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Discussion

Frustrated

I have an issue and would like some advice. I'm an RN and have been one for over 3 years. My first nursing job was in an LTACH. It was very difficult and stressful but I learned more than I ever thought I would. When I graduated I had trouble finding a job because the economy was so bad that new graduates had a hard time finding a job. My sister knew a nurse that was the manager of an LTACH in our area. I had never heard of LTACH's and, like most, I assumed it was like a nursing home. I had always wanted to start in acute care but I was so desperate that I was willing to work anywhere. The nurse manager looked and my application and set up an interview. I began looking into info about the unit and, was pleasantly surprised to find out that it was actually and acute care facility and the patient's were medically complex. The manager offered me a job right after the interview. Orientation was rough, as I began to realize how sick the patients really were. I made it through and after 2.5 years I decided to pursue travel nursing. As I talked to recruiters I began to have difficulty getting them to understand that I didn't work in long term care. I struggled to explain how the "long term" part was more of an extended acute care. In addition, the managers I was submitted to didn't get it either. As a nurse working in an LTACH, I gained experience with ventilators, wound vacs, central lines, feeding tubes, chest tubes, pca's, telemetry, and diseases including aids, pneumonia, DIC, cancer, traumatic brain injuries, MI, sepsis, kidney failure, liver failure, etc. Med surg nurses are often not floated to our floor because they can't be assigned to many of our patients. I really want to travel but I don't know how to get past the assumptions about LTACH's. I've tried explaining it and even directing recruiters to my facility's website. Is there anything I can do or should I just move on to something else? It's so frustrating because no one seems to listen to what I'm saying. For example, after explaining again my experience, my recruiter still emailed me and asked if I wanted an assignment in a long term care facility.

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    Rebrand yourself as a step down nurse! If you are not familiar with the term, in many hospitals, this is the next stop for ICU patients. It may be called an IMC for intermediate care. I think there are a couple other names as well I can't come up with, every facility has a different label. The focus will be a bit different than an LTACH but all the tasks and skills are very similar. Many of the patients will be ambulated for the first time post surgery or event (like stroke) so rehab and discharge planning should be a priority. Ratios are typically 3:1.

    Personally, I think step down has a higher workload than either ICU or med surg. It certainly requires advanced organizational skills. Anyway, it sounds like it would be right up your alley. You may find also that your skills will work in a smaller hospital ICU. Consider also PACU in the future.

    But for marketing purposes, tell agencies and recruiters that you are a step down or intermediate care expert and fill out the ICU skills checklist.

    If you have any concerns about your ability, visit your local hospital and ask for a tour or to shadow a nurse. Stop by a managers office and ask for an informal interview.

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    • Author

    Thanks NedRN, I will definitely give that a try. I did many clinical rotation on a step down unit and a friend who is working in a cardiac step down right now. My shift manager and I talked about how what we do is more inline with step down nursing vs med surg. I just don't know how to explain that when recruiters look at the website of the facility where I work and see LTACH. It's annoying though because the site does say LTACH but it also says "extended acute care".

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    A recruiter is looking at your former workplace online? Perhaps they are trying to get clarity about the name after a conversation with you or your facility has an unfortunate name. Tell them you are working in the step down in the LTACH!

    Recruiters are idiots and except for what they pick up from travelers, non medical. They often are not the ones talking to hospitals or submitting profiles so it can be doubly frustrating to talk to them. Try starting over with some new agencies, lots of them out there, and list your experience as ICU step down, not LTACH. Put the correct name of the facility of course. You will find recruiters that will understand your experience and have suitable assignments.

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