Rehab nursing-the good/bad/ugly?

meluhn · Mar 14, 2009, 06:38 AM

Re: Rehab nursing-the good/bad/ugly?

Originally Posted by OldPhatMC

Most frustrating are the career rehab/nursing home nurses that have no sense of urgency. If I have a patient with vomiting and abdominal distension, I want to start pushing the issue NOW to the doctor, not sit there and "let's wait until the PA comes in" or worse "I'm not going to call the doctor about that".

I think rehab nursing is a good waypoint. I think we all could benefit from doing some time in as rehab nurses, but as a career, you'd have to find some part of the job that incites a little passion. I can't say that I have.

Sorry for being a negative Nelly. The job needs people with acute level expertise. The problem is that the reality of variable, distressed, fragile patients hasn't caught up with the American system of third party payment. So on paper, you should not be seeing very sick patients. But in practice you will.

OldPhatMC, RN Sends.

I must point out that there is a difference between subacute units in LTC facilities and acute rehab facilities such as the one I work in. I work in a rehab unit that only hires RNs in a hospital (that uses LPNs). We use all the facilities of the hospital-dietary, lab, pharmacy, xray, endo etc. If we need a stat CXR or CT scan or anything stat, we get it. OldPhatMC is right, the nursing home subacute units have similar patients that can be very complex but they do not have the facilities to handle it and many are staffed by LPNs although some try to get RNs only. Another difference is nurse

atient ratios. I would never recommend LTC/subacute for this reason, to patients or nurses. Although they have improved in recent years, I have worked on subacute with 25-30 patients assigned to me. I was literally risking my license everyday.

I hated it. They had high acuity hospital pts but tried to staff like a nursing home. They have improved but the nurse still takes 12-15 patients. In acute rehab I have a max of 8, usually 6 or 7 on day shift.

ayla2004 · Mar 14, 2009, 01:39 PM

Re: Rehab nursing-the good/bad/ugly?

Waht my ward lacks at time is full time presnet on the ward medical coverage as pt are assumed to be stable. We do have one part time SHO(resident we are a teaching hospital)and use cover from 2 other wards and on call services.
Patients do become unwell and develpo exhib other contions cardiac, HAP, DVT etc
i would hate to do my job in one of out commiunty based reahb units without oncall cover a full crash chart and acess to ct and mri onsite.

PAERRN20 · Mar 15, 2009, 02:32 PM

Re: Rehab nursing-the good/bad/ugly?

OldPhatMC- I have run across this as well. Except we have the opposite problem at the facility I work at. The rehab RN's will be send in patients to the ER who have nothing wrong with them. Perhaps this is a good thing though. Rather send the patient back healthy. I can't recall a time when our hospital rehab sent a pt to us who was having an acute MI/PE/DVT/etc. I would bet that the docs just admitted the patient directly to the floor. Luckily the unit I am considering is attached directly to the hospital so they have the services on site.

The local subacute units of the nursing homes are different though. It seems as if they have forgotten how to be a nurse.

It seems as if my ER background would be of good use in rehab if I considered to go that route. I can easily get on that doc's back if he won't order something for the patient that they need

meluhn · Mar 15, 2009, 02:44 PM

Re: Rehab nursing-the good/bad/ugly?

Originally Posted by PAERRN20

OldPhatMC- I have run across this as well. Except we have the opposite problem at the facility I work at. The rehab RN's will be send in patients to the ER who have nothing wrong with them. Perhaps this is a good thing though. Rather send the patient back healthy. I can't recall a time when our hospital rehab sent a pt to us who was having an acute MI/PE/DVT/etc. I would bet that the docs just admitted the patient directly to the floor. Luckily the unit I am considering is attached directly to the hospital so they have the services on site.

I sent a 62 yo guy to the ER once with vomitting, crushing midsternal chest pain radiating down his arm and diaphoretic with a history of MI. We first call a rapid response, gave nitrox3, asa etc and then sent him to the ER. I sat there with him c/o 10/10 crushing chest pain for 20 minutes and then a tech(not a nurse or MD) came in to do an EKG which we had already done on the floor. I told the nurse and doctor and was borderline hysterical and still nobody came to see him. I felt like they thought I was just being overdramatic. Nobody was taking me seriously. That guy ended up dying later that night. He was in rehab for knee replacements. He was a handsome youngish newly retired guy and I felt awful for his family. I know it probably takes alot more to get an ER nurses attention but is this a typical situation? The ER nurses usually give us a hohum attitude when we bring our pts down to give report. Even though 9/10 times they get admitted with something. To quote Rodney Dangerfield, We get no respect.

PAERRN20 · Mar 15, 2009, 03:14 PM

Re: Rehab nursing-the good/bad/ugly?

Meluhn- this is really unacceptable. This would never fly in our ER. I take all the nurse's reports as well as the patient's reports seriously. Sounds like the patient was actively having an MI with ischemia. Our policy is to have ASA and EKG within 10 minutes of arrival. Sometimes we are busy and the techs do meet the patient in the room and do the EKG for us. But generally I am in the room within 5 minutes of the patient's arrival. You met the standard of care, the ER did not. I respect all nurses.

cfsleo812 · Apr 11, 2009, 11:59 PM

Re: Rehab nursing-the good/bad/ugly?

Meluhn is absolutely Right!!! The stand alone subacute care facilities give nurses sicker patients, higher patients loads and try to run it like a nursing home!!!! This is NOT practical at all. To top if off, management is not doing assignments according to patient acuity. Also, you just don't get the extras in a timely manner like in the hospital such as EKG stat, etc. I don't see how anyone can manage 30 patients. A facility I used to work at did team nursing which was good except when someone called in, it was a mess trying to shuffle the staff you got, and still give good nursing care. To top if all off, management have the nerve to wonder why complaints are UP!!!

Orca · Apr 30, 2009, 04:53 PM

Re: Rehab nursing-the good/bad/ugly?

Good: Chance to help patients regain normal function. Often see dramatic improvements in relatively short period of time. Get a lot of fresh post-ops, so you don't lose skills.

Bad: A lot of lifting, supporting and transferring. Stand-alone rehab hospitals tend to understaff, so patient loads are heavy. I used to leave after my 12-hour shift feeling literally numb as I walked to my car. I knew it wasn't going to be a long-term gig after about a month. I liked the type of work and the patients, but the workload was far too heavy given the physical nature of this type of nursing.

A story about patient loads. At my rehab hospital one day I was told that I would only have eight patients instead of our usual ten. I later found out why: Seven were diabetics with qid accu-cheks and the other was a tube feeder. Worst day I had working at that facility.

NurseKatie08 · May 01, 2009, 01:18 PM

Re: Rehab nursing-the good/bad/ugly?

Don't believe all horror stories you hear about sub-acute..not all facilities have bad ratios...at least mine doesn't..
Our ratio is never more than 9 pts: 1 nurse. (the team I work never has more than 8). There are always three nurses on the floor for the 26 beds, and at least four aides. (for day and evening shift).
At the moment, the acuity of my patients is pretty mixed--from a total care SCI pt to a L TKR pt, to a COPD/CHF exacerbation pt and anything in between...

meluhn · May 01, 2009, 02:41 PM

Re: Rehab nursing-the good/bad/ugly?

Originally Posted by NurseKatie08

Don't believe all horror stories you hear about sub-acute..not all facilities have bad ratios...at least mine doesn't..
Our ratio is never more than 9 pts: 1 nurse. (the team I work never has more than 8). There are always three nurses on the floor for the 26 beds, and at least four aides. (for day and evening shift).
At the moment, the acuity of my patients is pretty mixed--from a total care SCI pt to a L TKR pt, to a COPD/CHF exacerbation pt and anything in between...

You are very lucky. When I worked sub acute I had 25-30 pts to give meds and do tx. No one helped, 2 lazy good for nothing nurses sat at the desk. My day was one long med pass with ams going right into afternoon meds. Absolutely horrible, I dont know how I lasted as long as I did. It was literally impossible. I am scarred for life and will never go back. It sounds like you work in a nice place. With those ratios, sub acute is doable. I have heard that administration is catching on lately and staffing more appropriately.

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Rehab nursing-the good/bad/ugly?

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