Facility Types and Expectation

Alright. So today, we are going over facility types and what to expect. So we have myself, Ashton. We have Brad. So we'll be talking about some overall generalized, you know, facility types that we often see, with our with our nurses.

So the first one we're gonna be talking about are skilled nursing facilities. So what are these? Right? So skilled nursing really focuses on the short term medically necessary rehab and recovery services. So they often follow a typical hospital stay. So skilled nursing facilities provide transitional care. So the goal is to get well enough to eventually go home.

So they go from the hospital to the facility where they continue to recover after an illness, an injury, or even surgery.

So individuals are often discharged to a skilled nursing facility, or here in the US, we call it a SNF for sure, when they no longer need care provided by the hospital but are not quite ready to be sent directly home.

So they maybe can't get out of bed. Right? They can't move around safely. The use of a wheelchair, having surgical wounds, they just don't have the adequate help they have at home. So then they get sent to skilled nursing facility.

So they do accommodate some short term stays, but also long term. So it can vary from days to weeks to months to even years.

So these facilities often resemble hospitals in terms of their structure and the equipment, but they they are often ideal for patients recovering from serious health issues like a stroke or heart attack, where the goal is to support the patient in their recovery to restore as much independence as possible.

So the the next one, which is the long term care kind of environment.

So these two sometimes go hand in hand, and so the long term care provides ongoing support for individuals with chronic conditions or disabilities, potentially for extended periods of time.

So who are these are individuals who are unable to be independent, who need long term care services. So they live in these facilities where medical personnel and, you know, support staff can care for them, that they can't provide for themselves or they don't have the support or assistance that they would need at home.

So they these facilities support their ADLs, so activities of daily living, like dressing, eating, bathing, just simply moving around. Right? They need that a little bit more support, to remain safe.

So if an individual doesn't require as much hands on medical care as, say, they would in, like, a SNIP, the skilled nursing, long term care is probably the the best next step for them.

So for both of these environments, the let's talk about those skills that the nurse would be using, and required to be successful.

So they are required to monitor the residents and patients' health conditions, provide education, give medicine, and perform wound care, so just like you would in a hospital setting. Nursing assistants are there to help.

They do take vital signs and assist with those ADLs that we mentioned before, while being supervised by the RNs.

So oftentimes, the nurse will do assessments, basic nursing skills like tube feeds, catheter, ostomy care, oxygen therapy, drains, etcetera, while having that support of those CNAs or techs, even LPNs, therapists, all those things like that.

In the next environment, we will be talking about critical access hospitals. So these are oftentimes found in kinda remote areas.

So these are meant to just improve health care access to those that are more in a rural a rural area. So these facilities often have, you know, an emergency department. They often have inpatient. They even sometimes have outpatient services as well. Right? It's like kind of a one stop shop for those role, individuals.

So they are placed where there are, fifteen more than fifteen miles in areas with mountainous terrain or secondary roads only.

So the nurses do need to be adaptable and function in different roles in that sense.

And experience, a wide variety of nursing scenarios. Like I said, you know, the ER, clinic, even rehab, you know, they have a little bit of everything in terms of that patient population, including pediatrics all the way to geriatrics. So some of the skills that the nurses will need in this environment, you know, basic head to toe assessment of all ages. Right? Being able to triage patients, basic skills and procedures, emergency responses, infusion pumps, suction, you know, telemetry, maybe, defibrillators, dysrhythmia.

Of course, the charting and documentation, the use of technology, all very, very important.

Just being able to adapt and function in those different environments with those varying populations is very important.

The next one we'll discuss are correctional facilities.

So these are environments that are, you know, jails, prisons. You know, those, inmates need care too. Right? So they require a wide range of medical needs. So similar to a primary care patient, right, they are you know, the nurses are there to monitor and manage chronic conditions, but also possibly provide emergency care, first aid, you know, those kinds of things, at the same time, addressing some mental health concerns.

So correctional nurses handle everything from minor injuries to illnesses to even more complex chronic condition, like diabetes and even hypertension.

So that ongoing care and education for the inmates, very important. Very important.

So the nurses should be prepared to handle medical emergencies as they may arise for injuries that could be obtained for from various reasons. So they work closely with the physician, psychiatrist, even other specialists to ensure that comprehensive care that the inmates may need and and deserve.

So there could be limited resources compared to the traditional health care setting like a hospital. So the need for the nurses to be resourceful and adaptable in that sense is important too.

So with that, kinda leans us into the mental health facility. So with this area, you know, obviously, it's very specific to psych patients.

So the these areas and these facilities promote well-being through prevention and education in addition to the typical assessment, diagnoses, care, and treatment, that all patients do need at times and deserve related mostly to the mental health and maybe substance use disorders.

So they do require a wide range of nursing, psychological, even neurobiological kind of expertise. Right? You really need to understand more than just the the medical conditions, but also the mental health conditions too.

So nurses and psychiatric mental health, they do partner with individuals to achieve recovery goals, provide health promotion and maintenance, conduct intake screening, evaluation, and triage, case management, self care activities. They do teach those to the patients as well.

Administer and monitor psychobiological treatment regimens, practice crisis intervention and stabilization.

So a lot of de escalations. Right? So engage in the psychiatric rehab and intervention, educate patients, families, communities, coordinate care, and we will talk about, so this is a really great PDF, we'll say, from the American Psychology Nurses, Association.

So we'll break down a few of these parts here in the next few slides.

So the need. Right? The need is very much high for, you know, not just US, but kind of all over the world. So it says here that fifty six million Americans, experience mental illness and struggle.

Then only forty four percent of adults, receive the care they need, not even half, And only twenty percent of children receive that. And so with the mental health, you know, specialty, the psych specialty, you do and will be exposed to, you know, various age groups, which is really important.

So, again, this this is just a quick infographic on, you know, what do the psych nurses do. So we just kinda went over that not too long ago.

And then who are the patients? Right? So we kinda talked about how it could be children to, you know, even geriatrics. So it could be children exposed to traumatic events. Right? It could be soldiers going through PTSD from, you know, post combat. Alzheimer's disease and dementia is a big one.

Even teens and adults living with maybe addiction. Right? Self harm tendencies, those kinds of things.

So the skills that these nurses need to have patients. Right? Emotional intelligence, problem solving skills, time management, critical thinking, and just knowledge of and understanding of the mental health disorders and behavioral challenge that come with them.

And, you know, the infographic from the American Psychiatric Nurse Association can be found on the resource center for health carousel nurses. And so that's a great, kind of area. There's even a blog for psych nurses as well. So some great resources out there for for nurses. So for the second half of this, I will hand over to Brad so he can share his, facility types.

Thanks, Ashton, for reviewing some great content on some of the specialties. We're going to continue with some additional specialties here, by starting out with the children's hospital, a place that is near and dear to my heart, spent half of my bedside career inside of children's hospitals.

Children's hospitals in the US are highly specialized health care settings that provide a comprehensive care exclusively for from infants, children, adolescents, and even young adults. This environment is designed to be child and family centered with a strong emphasis on safety, emotional support, and collaboration.

Some of the nursing roles and responsibilities that you'll see within a children's hospital is providing developmentally appropriate care and understanding childhood milestones.

Also, one thing that is unique to children's hospital is age and weight based medications.

In the adult population, we tend to see standard dosing. And with, pediatric patients, there is more weight based dosing available. We use, pediatric specific equipment. So you're going to find a vast difference in sizes from a neonatal intense or needle neonatal infant blood pressure cuff all the way up to a small adult blood pressure cuff and every size in between. And knowing the appropriate sizes for your patient and how to get the appropriate, vital signs or or scores that you need is important. One of the big things in children's hospital is collaborating with what we call family centered care.

The family is involved in all of the decisions and conversations that are being had with the medical staff, and being supportive of the family in that time. The support is not only just physical help, but emotional well-being, play, and comfort as well.

With the children's hospitals, the culture in these areas, high standards for communication, professionalism, and accountability. You're dealing with somebody's child, and they're very touch with that. We mentioned the family centered care, emphasizing on continuing education.

In any health care, things are always evolving and improving. In the pediatric world, it is no different. We are always learning new ways to do things better and have better outcomes for our patients. You will find a very diverse workforce when it comes to children's hospitals, and you will have many different cultures. In the US, we have individuals that travel all over the world to certain children's hospitals in the US to seek out very specialized care. So very diverse environment there. When it comes to the, staffing and work culture, the nurse to patient ratios tend to be a little bit lower than the adult setting.

Nurses tend to still work twelve hour shifts. Multidisciplinary teams are involved in all areas. Being able to collaborate with those teams is very important. And going going forward in any health care setting here, the use of the electronic, health records is something that is vital within children's hospitals.

Yeah. Very standardized amongst really all facilities at this point. You know? Yeah.

Absolutely.

Our next area that we're going to discuss is what we're referring to as general hospital. This is going to be the majority of facilities here in the US are considered general hospitals. And by that, they that means they are not specialized in pediatrics, and they are not specialized in adults, but you could care for either of those populations from infancy all the way to the geriatrics.

With that, the hospitals in the US are highly regulated, very technology advanced, and fast paced environments that provide twenty four hours, seven days a week specialized care. Nurses are the center of this care, and are expected to function within a high level of autonomy, critical thinking, communication.

When looking at what the nursing roles and expectations are within these facilities, many times nurses are going to be expected to do the assessments and clinical decision making, medication administration, care plans, wound care, catheter care, trade care, many others. Education for the patient, for the patient's family is a big thing when it comes to general hospitals here in the US. There's a lot of patient education and ensuring that they have the information that they need when they're out of the hospital.

US nurses work independently within a defined scope and are expected to advocate for their patients and escalate concerns. Collaborate with the broader care team is a must as well.

Nurses in general in the general hospital setting work twelve hour shifts, and ratios vary depending on the type of unit. Many general hospitals have ICU, telemetry, med surg, maybe step down, rehab.

Each of those units have a different variation when it comes to the patient nurse ratio, and those variations are different from hospital to hospital.

That is a great question to ask when you are in your interview process to understand the facility that you are speaking with, what their expectation and ratios are.

The next facility that we're going to speak to there it is. Long term acute care center or LTACH. So an LTACH hospital in the US are specialized facilities that provide extended care high for higher acuity patients with complex medical needs who are too sick to go to a skilled nursing facility but no longer need the full resources from a short term ICU. So this is kind of an in between between the skilled facility and the hospital where the skilled facility and the hospital are not the appropriate place. It's a higher level of acuity in between those. These patients often require weeks to months of recovery time, and the nursing care is a blend of acute and rehab approaches. The patient population that you typically see within this are mentally complex patients with multiple comorbidities and common conditions, prolonged mechanical ventilation, sepsis, complex wound care, renal failure, or neurological impairments such as stroke.

Many are transfers from ICU or step down settings of a general hospital, and they have that temporary care until they're able to move to the next appropriate place, whether that be home or a skilled facility.

Nurses, the ratios vary, often four to five to one, depending on the facility and what their standards are. Twelve hour shifts are common. The nurses are expected to be strong in their clinical skills and critical thinking, understand infection control and isolation precautions, be comfortable managing, medically fragile patients for long periods of times, and teamwork. Teamwork is essential when it comes to nursing in general.

Nurses work closely in these settings with respiratory therapists, wound specialists, and rehab staff.

The next facility that we're going to be speaking about is the rehab facility.

Rehab in the US focuses on restoring the patient's function and independence after illness, injury, or surgery. Rehab facilities serve as a bridge between acute care hospitals and home or long term care centers, helping patients regain strength, mobility, and self care ability.

Inpatient rehab facilities are also called acute rehab hospitals. These must meet strict federal criteria. Patients receive three hours of therapy per day, whether it be PT, OT, or speech.

The patient population tends to be individuals with stroke recovery, postsurgical orthopedic procedures like joint replacements or spinal surgery, traumatic injuries like fractures or amputations, and neurological disorders, a spinal cord injury or multiple sclerosis, or, they are having some kind of functional decline from illness or hospitalization.

Patients are medically stable but require nursing and therapy support to regain that independence. Ratios here oftentimes vary but can be anywhere from five to seven to one, Twelve hour shifts, as many of these these type of settings have shown are common. Multidisciplinary collaboration, again, is is important, and a strong focus on that teamwork, communication, and patient advocacy.

There we go. Alright. So key takeaways when we're we're discussing the facilities. Different facility types impact different day to day nursing roles. Understanding your work setting helps you feel more confident and prepared.

Ask about the facility type when considering your your placement.

And as always, myself, Ashton, and the other members of the clinical team are always here to answer questions that you may have, regarding the expectation and understanding of the settings in the US nursing.

Yeah. Fantastic.

Yep. So we really appreciate you guys taking the time to listen to Ashton and I share some information about this.

And if you do want to eventually meet with us to discuss anything, you could reach out to your assignee, but we are always here to help support. Thanks, guys.

Thanks, guys.

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