New to LTAC

Loo17 · Jan 16, 2015

Lots of vented patients with many co-morbidities. Many of the patients I saw were obese, vented, with g-tube or TPN for nutrition. These patients were failure to wean in the ICU and came to LTACH after running out of hospital days. I worked on the telemetry unit there as well as high-obs. Very often I had patients on pressors requiring frequent titration, lots of cardiac drips too. I also would assist with conscious sedations pretty frequently. Lots of IV meds and wounds/wound vacs. Congrats on the job and good luck. I learned a lot and I am sure you will too.

Mixnmatch · Jan 17, 2015

Thank you so much for sharing! I am so excited to learn and strengthen my skills and critical thinking skills!

Here.I.Stand, BSN, RN · Jan 23, 2015

Congrats on the position! You will work hard--I've said that LTAC is like med-surg on steroids--but it's an incredible learning experience.

Do some reading on chronic critical illness (a simple Google search works.) Familiarize yourself w/ delirium and sepsis screens, basic vent settings (in my experience, AC and SIMV are both used quite a bit when full support is needed. Pressure support is used quite a bit too, since they're trying to wean). Review cardiac rhythms, since you'll probably have pts on bedside monitoring or tele. Remember that months in the hospital can take a toll on the pt and family--physically, mentally, emotionally.

The LTACH I worked at took many admissions straight from ICUs because the pt hadn't been able to come off the vent yet. We got a lot of trauma, complex wound care (think bad surgical site complications, stage IV pressure ulcers--sometimes 4 of them on one pt--necrotizing fasciitis, etc.), cardiac, renal, and burn pts. Actually the ICUs and burn units where I work now, send a lot of pts to the LTACH I used to work in. It's a great place to learn and grow as an RN! :yes:

Mixnmatch · Jan 23, 2015

Thanks Here.I.Stand for the insight! I am so excited to start. I love learning about disease processes and how to better understand them, along with treat them. You said you work in the ICU now, and that is an area I have an interest in working my way towards. How was the transition into ICU for you? Did you go after your LtAC experience, or did you work at a different kind of unit and then transition?

Cindycin37, ASN, RN · Jan 25, 2015

I think working in med surg will give some good experience before going to ICU. My friend who works in ICU from nursing school stated that she wish she had done that.

Here.I.Stand, BSN, RN · Jan 26, 2015

Thanks Here.I.Stand for the insight! I am so excited to start. I love learning about disease processes and how to better understand them, along with treat them. You said you work in the ICU now, and that is an area I have an interest in working my way towards. How was the transition into ICU for you? Did you go after your LtAC experience, or did you work at a different kind of unit and then transition?

You're welcome!

I did work in a SICU/CVICU earlier in my career, after starting on a neuro floor. Then I was out of the hospital setting for a few years, then LTACH, and now to my current ICU. That said, I did think it was good pre-ICU experience. It's very comparable to med-surg, with the exception that we don't get fresh post-op pts at LTACH. But you do work with ventilators and monitors--many pts were on tele, but some pts did have bedside monitors that the RN was expected to watch although we had tele techs. And these patients are very sick.

The LTACH I worked in had a small ICU that had pts less acute than a typical ICU, but more acute than a stepdown unit.

Also, I learned more about wound and skin care in the LTACH than in my entire career. This was very helpful because now working with critical trauma patients, they are very high risk for pressure ulcers (being they can be bedridden with turning restrictions, wearing devices, and on pressors). Learning what I did was good knowledge for my current job.