LTACH Orientation

bioniclewoman · Mar 21, 2013

A month is kind of short, but if it is a supportiveenvironment you should be ok. Most new grads that come thru where I work get atleast 6 weeks, but some have gotten only 4 weeks. Personally I think the ones that have less orientationdo better, but that might be a fluke.

You probably are going to be working with your preceptorvery closely the first 2 weeks. Since your orientation is so short, you shouldtake your own patients right away, starting with maybe 2. That way you areactually doing stuff and not just watching. You should work up to severalpatients ASAP. You want be working with a full load of patients while you stillhave a preceptor holding your hand, and helping you when you get behind. If youdon't have a preceptor during the last 2 weeks of orientation, you willprobably have a light load and a resource person assigned to you and they willalso have a light load. When I say light load, I mean they may give you oneless patient than is normally assigned or they may give you a full load witheasy walky/talky patients. The person assigned to you is supposed to be thereto answer your questions and help you if you get behind. Don't be afraid to askfor help. You don't want to get to the point where you fill like you are drowningbefore you ask.

You are going to have to be a very proactive learner to makeit. Ask lots of questions, find out who to ask for what, know your pharmacistand there ext., spend your days off brushing up on diseases/medications/treatmentsyou see frequently at work.

Froggy007 · Mar 22, 2013

Thank you for the quick reply and great advice. It has helped to ease my mind!

Esme12, ASN, BSN, RN · Mar 22, 2013

In an LTAC/LATCH(Long Term Acute Care Hospital)...organization is key. You will learn a TON. Does the LTAC where you work have the ICU? LTAC's are full of very acute patients, all the medically complex/complicated course/unusual illness patient are collected under one roof. Staffing can be an issue......take what they are going to offer you and learn.

LTAC's are a unique combination of very sick patients in a LTC setting. These people are the SICKEST of the sick AND they have had complicated hospital course. A 4:1 ratio may not seem like very much but in an ICU setting in an LTAC are the failure to weans so you will have 4 vented patients. Most will have multiple lines including PA Catheter's/Swan , including pressors and IV's.

Any LTAC I have seen or worked in is a tough environment. These patients are SICK!!! They have just "run out" of acute days and are sent to the LTAC. These patients are the ICU patients that remain critically ill but have run out of "paid days" on insurance/medicare. You will see a ton of stuff.......everyone else's failure to discharge home. Open hearts with complicated post op courses, trauma's with Halo traction, many unique disease process with complicated recoveries, open wounds, chest tubes, vac dressings, wound irrigation's. You will give TPN, blood, do labs...your IV skill will make you valuable to them. These patients are mostly full codes and every attempt is made to get them home.....but with a fraction of the nursing staff in an acute care setting.

The LTAC I am familiar with had an ICU and these patients were not DNR's, they were vented, with lines and drips. They are a collection of the most medically complex patients that have suffered complications and rough hospital courses due to comorbidities. The floor patients can be vented, multi lumen lines, feeding tubes, IVF, antibiotics with complicated wounds still receiving aggressive treatment to get them well enough to got to a rehab, SNF or home.

The nurses perform like any other "acute care nurse" and more "acute care" nurses and hospitals/administrators need to respect what these nurses do with little to NO help. They process labs, drugs, give blood, pass meds. I have seen HALO traction many times on the elderly who have fallen. There are a ton of young trauma victims that are not doing well as well as the complicated open hearts on telemetry. They will seen neurological diseases like ALS and weird meningitis like listeria.

Any nurse will work very hard....I think a new grad who is bright and a go getter with a thirst for knowledge and confidence is a good candidate. They usually have extensive orientation programs and are will to invest i the nurses education....but you will work very hard. The patient load is double...example most ICU patients are 1:1's or 2:1's when they leave the hospital....they are 3:1, 4:1 at the LTAC.

You will gain a TON of experience and at least they do have great orientations. I wish you every bit of good fortune and luck in your new journey. If you have any other questions about and LTAC....PM me.:heartbeat

You will learn a TON and LTAC's are willing to teach. Organization is key.

Here are some brain sheets.

brain sheets.......here are a few.

ntp medsurg.doc 1 patient float.doc‎

5 pt. shift.doc‎

finalgraduateshiftreport.doc‎

horshiftsheet.doc‎

report sheet.doc‎

day sheet 2 doc.doc

‎critical thinking flow sheet for nursing students

student clinical report sheet for one patient

I have made some for nursing students and some other an members (Daytonite) have made these for others.....adapt them way you want. I hope they help

GOOD LUCK!!!!

Horsebytes · Mar 17, 2015

Nice sheets!

cagjlg · Mar 28, 2015

Im also an LTAC nurse. I fell in love with it as an intern during nursing school. I often heard "You may go your entire nursing career & never see this or that" when I returned to class after that summer break. But I'd already seen it & done it! No other place to get such a wide range of experience. I had 4 weeks of orientation but asked for and received an extra week. I've only worked in three different settings, but all of them were willing to work with orientees on an individual basis.

But one word of warning. The part I enjoy most & least about working an LTAC a is the bond that you develop with most of your patients. And their families. Esme12 is right. Most of your patients have had a rough time of it by the time we get them. The families are defensive, protective, and very tired. And the patients are usually very, very ill. It will require all your diplomacy, patience, empathy to provide the care they need. And like any critical care nurse, you are going to lose patients you have come to care about. Talk to your preceptor about how she/he handles loss. Watch and learn how to support the families through very difficult times. Every patient is different & every family is different. Some will sit and watch you do everything for the patient, and others will want to jump in and do as much as they can themselves. Motivations will vary, too. But stick with it, work hard, never stop learning. It's a very rewarding field. I wish you all the best as you start a new journey.