Starting at LTAC facility after working at LTC- advice?

Nccity2002, MSN, RN · Jun 4, 2011

Congratulations on your new job, but...a word of caution. As an agency nurse, you will be expected to hit the floor running. I am assuming you mean acute care (as in in-patient hospitals) when you refer to LTAC....if that is the case, here are my two cents. Working acute care is very different from LTC. Depending on the type of facility (trauma center vs community hospital) med-surg unit population may vary, which can be challenging and stressful , even for the most seasoned med-surg nurse. Because you are an agency nurse, there is a high expectation in you abilities and skills. The staff nurses will expect you, to be experienced and able to handle the assignment (with minimal assistance from them). It is true that you only get five patients in med-surg (most of the times), but five busy med-surg patients ( the new post-op with a zillion new orders, the one trying to get out of bed at the other end of the hallway, the new admission, and let's not forget the code browns) do not compare to 40 stable residents in LTC, who only require their routine B/P medication.I am not trying to discourage you, but from my experience as an ICU nurse, I can tell you that I hate the unsafe practice of nursing staffing agencies sending nurses to ICU units, who are not trainned in critical care and most of the time can not handle their assigment ( I once had to DNR an agency nurse whose backgound was in psych). All I can say is that it is stressful on the staff and very unsafe for patients. To answer your question...be pro-active, take a reflesher course, in-services, and it the facilities contacted with your agency offer orientation (even without pay), take it.Good luck

westieluv · Jun 4, 2011

What is AL/IL?

CapeCodMermaid, RN · Jun 4, 2011

AL/IL= Assisted Living/Independent Living

westieluv · Jun 4, 2011

Oh, okay, thanks. I should have been able to figure that out on my own, but when she said that she was in AL/IL for the last month of her employent and then was let go by the facility, it made me think it was an abbreviation for something pertaining to that. At least I knew that she didn't mean Alabama/Illinois.

Esme12, ASN, BSN, RN · Jun 4, 2011

I was let go this time last month from my LTC facility and I recently got accepted to work with a staffing agency that will be sending me frequently to a LTAC facility. My official job description is Med-Surg nurse and this is really exciting to me!
However, I'm concerned now that I've forgotten most of what I learned in school. Not many of my skills were required in LTC, especially not the last month I was there because I was in AL/IL. Hospital and Med-surg is where my heart is, but I don't want to mess this up.
How can I make this a smooth transition, going from LTC to LTAC? The plus side is that I did clinicals at this LTAC facility but my teacher never let us have more than one patient at a time. I'm sure I can do that part okay since I had 40+ at the LTC facility but has anyone else done something like this?

LTAC.....Long Term Acute Care is a hospital and is licensed as a hospital. These are patients that have "run out" of days to allow them to stay in the hospital. This is a medically complex population that is going to require a lot of care. You ill be responsible for about 8 patients on days with an aide. You will be giveing meds and performing treatments. It is like any hospital setting but you will have more patients to care for. You will be responsible for patient care as well as their meds, treatments, drsg changes, labs, charting and intervention just as if they were in the "hospital". These patient are too sick to be admitted to a SNF and far too medically complicated for LTC. They will still be recieveing treatments, antibiotic and IV's....they belong in the hospital but medicare and the insurance companies won't let them stay.....hence LTAC's were born.

Most of these patients will have the expectation to go home. They can be open hearts and traumas, major surgeries that have had a complicated recovery and require hospital specialized care they have just ran out of days. YOu will have at least 8 to 10 of these medicall complex patients still recieving all the care they recieved in the hospital with less resources. I have seen vents on the medical floors as well as halo traction (cervical fracture) with the goals to return home. A lot of failure to wean vented patients will be on the medical floor while attempts to wean are ongoing. These are medically complex fragile patients that will require a lot of care.

As the agency nurse you will be expected to hit the ground running. You might recieve a 4 hour orientation.....but I have seen agency nurses come in 2 hours before their shifts to fill out their required fire and saftey packets and to the floor they go......Staff are not always nice to the agency staff. They figure you are geting the big bucks therefor you can work for it. They are inclined to give you the patients they have cared for a really long time and are willing to give to someone else to have a break from them. These are usually the very complex patients that can be exhausting to care for. Be very clear wjhat your limitations are. Don't back yourself in to a corner and get in trouble. Let the supervisor and staff know your limitations as a new grad but be sure the know you are smart and willing to take it on and learn. Don't be afraid to ask questions.

This is an amazing opportunity to get the acute care experience. As an LPN you will have greater lateral skills in this setting than in an Acute care hospital. I know you had a bad experience at your other place and I am sorry for that. I think your friend got in over her head and yelled out of frustration and fear. You will be expected to perform a lot of hands on patient care and treatments as your primary responsibilities as well as follow up on tests with the MD's on a daily basis and performing interventions necessary for the patients recovery.

Be clear on your limitations, be willing to grow and learn, ASK QUESTIONS and NEVER ASSUME ANYTHING......if you don't have Liability Insurance....get some.....you are vulnerable as an agency nurse........I didn't mean to scare you but I wanted you to have a good handle on what to expect. Knowledge is power!

Good Luck and Congrats...

mazy · Jun 4, 2011

My experience in LTAC is that it was very skills heavy (I am an LPN). Lot's of vents, trachs, PEGs, wound vacs, chest tubes, IVs, telemetry, etc. etc. These kinds of patients take up a lot of time, so you have to move very quickly and efficiently through some very complicated situations. A huge problem at the facility where I worked was that the patient load was not the same as you would see on a regular med/surg unit -- we were working with up to eleven patients per nurse. Very very hard to do.

So it would be a good idea to talk to your agency about some training for those kinds of patients, especially the ventilators. Most likely the facility has a solid team of respiratory therapists but you will still need to know what to do when you are alone with the patient and the vent starts to alarm, or sats go down, or the patient decanulates.

Best of luck.

Esme12, ASN, BSN, RN · Jun 4, 2011

My experience in LTAC is that it was very skills heavy (I am an LPN). Lot's of vents, trachs, PEGs, wound vacs, chest tubes, IVs, telemetry, etc. etc. These kinds of patients take up a lot of time, so you have to move very quickly and efficiently through some very complicated situations. A huge problem at the facility where I worked was that the patient load was not the same as you would see on a regular med/surg unit -- we were working with up to eleven patients per nurse. Very very hard to do.
So it would be a good idea to talk to your agency about some training for those kinds of patients, especially the ventilators. Most likely the facility has a solid team of respiratory therapists but you will still need to know what to do when you are alone with the patient and the vent starts to alarm, or sats go down, or the patient decanulates.
Best of luck.

Wow....eleven???? WOW.......

bstewart40 · Jun 5, 2011

So it would be a good idea to talk to your agency about some training for those kinds of patients, especially the ventilators. Most likely the facility has a solid team of respiratory therapists but you will still need to know what to do when you are alone with the patient and the vent starts to alarm, or sats go down, or the patient decanulates.

I've already asked about orientation. I'm familiar with the facility but only because I was there as a student. The facility wants me to come in an hour before my shift Wednesday night. I asked for a shadow shift from my agency and the hour was the best they could do.

I dug out my med-surg book and my care plan for the patient I took care of as a student at the LTAC facility. I am feeling overwhelmed and underprepared and I know the best I can do for myself is ask a lot of questions and brush up on what the books say. I think it's to my credit that I am eager to learn and to do this right. Hopefully they are willing to work with me and are willing to have me back.

Thank you so much for your support, everyone. I really appreciate it.