Too Smart for Rehab Nursing

Hi Lola

I read your posting and you really sound enthusiastic to work in rehab. I worked in acute rehab for 3 years in one of the very well known centers in the US. I must say it was a really nice experience. we got patients with a lot of commorbidity and who acuity level was very high. I really feel that I learned a lot n my floor. The benefit of rehab over other units is that you really get to know your patient and family. It is an amazing feeling to see your patients improve. I also supervise in a subacute rehab facility. I must say two different ball games. If you are just graduating my advise to you is to do acute rehab.

Your questions was do you get upset to see the comments that others make about rehab? and my answer is yes. I was having a conversation with someone that told me . "You will do real nursing on med/surg". I was left wondering of what that meant. I felt offendced, I am not a real nurse? I must say as a rehab nurse you do find it hard going to another department. Pre conception and ideas of people not in rehab is that we dont do anything, I must say in rehab you are everything for the patient, nurse, social worker, psychologist and much more.

I loved and love rehab! I am doing other things now, but I will encourage you to do it if your heart is on it.

Good luck

I love rehab. I have been in it for 10 years now, and fully plan on to retire working it. Boring, not hardly. Never in my career nor many of the other nurses I work with are we so challenged to be proficient in working with so many different types of co-morbidities. Many of our patient come directly from ICU to us. Our patient's very much keep us on our toes. Granted we love the uncomplicated patient, but they are becoming few and far between in Acute Rehab. I agree many nurses who have floated to us. have said the patients they see on med surg are not as complicated as most of our patients. I believe complicated patient are everywhere in any facilty, those easy walking, talking patients appear to very much becoming extinct in hospitals today.

Shame on anyone for "ranking" any aspect of nursing! A school nurse is "low" until it is your child hurt at school and needs immediate attention. An LTC nurse is "low" until it is your parent or loved on with Alzheimers and they dont recognize you anymore and there is a medical issue...you are to close to be objective. A psych nure is "low" until its your teen in trouble with drugs or depression.......Did anyone sail through all areas of the NCLEX and nursing school and think these areas were foolish or a breeze? ALL areas of nursing require a set of skills that are unique and until us nurses acknowledge it among ourselves we all look like fools! Be proud of your profession and stand up for all areas! I LOVE rehab nursing. I have spent 5 years in oncology, 12 in cardiac step down and 2 in med/surg. REhab tops all of them. There is GREAT satisfaction to seeing pts fianlly walk out on their own or move a limb or speak and swallow on their own. Familys can be a real challenge as some pts are with you for weeks. It is easy to treat and shove the pt on to another facility.....esp when dressing changes dont occur or showers or you put a cath in and pull it prior to discharge to save yourself work. Cant tell you how many times I have seen that! WE ALL WORK at or jobs

I spent the first years of my career in a free-standing sub-acute rehab hospital. We got virtually everything I later saw in med/surg. Only real difference is now having an OR, Cath lab, CT,MRI etc on site so there was a longer time gap between when docs ordered tests and when the pts went to have them in Rehab. I too was "guilted" into feeling that I needed to do some REAL nursing by the comments I kept hearing when I told people I did Rehab nursing. Let me tell you when I did move I was totally prepared in the REAL nursing aspects; assessment, communication with patients and families, critical thinking, plus I had already seen PICC's, central lines, TPN, CAPD, codes, every kind of wound treatment including wound vacs in Rehab. The biggest change for me in going to "acute" nursing was different paperwork, different equipment, and never having the same patient for long enough to see the positive effects of my work with them. I do like med/surg for one of the same reasons I loved Rehab-we saw just about everything and it required me to use ALL my skills- but I don't for a minute feel it is more challenging!

Lola: im so glad you posted this message, i am a new grad and just accepted a job on the rehab unit. As soon as i got on the unit, the nurses told me that i should move on to other speciality to get more experience. I've heard many times that i should look into working on med-surg and acute care from different nurses. It is easy to be impressionable as a new grad and i find myself getting restless partly because of the advises from well intended veteran nurses.

However, i agree with everything that everyone else said here, so far, i found rehab to be very rewarding, i get different kinds of patient's all the time, i have less support so have i have the oppertunity to develop indepedent critical thinking skills, and get tremendous satisfaction when patients leave this place in better shape when they came. It is a happy and proactive place and most of the time, it puts me in a good mood.

I just started working and as a brand new grad, is it hard to say that i want to settle down, but i will never regret working in rehab for my first job, and it is something that i see myself coming back to. So thanks for starting this post, it gave me a different point of view and a different voice than what i've been hearing.

I keep reading alot of this non-sense on other threads. I believe that it is all propaganda. ICU, ER, Trauma, etc. areas of nursing are, or so it seems so burned out and synical by/about the system in which they work. That they will put down another NURSES' area of interest and work. It is comparing Apples to Oranges in the same industry. Who's job is harder, who is smarter, who is....Bla, Bla, Bla, The questions: are you happy and are you trying to make a difference and are you making a living ? Very simple concept. JM2C.

I have to agree with EVERYTHING everyone else has already said.....

And I'll add a couple more stories you can tell people who want to cut you down!!!
I admitted a 75-yr.-old lady recently for a "LEFT HIP".....I always SAY their diagnosis in "QUOTES" and my
coworkers laugh because we ALL know they are usually WAY more than "JUST a HIP"......Amen?

By the time she was with us for 3 hours, her BP plummeted, pulse getting faster.......
then she became pale and diaphoretic....I was TERRIFIED she was about to code on me!
She also c/o chest pain, so we did an EKG (yea, and WE do our own EKGs if our resp. therapist
is busy!) and when I handed the EKG to the Nurse Practitioner, he was NOT happy....Bad sign!

I'm thinking they are CERTAINLY going to send her back to acute, but nooooo!!!
So, the BP is just getting lower and lower (can you sayyyy.....78/34!!!)
I'm thinking hypovolemia but also thinking her sugar has GOT to be low....because now we're in
the bathroom and she tells me she feels verrrrrrrrrrry dizzy. I'm thinking I'm going to be
pushing D 10 as soon as hubby tells me she hasn't eaten in three days.............

Nope, glucose was 263 AND when I tested her urine, she was spilling protein and ketones.....
I go to tell the doctor alllllllllllll this info (and again, we do NOT always have them
around like "acute"). I get orders for NS at 100 cc/hr, plus a unit of blood. WOW, I couldnt
believe what a couple hours of good ole' saline did for this lady!!! And, I was SHOCKED
that she in fact did NOT code, and she stayed with us about 2 weeks!!! Soooo, anyone
who wants to cut down rehab nurses needs to work a couple shifts with us!


Another story I JUST heard from my friend was that we had a lady with a Pulmonary Embolism......I do NOT
have experience with them, I just ASSUMED she "ship them out" immediately.....too scary
for our sub-acute rehab! NOPE......because of her status (again, I wasn't there to see it,
but her resps, breathing effort, sats, etc were NOT enough to "send her out acute")....she
DID stay at our facility, she got a nice double dose of Lovenox and some other interventions,
and she is now doing very nicely in our BORING rehab facility after her hip replacement....

I HATE IT when I orient a new nurse, and I'm not kidding----I've had TWO people say this to
me on their FIRST day---"I'm afraid I'll be BORED here"....OMG! I don't say it, but the first
thing I think is "then WHY are you wasting your time applying/ interviewing and working here!!?!!!?"
But what cracks me up is that we RUN the entire 12 hours, and I always ask 'em "are ya still afraid you'll be
BORED?"

One thing I DO hate is our recent change in paperwork....OMG! We keep saying we are back in the 1950's
and let's put on our white caps and white dresses again. We have to do SERIOUS, DETAILED narrative
charting, and not just on our own notes, but in the admission note---we have to write a longgggggg
paragraph (or two or three) to justify to Medicare why they're in rehab and not a SNF or their own home.
It is RIDICULOUS and since they changed it, we are ALL late, every time.....by an hour or TWO! UGH!

GOOD LUCK TO YOU AND DON'T LISTEN TO THE NEGATIVE PEOPLE!!!!!!!!! It IS wonderful to see a young
person (he had a major TBI) go from not talking, couldn't swallow, not walking......to a fully functional teenager
many months later.....when I saw him come to visit, I almost cried and I STILL get goosebumps when I tell
people about it. I could NOT believe he was the same person!!!!!!!!!!

Hey Lola, I graduated in December and just started my first RN job at a rehab hospital. I was a PCA in an ER for years and recently in Inpatient Rehab. Anyone who tells you rehab nursing isn't very impressive or looks down on rehab nursing is truly ignorant. Every single medical specialty prescribes rehab for their patients from hips, knees, and spines to cardiac, brain injuries, and major traumas. As more and more procedures are done outside acute care facilities rehab becomes more important to the patient's outcomes.

Karma is something, kiddo. Someday nurses that look down their noses at rehab nurses will be the ones who look to us to ease their pain. Follow your heart and you'll be just fine. Good luck on your final semester!

Wow I didn't know getting someone to their highest level of functioning was looked down upon! After all, we just restore independence and all...
No nurse is higher than the other, all of our roles are important.