Is there a slower paced floor to work at in the hospital?

Wise Woman RN · Apr 17, 2011

Again, no backlash here.. I work in acute rehab, and have for close to 20 years. I feel that if you have never worked in a rehab unit in a hospital, that saying it's slower paced and more relaxed reinforces the thought that it's easy. Yes, our patients are "medically stable," or at least they are supposed to be on admission per medicare regs, but in truth, many times they are not.

Also, with the new regs, ortho patients are more often referred to subacute units. The patients that we admit have many medical comorbities, and can fall into the "unstable" group within minutes or hours. But because of the general view of rehab being less intense and "more relaxed," the powers that be staff us with less than the staff we need to accomplish what we need to accomplish.

We have no unit secretary. There is a central unit coordinator that we can fax orders to, and they enter them, but we still need to go back to check, so it isn't a time saving thing for us. We have paper charting, so, lacking a secretary, nurses are printing the forms for the chart, then putting the chart together, prior to doing the admission, which, on a good day with a super efficient nurse, takes 2.5 hours. Discharges are similar. After printing out all the discharge forms, filling them out, going over them and the med sheets with the patient, we copy them. The chart gets one copy, the patient gets one copy, and one copy goes to the nurse that does follow up calls. We fax the discharge info to the home health care or subacute facilities.

Our patients are up and dressed every morning, and eat at the dining table in the middle of the unit. Many require 1:1 assistance. Many require two people to transfer to and from bed and wheelchair. We have nurse's aides, but they cannot be expected to perform all of the transfers, answer all of the callbells, dress all of the patients, etc. etc. Team work is essential here.

Consistently, if we need more help because of the medical and functional acuity of our patients, we are told, "sorry, the medical units need the staff."

I think that the general idea is that our job is easier because the patients are all in therapy, so we can sit around and play on the computer. Not so. The patients are all scheduled at different times, so at no time is the unit empty of patients.

We don't use bedpans. Every patient is assisted to the bathroom for elimination, every time, even if it's the LOL who has to go every twenty minutes and needs 2 people to assist with clothes and hygiene, or the patient that has to be transferred with a lift and assist of 2.

Time is the thing that we need to assist the patients in achieving increased functional ability, but, because the thought is that rehab is easy, time is what we are not allowed to have. Rehab is not task-driven. Most of our patients have, in effect, lost their lives, and their families have lost the mother, father, or other family member that they knew and loved, and need to learn how to adapt to the devastating effect of the loss of function that has occurred.

That is what is the driving force of a rehab nurse, the education and support given to patient and family members. It's not getting the vital signs, passing the meds, doing the dressing change, changing the catheter, or flushing the ports, although we do those things, it's providing opportunities for practicing skills learned in therapy, for families to learn how to care for the tubes and lines after discharge, how to care for a family member who might not be the same cognitively that they were, and to give hope to patients and families after the loss of life as they knew it.

I'm not saying that the nurses in the other units don't provide the knowledge and support that we do. I'm just saying that when they are in the general hospital, the patients are in the bed. I don't know of any area of hospital nursing that is "easy," and we nurses in all areas have to acknowledge the expertise of our peers in their respective specialties, and how hard we all work.

Florencebyondthepale · Apr 17, 2011

Someone mentioned oncology as a less hectic unit and I have to disagree. It is q4 vitals with patients on chemo and radiation. Strict i/o's. Patient's typically spend at least 30 days on the unit for their first round of chemo and often deteriorate as the chemo progresses. Patients with advanced cancer can often be total care and have wound care, fistula's, ostomies and trachs. Sickle cell patients in crisis are also generally placed on the oncology unit. Pain management is a huge concern. And in my unit we took med/surg overflow if we were not full. You also have to be ready to deal with emotional concerns, particularly depression. And because the patients often stay on the unit for so long and/or come back for repeat treatment it is easy to get attached. You get to know their families and friends and it can be especially devastating when someone doesn't make it. There is no predicting who lives and who survives with cancer. I have seen a 17 year old patient die while a 70 year old who is riddled with disease and near comatose suddenly perk up and start talking and asking to eat. Needless to say, it is both physically and emotionally draining. I am in awe of nurses who choose oncology and stick with it for their career.

MaueeBoiFlava · Apr 17, 2011

check MENTAL HOSPITALS for DEPRESSION UNIT. I am sure everything there should be slow.

Mommy TeleRN, RN · Apr 17, 2011

I think some of it depends on the hospital and how they staff various units. I float and there are some floors that tend to be better staffed and have a 5:1 ratio instead of 6:1 and they are a little easier. Stepdown can be easier depending on how it's set up.. they aren't as sick as ICU usually and you have 3-4 patients.

I find ICU a little slower pace than the floor. I have so much more time to spend with each patient and can learn more about them. You have so many nurses around it's easier to get help like pulling up the patient, bathing, toileting and you usually have plenty of RT's and often docs around (esp in a teaching hospital) at night than on the floor. The docs to me seem like they listen better and are generally more helpful in the unit, they tend to know about the patient and what is going on, monitoring their labs and things themselves a little more frequently as the ICU pt requires more frequent changes in the plan of care.

My hospital used to have a chest pain center and I really liked that.... you are doing the same type of thing all the time and it's easy to have a routine. Although you'd occ have someone unstable it was pretty easy to get a doc on the scene.

qt_rn · Apr 17, 2011

I work on a chronic care/transitional care unit (people that aren't quite ready for rehab). This floor recently changed from chronic care and slow stream rehab. I have to say that while more physically demanding, I find the chronic care and transitional are typically "slower" than the medical floors in my hospital as well as slower than when we had the slow stream rehab on our floor too.

I am a new grad as well, been working for a year, and I have found chronic care to be a better learning experience than I thought when I took the job. Lots of trach care, feeding tubes, we do peritoneal dialysis, tpn, we do a bit of everything. We do primary care on our floor (as do most of the floors in hospitals in our area) so we are staffed 4:1 on days and 7:1 on nights.

Our patients are mostly medically stable although we do have acute medical issues arise, not as frequently as on a medical floor. Medical is great experience but if your finding it to be too overwhelming maybe something like chronic care would be good for you.

During a day shift, we often have a lull in the afternoon when patients are napping, there are no meds to pass and the bells slow down a lot. It gives us time to do most of our charting, start writing our report, and stock things and do the extras. On nights we often have a good 4 hours where things are quiet. So it is rare for us to leave our shift late unless something happens near the end of the shift.

I am going on maternity leave soon and when I go back to work next year I plan on moving to a medical floor if I can just because I feel its time to challenge myself some more, but for a new nurse I think its a great place to start!

Hope you can find something that is the right fit for you!

himilayaneyes · Apr 17, 2011

I'm sorry, but you won't find it easier no matter what unit you go to. That's just part of being a new nurse. And in no way would I say that ICU is any easier than the floor. ICU requires more thinking since the patients are so much more complex where as on the floor there's a lot more of just doing things to do them (gotta pass the meds, sometimes you're so busy you barely have a chance to look up labs). Plus, I guess it depends what type of ICU you work in. Trauma icu is definitely not easy, but the patient ratios are much better than the floor. Give it a year and it'll be better. Hang in there.

MandaRN94 · Apr 17, 2011

My advice is get out of acute hospital nursing. There are many jobs available in clinic settings or public health that are much slower paced (but not less work). Not everyone has to "put in their time in Med/surg" as new grad RN. If you don't like it get out or you will burn out. If you really want to stay in the hospital I recommend the maternity floor. You still get to use acute nursing skills but will be less stressful. I worked on busy L&D floor that often hired new grads. The ones that found it too stressful or too fast paced were transferred to postpartum and they loved it. What interested you in nursing school?

GRUNGE · Apr 17, 2011

i started ND STILL AM IN THE REHAB UNIT. THIS IS A VERY GOOD PLACE TO GAIN YOUR BEARING

alalani3 · Jan 25, 2016

I was just wondering how this worked out for you? I am a new nurse now and am going through the same thing. I feel that it's not that I do not like the job. I just think that I do not have enough time to complete everything I need to complete. I am dedicated and I am not the only nurse who ends up staying 2 hours to chart. Many of the experienced nurses are right there with me. This tells me that we have too much to do in so little time. I am afraid that things can be missed or done incorrectly in such a rush. We don't have the time to spend with the patients as we would like to. This is not how it should be. I do not believe that the ratio should be any higher than 5:1. There is simply too much to do and we need the time to do it accurately. How do you feel about nursing now that you are experienced? What did you decide to do at that point? I am just wondering how it turned out for you.

Pangea Reunited, ASN, RN · Jan 25, 2016

I was just wondering how this worked out for you? I am a new nurse now and am going through the same thing. I feel that it's not that I do not like the job. I just think that I do not have enough time to complete everything I need to complete. I am dedicated and I am not the only nurse who ends up staying 2 hours to chart. Many of the experienced nurses are right there with me. This tells me that we have too much to do in so little time. I am afraid that things can be missed or done incorrectly in such a rush. We don't have the time to spend with the patients as we would like to. This is not how it should be. I do not believe that the ratio should be any higher than 5:1. There is simply too much to do and we need the time to do it accurately. How do you feel about nursing now that you are experienced? What did you decide to do at that point? I am just wondering how it turned out for you.

The OP hasn't been by since 2012, so don't hold your breath.

nutella, MSN, RN · Jan 25, 2016

I interviewed at a large psych hospital some while ago and while the pace seemed decent enough - the pay was horrible - so no go...

Hoosier_RN, MSN · Jan 25, 2016

I interviewed at a large psych hospital some while ago and while the pace seemed decent enough - the pay was horrible - so no go...

Pay isn't everything. Believe me. The highest paying jobs were the worst, and for a reason. The worst, treated like a queen with excellent tangible and intangible benefits