Spotlight: Long-Term Acute Care Nursing

by Premier Medical Staffing Services on September 8, 2020 in Nursing Specialties


Within the healthcare industry, there is a growing demand for nurses that are qualified to work in long-term acute care (LTAC) settings. However, misconceptions about LTAC patients and the work environment prevents many nurses from pursuing these career advancing positions. Continue reading to find out more about LTAC facilities and why a job there might be the right career choice for you.

What is a long-term acute care facility?

a long-term acute care nurseA long-term acute care facility is specifically designed for patients with complex medical conditions that require the ongoing support of an interdisciplinary team. While patients in a LTAC unit no longer need extensive diagnostic procedures or the level of care available in an intensive care unit (ICU), the severity of their condition(s) makes them inappropriate for a rehabilitation center, skilled nursing facility or home healthcare service.

What types of conditions are treated in an LTAC facility?

Patients are admitted to an LTAC facility when they have multiple serious medical conditions that cannot be effectively treated at a lower level of care. Examples of these conditions include:

  • Prolonged ventilator use or weaning;
  • Complications following surgery;
  • Complex wound care/care for burns;
  • Post-intensive care syndrome;
  • Multi-organ or multi-system failure;
  • Traumatic or acquired brain injury; or
  • Multiple chronic conditions.

What are the criteria for admission to a LTAC unit?

Before a patient can be admitted to a LTAC unit, they must undergo a clinical assessment and meet the admission criteria established by InterQual or the National Association for Long-Term Hospitals (NALTH). In essence, both of these criteria state that a patient must:

  • Require ongoing acute care;
  • Need daily visits from a physician;
  • Have had an acute care hospital stay that was longer than five days; or
  • Have failed a lower level of care/had a readmission.

Where are long-term acute care facilities located?

Long-term acute care facilities, also known as long-term care hospitals, can either be located within the walls of an acute care hospital or in a stand-alone facility. Units that are located within a hospital setting must function and be licensed independently of the hospital and have their own governing board. Currently, there are 432 LTAC hospitals located throughout the United States.

What are the primary differences between a LTAC facility and a rehabilitation center or skilled nursing facility?

The primary difference between a LTAC facility and a rehabilitation center or skilled nursing facility is the level of care that is available. For various reasons, LTAC units are able to provide a higher level of care. Generally speaking, the level of care that is available in a LTAC facility is a just a step below the treatment that is received in an ICU or emergency department.

Furthermore, LTAC units are staffed differently than a rehabilitation center or nursing home. LTAC facilities have a physician on-site 24-hours per day. Additionally, a host of other specialized services (physical therapists, occupational therapists, speech therapists, etc.) are located onsite, allowing the patient to receive specialized care on a more frequent basis.

The chart below summarizes some of the high-level differences between a LTAC unit, a rehabilitation center and a skilled nursing facility.

LTAC Facility Rehabilitation Facility Skilled Nursing Facility
Focus Medically complex patients with multiple comorbidities, respiratory failure and/or brain injured Restoration of functional independence Long-term supportive care
License/Certification Licensed, accredited and certified as an acute care hospital (med-surg floors, telemetry and ICU) Licensed as an inpatient hospital or distinct rehabilitation units within a hospital Licensed as a skilled nursing facility
Anticipated Length of Stay 20+ days 15-20 days Indefinite
Daily Physician Visits Yes Yes No
Services on Site pharmacy, lab, radiology, procedure rooms pharmacy, lab, radiology services readily available as send outs

What are a LTAC nurse’s job duties?

Because their patients are dealing with long-term, complex medical conditions, LTAC nurses must possess a wide array of knowledge and skills. For example, LTAC nurses are traditionally responsible for:

  • Assessing a patient’s condition and planning/implementing the patient’s care plan;
  • Ensuring ventilators, monitors and other types of medical equipment function properly;
  • Administering intravenous fluids and medications;
  • Observing and recording the patient’s vital signs;
  • Assisting physicians in performing procedures;
  • Ordering diagnostic tests;
  • Treating wounds;
  • Responding to life-saving situations using nursing standards and treatment protocols; and
  • Providing education and support to patients and their family members.

What are the requirements to become an LTAC nurse?

While the exact requirements vary between facilities, LTAC nurses are generally required to:

  • Hold a current license in the state that they intend to practice in;
  • Have 1-2 years of recent ICU, medical-surgical, telemetry, step-down, progressive care or ER experience. Some units may also consider candidates with rehab experience. 
  • Have ventilator, tracheotomy and drip experience;
  • Hold a current Basic Life Support (BLS) certification from the American Heart Association or the American Red Cross; and
  • Hold a current Advanced Cardiovascular Life Support certification from the American Heart Association or the American Red Cross.

Why should a nurse consider pursing a career in long-term acute care?

Nurses that thrive in fast-paced environments and enjoy making a positive difference in the lives of their patients will find a career in a LTAC facility extremely rewarding. Furthermore, nurses that are interested in expanding their skill set and (eventually) working in an ICU will find that their time in a LTAC unit allows them to do both.

Long-Term Acute Care Nursing Resources

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