[takenbyjoy]

Hi there....I've worked in acute medical rehabilitation for about 20 years now..............and wouldn't do anything else. The facility I worked at previously had staffing ratios about the same as what you are talking about. We did have more CNAs and that does make a difference. The facility where I am now actually has a lower nurse patient ratio (5:1). We are a "combo" center....we have all types of rehab diagnoses. We still have at least 2 CNAs/PCTs when we have 15 patients (we have a total of 25 beds). Personally, I have no problem handling 6 or 7 rehab patients, because they are not on the unit all day....BUT that is with the back up of well-trained CNAs and help of therapists too.

What is really unacceptable about your situation, to me, is the lack of equipment and training. ALL rehab staff should have extensive training in patient transfers.....how do you reinforce what your therapists are teaching patients and families if your nursing staff doesn't know how to do them correctly? And there's the issue of staff injuries. Then,there's the issue of lack of equipment. Hoyers are really a necessity in this day and age of the morbidly obese and extremely dependent patients that we are getting in rehab. There are also sliding boards. If used properly, they are great back savers! BUT, it takes practice to learn to use them correctly.

As far as your own back problems......rehab is physically taxing because it takes the whole team working together to provide these patients with the most thorough rehab experience. Even if you had a Hoyer lift, you still have the issue of turning and repositioning patients in bed. I'm sure I'm not telling you anything you don't already know...this can really put a strain on your back. If you really are set on continuing in rehab, I would say YOU need to be proactive and keep yourself as fit as possible.....if you don't already have a personal back program, get one of your physical therapists to design an flexibility/strengthening program for you.

I certainly hope things work out for you and for your unit.

[memesuzRNC]

Thanks for your wisdom. I know you are right and I hate to tell you but I came from a desk job and we have yet to have any training in transfering or lifting a patient! They (administration) have talked about doing some training but we just do the best we know to do. The acuity of our patients is also great most of the time. Today we admitted a 78M with a Lt AKA, Rt transmetatarsal amputation, CVA Lt with flaccid arm, COPD, CHF, CAD, Renal failure, Severe Depression (lost his wife in August) along with a couple of more co-morbidities! Wow, when they wheeled him in on his bed, one of the nurses working with us today (a flex pool nurse with rehab experience) asked if the patient wasn't at the wrong facility. She thought they intended to take him to the LTAC that we have on the 6th floor. I got tickled at her as she never dreamed he was really coming to us. She couldn't believe that this poor fellow who has no strength or use of the left side and little strength on his right side to even use a sliding board. His amputations were old but the CVA was fresh. Anyway poor fellow was pitiful and you couldn't help but feel for the patient but just doesn't seem like there is much to do for the man. We all felt that he should have had at least 3 weeks of LTAC then to us. That way he could work in to rehab and build his strength some before getting to the last phase of his time. Now he has at the most about 2 weeks total instead of 3 weeks in LTAC and then to us for 2 weeks. Oh well, funny how no one asks me my opinion either! haha! Anyway, I could go on forever but I'm sure everyone has their own ideas. Anyway thanks again for everyone's input. I just want to do a good job for the patients and at the same time take care of my health so that I can work for a few more years as well. Thanks again everybody!

[natkat2816]

Regarding transfer training - could you just go right to PT and ask them for proper training/inservice on transfering instead of waiting for the cold day that administration will get to it?

[pamperednurse]

I am the nurse manager for a 18 bed acute rehab at a 200+bed hospital in a rural community. We generally have 1 RN/1 CNA to 7 patients on days and noc. At 8 it goes to 2 Lic. Rn/Lpn and 1 CNA on days and noc we go to 9 pt's we have 2 lic. and 1 CNA. 9 on days gets 2 cna's and 2 lic. Then at 13 pts days get 3 lic/2 CNA and noc get 2/2. At 15 patients the noc shift goes up to 3 lic/2 cna's. It generally works- we do self scheduling with 2 lic and 2 cna schedule each shift. If censes goes higher we have call in and generally pay double time for extra shifts worked above one's hired hours. Kills the budget, but patient care comes first. We also, have a mandatory no lift policy going into effect in Jan 06. We have spent numerous $ on the ARJO lift equipment throughout the entire hospital. We have 3 mechanical lifts, a sit to stand device, and are waiting to install a ceiling lift in our double occ. patient room. We use this room for our bariatric patients. Our no lift policy is very strict-if one does not comply and gets injured, there may be disiplinary points assigned. Hopefully, you can use your judgement and get lift equipment, otherwise I would def. find a different place to work. One's own health is important. Administration support is needed for getting equipment. Good luck.

[wendilynn]

I work on an acute Rehab. Our staffing is 7 patients up to 8. We do have PCA's. I even think that's too much. Our acuity in Rehab isn't what it once was. We transfuse blood and blood products etc.......I would ideally like to have 6 patients. We have no charge nurses on any shift. I am the Nurse Manager / Educator and I am supposed to be the "charge nurse" as well as do everything else that I'm supposed to do..meetings....discipline....scheduling....educat ion.

[SueIP]

I have been in acute rehab for almost 3 months. (I moved here from the UK) The normal ratios we have worked with since I have worked here in Florida is about 10. The last few shifts I have had the pleasure of 8 which has been great as I have had the same patient assignment. Last night I had 15 and had one tech with me and shared another tech with the other nurse (who happened to be the Supervisor - she had to take 15 pts herself becuase of the shortage of staff) These numbers are ridiclous and so unsafe. I felt I wasnt doing my job properly and guess what I didnt get a break and left late. So much difference in havign 7-8 pts the previous few nights as i was able to spend more time doing my assessments and doing that little bit extra with them and helping the techs out who are awesome