New grad starting LTAC job next week - advice?

Clovery · Mar 15, 2013

Sorry I can't offer any advice, but I'm pretty much in the same boat and I'd love to hear how it's going. I'm a career changer too, new grad, and have a good feeling I will get an offer from an LTAC next week. PM me if you like :)

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.

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

theantichick · Mar 23, 2013

Esme, thanks for the encouragement and the info. I'd already scavenged the forums and pulled down the brain sheets and am currently trying to figure out the right "flow" for me. :)

I wasn't sure when I posted before because they'd said one thing in my interview and something else in the offer letter, but the job is actually for ICU at the LTAC. I've worked 3 shifts with one of the preceptors now, plus a week of orientation stuff. I can already tell I'm going to learn a LOT here.

I also think from everything I've read that I'm very lucky in which facility I'm working. Our ICU has 5 beds so one RN takes 3 and one RN takes 2. We don't have a patient care tech, but we do have an RT there all the time. So the ratio is not crazy like some places I've heard. And you're right the patients are total care and so far all the ones I've seen are on vents, so there's a lot for me to learn. They do seem committed to a lengthy and involved orientation/training process for me, and only asked me to be willing to commit to a year which I had no problem with. I'm hoping to start my BSN bridge this fall online and if that happens I'm not likely to look to move until I finish that as changing jobs is stressful and I've learned that stress and school don't complement each other well.

I'm sure I'll have lots of questions as I move through this process. I'm incredibly grateful for the opportunity, and am already digging in to further my knowledge and figure out how to get the most out of my orientation.

Clovery · Mar 23, 2013

Thanks for the info. I got the job at a Kindred LTAC. Really excited to start my orientation in a couple weeks. I think I've read every thread in this LTAC forum :)

Road2CNO · Oct 17, 2013

Esme12....a lot of great info you posted here. I just recently switched from hospital setting to LTAC and am really liking it. I'm getting ready to apply to NP school and this job is perfect.

SE_BSN_RN, BSN · Nov 23, 2013

Esme,

This is great advice. I know this thread is old, but I stumbled upon it looking for ideas....I am considering a position in a LTACH....but I don't know if it would be a good first step. I am a new RN, but have been a LPN for some time before getting my RN.....so I am not considered a "new grad".

Do hospitals consider LTACH experience acute care, or LTC? Eventually I want to work in a hospital to get acute care experience, but of course I can't get in anywhere. New RN, and all that.

SquishyRN, BSN, RN · Nov 23, 2013

Esme This is great advice. I know this thread is old, but I stumbled upon it looking for ideas....I am considering a position in a LTACH....but I don't know if it would be a good first step. I am a new RN, but have been a LPN for some time before getting my RN.....so I am not considered a "new grad". Do hospitals consider LTACH experience acute care, or LTC? Eventually I want to work in a hospital to get acute care experience, but of course I can't get in anywhere. New RN, and all that.[/quote']
I think it would depend largely how you market yourself. I work at an LTACH now. I haven't tried applying anywhere else yet, but I have several coworkers who were able to move into traditional acute care hospitals on to Med-Surg and ICU units after a year at the LTACH. They started there as LVNs, worked for a year as an RN, and then went into traditional acute care hospitals.

Esme12, ASN, BSN, RN · Nov 23, 2013

Esme,
This is great advice. I know this thread is old, but I stumbled upon it looking for ideas....I am considering a position in a LTACH....but I don't know if it would be a good first step. I am a new RN, but have been a LPN for some time before getting my RN.....so I am not considered a "new grad".
Do hospitals consider LTACH experience acute care, or LTC? Eventually I want to work in a hospital to get acute care experience, but of course I can't get in anywhere. New RN, and all that.

Not all hospitals know exactly what a LTACH is...so it may involve in selling yourself and your skills.

LTACH facilities are licensed as Acute Care...just like any other hospital. Your patients will be a collection of the sickest of the sick with multiple co-morbidities and complicated recoveries and wounds. You will have vents, drips, antibiotics, treatments, complex dressings. The patients will be actively treated MD's make daily rounds...you will have labs that need to be treated and blood to transfuse....you will have acute care coming out your ears.

You will work your behind off as they are not staffed like the hospitals but they are better than LTC/SNF. But you will learn a ton. When you go for an acute care hospital position you may have to sell your skills...but the point is you will have the skills to sell.

theantichick · Nov 23, 2013

I agree with the selling of the skills. My experience has been that my LTAC ICU population aren't as high acuity as an ICU in an STAC but they ARE higher acuity than the average telemetry patient. We frequently have vents and vasoactive drips, lots of sepsis and other multi-system failures and complications.

I'm finding it is NOT my preferred patient population - I'm in love with ED. But it has been an excellent learning experience and I'm hoping I can sell the skills I've learned when I go job shopping after I get my BSN in the spring.

Esme12, ASN, BSN, RN · Nov 23, 2013

It depends on the LTAC....the LTACH I supervised was very acute....the had a local hospital that sent them their failure to wean post CABG patients....4-5 days post op. If the heart didn't fast track...and ran out of days....out they went.

TexasRN09 · Mar 20, 2014

I have an interview with Kindred tomorrow. Any idea on what to expect for an interview since you got a job there. I know this is a year old post, but any help would be appreciated :) I am really nervous about an interview. I am a new grad and this is my first interview which is making me a little nervous.