new to LTACH-tips?

Larry3373 · Jan 22, 2016

Not to burst your bubble, but LTACH is not a fun place to work in my experience. I briefly worked for Select, because it was closer to home than the ICU I was working for, and they were offering a 5000 sign on bonus. What you will see is lots of wounds, trachs, chest tubes, picc lines, and just sick total care patients in general. LTACHs also attempt to wean patients off the vent who have required long term vent support. To me I was reminded of a nursing home with the flavor of medsurg and the critical care patients that the ICUs want to get rid of. The LTACH I worked for had an ICU and a regular floor. In the ICU I had 2-3 patients (mostly 3) and they could have vasopressors and be trached on the vent. On the floor I had 6 patients and they were usually medically complex with wounds, trachs, and sometimes chesttubes. We also still used paper charts which was a big pain in the butt. Hopefully the place you work for uses EPIC, because that will really help. In the end, I didn't stay because the workload is just too heavy with 3-6 total care patients that have to be bathed every night, and it reminded me too much of a nursing home. However, I think most places would certainly look favorably on previous LTACH experience just because of the aforementioned skills you will learn, and because these patients are often considered critically ill. Personally, I would just look for a good ICU that will hire you.

irishlynn5 · Jan 25, 2016

haha..well thank you? I already accepted the position so here goes! Anyone else have advice for me?

Here.I.Stand, BSN, RN · Jan 26, 2016

I too have worked for Select, and it's a boatload of work. When I left 3 yrs ago, they were starting to transition to an EMR. On days we had 3 pts in the ICU, 4-5 on the floor. Sometimes we'd have 3 pts and an admit bed, but I'd get admits when I already had 4 pts; it depended on staffing. Floor pts could be on the vent. Wound care was the worst. Those were some huge, complex, nasty, and VERY time consuming dressing changes. Some could take 1.5-2 hrs, no joke. I like to say it's med surg on steroids

On the bright side, it was extremely gratifying to see those wounds heal, or to see someone wean from the vent, or to see TBI victims recover function. :)

You'll want to review cardiac rhythms (you'll have pts on tele or bedside monitors), vent settings, sepsis, and chronic critical illness.

cjdiamond · Jan 27, 2016

Hi irishlynn5,

I have worked for a LTACh since 2007 & I love it. I started as a floor nurse, transitioned to wound care then WC supervisor & am currently assisting the DON in a management role (still overseeing WC & all facility infection control & prevention responsibilities)

We haven't began transitioning to EMR at our facility - our corp offices determine roll out dates.

It is not an easy job but nursing never is. It's rewarding though. Plus you get the skills of working acute care / ICU but a longer LOS - not as long as SNF pt's though :)

Good luck!

Rjprn · Jan 27, 2016

Is it true ICU will hire you faster for having this experience?

Here.I.Stand, BSN, RN · Feb 1, 2016

Is it true ICU will hire you faster for having this experience?

I don't have statistics, but it would seem so; pts are much sicker than typical med-surg pts. Plus you're getting experience with vents, and sometimes drips and invasive monitoring.

cagjlg · Feb 10, 2016

I've been in LTAC for over five years and I love it!! Like mentioned before, there is a wide variety in types of patients. And the CMS rules are changing so that the acuity will be higher. You'll learn so much! I've worked for Select, too, as well as two other LTACs. (I haven't moved, the hospitals have!) If you want, PM me and tell me about your new job. I'd be interested in knowing where & who & comparing notes.