[SusanRehabRN]

This is my first post as far as a subject but I am at my wits end and want to know what you all think. First off I work on a 22 bed unit that is also part of a 360 bed hosp. The rehab unit is just over 1 year old. We are one of the few units in the hosp that is currently making money. Our manager has this idea that she doesn't need a charge nurse even though we are full a lot of the time. She says all we need is a "lead" nurse which is what I am. Now of course you know that the "lead" nurse gets no extra pay but has all the same duties of a "charge" nurse and carries a full load. Their idea of a full load is up to 8 patients and occasionally more if staffing is low and we can't find any other nurses to work. (She keeps no PRN or Part time nurses to fill in when we need to be off.) Anyway most of the time we are short on CNA's too and most of the time we only have 1 CNA for the whole unit. We also take higher acuity patients than we were told we'd have. I am 54 years old with lots of health problems. When I started here I was honest and brought all the up and the fact that I had also had back surgery and wanted to know if she was sure I wouldn't have to lift...she said told me no that there were plenty of people to help out. Now we all know that hasn't worked out. PT and OT is busy and doesn't want to stop and help clean a total care patient when we need help. It's really miserable and I don't know what to do. Please let me know how your units work ao I will have an idea if this is just rehab and I need to shut up or if you have any other ideas. By the way we have no equiptment to lift folks either. Thanks!

[mom and nurse]

Unfortunately for the nurses at our rehab hospital, we are often expected to lift patients....though we do have the Hoyer lift which helps if the patient is too obese for us to lift. Therapy will sometimes help, but that may be changing too. Since I'm in my 40s, I also have been concerned about my back. Wondering if I will have to find a new field of nursing if I can't lift the spinal cord injury, etc patients and get them up and ready along with the nursing assistant's help. I'm planning to try to go to a class soon on transfers since the nursing staff is being expected to do more lifting of our patients......

By the way, welcome to allnurses

[bluestar]

Eight patients and maybe more is too many. I'd be seeking another unit to work on. I wish you well.

[LoriAlabamaRN]

Welcome! I work at a LTC with a rehab unit, our rehab unit is also very new. We have only 2 LPNs at any one time with a total of 32 residents on the floor, so each nurse gets 16 residents. I think your ratio is actually very good! I do question the lack of equipment- a Hoyer lift is definately needed. If I were you, I would submit a request for one in writing to management, making a copy to keep for yourself. Protect your own health at all costs. When the patients start complaining of having to wait for people to come help lift, and the other nurses/CNAs complain that they are always getting called over to the rehab unit to help lift, it may cause management to rethink the idea of purchasing a Hoyer lift. I would also meet with management about only having one CNA. When most people are a 2- to 3-person lift/transfer and the nurse has a bad back and cannot assist, what do they think is going to happen? Are you officially on light duty? If not, I would look into it. If you end up injuring yourself, it will cost your facility far more than the Hoyer lift would. They should be able to understand that.

Lori

[CrunchRN]

I think this staffing is wrong, and not having proper equipment is also very wrong. They will pull this as long as you let them. You need to take a stand. Give them your requirements in a calm and professional manner with a deadline. If they choose not to meet it then step down. One back injury can put you out of "service" for life. It is not safe for you or your patients. It really is in your hands and you do have power so use it. I wish you the best of luck. You should not be required to risk your health for your career.

[CrunchRN]

Delete duplicate post - dang computer!

[CrunchRN]

Delete duplicate post

[Chaya]

Whether that ratio works depends on a number of things: patient acuity, non-licensed back-up, and which shift. In our 4 unit sub-acute rehab facility the day nurses have 6-7 patients with a CNA for personal care and a charge nurse who does not take an assignment. On eves, 7-8 patients for each nurse/ CNA; the charge RN will take an assignment. On nights, 14-18 patients per nurse and CNA. Most admissions come on eves, usually 1-3. There is usually an admitting nurses and a couple of secretaries that float between the units wherever the need is greatest. Of course sometimes **** happens so it isn't without problems but this does give us a little flexibility.

[SusanRehabRN]

I can't imagine having 16 patients and trying to give meds, help them get ready for therapy and doing wound care etc on them. Maybe with lots of CNA's that would be ok but we are constantly chasing lights as with only one CNA she is trying to do baths and get folks ready for therapy too. Maybe our patients have more meds but I know some of them have two to three pages of regular scheduled meds not counting PRN meds. I don't know....I am trying to hang on as I only have 6 years left to retire and to go somewhere else it would be like starting over. Maybe working the floor would be better but I don't see how. My areas of experience are NICU, L&D, Hospice, Home Care and a couple of other desk jobs so see I don't have a lot of floor experience to draw from. I guess I will wait and see how it goes and if she finds someone else to work.

[SusanRehabRN]

PS: Thanks for the welcome!