Sub-acute/rehab floors - page 2
Can any of you tell me what staffing is like on your sub-acute units?... Read More
May 7, '04Quote from CapeCodMermaidCome to Virginia.....I can work you out a schedule you would not believe :chuckle and have you enough help! It is not perfect all the time...but well on our way!One nurse for 10 patients???????????????????????????????????????? Can I move to Virginia, please? On the sub-acute floor of the place I just left we had 2 nurses for 41 patients! Not all were sub-acute of course, but out of the 20 they each had, at least 15 were...4 CNA's day shift,3 on pm's and 2 on nights.
The place I will be going to is much better staffed.
May 20, '04I just started a new job at a different facility. On the day shift on the subacute floor for 32 patients, 2 nurses with 16 patients each for meds and treatments, a charge nurse who does 95% of the paper work, and me the nurse manager. We also have 5 CNA's on day shift. Our census has been low so last week one of the nurses only had 12 patients and all she did was complain about how overworked she was. The floor nurses don't door MDS's or go to family meetings or anything. And they don't even want to call the docs!! They write what they want on a piece of paper, and I'm supposed to call the docs with it....puhleeeeze. If you are the one taking care of a patient then you should be the one to call the doc. I want to suggest to them that they try working on a 41 bed unit with 2 nurses and 4 CNA's
Jul 23, '05Quote from CapeCodMermaidI have worked 2 different sub-acute units in the last 3 years. My first one was a sub-acute unit with approximately 35 residents under my care as an RN. Our long-term care nurse, usually an LPN, had anywhere from 55-65 residents. We had one float nurse who picked up bits and pieces of each of our halls who could have 30+ residents including working in the Alzheimer's unit.Can any of you tell me what staffing is like on your sub-acute units?
My 2nd job is presently as an RN with about the same amount of sub-acute residents (35-40) 7 of which are long-term care.
I work night shift and sometimes it can be fairly manageable...other times, it is crazy! My first job I was the night shift supervisor, plus had to take a full patient load. That is why I evenutally left. I am much happier at my present job.
I am presently considering going back into acute care, maybe to a rehab unit....but time will tell.
Jul 23, '05We have a combo unit that has 6 rehab and 6 subacute. On 1st and 2nd shift, we have 1-RN, 1-LPN, and 1- aide. On 1st, we also have all the therapies and a unit clerk. On 3rd shift, we have 1-RN and 1-aide.
Jul 23, '05Quote from sagarcia21012 patients????????? Twelve??????????? With 2 nurses and an aide? XII????We have a combo unit that has 6 rehab and 6 subacute. On 1st and 2nd shift, we have 1-RN, 1-LPN, and 1- aide. On 1st, we also have all the therapies and a unit clerk. On 3rd shift, we have 1-RN and 1-aide.
I am dumbfounded....that's a better nurse to patient ratio than the hospital!
Aug 2, '05Quote from renerianYep.Is it hard to keep up with 20 patients sub acute?
My assignment is 20 subacute patients and 10 long term care. Out of the 20 subacute patients, at least 3-6 at any given time would still benefit from a med surg floor. Their medical stability is at times creative writing on part of the dc planner and the doc at worst extremely fragile. My long term care residents are for the most part stable. Yet require a different type of vigilance because their changes in medical condition can be barely perceptible unless you know them well. We have 2-5 admits and discharges on any given day in our sub acute unit. Fortunately the house sup, UM, DON and ADON jump in with the discharges and admits. We usually have a wound care nurse on 7-3, at least 3 days of the week. Our floor total is 40 subacute beds and 20 ltc. 7-3 mon-fri also has a unit clerk. We try to staff at least 8-10 aides on both 7-3, 3-11, but with call outs usually end up with 6 or 7. And if our 50 bed dementia unit is short, they pull our aides. 3-11 also has 2 nurses with the same split and a house supe. No wound care nurse or unit clerk. However we schedule the time consuming treatments for days when there usually is a wound care nurse. 11-7 ideally has 2 nurses and house sup, if census is under a certain # (no hard and fast rule usually around 46) One nurse takes the floor and the house supe has the house. If we have one nurse and census is higher the house supe takes an assignment. Anywhere from 3-5 aides on 11-7.
I really do love my facility. I have no compunction about asking for help when I have several emergent issues at once...eg last weekend I was sending out one resident for gross hematuria (couldn't be handled in house), another resident in acute resp. distress, while I was on the phone another resident took a header and had a head lac, and while all of this was going on one of our aides gave herself a nasty cut on a piece of equipment......then there was a code....just a normal afternoon. So during my shift I pretty much resemble a hamster on speed. The great thing is we do work very well together as a team. Everyone does help everyone. And the doctors who admit to us are for the most part extremely reasonable and easy to work with. Though there is one, I will probably run over with my truck. And then back up and do it again, but hey every facility has one of those....
It does get crazy though.....but shhhh don't tell anyone I am a secret adrenaline junkie and thrive on this environment. And being a new nurse, I have learned so much from my co workers and seen more and done more here than I did on my clinical rotations in the hospital.
And as to the safety of those we are entrusted with.....I feel my license is safe here. I once refused to do a procedure because we had no protocol. Called the doc and med director they were fine with this decision as was admin.
Yeah we get crazy, cranky, grumpy and a whole lot of snarky at times, fortunately we all have a sick twisted sense of humor.....
I have a strange schedule and work all shifts....so I see the benefits and disadvantages of each shift, I also work all different days of the week, including weekends....
Ok I shall cease to ramble.
who still does sometimes fantasize about a job as a walmart greeter when things are really hectic....
Aug 2, '05On nights the subacute floor I worked had one nurse, one RT most of the time, and were supposed to have two CNAs although usually it seemed like one. The unit held 25, but usually at least a few beds were empty.
All shifts had one nurse and one RT. The only difference in staffing was the number of aides. Days had a bit of help in certain areas from the UM and the tx nurse.
Aug 2, '05Can someone edumacate us old hospital nurses on the terms used?
I don't really know the difference between the terms 'skilled' 'subacute' and what this means in LTC. And some patients are labeled 'rehab' too?
Is there some benefit to facilities classifying patients in these groupings or are the terms just interchangeable???
Aug 2, '05In my LTC facility, there is one unit that I have heard called "Rehab".
I am guessing that Rehab could mean not sick/ill enough to stay in the hospital, but also not well enough to go home. Perhaps he/she is there for physical therapy, occupational therapy, or monitoring of medication? Rehab residents seem to be there for a couple of weeks to a few months.
The other unit is called '"Long term".
When a resident is not going home, he/she is moved from the Rehab unit to the Long Term unit. Some residents are independent (sometimes, I wonder why they are there), some need a little assistance, some need more assistance and some are total care.
Rehab, Subacute, Skilled ... are there other classifications/terms?
Aug 2, '05Off thread... as far as wondering why someone independent is in LTC... We have an independent gentleman, leader of res. council, volunteers thru out facility, sets tables for meals etc. He does not have family, horrible horrbile history of alcohol abuse and 2 previous suicide attempts. He functions great in our facility, but he can not function independently in the community. You would never guess this to look at him though.
Aug 2, '05It can get a bit confusing as some of the terms overlap.
ICF- intermediate care--- This would be your average LTC resident.
Rehab residents are usually short term for therapy.
They can be "skilled" for nursing care or therapy. These have a lower resident to staff ratio and require more care.
Aug 3, '05Rehab-what it sounds like....new knees, hips, fractures....Physical and Occupational therapy is their main focus and then they go home. (of course some long term residents are on rehab services if they have had a decline)
Sub-Acute....picture a really busy med-surg floor, but with fewer nurses and you have a picture of today's sub-acute patient...pneumonia, CHF, COPD exacerbation...or a fractured hip in a 89 yo who also has pneumonia...wound vacs, IV's, you name it. People this sick used to be in the hospital
LTC--long term care....most are too feeble or frail or demented to take care of themselves anymore, so we do it.
Skilled nursing..covers the gamut. anyone can have a skilled need....it's something that requires an MD order and needs the, well, SKILL, of a nurse or therapist...wound care, insulin with a sliding scale, lung sounds s/p nebs.....