By Kora Behrens, Clinical Nurse Manager, Medical Solutions
Did you know that the total number of hospitals across the U.S. is nearly 5,534? States like California, Florida, and Texas have upwards of 200-300 hospitals in their state alone. Every day Travelers clock in and out at many of the nation’s hospitals, yet every hospital is different. Many misconceptions exist amongst all the different facilities and it is crucial for Travelers to know what these differences are so they can understand the impact that such variances can have on patient care.
One type of hospital that’s often misunderstood is the critical access hospital (CAH), as many healthcare workers don’t realize the limitations these facilities have on the resources that are available for patient care. A critical access hospital is a rural hospital with 25 or less acute care beds. It is also located at least 35 miles from another hospital and the average length of stay for acute care patients is 96 hours or less. The critical access hospital designation is given to reduce the financial vulnerability of rural hospitals and to improve access to healthcare for rural communities. Providing care in these facilities can be very different than any other hospitals. Most often the staff that work in these facilities (mostly nursing) are skilled in a variety of areas. For example, a medical-surgical nurse would be required to work the ER and may also float to take care of critical care patients. Some labor and delivery nurses will be required to work a variety of areas outside of their specialty including medical-surgical units or even the ER as well. Another important thing to remember is that CAH may not have some of the luxuries that bigger hospitals have. For example, they may have little to no help in terms of nursing aides. They also may not have secretaries, unit clerks, administration, etc. This will require nurses to know how to do more of these clerical tasks that they may not have had experience with while working in a larger facility.
Other types of facilities that are misunderstood are long-term care facilities (LTC) and sub-acute care facilities (LTAC). The main difference between these two facilities is the length of stay and the patient acuity. The acuity of the patients within an LTAC facility is much higher than the acuity within an LTC facility. Many times, the patients within an LTC facility need assistance with activities of daily living (ADLs). These patients are also receiving care for extended periods of time. The patients within an LTAC facility are getting care that is more complex. These patients need intensive medical treatment for an extended period (usually 25 days or greater). Much of the patient population within an LTAC facility will require chronic ventilator care and other complex medical treatments not offered in an LTC facility.
To better understand the differences in acuity amongst these facilities it is helpful to understand the treatment levels. The highest acuity and treatment level is a short-term acute care hospital. This would be considered your average hospital. The second acuity level would be the LTAC facility and then acute care rehab, sub-acute rehab, and lastly long-term care (LTC). Acute care rehab would be considered a rehab facility within a hospital setting. The sub-acute rehab setting would be considered a rehab unit within an LTAC facility. Understanding each of these facilities and the patients they care for is extremely important for travel nurses to know so they are aware of the expectations coming into their assignment.
Travel Nursing is not just about finding a hospital and working. It’s much more than that. It is finding the right hospital or facility for your skillset so that you can provide quality care to each patient. Knowing the difference amongst the number of hospitals or healthcare facilities around the nation is extremely important to know when you are embarking on your Travel Nurse adventures. Ask a lot of questions and advocate for yourself to make sure the contract you are accepting is the right fit for you!