new to acute rehab...how is it different from med-surg/ortho?

mom2cka · Jul 25, 2008

I work FT in rehab and float to our ortho/neuro floor and it's much different. Rarely do we have an IV, perhaps 1 in 50 patients has a trach (maybe less) and I've been there a year and have yet to hang blood on our floor - assisted on ortho, though. Our patients are 'sicker' than in the past, I've heard, but as a new grad, I started in rehab and often don't feel I'm getting skills I need/want if I were to venture into the medical side of things.

Ortho - ratio may be RN/PCA with 3-4 patients or RN/LPN/PCA with 5 or 6 patients; in rehab it is often 16 patients on the floor (we can have up to 20) with 2 RNs, 2 LPNs, 2 PCAs (or at times 1 or 1.5 PCAs) - often another nurse on day shift is added to the mix. Our PM and night charges take patients, and on weekends all shifts the charge takes patients. It's different - not bad, but different.

I hope that helps :)

FranNHRN · Jul 26, 2008

I work on an acute rehab unit. To me, it's different from med/surg because patients are expected to get dressed and out of bed daily for rehab. they are encouraged to do as much for themselves. We do get sick patients that need blood transfusions or IV antibiotics. We sometimes get TPN. Frequently, we have people of tube feeds. It's very hectic in the am because you have to get your meds passed by 0900 to get done before therapy starts. From what people have told me that have worked there for a long time, the type of patients have changed due to medicare reimbursement. We get sicker patients that often don't do well on rehab. People that are too good are not qualified. It's sad when we get these cases that just don't belong there. It happens.

mom2cka · Jul 26, 2008

I would be happy to have until 9 AM to get my meds done :) Many of our patients start their first therapy by 8:30 - so start at 7, get report, on the floor at 7:30, try to get glucs, people up for breakfast (that's at 8) then pills done before therapy... we were going to try to change everyone to PM baths, but that didn't work, so 1/2 of our patients get baths between that time frame, too... hectic is right! We get patients with tube feedings, often A2 to transfer, with 1:1s fairly frequently. My days go by too fast... oh, and did I mention admits/discharges/transfers???

mom and nurse · Jul 27, 2008

I worked acute rehab for about 3 years right out of school. We had IVs, peg tube feedings, TPN, etc. Our patient population consisted of people with spinal cord injuries, traumatic brain injuries, strokes, neurological disorders, amputations, and a few folks who were hip and knee replacement folks with other major health issues.

I'm now a Nurse Practitioner and still work in a rehab hospital. I enjoy rehab and enjoy having the folks come in flat on their backs and walk out using walkers or canes (or roll out more positive about their life as a newly handicapped person in wheelchairs). Since I stayed in rehab I would say I had a good background for the kind of work I do. It would have been more of a problem if I had decided to work as a nurse practitioner on a med/surg oncology floor since we didn't deal with many oncology patients. Though we did see a few folks with Coronary Artery Bypass Grafts (CABG) and I will be working with more of those kind of patients in my new position.:wink2:

nervousnurse, ASN · Aug 26, 2008

I've just completed a year in rehab, and I call it "med-surg without all the IVs".....:)

I've noticed in the past few months what others are saying about patients being sicker and NOT good candidates for rehab! Lately, more and more 85-95 year olds who TELL us

"I do NOT want to be here and I am NOT going to therapy!" Ummm....I thought all of this was considered when the liasons assess the patient? :confused: Believe me, I don't claim to be an expert on this by ANY means!! I am too BUSY running the whole shift to know alllll the details of who gets admitted versus who doesn't.

We give blood about every couple weeks, IV fluids/antibiotics are also not that often. We have to start peripheral IVs maybe once a week, and lots of our patients have PICC lines or other central lines. We have to draw our own blood for cultures (for a temp over 102) and type and cross; otherwise outside phlebotomists draw all our other labs verrrrrrrry early (starting at 3:30 am!)....the patients are NOT happy about that! :devil:

What kills me is that I have oriented THREE people lately who, on their FIRST day, say "I'm afraid I'll be BORED here".....(all 3 come from a med-surg background). My first thought is "then WHY are you here?" (although I don't say it!).....then after we RUN for 12-13 hours straight, I wonder just how BORED they are! :cool: I think a LOT of nurses think all we do in rehab is push pain meds----oh, I WISH!

We have LOTS of serious wound care, lots of COPD, CHF, and a million other co-morbidities along with their rehab diagnosis like joint replacement or spinal cord injury, traumatic brain injury, CVA, debility ....Sometimes we have a patient load where a couple of our patients have trachs, bolus tube feedings Q4, and wear Depends--etc.

The MAJOR difference between us and med-surg that we got to know the patients, and I LOVE is seeing a CVA/ brain inury patient improve after weeks with us!! It is AMAZING!!!