LTACH with med-surg background?

[Calm_Down]

Hello,

Does anyone have any experience going from a med-surg background to a long term acute care hospital? There are a few positions open in my area and I'm considering applying, the pay is higher than my current position but the acuity is also higher.

From the threads I have read it seems many people take the opposite approach and go from LTACH to a hospital setting but rarely from med-surg to LTACH.

[YUKONrn]

I start an LTACH tomorrow. I have 9 years of hospital experience and 3 years of LTC/SNF. I will be making more money than I made as a traveller which made me a little suspicious. I asked the same question, look at my post below. Once I get into if you want more insight PM me.

[anglophile80]

I do! I had 2 years of med-surg experience before switching to LTACH. Med surg was much too busy for me. I'd have 6 patients with 2 to 3 discharges and admissions a day which meant I was doing and charting 10 assessments every shift! Not to mention all the paperwork. On medsurg I had to be my own secretary too answering all calls about my patients from family to doctors to PT, OR, endo, lab ...my phone never stopped ringing! Which impacted pt care. At my LTACH I usually have 4 patients with maybe one admit or discharge a week. I get to know the patients better because most are there for 1 to 2 months. Its neat to see them get better and go home or to rehab. You will also get hospice type experience because we regularly have patients on comfort care. Yes the patients are more acute but there is closer monitoring at LTACHs and during the day there is always an MD or NP there if a patient starts to go south. Which means we usually catch it in time before a pt codes. Most of my pts have PEGs and trachs or large wounds. I regularly draw my own labs, hang blood, check blood sugars, take vitals, and do a LOT of dressing changes. I also have to take patients to and from tests and procedures at the host hospital. There are lots of PT, OT, ST and RT which allows me to just focus on providing nursing interventions. It seems like a lot of LTACHs have paper charting which is a pain but not so bad once you get used to it. I'm grateful for my med surg experience because I learned a lot of skills that I don't use anymore like starting IVs, monitoring chest tubes, CBI, NGs. Unlike some other nurses I'm ok loosing my skills if it means a better work environment. I'll never go back to med surg. You are also eligible to get your CCRN certification which is a specialty and specialty=more money. Good luck!

[KatieMI, BSN, MSN, RN]

There were tons of nurses who did that where I worked, as well as those who rotated between LTACH, med/surg, PACU and pretty much everything else in between.

While two main reasons were money (LTACH paid significantly more) and self-scheduling, the other things which existed in LTACH and not in many other units were:

- stable population. Patients stayed much longer, so nurses had a chance to get to know them. Sometimes it really made a difference on both sides. Plus, just not everyone likes to "welcome" 4 new admits per shift and say good bye to 5 more.

- since we had nurses from literally every walk of life in LTACH, there was close to 100% chances to learn something from somebody who really knew the trade every time you got stuck... or find someone loving to do what you hate. I was a techie of the unit. Everybody knew that I would jump and run for some tricky wound vac or hard stick or crushing patient, and nobody usually minded taking some LDOL instead.

- autonomy was a BIG deal for many. LTACH is a "neglected" enviroinment with frequently cut down to bare bones support services - while dealing with patients rightfully belonging to ICU but bumped out of there for $$$$$ sake. So, nurses there do it all. We could, through charge, independently order ABGs, Xrays, ECG and start do stuff before any doc got a chance to get there. Wound care - all yours, as much as you want. If you would like, you might learn enough dialysis to test out of half theory in DaVita or Fresenius. You might, with some luck and friendliness toward RRTs, start to run vents, trache changes, etc.

- and, yes, in this enviroinment, there were WAY less policy-kissers and rules-adorers.

LTACH, more frequently than not, is a medsurg on high dose steroids. It is an excellent spot for hard workers, avid learners, those who want to get hands dirty and try new things before jumping into them. But for those nurses who like written rules, policies, specialty concentration and not many out-of-the-box situations, it probably wouldn't be a good fit.