New grad-start job next week

I'm looking forward to my starting date too.i'm really interested in advice to this thread.goodluck,my Dear.

I am a new grad too. I just quit rehab after about 2 months because I'm moving. I would suggest reviewing wound care, particularly surgical incisions. I did a lot of dressing changes. Know the signs and symptoms of infection. And always look at the wound before you chart on it. It seems like common sense, but if the dressing isn't due to be changed I see alot of nurse chart "dressing dry and intact." I would rather take the time and redress it just to see what it looks like.
I have alot of knee replacement patients and have them bend their knee a little when putting on the dressing, otherwise it will be too tight when they ambulate. Another thing I have noticed about knee replacements is they often blister around the edges. The blisters can be huge and fluid filled. I have been seeing that quite a bit. Our NP is trying to figure out if it is the tape or cleaning solution used before surgery that causes this. Many patients complain of itching in the area too. I always use a skin prep wipe before applying the dressing to protect the skin from tape irritation. As the wound heals, I like to downsize the dressing so they're not interfering with PT. I really like Telfa Island dressings. They seem to fit perfectly.
Another thing about rehab, let the patients do what they can. As a former CNA, it seems easier and quicker for me to just help them transfer or stand up. Let them do it how PT showed them, even if it takes longer. Stay really close so you can help if needed. It's really important to allow them to rehabilitate so they can go back home.
Where I worked, I had 12 patients and 2 techs to help. Learning to prioritize and delegate is big. Pain meds take main priority often, because you don't want the patient to be in pain while doing PT, they'll get less accomplished. Our physical therapists are really good about letting me know when they'll do therapy so I can pre-medicate for pain.
I don't know what type of facility you're in but in mine, we had quite a few sitters. Families hire them from outside agencies and they just come sit with the patient so they're not alone all day. Some can be very helpful, but in my experience, they can drive you CRAZY! They only have 1 patient, they don't acknowledge the fact that I have 12. And alot of them think they're nurses and will try and tell you what needs to be done and when. Just remember, you work for the patients, not them. Don't let them stop you in your morning med pass to "go ahead and change the dressing." It is not fair to the other patients that are waiting on you to give their meds so they can do therapy or take a shower, whatever. I found this to be very difficult, but you must prioritize.
Overall, rehab is a pretty good place to start out. You get experience with managing multiple patients and overseeing CNAs. I consider it like med-surg but more predictable. With most patients staying about 30 days, you get to know them, their routines, and what to expect for the day. This helps alot with planning your day out if you're a bit anal like me and like to stay on top of things.
Good luck with everything and I hope I answered some of your questions!

If its anything like my acute rehab.....buy yourself a good pair of RUNNING shoes!!

Well you should have been working for a couple of weeks now, what do you think? I get really frustrated because other nurses think Rehab is easy and that our patients aren't very sick. The acuity on our unit has increased substantially over the last few years. Rehab isn't just hips and knees any more, at least at my hospital. We treat spinal cord injuries, TBIs, and patients with a variety of serious comorbidities that fall under the diagnosis of "peripheral neuropathy" for us. We have trachs, peg tubes, ostomies and wound care just like the rest of the hospital.

The thing that I love about rehab is that our average length of stay is two weeks. We get to know our patients. We get to do a lot of teaching and, in most cases, our patients get their independence back. It is very rewarding.

Thank you for this post....I too start orientation in an acute rehab hospital this Monday.....so all the tips were helpful....

just wondered since you posted this in August, how has it been? and do you have any more tips on how to prepare myself.

tips from others welcome too.....

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