Long Term Acute Care

[Skwidward]

Is this a good place to start as new grad?

My goal at first is to just get some well rounded experience. The place i am looking at going is a LTAC facility that trains lpns up to work with ventilators and gets you IV certified. The nurse educator also told me you start off on medsurg at first, so I guess that's a good place to start. This place pays more than the county hospital and doesn't seem to have as bad of a reputation.

[pagandeva2000, LPN]

Learn what the nurse to patient ratio is before accepting and also check out how long your orientation is. That means alot...some places have one LPN to 40 patients. That does not appeal to me...but others have a knack for that sort of volume.

[kat7ap]

I think those are excellent places for LPN's to work. I did my last quarter of clinicals at a LTAC hospital that had mostly LPN's on the floor. It was basically a med/surg unit but for very acute pt's requiring longer term care than a traditional hospital. There was a lot of wound care, long term IV antibiotics, and vents. Find out things like pt-nurse ratios and orientation length. The place I was at had about 6-7 pts per nurse and they were kept very busy.

[hlfpnt, BSN, RN]

I started in LTAC 2 weeks after grad & 8 1/2 mos later I'm still there. It's a decent, but hard place to start...you'll learn ALOT! It also depends on what you ultimately want to do. I'd like to try CVICU, so I thought this would be a good place for me to start. I'm learning some of the acuity & equipment plus the time management. Our pts are multisystem failure (most on vents) with multiple lines, tubes, drains, & extensive wound care. Very few of our pts are po, so feedings & most meds are crushed & put through g-tubes. There's alot of IV meds as well. Our average is 6-7 pts per nurse. It's a very busy job. I don't know about other places, but where I work our LPN's do everything the RN's do except new admit assessment & hang blood. They can monitor the infusion, but can't initiate it. I agree with the OP, it's a very good idea to find out nurse/pt ratios & orientation. Good luck to you.

[TheCommuter, BSN, RN]

I have been working at the same large LTCF for about 15 months, so it has been a little over 1 year. I started in the LTC unit, and remained there until about a week ago.

I was involuntarily transferred to the rehab/long term acute unit very recently. Our long term acute care units have horrendous employee turnover rates because the work load is challenging. I would say that the entire long term acute care staff turns over every 2 to 3 months at my facility due to lack of orientation, excessive paperwork, and sorry nurse managers. In addition, the very sick residents are demanding and expect instant gratification, without any regard of the fact that you are caring for 14 other patients.

The family members also tend to be abusive and bothersome, because they expect instant gratification. They will curse, swear, threaten to sue, or hold you up for a very long time. Furthermore, the admission paperwork often takes up 2 to 3 hours of your time, so you will often fall behind in your other duties (med pass, treatments) to get the new patient properly admitted and assessed.

Here are the positive aspects of rehab/long term acute care. You will learn many skills. I give IV push, IV piggyback antibiotics, accomplish very complicated wound treatments, flush PICC lines, etc. Also, your shifts tend to pass by very quickly. Good luck!

[kat7ap]

Are you applying to a LTAC hospital or nursing home/SNF? Because there are differences between a medicare unit in a nursing home which handles rehab and subacute and a LTAC Hospital. I worked 6 months on a medicare unit in a nursing home and half the time it was absolute hell from the pt overload. If it's in a nursing home defininetly make sure there is an admitting nurse that does ALL the admissions, it's dangerous without one.

[txspadequeenRN, BSN, RN]

amen sista!!!!

if it's in a nursing home definitely make sure there is an admitting nurse that does all the admissions, it's dangerous without one.

[feisty_lpn, LPN]

If you can get on as a staff LPN in an acute care setting, go for it! I'm agency and 80% of my shifts are in a LTAC hospital that specializes in vents and vent weaning. I've never had more than 5 patients and there are at least 2 RTs on the floor. I lost alot of nursing skills working in a traditional nursing home setting. In LTAC, I've relearned those skills and then some! I love the hospital setting... I don't feel like "just a pill pusher" like I did in the nursing homes.

[NurseElaine]

I worked in a SNF which handled Rehab and Sub-Acute. The work there was very challenging!! The demands put on you by the residents, family members, and staff was unbearable most of the time. Our new hires were usally new grads who didn't last beyond 2 weeks. I'd return to work from my days off to find that so-and-so had quit. The biggest complaint the new hires had was not enough orientation and TOO many residents. Although, I acquired many new skills there and was able to practice skills not often used in LTC, I did find out this particular setting was not for me. It was very stressful and oftentimes the girls would be in tears by the end of their shift; not to mention they very rarely finished on time. I guess it really depends on the facility. Administration/nurse management was horrible and there was absolutely NO TEAMWORK, no one was "available" if you ever needed asssistance. I also suggest that you find out the nurse/patient ratio and how long orientation is; ask lots of questions. I only lasted 3 mths. Good luck!!!!

[rnwaller]

Hi Everybody,

We need to distinguish here between an LTAC (Long Term Acute Care HOSPITAL) and LTC ie. long term care or a SNF - Skilled Nursing Facility/Nursing Home

LTAC is a hospital (and licensed as one) some even have ICU level of care. Per Medicare guidelines (thats what everybody uses as their standard) the goal length of stay is 20-30 days (you do not keep patients in an LTAC long term - although some stay a few months). Patients are seen by physicians daily and respiratory therapists are an integral part of the system. An LTAC is designated for "medically complex" patients requiring extended recovery times from an ACUTE illness. The most common LTAC patient is a complicated ventilator wean or complicated wound patients. What is mentioned as a 1 to 5 nursing ratio is common although ICU does remain at 1:2.

SNF - Skilled nursing facility What is commonly know as a nursing home. Both short term medically stable recovery patients and chronic conditions. Licensed as a SNF not as a hospital. Nursing ratio's can range from 1:20 to 1:26 and I agree they are a challenge to work in. They are accepting sicker and sicker patients (some that meet the criteria to go to the LTAC hospital.) God bless the SNF nurses!

FYI Acute Rehab - Patients with acute medical condition, stabilized, that can tolerate 3 hours of rehab per day. Most common stroke and trauma ie. Senator Gabrial Gifford.

Hope this helps!

[SJ Cory]

I'm considering applying for a LTACH. All of this information has been very helpful. Ultimately, I want to work in the ICU. It sounds like a lot of the skills I will learn will be applicable if I did work in a LTAC. Query: do any LTAC require a work commitment?

[xoemmylouox, ASN, RN]

Most don't require a commitment. I would make sure to ask a lot of questions first. I was at one. They promised to get me ACLS cert, IV cert., etc. Guess what.. after 2 months I still was not closer. I left that place ASAP. They patients are often very very ill. If someone codes we were expected to take care of it, not to send them via ambulance even though often there was no doc on site, and if we were lucky one RN. There were issues and incidents. After a very serious happend I quit after that shift. No way would I go back.