[1studentnurse]

I have had up to 28 of these higher-acuity rehab patients by myself due to critically short staffing.

28 patients? That is insane! There is absolutely no way you can adequately take care of that many patients. Overwhelmed is an understatement. Drowning may be more appropriate.

I thought my unit was understaffed (often 7 patients per nurse with one tech on AM shift--and need to transport pts several floors away to therapy). We are the stepchild unit, because of where we are in the hospital (away from our other two units) and it sucks. People get stuff like MRSA and Cdiff, because nurses and techs rush between rooms and don't get cleaned up properly.

The most I have seen on a night shift at my hospital is 13 to 1 nurse with three techs. That's not safe, either, but at least there are more bodies to toilet people and help reposition or clean them up.

Some of our rehab units, however, did not have nursing managers, so that made them completely useless (PTs and OTs are great, but they can't pass meds or do treatments). Our nurse managers don't get it, either, because in these situations, they are supposed to come in and cover. I have yet to see that happen. Occasionally, we have them help pass meds, but most of the managers barely answer call lights. (Our CNE, believe it or not, is the exception) I saw our last manager wear scrubs on one day--Halloween--because she had "cute ones to wear". This is also a red flag--if they don't wear scrubs, whether management or nursing education, they are not serious or willing to jump in to situations (I have encountered only two in my job who weren't wearing scrubs who jumped in on a code, one was said CNE and another our Case Manager Director--also an RN).

Most of the management doesn't want to get their hands dirty anymore. That's why I'm going to a rehab unit where the nurse manager actually works (wears scrubs, fills in, etc.) I'm just waiting to get my final offer and then I'm sending my note to the boss, with a two week notice.

[1studentnurse]

Originally Posted by delta32

the behavior on our unit just keeps getting worst and worst. I have a young male ~50ish that on purpose keeps soilling himself them hidding it or worst leave it in his room. My attitude in nursing is not to tolerate behavoir like this. if you give them an inch they will take a mile. well my boss the DON thinks i should tell him that its alright that he does it and continue to remind him each time to use the call bell if he has to go. I feel this is enabling his behavior. I hvae spoke to him several times reguarding this and it makes me ill. I will not accept nasty behavior just because this guy is to lazy to use the call bell.
I truley hate hate hate rehab nursing, i am applying other places way way out of any sort of LTC or rehab. I interviewed on friday for an insurance job. keep your fingers crossed.

Jamie

This guy was on my unit recently. He just didn't want to unfasten his Depend to use the urinal.

I refused to let him go to therapy until he helped me clean himself up (with me as standby--passing stuff). I got to score him as continent one day of the almost 30 that I cared for him.

He made me so mad one day, I asked him what made him do it. I told him, "M. all I wanted to do was score you as continent today and you messed that up. You're not on Lasix anymore. What happened?"

Another part of the problem is some people like the "hotel" aspect of the hospital. At home, no one's around to clean you up. At the hospital, they are and are graded on it.

Some days I just want to strangle people who can and won't be continent!

[TheCommuter]

Originally Posted by 1studentnurse

Some days I just want to strangle people who can and won't be continent!

This is just my opinion, but I suspect that some of the younger and middle-aged males who "purposely" urinate and defecate in their adult diapers when they are really continent of bowel and bladder, are doing it possibly because they are nothing more than undercover perverts. I think that a few of these men actually find something pleasurable in being cleaned and wiped from front to back by female nursing staff.

[1studentnurse]

Sure, that's logical and I've seen that, too.

This character was equal opportunity, so I don't know if I could call it a sexually-loaded perverse situation or not.

He was just plain lazy, which was the reason why (along with a few other bad habits) he ended up in rehab with us. Mind you, we're physical rehab. I'm sure he'd done some stints in other rehabs, too, if you get my drift.

That is a whole other ball game, and just another reason why rehab is so fascinating--part med-surg, part psych.

[zuzi]

First of all, I like your subject!
Rehab is not the heal! Is all about building attitude and much more about TEAM management! If you have a positive atitude and you have a good team nothing is impossible! Rehab is not a heal in these conditions but could be if one of you try to cheat or you really don't have team ....looool
Is hard work but satisfactions are huge, the team is like a family and you are at home! I worked in a ortho trauma and rehab hospital, was great, years ago, I will remember all my life my team members, we keep contact till now.... we was a team! Good and bad we pass togheter and yes we was all like one and one like all!

Nothing will not working without a good team management if only one is out of the game and this is an unexpected movement or the communication is poor, the team felt down, this is the rule of rehab team, all like one and one like all! Is hard to build a such team (very hard to find perfect membres for this type of team) is much harder to keep it!
But is the much amazing team ever, is like a drug after, you can't live without them, you want more and more, more complicated nurses cases, more excited about, a perfect coordination, the perfect results, the perfect team, let's celebrate after! Yeaaahyyyy!

Rehab can not be done with always complaining people, neither with "princesses", or people thinking about them self before thinking at their team, rehab was and is for TEAM, and really I am intersted about how looks here in US a perfect rehab team, what is your perspective about reahab team (structure of the team, number of patients pe nurse, how they organize their actvity, coordonation, and how it's work). I could tell you how worked from where I come, and the results was great!

I will always belive that rehab could be possible with a perfect team, and yes you could be in heaven not in heal...loool
Hope that one day you will find your place and you will be happy!
Hugs Zuzi!

[tropicbound]

There are good and bad facilities in any nursing specialty. It's sad to hear about the negative feelings some you have, but if you enjoy rehab nursing and the victories you get to share with patients and their families, look for another facility that has a better approach towards the "team" and everyone's success. I work at a VA hospital in spinal cord rehab, another wing is TBI and the last wing of the building is polytrauma; the team approach, adequate staffing, and patient wins are common throughout. I saw the same thing in a county hospital TBI rehab I rotated through in school. Maybe it's government facilities, I don't know, but rehab nursing is rewarding, and I hope you all find a "home" to work in where everyone wins.

In terms of patients that "won't" control bowel and bladder when they "can", it seems that oftentimes it is an issue of this being something they can still have control over, even negatively, in the face of the "losses" they have had. Things are often not what they appear to be with all the emotional/loss issues being dealt with along with new physical challenges.

Best of luck to all, and remember that it is our consistent, caring touch that helps our patients and their families deal with their loss of wellness.

[delta32]

well I gave my notice a few weeks ago and today was my last day. I am glad to be leaving the rehab setting where i don't have to deal with pysch issues that have never been dealed with and manipulative behaviors. I am going back into the insurance industry and i feel so relieved good luck to you guys that stick it out.

Jamie

[TheCommuter]

Originally Posted by delta32

well I gave my notice a few weeks ago and today was my last day. I am glad to be leaving the rehab setting where i don't have to deal with pysch issues that have never been dealed with and manipulative behaviors. I am going back into the insurance industry and i feel so relieved good luck to you guys that stick it out.

Jamie

I wish you the best of luck! Rehab is not for everyone.

[geauxtigers]

I feel for you, Rehab is a hard way of life in this business and if it is not in your blood then it will drive you nuts.

I have managed an Acute IP unit for the past 14 years in a town just north of New Orleans. The shortest tenured staff member I have on my unit is 8 years. We are a family, we live and die for each other, but we don't do it alone!

How is your relationship between your nurses and the therapist? If you have an us against them relationship with your therapist then life is HELL. Our therapist give as much nursing care as they do therapy and that's what makes it work. They answer call light , toliet patients, ect. It's not always been that way, but we worked it out. It takes time, but I feel you have to look to them for your solution if you want to make it work.

Give it a try! I hope things get better for you.

[Borchey, RN, BSN]

I have been working in our Rehab unit for a little over a year and a half and I love it. But I will have to admit, rehab units do have high turnover rates and ours is seeing this first hand at the current place in time. We had 2 Full time nurses quit within a couple weeks of each other, leaving us nothing but short staffed. Our staff have been very helpful by picking up extra shifts and everything, but I think at the current state in mind we are all beginning to become burnt out.

However, I still enjoy my job, even though some days it is the most stressful thing that I can do or even think about.

We are a 12 bed rehab unit and with the short staff situation we have been only allowing ourselves to take a max of 10 patients at any given time. Not too bad, besides half of them are on bed alarms and 2 assists. But what are you going to do. Has to get worse before it gets better.

Help is on the way though, I believe we hired a couple new people and I hope that they feel as passionate about rehab nursing as I do!!!