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.