Bridging the transition from
intensive care to home, nurses in long-term acute-care hospitals draw on their
critical-care skills while building professional relationships with patients
“I get to do all the things I
love about critical care, but I also have follow through,” said Lisa McEwen,
RN, director of clinical services at Select Specialty Hospital of Greensburg,
Most LTAC patients transfer from
an intensive-care unit and are receiving ventilator assistance. Some have large
open wounds or other acute problems. They may be on inotropic agents and in
need of careful monitoring. LTAC patients, age 18 on up, stay an average of 25
days or longer.
“We see a lot of different
diagnoses and patients,” said Natalie Jones, RN, BSN, unit operations manager
of the DeKalb Medical Center LTAC unit, Decatur,
“Sometimes you think your patients are not getting better. It takes quite a bit
of time to get them weaned, but you can see results after working with them for
As part of an interdisciplinary
team, LTAC nurses aggressively wean patients off their ventilators and drips.
Patients get up, even while on the vent.
“We are the pretty much the last
stop as far as trying to get them off the respirator,” said Laura Ray, RN, a
nurse at Kindred Hospital
for the past 10 years. “They have been months in the hospital by the time they
get to us. They are frustrated and at the end of their ropes.”
LTAC nurses agree that the most
challenging aspect of care is managing multiple, long-term, complex medical
conditions, multiple system failures and patient anxiety.
“We may not see a diagnosis
again for several months,” Mary Beth Bell, RN, MN, CEN, CCNS, at DeKalb LTAC.
“The staff has to really be on their toes.”
The majority of LTAC patients go
home or to a rehabilitation or long-term care facility.
“We have a chance to maximize
their potential,” said McEwen, who takes great pride in the “miracles” that
take place on her unit, such as the patient who arrives in a fetal position and
on a vent and, eventually, walks out the door.
“We have patients come back to
visit,” Ray said. “Most patients are very appreciative of everything we have
done for them, and that’s the biggest reward of all.”
In addition to caring for their
patients, LTAC nurses also spend considerable time with family members. Loved
ones may feel frustrated by the patient’s perceived lack of progress. They also
may have to travel quite a distance to visit their loved ones and be unfamiliar
“We do a lot of being a sounding
board for the families, allowing them to ventilate frustrations and being
emotionally supportive,” Ray said.
DeKalb community education
specialists visit potential patients and family members at the transferring
facility to dispel fears and ensure the hospital would be a good match for the
patient’s needs. In addition, DeKalb provides a nonclinical patient ambassador
to every patient to assist with orientation and follow up on any concerns
raised by the patient or family.
LTAC nurse staffing depends on
patient acuity, ranging from one-on-one with a patient who had recently coded
to five- or six-to-one when caring for relatively stabile ventilator patients.
“It’s hard work, with all the
equipment—the wound vacs, the ventilators,” Bell said. “It’s not an easy job, but it is
Most LTACs hire experienced
nurses, primarily in critical care. LTAC nurses work more autonomously than
typical in critical care. Unlike in an ICU, the physician is on call, not in
“Your satisfaction from your job
comes from within yourself most of the time,” said Ray explaining that
management recognizes accomplishments but nurses do not receive immediate
gratification of quickly fixing patients’ problems. “You have to work
independently, have a lot of critical thinking skills and be able work in a
pressured environment and maintain the control. And I love it.”
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