considering rehab - is 8:1 with a CNA good? - page 4

Hi all, I am possibly considering a job change into rehab. It is a 60 bed free standing rehab hospital that is all over the country. I've never done rehab before but I have done med/surg. I was... Read More

  1. by   NancyJo
    My job before this one was in rehab. Was told in my interview that I would typically have 8 pt.'s and a CNA. She neglected to tell me to that usually we only had one CNA, sometimes two for a 38 bed unit, that we all shared. What a rude awakening. You can never ask too many questions. Needless to say, we couldn't keep CNA's as some would run them absolutely ragged and at times would have none. Our nursing numbers kept declining also and by the time I left it was nothing to have 12-13pt.'s on weekdays and usually two of us to split the floor on weekends. Talk about unsafe!
  2. by   FEELYRN
    Our ratio is 9:1 -- one nurse (LPN or Rn) and one aide -- unless we are short staffed then the numbers go up. We are a free standing acute care rehab with stroke, brain and spinal cord injuries, ortho and post op cardiac patients, with a mix of other stuff thrown in. In my opinion this is too many patients to give adequate care because many have intensive wounds that need dressed/packed, IVs and tube feeds, traction devices, etc. We also have co-morbidity issues like Alzheimers patients and dialysis. It can be trying, to say the least, but you learn so much every day.
  3. by   FEELYRN
    A PS to my post -- You learn every day, especially time management!!!
    Rehab nursing is hard work, for the nurse and CNA, but also very rewarding.
  4. by   chris_at_lucas_RN
    Quote from psychrn03
    My blanket statement would be it's good for the hospital, bad for your license, so just show me right out the front door to the next hospital. Of course my knowledge of a rehab unit within a regular hospital is that it's the dumping grounds when the other specialty floors are full. I don't know much about free standing units, but I might be inclined to stick with my previous statement. Also, you didn't mention what shift, but if you're talking about it being days, I'd say don't wait for them to show you the front door; rather run to the light.
    I just had an interview at a rehab hospital for a PRN slot. I thought to get a few shifts a month where I was doing more hands-on patient care since I am doing fulltime psych nursing and I miss the patient care aspect.

    I was told I would have 10-11 patients after a 10 day orientation "to teach you the paperwork." I was so relieved when they said I wasn't experienced enough! They said their pts had various diagnoses (all of which I recognized and remember well from school and my externing, plus a few from my clinical rotations), and they preferred the patients be transferred out a couple of days before they would have crashed.

    (I thought the whole thing was a little odd, actually, but I was nice about it.)

    I believe these bizarre staff ratios exist because nurses continue to work in them and because cheap foreign nurses can be had and don't know any better.

    And because the bottom line is more important than patient safety, much less patient care.

    It's discouraging, but unless we "vote with our feet," we have only our own profession to blame.
  5. by   LIRN
    I'm the MDS Coordinator in a 120 bed facility in Florida where 60 of the beds (3 units) are short term rehab, a good deal of the patients are orthopedic rehab. On the day shift there are 4 nurses for those 20 patients, and 9 CNAs. There is also a unit manager at the desk, and a unit secretary. Everyone's busy, but it works out OK. The rehab staff does a lot of the AM care with the patients, since occupational therapy is part of their rehab. The speech therapist feeds some of them every day (stroke patients). There is a big turnover of patients--some stay only a couple of days (like post CABG patients). The dense CVAs stay the longest. We have lots of PICC lines and IVs running at all times. Until recently, there were only three nurses, one for each 20 bed unit. THAT was not enough. The fourth nurse made all the difference.
  6. by   Sapphy
    I work in a freestanding rehab facility where our census is usually 36 or 37.... during the day there are two nurses with patient assignments, one assessment nurse, and sometimes if we are lucky we get an admission nurse... ratio usually ends up 17 or 18 to one. In the evenings when I work... I always have at least 11 patients but usually 12... there are always RNT's on the floor...usually 3 so we each have one aide to help with showers and BG's and stuff. I have found it to be a huge learning experience...I am a new grad as of May 6t6h and I took my boards and passed on Monday. I have learned a lot about prioritizing because of this job and I must say, even though I rarely get out of there on time, I love my job. Part of it is that I am constantly busy so my evenings go really fast!
  7. by   nurws
    We are a free standing rehab unit, 20 beds. We have 2 nurses, and 2 CNAs, for day shift. Of course on days you get the privledge of all the other staff members breathing down your neck, all demanding of your time, each with their own personal important agenda. We have PT,OT,ST, and Aquatics. Usually we have pt. up and dressed and eating by 7AM, and thereapies start before they even leave the dining room table. We also have no unit secretary, and also transfer telephone calls to other depatments, (there own lines would cost to much). We are seeing much sicker, and more varied DX/patients. We have currently 2 pysch pt with CVAs, 2 MVAs with multi trauma, 4 hips, 2 knees, 2 compound fx ankles, 1 cervicle fx, 1 back surgery, 1 brain tumor with CVA during surgery, 5 others in various stages of deconditoning, including detox. Not to mention AB TX/IV, PEG Feed, and all the other stuff that goes along with "the privledge". We have bed alarms on probably half of the pts, and No Rails policy, No restraints. They say we are "Fat staffed", and have nothing to complain about. We also get paid almost $3 less and hour than the acute floor at the hospital. Somedays feel more like a mental institution than a rehab! Good Luck to All. We are there for our patients, and sometime giving all isn't enough. RN WA State
  8. by   thegreenmile
    Rehab? You can have it! I went into it 6yrs ago with 1:6 ratio, it became 1:8 and now 1:11. I had 2 herniated cervical discs and now have 3 herniated C-discs, 3 L-discs, OA & DJD. It was a dumping ground for anyone the insurance co. wouldn't authorize anymore acute days for, many were nursing home level, lots of skilled needs and staffing and safety were always an issue. I've since gone back to Mental Health and should have done it years ago when I still has a viable spine!
  9. by   BAckPane
    i work in a rehab unit and it is in our policy that there should be two licensed people always.. even if it goes down to one patient. i dont know if it applies to all though. in our unit, i have an lpn and a cna with 8 patients. the cna stays with 5 patients but off the floor with 4 and below.

    consider these if u only have the cna with 8 patients:

    u come in the morning, you and ur cna have to prepare your patients for therapy-- baths then put on their therapy clothes, food trays which you have to set up for strokes especially those who have hemiparesis, vitals signs which u need before you give ur medicines and by the way, you have to pull out your medicines also (coz u don't have any lpn). how about the nursing station? doctor's come and make their little rounds, and oh, the telephone is ringing-- constantly.. how about the patient who needs to go to the bathroom-- he cant walk so you have to put him on the wheelchair then to the toilet then aftercare then back to the wheelchair. how about your toileting q2hours while awake? how about those awaiting doctor's orders at the desk? how about your wound dressings? and mr x is going home today and by the way, 2 admissions are coming before 12 noon.

    you may think i'm exaggerating but these are happening in our unit. then you would imagine your situation with only the cna at ur side. you better think twice first.
  10. by   Becca2003
    Hey i have been a CNA in a Rehab facility for 2 years now and i love it the pt to CNA ratio is 8:1. Nurses have 16:1 and it is good at least for boise other facilities that i have worked in it is 16:1 for CNAs and 32 per nurse