Is taking 10 patients too much

LadyFree28, BSN, LPN, RN · Jan 24, 2015

Because sub acute is NOT acute care, even though they take very sick patients; in theory, the acuity is supposed to not be as much, but it really is-it is what it is, and most places are operating on an outdated premise and per their "bottom line" and reimbursement, there's "no funding" in having ratios like an acute setting.

If you decide to take this position, the best way to be organized is to find a brain sheet-you can use the search button and find a plethora of brain sheets here on AN. Learn to organize with vitals, insulin and BG times, teaching, IV, etc.

Best wishes.

westieluv · Jan 24, 2015

They said they do have patients that are sick, so why in the world would you give one nurse so many patients?

Short answer, because they can, and if you "only" get ten patients in sub-acute rehab, consider yourself well staffed. At the facility where I used to work, the patient load on the crazy busy afternoon shift was 16 patients to a nurse. My daughter-in-law works in sub-acute rehab now, on day shift, and she has had to take up to twenty patients, depending on the staffing. These patients are only a couple of days post-op and still quite ill. Years ago, they would have spent at least 2-3 more days in the hospital.

Before I accepted that position, I would ask them point blank, "Will I ever have more than ten patients during my shift?" They may lie, but hopefully you will be able to squeeze the truth out of them if that number is just a come on to get you to accept the position.

Katniss88 · Jan 24, 2015

Short answer, because they can, and if you "only" get ten patients in sub-acute rehab, consider yourself well staffed. At the facility where I used to work, the patient load on the crazy busy afternoon shift was 16 patients to a nurse. My daughter-in-law works in sub-acute rehab now, on day shift, and she has had to take up to twenty patients, depending on the staffing. These patients are only a couple of days post-op and still quite ill. Years ago, they would have spent at least 2-3 more days in the hospital.
Before I accepted that position, I would ask them point blank, "Will I ever have more than ten patients during my shift?" They may lie, but hopefully you will be able to squeeze the truth out of them if that number is just a come on to get you to accept the position.

Before I went for the interview I asked someone that I know who works there and she told me it was usually 9-10 patients on a low staffed day and she said that she wanted to be honest with me because she didn't feel like they were totally honest with her during her hiring process. During the interview they told me 10. In my mind I was thinking that a rehab facility took patients who are stable and well enough to transfer from a hospital into a rehab facility. They nurse I know told me that they have antibiotics to give, change dressings, and have patients who have wound vacs. I already had doubts about working at this facility when I was told about their nurse patient ratio. The patients that I take care of now are not really sick patients, but it can get really busy with having 6 to take care of. I'm really wanting to get some medsurg experience but I don't want to take a chance of losing my license in the process. They gave me the opportunity to shadow a nurse to see if I was still interested in the position. At this point I have more doubts about taking this position.

Ayvah, RN · Jan 24, 2015

I think the biggest question you need to ask is what is the support staff/CNA ratio? That makes an enormous difference, especially in rehab.

TheCommuter, BSN, RN · Jan 24, 2015

1 nurse to 10 patients is a very normal nurse/patient ratio in subacute rehab. Remember that it is not acute care, and therefore, the patient population is not as sick as what you'd encounter in a hospital setting.

When I worked in subacute rehab I had up to 17 patients on day and evening shift and up to 34 patients on the night shift.

ponymom · Jan 24, 2015

Remember you are interviewing THEM, as well as they are interviewing YOU. Ask any and all questions you can think of, bring a notebook and write down the answers during the interview. You are a licensed professional.

dudette10, MSN, RN · Jan 25, 2015

I have worked at our in-facility acute rehab and sub-acute rehab.

Acute rehab is easy to take that many patients because they are, by definition, able to tolerate three hours of rehab a day. They are with the therapists a lot, and they are often motivated to do their own ADLs.

Sub acute is less rehab time but OT will schedule many for ADLs so the nurses and CNAs don't have to do it. PT will do ambulation and get them up to the chair after. Sub acute can also take those that need longer-term antibiotics.

You are also not going to experience the quick turnover of acute care, either. Discharges are known days in advance, not hours. You can always get admissions, however. You will not have to monitor VS as often, and you will not be getting order after order to implement. I can go an entire shift on subacute without new nursing orders on my patients. All this is to say, you can't go by the numbers; you must take into account the setting.

In my opinion, 10 in sub acute is very doable, especially if you have CNAs. You still need to be alert for changes, though. In the time I've worked those areas, I have sent a handful back to acute care for things like chest pain, acute abdomens, and sepsis.