Rehab Nurse UNDERSTAFFED, need advice please!

  1. I am a new graduate RN and have 2years LPN experience. I was hired in August to a skilled nursing facility with a floor dedicated to "Post Acute Rehab". Today my beds were full with 19 patients. NO unit manage, an LPN med nurse taking over as charge nurse, and a new hire on the other side. These 19 patients include about 12 recent orthos along with strokes, COPD, nephrostomies, gtubes, urostomies, ileostomies, IV antibiotics etc. I am responsible for 7-3 meds, treatments, and a skilled check off and notes on EVERY patient along with any admission assessments or discharges. I don't start my am med pass until 9-30 because it takes a half an hour to count the narcs that have not been emptied in months. The scripts and narc kit do not even fit inside the narc box. On top of that almost every patient is looking for pain meds the moment I get onto the floor or physical therapy is chasing me to give someone pain meds so they can take them to the gym. Even with help with some treatments from the charge nurse I am not leaving until at least 5pm. I have already addressed my concerns with the DON and ADON with them saying that they can hire another nurse but will take away the charge nurse. I feel that every day I will either make a med error, screw up the narc count, or have a patient upset because their pain is not managed immediately. Im forced to clock out for a lunch break and I spend it either medicating, doing treatments, or writing notes. I don't know how to go about doing anything else? Who do I tell? Can i call the BRN? Is this patient load safe?
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  2. 10 Comments

  3. by   wishinguponastar
    After a year and a half of working in the Short term rehab setting and working in the exact same conditions you have been is why I have decided to try something else. I am sick of being understaffed, working with no help, getting 3-4 admission in a day, plus being responsible for 15-20 people who are post-op only a few days, confused, etc. I am sick of the management only out for their census bonus. I have tried moving to other companies, or facilities, each time praying it will be better to only find it to be worse or just the same. I'm over it.

    Sorry for the negative post...
  4. by   MichelleRN34
    Whats your ptient load per shift. I worked inpatient rehab...The patient to nurse ratio never exceeded 8:1.
  5. by   vampymegs
    I work in a SNF, ratio for out unit is 16:1 , that's at full census. O agree, the money aspect of all this makes me sad, and a little sick.
  6. by   sommeil
    Quote from wishinguponastar
    After a year and a half of working in the Short term rehab setting and working in the exact same conditions you have been is why I have decided to try something else. I am sick of being understaffed, working with no help, getting 3-4 admission in a day, plus being responsible for 15-20 people who are post-op only a few days, confused, etc. I am sick of the management only out for their census bonus. I have tried moving to other companies, or facilities, each time praying it will be better to only find it to be worse or just the same. I'm over it.Sorry for the negative post...
    I bet we work for the same company. Hahaha.
  7. by   RNinFL2010
    I also work Sub Acute/Skilled. We have trachs, cardiac, pulmonary, GI and ortho. I currently have 27 patients with 2 aides on 11-7. I'm running my butt off even at night. During the day and evening we have 3 nurses and they split 55 patients. It is getting ridiculous. At night, the other nurse is on a floor on the other side of the wing, so we don't even get a break since we can't leave the wing without another nurse on the floor. I don't leave because I hear its the same pretty much every where. The only move now is the hospital, so I'm getting all the extra licensure to aid in getting a job. Keep you're head up and good running shoes on your feet!
  8. by   TheCommuter
    I left the SNF/nursing home rehab setting due to the high nurse/patient ratios.

    I now work at a freestanding rehab hospital. On adequately-staffed nights I receive 7 to 9 patients with one CNA, and on understaffed nights I receive anywhere from 10 to 12 patients.

    So, on a very short staffed night at the rehab hospital, 12 patients is a heck of a lot better than the 15 to 30 rehab residents that I would certainly receive at the SNF/nursing home.
  9. by   brown eyed girl
    I feel you. I left 2 jobs because of the high nurse to patient ratio. We maxed out at 17 a piece and you have to do your own treatments, plus you have to deal with the overly anxious, protective, and sometimes guilty family members! It was all too much for me to do on a full time basis; especially when you work 8 hours and they don't want any overtime (Really????). You learn how to manage (most of the time) but, it doesn't make it any easier.
  10. by   styx876
    Quote from brown eyed girl
    I feel you. I left 2 jobs because of the high nurse to patient ratio. We maxed out at 17 a piece and you have to do your own treatments, plus you have to deal with the overly anxious, protective, and sometimes guilty family members! It was all too much for me to do on a full time basis; especially when you work 8 hours and they don't want any overtime (Really????). You learn how to manage (most of the time) but, it doesn't make it any easier.
    In our rehab facility we have abt 24-26 Nurse-Patient ratio. During the day there is a treatment nurse but not on PM shift. The Pt load is so high that all nurses stay at least 2hrs up to 4hrs just to finish up carrying out orders and charting. Almost every nurse there clocks out for their 30min break then just go back to work. That means we are not only getting paid OT for 30mins, we are working for free for 30mins.

    We are always taught, Safety first. But what can be done so nurses are not abused like this?
  11. by   TheCommuter
    Quote from styx876
    We are always taught, Safety first. But what can be done so nurses are not abused like this?
    Vote with your feet...seriously.

    As long as nurses continue to willingly deal with substandard treatment year after year, employers will continue to provide crappy working conditions.

    However, if too many nurses drop like flies in rapid succession, the high employee attrition rates will become too expensive for the employer and affect profits. If more members of nursing staff vote with their feet, changes might arise.
  12. by   styx876
    Quote from TheCommuter
    Vote with your feet...seriously.

    As long as nurses continue to willingly deal with substandard treatment year after year, employers will continue to provide crappy working conditions.

    However, if too many nurses drop like flies in rapid succession, the high employee attrition rates will become too expensive for the employer and affect profits. If more members of nursing staff vote with their feet, changes might arise.
    The Commuter, thanks for your feedback. WOW! I would take 12 patients any day!

    Since you have background in SNF/ Rehab setting, you must know how all of us feels about this situation. I also read threads about this topic way back almost more than 8yrs ago. So it's been going on.

    Honestly, I'm currently looking for another job. I wanted to learn more about SNF but the working condition is getting ridiculous. It's only a matter of time before the mgt will try to talk to me abt the recurring OT. Some other nurses there don't want to say anything for fear of losing their jobs. So they just continue being exploited. This is my first job as a new grad and I'm pretty much stuck at this job because hospital jobs require to have at least 6mos acute experience.

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