Began in psych, want to go into medical

[Neurotic Student]

I started off in psych nursing for a little over 1 year and now I'm looking to move into more medical/physical-focused area.

I've been researching here and it seems like ltac's are basically like acute hospitals but underbudgeted/understaffed. Seems like a great place to learn but I'm scared there will be lack of support. I thought I would never make it with any job but I'm now decent at my job which I attribute to having being supported by some amazing coworkers. I also read that there's backstabbing and CNA's sticking it to you by not doing their jobs.

At my job the most common medical conditions I deal with are HTN and DM, but they're not that severe and out of control. All my pts are ambulatory and independent with ADL's. I feel as if 60% of my nursing knowledge has faded away. I feel like a stale new grad.

Do you think I can work in ltac, or is ltc more suitable? Also, what should I brush up on? Is the pay less than $30 in CA? If it is, I'd like to stay PD or PT at my current job.

Thank you, I appreciate your time.

[Mixnmatch]

Hi neurotic student,

I too started in psych, for almost one year, and always had the goal of making it into acute care. I started working at my local LTACH and it is definitely a huge learning curve but doable. It is true what they say, the work is extremely hard and wears on your body/mind, but I have learned and done more at this job in the last 6 months, than through all of nursing school! It is a short orientation, so I have done a lot of self learning at home. We get medically complex patients from surrounding area short term acute hospitals who need more acute care time. I have purchased several critical care books to look up diseases/meds and despite the hard work, I love that I learn and make new connections every week I work. I highly recommend LTACH if you are interested in learning and strengthening acute care skills!!

[Here.I.Stand, BSN, RN]

I worked in an LTACH for a year and a half. It is very hard work, and yes there's a steep learning curve, but once you get the hang of it it is very good experience. I worked with some truly wonderful people. We were for the most part willing to help each other, but pt loads and acuity made it difficult sometimes. As for lazy CNAs, we had a few who hated to work and many who were incredible. You'll find a mix of work ethics anywhere you go, though.

If you're looking to practice in a more medical setting, I would do LTACH over LTC. LTCs do have pts who have medical issues, especially given the push to get people out of the hospital more quickly, but LTACH pts are quite high acuity. With the possible exception of DKA pts, my LTACH pts were sicker than my current hospital's stepdown pts. Many are on ventilators, many have complex wounds, we'd see the occasional burn pt.

If you decide to go for it, I'd recommend brushing up on cardiac rhythms (many pts are on tele, and some with bedside monitors), sepsis/sepsis screening, delirium screening (my hospital used the CAM-ICU). The biggest thing that I encourage LTAC RNs to learn about is chronic critical illness. You can find a lot of info by Googling it, but in a nutshell it refers to the courses of pts who years ago would never have survived their ICU stay, but because of modern ICU care, they often do survive.

You should also be aware that families can be difficult to deal with. This too you will find anywhere, but many of these families have been with their loved one in the short term ICU for weeks or even months. They've been through the ringer, and stress does things to people. It doesn't help that for pts transferring from an ICU (vs. med-surg or what have you), the family is used to having very dedicated nursing care. At most, the pt's nurse only had one other pt. In LTACH floors, they are suddenly 4-5 pts per RN so the nurse can't devote that same amount of care to any one pt.

[KatieMI, BSN, MSN, RN]

Your psych experience can be a God-sent gift to LTACH team, we get patients who truly belong to ICU but cannot be there because nurses there are not "comfortable" with their acute/chronic psych issues and, for some reason, the patient just cannot be medicated the way ICU wants it. ODD, ASD, BD (prisoner protocol, which ICU disliked due to interference with customer satisfaction), DT, multiple addiction, but almost every med for all that contraindicated b/o alcohol-induced cardiomyopathy with unstable rhythms on a drip and tele - you get the picture.

Understaffing, backstabbing and lazy CENAs (and RNs, for that matter) happens everywhere nowadays. I work in LTACH for a year now, and honestly say that no other place besides ER gives such an amazing opportunity to learn nursing skills, although, yes, the job is extremely hard in all terms. Most of the patients are somewhere right between ICU and floor in terms of acuity and you will learn a ton. Some LTACH like Select have excellent education during orientation, but you might want to dust off your med-surg notes and refresh at least ECG, rhythms, sepsis and its treatment, and IV therapy with dose calculations.

Good luck!