I think you really need to look at these alternatives. But......an LTAC is not a nursing home. These are hospital patients that have "run out of days". The are vented, have complex ACTIVE medical problems. You will see HALO traction, vents, complex wounds, chest tubes, feed tubes, drain tubes. The hospitals that have BUs will have vents, multiple lines, including invasive monitoring PA lines (Swan Ganz) art lines with active interventions. They have telemetry floors that will have post open heart patients that have complicated post op courses. As a supervisor, I have seen some amazing stuff get transferred through the LTAC door. LTACS are licensed as acute care facilities and usually will perform same day surgery stuff like EGD's, G Tube feeding insertion and trachs.
These patients will be actively treated with staff MD's that are in house (most of the time) The goal is to wean and discharge to LTC/Skilled or home with services.
The problem with LTAC is the acuity. These facilities get all these medically complex patients from several facilities and house them in one place. They are not reimbursed as acute care and there has been some progress towards a middle tier reimbursement that is higher than LTC/skilled but lower than acute care. These patients have labs and can receive transfusions. They will have insulin gtts.......but you will have several because they are now all under one roof from the multiple facilities.
They will train new grads. Their training is usually longer than usual, for a new grad, they will invest time and money on training. But.....staffing is not all that great. Burn out is very high. They historically run a very tight ship supplies wise and have very frugal budgets. This burns nurses out quickly.
Working at a a LTAC will give any nurse experience beyond belief. Unfortunately.....Hospitals still view them as "nursing homes" due to their lack of understanding of what an LTAC is....even though they send the patients they failed to get home. So a nurse who has worked at an LTAC has more selling to do about her experience than other nurses in acute care.
It is worth the effort and training ....IMHO To quote myself....
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 learn valuable IV skills. 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 co-morbidities. 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. Visit the LTAC/LTACH forums. I think you will find them helpful. You will get that acute care experiences and they are willing to hire/train new grads.
If you have any other questions about and LTAC....PM me.
AS a new grad you will need brain sheets to help organize yourself.
ntp medsurg.doc 1 patient float.doc
5 pt. shift.doc
day sheet 2 doc.doc
critical thinking flow sheet for nursing students
student clinical report sheet for one patient