what is a typical patient load like

Here.I.Stand, BSN, RN · Jun 16, 2014

I'm new to this world, but we have 2 floors at my SNF that are considered LTAC with trach pateints, PEG tubes, complex wound care, IVs, etc. and the ratio is rarely less than 12:1 and often up to 15:1. The nurse is responsible for all meds, treatments, admits, discharges, doctor's orders, etc. Is this not LTAC? We have a specific LTC floor and other nurses say it's more 'laid back' than the two acute floors, but every time I've gone down there to get a form or something (when our floor is out) they seem to have their own issues.
I work the ortho/rehab floor.

Probably not LTAC, because LTACH's are accredited as hospitals. I used to work on a "transitional care unit" within a facility once; this was in a building that had an ALF apartment attached, a memory care floor, and typical LTC floors. But the TCU did wound care, IVs, trachs, tubefeeds, fairly frequent labs etc.

The LTACH I worked in had an ICU with drips, sedation, higher vent settings. They even took pts with LVADs. Cardiac monitoring looked like a typical ICU with monitors at the bedside and at the desk. Even floor pts could be on the vent--just had more basic settings, sometimes just at night after pt had been on trach dome/T-piece/capped all day. (Usually the pt hadn't been on a vent long-term; they had simply been unable to wean it before the pt's typical hospital covered days ran out.) Floor pts could also be on tele. They have a lab and a CT scanner in the building. On any given day we had 4 MDs rounding and treating through the day and had 1 on-site overnight. RTs and rapid response RNs were available 24/7/365.

lifelearningrn, BSN, RN · Jun 16, 2014

I'm curious what the criteria differences are as far as acuity go though... I realize that LTACH are 'hospitals' and can have ICUs, but what sets a trach patient from your LTACH apart from my trach patient that needs suctioning no less than Q2hrs (and often more so)?

Here.I.Stand, BSN, RN · Jun 20, 2014

Mechanical ventilation is probably the big difference.

what sets a trach patient from your LTACH apart from my trach patient that needs suctioning no less than Q2hrs (and often more so)?

lifelearningrn, BSN, RN · Jun 20, 2014

Mechanical ventilation is probably the big difference.

Maybe so- we don't have vents in our facility.

mosaicism105, MSN · Jun 27, 2014

We have 1:4 ratio. Because they are also hooked with telemetry.

mosaicism105, MSN · Jun 29, 2014

plus 99.9 % of LTACH patients came from ICU.

seaofclouds21, BSN, RN · Jul 1, 2014

I've been working at a LTACH for 3 years now. On day shift, our nurses average 4 patients, but can go up to 5 depending on the acuity. They also go down to fewer patient's if there is a high acuity. On night shift, our nurses average 5 patients, but can go up to 6 or down depending on acuity. Our charge nurses usually do not have an assignment, but sometimes they'll take an assignment if necessary.

FockerizedRN · Jul 16, 2014

Ive been working at a facility that has 2 LTACH floors, on 1 of these units. I work on day shift and typically the nures have 6-7 patients, night shift typically has 8-9 pts. 95% of our pts have trachs, probably 80% are on vents. Many of these vent dependent pts (primarily ALS or veg state pts) will be there until they die, so our admits/discharges/transfers is definitely on the lower side. 80-90% have PEG/Gtubes so med pass is time consuming. We have no drips or tele. We have a wound care team that handles all wounds except simple skin tears. There's always 2 RTs on the unit (each typically assigned 12-15 pts) that handle all things respiratory wise. And then 3-4 CNAs for each shift.

Our nurse-pt ratio is manageable I feel like with all things considered, but they are complex pts and prioritization and delegation is very important. When youre going up to 8-9 pts IMO its a little too much. It looks like Im going to be stepping in as the full time charge nurse for our rotation and while I was hesitant to take the position as I still have less than 1 yr experience, I think on the typical day that position has been less stressful than being on the floor with those 6-7 pts, and certainly if they're short a nurse or something and you have 8-9 pts.

KindJ7RN · Jul 23, 2014

Just made the year anniversary mark at a LTAC facility on a respiratory care unit (all pts trached, lots of ALS, muscular dystrophy, and spinal cord injury pts) and most days we have 9 pts assignments. It's a lot, but you learn to prioritize and get everything done. I like it, but lately I've been wondering where I could go from here to get more nursing experience. We have rehab and neuro units for more acute brain/spinal cord injury pts, but I really think I want to get into community health nursing. Maybe visiting nurses? We'll see. Just my two cents.