love rehab :)

[mel1977]

I am getting my LPN right now, but have worked in a well known rehab facility for seven years as a rehab tech and love it so much. I may stay after I get my LPN, but after this last back surgery, I don't know if I can do it. See, nurses where I work either 1. Team Lead (some take a small patient assignment like my mom CRRN and others just focus on their nursing duties while helping the techs), 2. Pass medication 3. Tech on the floor doing total patient care.

we house very heavy patients-TBI, SCI, CVA, and general disability. My "specialty" as well as my mom's is TBI. LOVE IT. Anyway-I kind of wanted to know if the medicare and medicaid stuff was hurting any of your census numbers. We hold 60 beds and during the Holidays we dropped to 28. It isn't unusual to drop during that time, but this was bad. I am unit clerking right now bc of my lifting restriction-and instead of 10 hours a day for two days I worked a total of 8 hours the whole weekend.

I graduate in July.

It was really nice to see this forum bc so many nurses don't understand rehab or know what it is about. My particular facility is not a nursing home, it is a rehab center and there is one in atleast every state and major city-but I get suprised as to how little known it is. I almost wrote a book about four years ago from a tech point of view to the nursing student, kinda as a introduction to bring more into the profession. I got stuck though and couldn't do it. Anyway, I am blabbing. Glad to have found this one!

[takenbyjoy]

With your new documentation, you are probably capturing the "real" FIM scores. This is not a bad thing, just reflects more accuracy with your charting as it relates to FIM. As long as you can document a good FIM change (compared to your region, etc - see your UDS reports) you should be ok. Did you have to design your own Medilinks nursing forms or did they provide you with templates to chose from? Our therapy, social work and case management documentation just went to Medilinks. The main hospital is going to computer charting for nursing, but we think it would be better to use what ever program will reflect rehab, especially if Medilinks is already being used by every other discipline here.

[mel1977]

We are really getting serious about our FIMS. Putting more into the aids'

hands and allowing them to "score" on a modified FIM flowsheet, which then those of us FIM cert. will score onto the FIM sheets. In our staff meeting our DON told us we are scoring that most of our pts are Mod assist-Uh, no. Most when they get to us are max to dep. Problems? we are scoring too high or not scoring at all, and then the scores are based on what therapies charted, which are always higher than nursing. I am not FIM cert yet, but will be soon and I hope that we as a team can turn this around. we are not only hurting our patients rehab potential, but these directly affect our PAYCHECKS.

Rehab is great for starters, but so much depends on the facility. I love where I am-we have a low turn around rate and are a big family. Our census is hurting though, STILL. Right now we may be sitting around 45 out of 60.

[takenbyjoy]

all rehab units must get serious about fim scores.....we're being required to go to a 24-hour fim tool to capture the fim scores on the night shift. also, our nursing documentation tool (dar) is going to be based on fim....total nursing assessment using fim. we are modeling this on a form from touro infirmary in new orleans. sounds like your staff need more education regarding fim scoring. i do the education here and what i find is that people forget that you are suppose to score the lowest score, not the highest. the lowest score reflects the burden of care for that patient. all staff should have imput into the scores. have your cnas been trained in fim? we use our interdisciplinary team meetings to discuss discrepancies in fim scoring. i hope your therapy staff are open to discussing the differences in scores. if there is little to no carry-over in what patients are doing in therapy, then the burden of care at home is going to be tremendous.

[mel1977]

our scores are done for 3 days which include Day, Eve and NIght shift so we will get very accurate scores as long as people fill the sheets out. We aren't so big so it shouldn't be hard to keep on top of it. I think the hardes thing at first will be for the techs to remember to do it. We haven't yet trained our aides in FIM-they have a different paper to fill out, but at our staff meetings we went over our entire fim module. We'll see.