LTACH nurses

[YUKONrn]

So I start my new job at an LTACH on monday. I am getting a huge sign on bonus and my pay rate is the equivalent of what I made as a traveller. It has me a little worried. I have 11 years of critical care, LTC, and SNF experience combined. I've toured the facility and it is well equipped, it's almost like a small hospital. I was told I will have 4-6 patients. I want to hear from nurses who have worked in an LTACH what have your experiences been like? This is the only area of nursing I have not worked in and I'm a little apprehensive. Any input?

[Triddin]

Your best bet is to talk to the staff at the facility. Everyone's experiences in this field will be different because they have different employers. I feel the only opinions that should matter to you should be the ones pertaining to this facility

[KatieMI, BSN, MSN, RN]

As a former "acute" LTACH RN, I would suggest the following:

- access, assess, assess! You are working with VERY sick people. When they go south, they do it fast (I was so much on my toes while working there that I did not let CNAs to do vitals - and couple of times it made the day).

- make sure you have enough supplies as soon as you know what is needed

- make RRTs and WOC-RN your best friends...

- .... and get ready to do their job at any moment. You may have to get very creative with wound care, for one example

- make connection with providers ASAP. LTACH patients are often "passively neglected" by docs, so let them know that you are the nurse they can trust

- for the same reason as above, be ultra-super-organized. Seriously - more so than in any other place.

Your experience will serve you lot of good. Don't be afraid. LTACH is a golden throw for learning new things, and I still kinda miss it. Good luck and positive vibes to you!

[YUKONrn]

As a former "acute" LTACH RN, I would suggest the following:

- access, assess, assess! You are working with VERY sick people. When they go south, they do it fast (I was so much on my toes while working there that I did not let CNAs to do vitals - and couple of times it made the day).

- make sure you have enough supplies as soon as you know what is needed

- make RRTs and WOC-RN your best friends...

- .... and get ready to do their job at any moment. You may have to get very creative with wound care, for one example

- make connection with providers ASAP. LTACH patients are often "passively neglected" by docs, so let them know that you are the nurse they can trust

- for the same reason as above, be ultra-super-organized. Seriously - more so than in any other place.

Your experience will serve you lot of good. Don't be afraid. LTACH is a golden throw for learning new things, and I still kinda miss it. Good luck and positive vibes to you!

This is the info I was looking for. Sounds like it pays so well for a reason. Thanks for the advice!

[mscassandra]

Coming up on my two year anniversary at my LTACH, and I enjoy my job very much. The experience has made me a better nurse due to acuity, and spectrum of patient issues. Some patients are there for wound care long term iv ABX, most are vent dependent resp fail. Wound care usually involves wound vac therapy with management of drains.

Majority are trach/peg/picc/foley/flexiseal on the vent. See a lot of chest tubes, intense wounds, blood transfusions, CBI etc. Patients will sometimes/often be or be admitted on gtts- levophed, cardizem, milrione, propofol, versed etc. Sepsis/initiation of sepsis protocol occurs frequently. Comfort care/ codes occur frequently.

Our unit is fast paced and many of the patients are really sick. Although our average LOS is 28 days, some stay longer/shorter. I catch myself almost every shift wondering how in the world some of these patients will get out of here (most d/c to rehabs) or ever get better. But many do and eventually- I get to here my patient's voice for the first time. Rewarding specialty a lot of the time. At the end of the day, the people you work with will make the biggest difference.

Good luck fellow superhero :)