New to LTAC

You'll want to review heart rhythms (you probably won't be expected to read a 12-lead, but LTAC has many pts on tele or bedside monitor).

Basic vent settings, e.g. AC, SIMV, pressure support (lots of vent weaning happens in LTAC).

CAM-ICU delirium screen, sepsis screens. We did those on every pt, q shift.

"Chronic critical illness syndrome," very very important to know about. You can Google it if you haven't heard of it before. In a nutshell, it's the complications that result from being very sick for (sometimes) months. These are people who before modern critical care would have died from their illness/injury.

Remember these pts and families have been through the ringer. Many of the LTAC pts I took care of were discharged from level 1 trauma ICUs, high acuity MICUs, and burn units. Some came to the LTACH after months in a typical hospital. Sometimes all this stress makes people act in ways they wouldn't ordinarily, hypervigilant, etc. Of course outright abusive behavior is never okay, and that does need to be addressed. But sometimes you just have to tell yourself not to take things personally.

On the bright side, you'll learn a ton!!

Feel free to PM me if you have any questions.

Sorry, missed your other questions. I only worked days in the LTACH, but worked w/ someone who switched from nocs to days, and would say she got paid less to work harder. On the other hand, nocs had more pts-- 6-7, vs. 3-5, and the RNs had to draw all their own labs (most pts had daily a.m. labs.) And then nocs is difficult by it's nature; humans are not nocturnal.

Invest in good shoes! Your body will thank you.

You will have days where a break is hard to get. If your life allows you to stay late to chart, take your break. If you don't finish on time, let them pay you for it; don't skip lunch simply to avoid OT. Self care is so important, esp. in a specialty that can be difficult.

It occurred to me also, that LTACH pts are put on comfort care fairly often. (At least where I worked.) The family and team gave it all they had, but maybe the pt couldn't come off the vent, and didn't want to live on a vent and FT. So they go to comfort care. Your hospice experience will be a great asset in those situations!

Compression Socks, rotate good shoes, vitamins, Tylenol, healthy snacks, take your lunch break, ask questions and don't sweat it. The facility will train you.

I would advocate for days. LTACH environment has a whole lot of things to learn, and most of it happens during the day shift. Also, during the day there are less patients per nurse, and you will want to know your patients literally inside out.

Do not think about LTACH as something between LTC and med-surg. Although some places are more about rehab, many collect people who wholly belong to ICU but for one reason or another cannot be there. Mostly they either overstayed their time allowed by insurance and unable to pay, or entered category of "that guy we all just cannot wait to see getting outta here". Either way, they don't become any healthier in the process. Most patients are very complex and mentioned "chronic critical illness" syndrome is pretty interesting condition. You will really need your critical thinking skills as these patients go downhill really quickly, and pharmacology too (my personal record so far was a patient who took 47 separate meds daily). It can be fast-paced, stressful and resources-deprived. Families can also be a problem, as many of them live on the edge for months. Your hospice skills will be very handy, as terminal weans and comfort care cases are quite common.

Learn some yoga back stretches as you will move your patients a lot and spend sometimes hours bended doing dressing changes. Get good shoes, compression socks you like and a good portable pharm book.