new rehab nurse - page 2

Hello. I am a new member to this board. I've been working in a rehab hospital for the last 4 months. I've become a little discouraged with the nurse to patient ratio (some nights it has been... Read More

  1. by   mom and nurse
    Thanks CC123, I kind of found the 15:1 ratio that someone wrote about for rehab nurses kind of scary also...but then I'm only a student and 6:1, which I know is a good ratio, seems scary also. Hopefully at my senior practicum at the rehab center I'll be able to do more med surg nursing. I've heard its good to do as much med surg as you can before taking the NCLEX because much of the NCLEX is med surg...as least that's what I've been told. I'm really leaning toward trying to find a job in rehab nursing after I graduate. We'll see if I feel the same way after my senior practicum.
  2. by   sallyrnrrt
    I work in a sixteen bed in patient rehab unit which is part of a community hospital--rather small but progressive. During the day there are two RN's two aides, same on 3-11 and two RN's and one aide on nights. Not too bad. Some nights you run your legs off but we can have nice peaceful stretches--depends on what our population is like at the moment.
  3. by   JWaldron
    Quote from mom and nurse
    NLHRN I'm curious that you said "Even with all this said,,I wouldn't do med-surg (floor) nursing for anything!!! They may have less patients but they have it much,much worse then us,,in our facility anyway!! "
    __________________

    NLHRN (or any other rehab folks) - I'm a senior nursing student about to do my senior practicum at a Rehab facility (brain, spinal cord, etc). I loved the tour they gave me of the place. Doesn't rehab nursing involve a lot of med surg? The nurses in rehab seemed happier than the ones I remember on the med surg floor of the hospital that I did my clinicals at. Why are those of you who are rehab nurses doing rehab instead of med surg? Those of you who have done both....what's the difference between the two?
    I've done both - I'm a CMSRN (certified Med/Surg RN), and I'm still doing Med/Surg on Rehab. Don't tell me that pts. w/ central lines, multiple complex dressings, etc. aren't Med/Surg patients! Any patient who needs several IV poles to hold all the pumps is certainly a M/S patient. Yesterday I got a vent patient direct from the ICU. My patients are just as sick when they arrive. And many of them leave for Intensive Care or Stepdown again within a day or so. (They were not appropriate admissions in the first place, but it's a $ thing, IMHO)

    However: On the M/S floors, I was responsible for 16 patients (with an LPN and an NA under me). On RHB, I rarely have more than 8 patients, w/ an aide. And the majority of patients stay long enough to develope a true therapeutic relationship with them and with ther family. I get to see significant improvement in 'my' patients, and sometimes I get to see them come back later, walking, talking, leading productive lives. Or I know that their quality of life is better, because I can see it improving. I get to see grandparents who can hug their grandchildren again and/or read to them, can go to church again, or who can go back home instead of to a nursing home. Or who can use a walker instead of being wheelchair-dependent. Or people who can now dress themselves, or help to dress themselves, or toilent themselves, Or who can develop tthe skills to function with a spinal chord injury (altho we usually have to transfer many SCI to longer-term RHB facilities).

    But: I also feel frustrated by the fact that I have not learned MORE about RHB nursing than I have, because I work the evening shift. I don't get any feedback from the therapists, or get to see what they do w/ the patients so that I can reinforce it, Or point out problems pts have later in the day when they are much more tired. The therapists see them at ehir best - well-rested.

    I don't think there is a PERFECT nursing job, but I love what I am doing, and I love the fact that I have much more opportunity to do patient teaching, answer the questions of patients and their families (not always, but once in a while). I'm glad I shifted units, and I'm glad Ihave my Med?Surg skills, because I use them every day. Our patients are getting sicker and sicker too.

    Savvy One
  4. by   mom and nurse
    Thanks JWaldron - I've started my practicum in rehab nursing and I have noticed that some of the patients are sicker than I thought they would be in a rehab facility and I've seen the usual peg tube, IV, etc. Med Surg skills come in handy. The majority of patients are pretty much what I expected (amputees, hip and knee replacement, etc.) I am enjoying that I get to know the patients before they leave and I am learning about FIM scores, etc. The patient load is usually around 6 - 8 patients per nurse. Hours worked are anywhere from 8 to 16 hour days . I'm definitely learning about many medications (since many of the patients are elderly).
    Last edit by mom and nurse on Mar 7, '04 : Reason: slight correction
  5. by   phyrenrain
    Hi Yeti,

    I am also a rehab nurse (x almost four years) and just wanted to share a tidbit with you. I was on the unit yesterday when an instructor for a hospital-based nursing programs came through w/a lg. group of students. He paused for all of about 10 secs, long enough to inform the students that the pts. on this unit are "getting ready to go home.":angryfire :angryfire :angryfire I was infuriated and wanted to say, "Hey, have a look at some of our diagnoses!!!" When was the last time you tried to transfer a CVA pt w/total hemiparesis to a toilet from a WC!?!?!?! GRRRRRR! Our unit is generally a staffing pool. Just last night on 11-7(we have 8 pts, one of which is confused and pretty much 1 on 1), the house super pulled the LVN, replaced her w/ a CNA (okay), but then at 0330, pulled the CNA and left the RN alone! We both know that not only is this not SAFE for the pts., but also against CARF regs!!! Just venting.....Thanks!








    Quote from Yeti1313LPN
    hmm.... depending on the facility, your acuity, and about 17000 other factors...
    sometimes ratios in rehab are horrible, as our patients are considered 'sub-acute' in the realm of categories.... wheras we all know, a 'sub acute' can go 'critical' in a matter of instants...
    best of luck...
    --Barbara
  6. by   sallyrnrrt
    Amen to everyone! We too, are getting people who are more and more ill. The difference is, I am only responsible for eight, not sixteen like M/S or 45 or more like LTC. Just the other day we had a gentleman admitted. The 7-3 Charge nurse took his information and just as she was wrapping up, he c/o #10 chest pain. Three nitro did not relieve it, so back he goes to the ICU. Then he gets sent to Lehigh Valley Hospital, a large, level one trauma hospital here in the northeast. He's there a couple days and comes directly back from their CCU and post cardiac cath. Last night he developed a GI bleed rectally for me about four am. Became unstable about 7 just at shift change and is back in the unit with a Hgb of 7.5 AFTER two units PRBC's. Guy has a laundry list of diagnoses. We were told at a recent staff meeting that they will be looking for admissions with "comorbid" conditions. You are right--it's a matter of money. Nothing to be done about it. Focus on the good things about Rehab nursing and the good you are doing. I looked on the bright side of that episode--I could have had this gentleman in the nursing home, with me, two aides and 45 residents to be responsible for, many of whom are confused and climb out of bed at night.
  7. by   amylou85
    Quote from Jaaaman
    Hello. I am a new member to this board. I've been working in a rehab hospital for the last 4 months. I've become a little discouraged with the nurse to patient ratio (some nights it has been 15:1). I don't feel like adequate assessments and nursing care can be done with nurse to patient ratio's like this. I'm thinking about going back to the general hospital I worked at before this. I'm just wondering if this is the norm for rehab nursing? p.s. I am a fairly new LVN (graduated last December) Its possible I'm still trying to find my niche.
    Wow 15:1 that is tough. I work in a 53 bed rehab hospital, Typically we have between 5- 8 on days and night can have up to 11 but thats really rare- we have two units and 3 day nurses and 2 on nights- I have had 11 on nights and its too much-- you are doing good just to get your meds passed and to chart. And its been my experience that you do alot of the techs work, like toileting, dressing, etc....15 is way too much, and you have to consider the acutity of the patients..amy
  8. by   LOU12345
    Quote from Jaaaman
    Hello. I am a new member to this board. I've been working in a rehab hospital for the last 4 months. I've become a little discouraged with the nurse to patient ratio (some nights it has been 15:1). I don't feel like adequate assessments and nursing care can be done with nurse to patient ratio's like this. I'm thinking about going back to the general hospital I worked at before this. I'm just wondering if this is the norm for rehab nursing? p.s. I am a fairly new LVN (graduated last December) Its possible I'm still trying to find my niche.
    Im a rehab nurse in Australia, ratio day 5:1 eve 8:1 and night 15:1..we are classed as sub acute, roatios 4:1 in acute
  9. by   caren2005
    Quote from redshiloh
    What type of rehab medicine? I work spinal cord injury and our ratios on days and eves are 3-4 to one and on nights 6-7 to one. Rehab medicine is a line of work that's tough on the body.
    Hi My name is Caren. i had a question. You stated that you worked in spinal cord injury rehab nursing... i have a question just for you. i have a spinal cord injury. Brown Sequard syndrome 11/8/04. i just began nursing school last week in NJ. i am still at kessler institute for rehab as an outpatient. I really want to be a nurse but i am unsure of the specialty i want to work in b/c my physiatrist said i have to find a type of nursing that will not be too high impact. I would love to work in rehab nursing specifically SCI patients. My nurses in the hospital were great and i would love to be that supportive and have that impact on another person with SCI. I would also love to show them that you can perservere, and make something of yourself in spite of having a spinal cord injury. Do you really think that this is a realistic expectation to have at this point? I would really appreciate your advice.Given your experience and perspective, what types of nursing do you think would be worth considering?
  10. by   NANNERS
    New To Site With Question. If Your Census Is Down How Does Your Staff Get Adjusted? Do You Have A Formula That Maintains The Appropriate Amout Of Staff Needed? I Work In A Rehab Facility That I Think Depends On A System That I Believe Is Failing. Our Patients Are Not That Critical And The Acuity System That They Use Makes It Almost Like Icu And Almost A One On One Staff Situation That Cannot Last. Any Advice Suggestions?
  11. by   TracyB,RN
    Caren... I admire your determination. I have to check out your diagnosis, as I am not familiar with it or your limitations.
    I can tell you that I had back surgery (discectomy L4-5) 10 months ago today, & STILL am unable to work rehab, (or any other job) despite my efforts to do so. I am currently on a 10# lift restriction, with other restrictions for bending, stooping, stretching, etc.... At this rate, I am probably looking at a disc replacement or fusion in the next 2 yrs. I don't see myself ever being able to do rehab, let alone basic nursing care & I am not even 35 yet. I a, searching for a less physically intense nursing job & not having the greatest luck. Nobody wants a nurse who can barely lift a gallon of milk...
    So, rehab is totally cool.... But very physical at times.
    Be careful & best of luck to you.
  12. by   unknown99
    Wow!! Our ratio is 6 rehab patients to one team of an RN and a rehab aide.
    I cannot imagine more!!
  13. by   Gennaver
    Quote from TracyB,RN
    Caren... I admire your determination. I have to check out your diagnosis, as I am not familiar with it or your limitations.
    I can tell you that I had back surgery (discectomy L4-5) 10 months ago today, & STILL am unable to work rehab, (or any other job) despite my efforts to do so. I am currently on a 10# lift restriction, with other restrictions for bending, stooping, stretching, etc.... At this rate, I am probably looking at a disc replacement or fusion in the next 2 yrs. I don't see myself ever being able to do rehab, let alone basic nursing care & I am not even 35 yet. I a, searching for a less physically intense nursing job & not having the greatest luck. Nobody wants a nurse who can barely lift a gallon of milk...
    So, rehab is totally cool.... But very physical at times.
    Be careful & best of luck to you.
    Hi TracyB RN,

    I am a student nurse who worked almost three years in Physical rehab. Yes, it is very physically demanding, very much so. We did get our patients up, (even the spinals) every day. Most patients we got up several times a day and gave really good care, (I am proud of the care my coworkers and I gave, they really cared). However, this was so very physically taxing.

    Many of my coworkers had mentioned remembering a time before they hurt their backs!

    My grandmother had her spine fused due to degenerative disk disease and herniating disks and my mother had ortho surgery when hers went bad and then had neuro-surgery for the second and third times. I also know another person in my personal life who had a fusion and two other people with herniating disks that did not have the fusion.

    Based upon my conversations with those people and from my observations of them, I am ready to make the choice of fusion if my day ever comes. Personally, I think I would rather loose a little range of motion right off the bat than to risk years of herniations. Of course this is not very well thought out as, (knock on wood) my back is still trying to hold its own.

    I want to wish you well and suggest you look into office nursing. When I worked at a large women's health facility we did get nurses to come to work for us from two of our companies hospitals when they were on physical restrictions for either bad backs or injuries or what not. Maybe this is an option for you. It is not bedside nursing but, it IS nursing.

    Good luck,
    Gennaver

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