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!