Nursing Safety: Patient ratio in Subacute Rehab

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    Does any one know what is the nurse patient ratio in subacute/rehabilitation hospital?
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  3. 12 Comments so far...

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    It depends on a lot of things, like what state you are in and the company you work for and the acuity of the patients. I work in a sub acute rehab facility, not a hospital. Our ratio is 15 patients. Most of the other facilities in town are 12.
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    I was told 7-8 when I was hired in subacute. However it could be more or less. I refused an assignment in subacute because I one point they wanted to put more on me then I could bear, and with limited resources.
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    CMS (Centers for Medicare and Medicaid) sets forth guideliness for long term care SA rehab floors and TJC has standards but are usually pretty vague. You should check with your state nursing board. It will also depend on your P&P's. I worked a SA floor in a nursing home where during the week it was 1:15 (not ALL were SA patients tho), but on the weekend the nurse had the whole floor. It was very stressful and nerveracking. I would pray every day on the way home that I gave all the right meds to all the patients. Not a good feeling for a nurse.
    LockportRN likes this.
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    Where I work its from 9-14 to one RN but at others I hear it goes to as high as 24 at neighboring places. The day staff hates when they get 9 so I guess they get a lot less.

    I work nights though so no one cares about us.
    LockportRN likes this.
  8. 1
    Quote from a4amal
    Does any one know what is the nurse patient ratio in subacute/rehabilitation hospital?
    The rehabilitation hospitals in my area will staff 1 nurse for every 6 to 11 patients.

    The subacute rehab facilities (a.k.a. nursing homes with skilled Medicare wings) in my area will staff 1 nurse for every 12 to 25 residents. It depends on the facility.
    LockportRN likes this.
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    I work on a subacute floor in a nursing home and I have between 17 and 21 patients depending on the census. Fair amt of turnover from day to day...we have at least 4 discharges a week and admissions almost every day. The LTC parts of the facility have 40 patients for one nurse. It surprised me when I first started but it's surprisingly do-able. I can't do everything for my patients, but I can medicate them and provide treatments and still feel safe. Of course the CNAs, PT, OT and charge nurse help out a lot too!
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    Quote from sbostonRN
    I work on a subacute floor in a nursing home and I have between 17 and 21 patients depending on the census. Fair amt of turnover from day to day...we have at least 4 discharges a week and admissions almost every day. The LTC parts of the facility have 40 patients for one nurse. It surprised me when I first started but it's surprisingly do-able. I can't do everything for my patients, but I can medicate them and provide treatments and still feel safe. Of course the CNAs, PT, OT and charge nurse help out a lot too!
    Can you tell me how you organize your day? If there are no incidents and no admits, I can manage the 17-28 patients I get per day, but when you add in those extras, I have trouble. Last night I had a new admit that I didn't know about until I got report from the hospital. I had no med list or anything to start on the paperwork until they arrived. In addition, the patient had 4 psychoactive meds that I had to get consent for and of course the RP wanted to talk out her decision about each med. I also had to call the MD to verify the medications, write them all out and fax to the pharmacy, do a complete assessment (about 5 pages of information), write a detailed nurses note (which must include most of the information from the assessment already completed - yup, gotta write twice), write the admit order, fill out the CNA care information, write a dietary order, and complete all of my normal work including numerous requests for pain medications, HS blood sugars (yup, we do those too), and two G-tubes. I didn't clock out until 11 pm (my shift ends at 10 pm) and will get a "note" about that when I go in today. I honestly don't know how I could have organized myself any differently to get it all done on time.
    LockportRN likes this.
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    With an admission that complex, I wouldn't have gotten out on time either. In fact, I rarely get out at 3:30. Usually I get to work at 7 AM (I used to get there early but I got lazy), get my cart prepped with Ensures, insulin, ice water and anything I know is running low or things I know I'll need. I rarely get a full report because I work every day so I just ask if there's anything critical I need to know. I take narcotic count from the previous shift and get out on the floor by 7:20 (ideally). First thing i do is my blood sugars, then pop out a few people's meds before the breakfast trays come up around 7:45. Nurses have to check the trays to make sure allergies, textures and diets are all correct. Once the trays are up I give insulin.

    Then I continue going room to room giving meds until about 9:30 ideally. Sometimes if it's a heavy med pass or my side is full, I don't finish until 10:30 (at the latest). Then it's time to do treatments. At my facility I have fantastic CNAs who will apply most protective creams and put on Teds to those who need it. I verify that Teds are on, hearing aids are in, dentures are in, and creams have been applied. I put on any creams that are medicated creams, do dressing changes, etc. in this time. Basically I try to get done with ALL of my treatments before the lunch comes up, because you never know what the afternoon holds. Usually I am successful but it depends on who is down with Physical Therapy because sometimes the pt is gone for too long. Around 11:45 I check blood sugars again, give out any pre-meal insulins or Omeprazoles, then check the lunch trays. At this point I take a 15 minute lunch break and will fill out mindless Medicare documentation. Once lunch is finished I'll start my 2PM med pass around 12:45 or 1:00. That's usually done by 1:30 (not too many afternoon meds) and if everything is going perfectly, I'll stock my cart again and start notes.

    We're very lucky in our facility to have a 4th nurse on 99% of the time. So two med/treatment nurses, 1 charge nurse (to do MD orders, make appts, do labs), and one extra nurse to either help with treatments, help the charge nurse, or do admissions and discharges. She enters all the orders, verifies things with the doctor, and sometimes even does the head to toe assessment. The only thing I sometimes have to do is the head to toe and note. You are fully justified in working 1 extra hour to do an admission of that depth. That would take me probably 3-4 hours to do!

    Even on a perfect day with no emergencies and no admissions, I still work overtime. I think there have been 2 days that I haven't worked overtime in the entire time I've worked there.
    LockportRN likes this.
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    Thanks that makes me feel better. I guess my administration just needs to realize that what they are asking in simply impossible. Right now I am the nurse on 2-10 that has been there the longest and I've only been there since June 28th.

    Unfortunately, our unit manager is told not to help us with things like orders, lab requisitions, phone calls to MDs/families, etc. They are given specific tasks they have to do within the timeframe they are working and don't have much time to help us out with anything. It's not that they don't want to (although some really don't want to help), but they get "talked to" if they do.


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