Working in an LTAC is not for everyone. If you are used to working in a large acute hospital with all of the amenities that it entails, you will be shell-shocked when you start working at an LTAC. Most LTACS are far smaller than your average hospital; as a result, many services that are commonplace in the hospital are not cost-efficient for an LTAC to provide. Services such as in-house labs and radiology departments are provided for by third-party companies. Therefore, your turnaround time for these tests is much longer than you may be used to. That is why patients with specific health problems cannot be cared for in them. A patient with an active bleed needs to be transferred out to a hospital that can provide the tests and services to diagnose, monitor, and treat these health care issues. Once you get used to these shortcomings, you will find the pacing to be much more pedestrian. It, therefore, may be an option for nurses who are nearing the end of their career, such as myself. Nurses who have nothing to prove and don’t need to take care of open-heart patients any longer or burn patients. Because these patients stay in the LATCs for extended periods, you can develop friendships with them and their family members.
Working at a smaller facility may also bring about conflicts with staff members. If you dislike the people you work with, the smaller staff size makes it harder to avoid them or work different schedules. When more than a few nurses or other staff members call in sick, the smaller pool of workers results in a shortage; there are not enough resources to cover these call-offs. There is also less flexibility in your schedules. It is undoubtedly more challenging to find someone to cover you if you need an unscheduled day off. If you frequently need to change your schedule, LTACS may not be the best fit for you.
I work in the ICU, where there are only four patients and just two nurses, so if you have issues with a patient or their family members, it can be a problem working out an equitable assignment. On occasion, irreconcilable differences arise, leading to staff members being fired by the patient or their family members. In this case, your partner has no choice but to take care of that troublesome patient and family. For the most part, the acuity of ICU patients is lower than you would usually find in an acute hospital. Our facility does not have the resources for arterial lines, nor do we take care of patients that require balloon pumps, CRRT, and Code Chills. We can place chest tubes, central lines, peg tubes, and tracheostomies.
Because we have a lot of long-term ventilated patients, medical/telemetry nurses frequently care for these patients. Something that would never happen in an acute hospital. In many hospitals, only ICU nurses would care for these patients. While I disagree with this policy, I do understand it. There aren’t enough critical care nurses to go around, and there simply is not enough money to provide this type of care. LTACs are expected to provide more economical patient care than hospitals. I may be criticized for my candor, but I would never work in an LTAC as a medical nurse. I feel that the workload is too high for these nurses. Maybe if I were younger, I would feel differently. Having said that, working in an LTAC hospital, at least the one I work at, is a choice assignment. But LTACs vary; our sister hospital routinely requires its ICU nurses to care for three patients. I did that for three years during the COVID pandemic, and it was not fun. I knew that when I applied for work. There were openings in both hospitals, but I now only chose the one closer to my house. I chose the one with the most favorable staffing ratios. The one feature that I miss the most is a 24-hour pharmacy. Though in all fairness, many hospitals don’t have them either. Doctors also don’t put in their orders, nor do we have nurse practitioners or physician assistants to admit the patients, so admits can be quite laborious and time-consuming. I expect the issues that I have with LTACs are probably quite common in small towns where the medical facilities are not as well-equipped. I guess you could say that I have become spoiled over the years.
Because there are fewer staff members, you tend to develop closer working relationships. If you are not one who readily shares your life with people, you may find this closeness somewhat awkward. Give it time, you will be happy that you did. Having friends with similar careers gives you more things in common. I know one thing, I am no longer apprehensive, or go to work with a sense of forboding. I actually look forward to going to work. That is something that I have not experienced in a very long time.