variety of patients.

Let's see...for the 2 months I have been employed, I've managed peripheral lines, central lines, arterial lines, patients on full ventilator settings to nasal cannula, enteral nutrition and TPN/lipids, PEG tubes, Dobhoff tubes, wound vacs, PCA pumps, blood administration, critical drips such as Levophed, insulin, Fentanyl, amiodarone; chest tubes, different types of ostomies and drains. You get to draw your own labs usually - from central lines and venipunctures. You will get to insert and discontinue foleys, fecal management systems, dobhoff tubes, central lines (insert only you're certified for it - but d/c, yes). You'll do tons of sterile dressing changes for central lines and wounds dressing changes. You will definitely learn to critically think and prioritize - because things do come up and you need to figure out what do first. You have patient with 3+ edema with CHF receiving blood vs. a patient who wants their prn pain medication q 4 hours -who to assess first? You will have needy patients, nice patients, older patients, younger patients, emotional patients, unsatisfied patients/family. You will have to communicate with family members, MDs, NPs etc. I'm not sure of the acuity of a skilled nursing facility, but I can speak for LTACHs due to experience. However, every LTACH is different.

I received a pretty lengthy orientation of 12 weeks and will be on my own after next week. I was also hired for full-time, nights - and I must say I definitely prefer nights. LTACH is definitely acute care, but some individuals think differently due to the LONG TERM of LTACH. I've learned tons. Maybe shadowing will help make your decision. Good Luck!