what is a typical patient load like

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Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience. 5,047 Posts

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

Specializes in School Nursing. Has 8 years experience. 2,533 Posts

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

Specializes in SICU, trauma, neuro. Has 16 years experience. 5,047 Posts

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

Specializes in School Nursing. Has 8 years experience. 2,533 Posts

Mechanical ventilation is probably the big difference.

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

mosaicism105

mosaicism105, MSN

Has 13 years experience. 199 Posts

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

mosaicism105

mosaicism105, MSN

Has 13 years experience. 199 Posts

plus 99.9 % of LTACH patients came from ICU.

seaofclouds21

seaofclouds21

151 Posts

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

FockerizedRN

2 Posts

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

KindJ7RN

1 Post

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.