Offered "ADON2" if I'll stay...what do I do?

Jo Dirt · Mar 30, 2009

The nursing home is overstaffed. So overstaffed that is why I left-they cut my hours so I went looking for another job, then they told me they'd do whatever it took to get me to stay...

SRNAs most certainly told me LTAC would not be hospital experience.

Editorial Team / Admin · Mar 30, 2009

Jo Dirt, the CRNAs and SRNAs were telling you that LTAC would not count as critical care (like CVICU) experience necessary to start a nurse anesthesia program.:wink2:

Several CRNAs who have served or are serving on admission committees were giving you good advice.

RN1982 · Mar 30, 2009

If you are trying to get into a CRNA program, you had better get yourself into an ICU because most CRNA programs want 1-2 years of ICU experience.

Trauma Columnist · Mar 30, 2009

Jo Dirt - if your goal is FNP - hospital experience will only help you. NH care is not suitable for FNP experience and I still state that you need to be at least somewhat familar with peds and adolescent care as the FNP is birth to death.

sissiesmama, ASN, RN · Mar 30, 2009

LTAC hospitals are ACUTE CARE. I cannot stress that enough. They are NOT nursing homes. Although some people think they are, until you work at a good LTAC, you just won't know what to expect.
LTAC's are acute care, but the average stay is somewhere around 28 days. Sometimes longer, sometimes shorter. Most LTAC's even have ICU's. REAL ICU's.
The difference in the patient population is that in the LTAC patients need acute care longer. They are too sick to go home, to sick to go to rehab, too sick to go to the nursing home. LTAC's have a lot of rehab services, but there is still acute care going on.
Whoever told you that an LTAC hospital is like a nursing home is dead wrong.
Add on: LTAC is definitely acute care experience.

Exactly!! Any LTAC hospital I have worked at is definetly acute care, dh agrees with me, and until recently he was nurse manager of a busy ltac facility where we both had been working. I have had more acute patients there and run more codes, ect at LTACs than at some of the hospitals. JIMO, the patients are still acutely ill and need that type of care, but they just need it longer. There's just no way they aren't acute. Some days, my assignment has been as critical as a "regular ICU assignment" that one would have while working in an ICU.

They don't just have vents that are considered "nh vents", or patients that are on vents at home and have been that way. The LTAC where we worked was a unit upstairs insidea regular hospital, and we sent patients to and from surgery, to and from dialysis, wound care out the roof, cardiac monitors and vaso drips, CVLs, art lines, you name it, we had it.

Anne, RNC

Trauma Columnist · Mar 30, 2009

But unless you have peds/adolescent pts, you are still missing the boat by not having peds experience.

Editorial Team / Admin · Mar 30, 2009

I can understand your dilemma, Jo Dirt. This offer is intriguing and flattering.

But, I am with traumaRUs here; if you are to finish an FNP program, you really need hospital experience. Your experience in LTC is excellent, but you need a well-rounded RN experience with acute care (the LTAC would be nice), peds, GYN, young adults treating acute and chronic conditions...etc.

Think hard and weigh the pros and cons for immediate goals as well as long-term goals.

(now, if you are still considering CRNA, you need to consider going the route of experience on the level of CVICU)

Good luck.

Jo Dirt · Mar 30, 2009

Here is what justOrtho said about LTACs:

LTAC is similar to a rehab hosp but with some vents, etc. You won't even have the challenges of a fast paced tele/med/surg because the parts are 'long-term'. Therefore you have a BIG advantage b/c you know everything about their hx. (b/c they are 'long-term' stay pts you've had before you aren't thrown a lot of curve balls.) And they are stable in that their conditions are not usually expected to improve much.

If you can get hired on a tele/med/surg unit you'll have ever changing pts. That's the experience you should seek. I often d/c and get 2 to 3 new admits out of my total load of 7 pts/per shift. I'm challenged daily b/c they aren't long-term, every shift has new pts with new problems I must assess quickly. After 6 mos in tele/med/surg you'll be able apply for a spot in ICU at the hospital. Several previous RN's on my unit have gone that route and then on to apply to NA school.

Then, HT3RN added:

I have worked in two different LTAC's in two different states as well as ICU's in 6 states. An LTAC is not critical care period. If the patient gets "unstable" then they get shipped out to a critical care setting. Like I read earlier they are mostly failure to wean from vent patients. They can't breathe effectively on their own but everything else works okay.... relatively speaking. They may require dialysis, tpn etc. Some eventually go home and some go home. If you know what I mean...

This came from over on the SRNA forum.

Editorial Team / Admin · Mar 30, 2009

Regarding your post above - Right, as it applies to CRNA school and experience necessary for application to the program. They were pointing out that some use this avenue leading to being hired on in ICU (critical care) and that satisfies the experience required for anesthesia program.

LTAC is not critical care experience and critical care experience is necessary for the CRNA program.

Magsulfate, BSN, RN · Mar 30, 2009

Not sure where they've gotten their LTAC experience from, or how old the experience is. But I've worked in three different LTAC's in Houston TX, and each of them I worked in the ICU. The ONLY time we transferred someone out of this ICU is when they needed surgery.

They can be critical and knocking on death's door, but if they don't need surgery, they are not going anywhere. Even when they do have the surgery, the patient is brought back in less than 24 hours. This is because of billing and money of course. If the patient stays more than 24 hours at another hospital, money is lost by the LTAC.

I don't know what else to say, other than,,, maybe they have worked at a *different* kind of ltac.. lol ...

edit: when I say surgery, I mean major surgery. Bronch's, peg insertions, trach's, wound care debredment, and procedures like these are performed at the bedside, with the surgeon and ICU nurse of course.

Here is what justOrtho said about LTACs:
LTAC is similar to a rehab hosp but with some vents, etc. You won't even have the challenges of a fast paced tele/med/surg because the parts are 'long-term'. Therefore you have a BIG advantage b/c you know everything about their hx. (b/c they are 'long-term' stay pts you've had before you aren't thrown a lot of curve balls.) And they are stable in that their conditions are not usually expected to improve much.
If you can get hired on a tele/med/surg unit you'll have ever changing pts. That's the experience you should seek. I often d/c and get 2 to 3 new admits out of my total load of 7 pts/per shift. I'm challenged daily b/c they aren't long-term, every shift has new pts with new problems I must assess quickly. After 6 mos in tele/med/surg you'll be able apply for a spot in ICU at the hospital. Several previous RN's on my unit have gone that route and then on to apply to NA school.
Then, HT3RN added:
I have worked in two different LTAC's in two different states as well as ICU's in 6 states. An LTAC is not critical care period. If the patient gets "unstable" then they get shipped out to a critical care setting. Like I read earlier they are mostly failure to wean from vent patients. They can't breathe effectively on their own but everything else works okay.... relatively speaking. They may require dialysis, tpn etc. Some eventually go home and some go home. If you know what I mean...
This came from over on the SRNA forum.

Jo Dirt · Mar 30, 2009

I can understand your dilemma, Jo Dirt. This offer is intriguing and flattering.
But, I am with traumaRUs here; if you are to finish an FNP program, you really need hospital experience. Your experience in LTC is excellent, but you need a well-rounded RN experience with acute care (the LTAC would be nice), peds, GYN, young adults treating acute and chronic conditions...etc.
Think hard and weigh the pros and cons for immediate goals as well as long-term goals.
(now, if you are still considering CRNA, you need to consider going the route of experience on the level of CVICU)
Good luck.

This is such a hard decision. I feel like whichever I choose will be wrong. But in the words of the great philosopher Bob Seger, Youth and beauty are gone one day No matter what you dream or feel or say

It ends in dust and disarray

Like wind on the plains, sand through the glass

Waves rolling in with the tide

Dreams die hard and we watch them erode

But we cannot be denied

The fire inside...

Anyhow, time's ticking, I've got to get up in a few hours and head to Arkansas...if I'm going.

Editorial Team / Admin · Mar 30, 2009

This is such a hard decision. I feel like whichever I choose will be wrong. But in the words of the great philosopher Bob Seger, Youth and beauty are gone one day No matter what you dream or feel or say
It ends in dust and disarray
Like wind on the plains, sand through the glass
Waves rolling in with the tide
Dreams die hard and we watch them erode
But we cannot be denied
The fire inside

I know it's hard. Believe me.

You just have to weigh the short-term and long-term pros and cons. Write them down. Study them for a little while. What is it you are wanting to do in the long run? As an FNP........future goals contemplating CRNA?

Love the Bob Seger song quote. You truly have a fire inside, don't you??