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Acute Care Registered Nurses are bridging the transition from intensive care to home. Acute Care patients normally transfer from an intensive care unit and are receiving ventilator assistance. Some patients have large open wounds or other acute problems. The patient may be on inotropic agents and require careful monitoring. Most patients in these units, age 18 and up, have an average stay of 25 days or longer. LTAC RNs state that one of the most challenging aspects of caring for these patients is the management of multiple, long-term, complex medical conditions, multiple system failures and the patients anxiety. LTAC is the final stop when trying to wean patients off a respirator and most patients in these units have been in the hospital for many months by the time they reach this phase. It is a long, hard road for them and some are nearing wits end by the time they reach this point in their recovery.

The RN or LPN must spend considerable time with family members in addition to caring for patients. Family members may be frustrated by their loved ones perceived lack of progress. Some may also have travelled long distances to visit their loved one and can be unfamiliar with Long Term Acute Care.

Critical thinking skills and independence are essential in this setting. Unlike the Intensive Care Unit, the physician on call in not in the unit and therefore the LTAC nurse may work more autonomously than typical in a critical care setting. RN LTAC must be able to manage stress appropriately, make decisions under pressure and manage the anger/fear/hostility and violence of others appropriately. RNs may be exposed to toxic/caustic chemicals and detergents and extreme hot and cold conditions. Exposure to communicable diseases, blood and/or body fluids and exposure to dust/fumes and gases are also possibilities.

Responsibilities of the Acute Care Registered Nurse may include:

Appropriate response to an emergency situation.

Staple/suture removal

Chest tube care

Accurate assessment, reassessment, development and implementation of care plan in a safe, accurate and appropriate manner

Knowledge of specific conditions, disease and treatment therapies for the specific population of the setting

Tracheotomy care

Accurately document records in a timely manner

IV Therapy

Serve as advocate for patient and/or family members regarding decisions affecting the care plan

Wound care and skin care protocols

Ostomy care

Identify the educational needs of the patient and family members and provide the necessary education to meet those needs

Post of care of patient

Assess and evaluate patients response to care plan and prioritize and implement appropriate changes to plan

Collaborate, assess and coordinate discharge planning needs and readiness for discharge with other health care team members on a timely basis

Always show respect and awareness for the patient and family members as individuals and as a family unit

Provide direct supervision and assistance in evaluation of staff performance

The RN in Acute Care settings will stand, sit, walk, perform repetitive tasks and motions, have good manual dexterity, hear alarms/telephone/normal speaking voice, have clarity of vision and be able to distinguish colors.

Demonstrate Safe and Effective Use of Equipment such as:

CPM

Oxygen wall regulators/portable oxygen

Patient Call System

Electronic thermometer

TPN administration

Foley catheters

Geri chair

Specialty beds

Computer, printer, copier, fax

NG tube/suctioning

Drains

Safety bed alarm system

IV pump

Gait belt

Dinamap

PCA

Crash Cart

Defibrillator

Insulin pump

Lifting equipment

Enteral feeding pump

Anti embolic stockings

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