Newgrad rehab Interview/is it slower-paced than med/surg?

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    Hello Rehab Nurses!

    I am a newgrad who has been working on a post-op lung surgery/medsurg with tele floor. I have just completed my 12th week of floor orientation and my manager told me that I am not a good fit for the floor because I am too slow. I have been improving and taking 4 patients a day. My manager wants me to be able to take 5 patients. Unfortunately, I was told to resign or be terminated in 2 weeks.

    I spoke to human resources about transferring to another floor. I was told that the sub-acute rehab floor in our skilled nursing facility is slower-paced. I have an interview on the sub-acute rehab floor on Thursday. Has anyone worked in both med/surg and sub-acute rehab? Is sub-acute rehab indeed slower-paced or more manageable? What is the nurse patient ratio like? Since I may be transferring, should I ask if there will be any sort of orientation at all?? Even a week of orientation since it is a different floor? What are the differences between sub-acute rehab and med/surg? What other questions should I ask?? I appreciate any advice.
    Last edit by KdubsRN on Nov 1, '11 : Reason: smiley that should not be in there
  2. 8 Comments so far...

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    So looking through some previous posts I've realized sub-acute nursing units have nurse patient ratios of 1 nurse to 7 or 16 patients.

    I guess whether it is the same pace as med/surg or slower depends on how many patients one has.

    Still...is a sub-acute rehab floor more manageable than a med/surg floor? and should I ask for a one week orientation? The position I have an interview for is a 11pm to 7am shift. What kind of things go on during that shift? I appreciate any advice.
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    If you are going to work an 11pm-7am shift on a sub-acute rehab, the pace is definetly going to be slow. Most of the time when you begin your shift you won't have many medications to give. You can pretty much thoroughly assess each patient and get your charting done within a reasonable amount of time. After the patients fall asleep, the time tends to go by pretty slow, although you will have a few patients who will use their call lights for assistance to the bathroom.

    Daylight shift is another story. I've had up to 7 patients before (even during nights) and half of the time there is no nursing assistant. There is a rush to do your med passes and make sure that your patients are ready to attend therapy on time (physical, occupational, speech, and adls).

    As for the managability of a sub-acute rehab unit, patient's have to be considered "stable" to attend three hours of therapy. These patients will come in with deconditioning or post-op status (total knee, hip, back). A good number of them will have numerous other medical conditions such as diabetes, obesity, respiratory/cardiac/GI issues as well as psychiatric. However, don't expect to work too much with IVs, PICCs, blood, tube feeds, bladder irrigation, and all of those other things you've seen on a med surg unit. Nonetheless, these patient's still require more care, so imagine having a total of 13 patients on your unit, only 2 RNs, no nursing assistant, and having to get these patient's ready for therapy, transfer them in/out of bed without a nursing assistant. This is typical on my unit.

    I see no reason for you to not have oriention, but that's a good question to ask the unit director. One thing you will definetly learn how to do on your rehab unit- if it is done- is FIM scoring (Functional Independence Measure). If you get the job on the rehab unit, just use it as an opportunity to improve your organization, prioritization, medications, assessment and communication skills.
    mitral and KdubsRN like this.
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    sub-acute rehab in a skilled nursing facility is different than an acute rehab unit (where I work) - I started as a new grad, and am happy here - we get patients who have medical conditions that require 24-hour nursing care... but we stay busy, even on the night shifts, and at times it's a 'break' to float to one of the medical units... good luck! you'll find your fit - it just might take a bit. If you can - look for a magnet hospital, a strong system, or at least one with an established new grad program, that will give you support through that first year, and will work with you to ensure your patients are safe...
    KdubsRN likes this.
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    When I did subacute rehab at a skilled nursing facility, my average patient load hovered between 12 and 18 during day and evening shift. I could have up to 36 on nights. You cannot be slow if you're going to work in a skilled nursing facility because you'll have more patients, which means you must manage your time effectively. Good luck to you!
    KdubsRN likes this.
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    I am a new lpn and took a position on the rehab floor. My patient load is 5-8 , it is slower than most floors but you will stay busy. We care for a lot of skin breakdown problems and do a lot of "cna" tasks. Charting takes the most time as we use epic in our facility.
    KdubsRN likes this.
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    Thanks everyone for all your advice! I interviewed and got the job! My manager will be giving me 3 weeks of orientation. Ratio is 9 patients. I'm excited about this facet of nursing I have never considered and hope it is a good fit for me.
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    I work in an acute inpatient rehab. They don't qualify to be there unless they can tolerate 3 hours of therapy a day for 5 days a week out of 7, and have co-morbidities that nurses have to manage. Our ratio's are 6:1 total care, so no CNA's for us. I have a background in med/surg/tele, and I can tell you it is not all passing meds, fim scoring, and charting. Your assessment skills have to be sharp! We have brain injuries, traumatic and non traumatic, spinal cord injuries, hips, knees, cardiac, etc. One small change in a patient that goes un-noticed, or a small change in their vitals, is the difference between getting them to the ICU quick, or calling a code. There are definitely shifts that I can't wait to get home so I can sit down for 10 minutes. I find it very rewarding to take care of patients who come in unable to swallow, breath on their own, sit up, walk, or talk, that by at the time of discharge they hug me goodbye, say thank you for all I have done, and walk out or roll out under their own power! It is amazing!
    Kindnessecity, JPA_RN, and KdubsRN like this.
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    HI! i came across your thread when searching for acute rehab information on this site, and like you a year ago also have an interview for an acute rehab unit, and was wondering if you could tell me what kind of interview questions you came across? Was it specific to the unit? or just the general? Thank you , I appreciate your help.
    Last edit by FaithHopeLove22 on Aug 14, '12 : Reason: redit


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