considering rehab - is 8:1 with a CNA good?

renerian, BSN, RN · Nov 26, 2004

Is it one nurse being defined as an RN or it is possible one LPN is defined as a nurse and your also having to cover their patient load as well as yours? Just curious.

renerian

PMHNP10 · Nov 26, 2004

Hi all, I am possibly considering a job change into rehab. It is a 60 bed free standing rehab hospital that is all over the country. I've never done rehab before but I have done med/surg. I was told during an interview that the patient nurse ratio is - one nurse and one aid for eight patients. The patients are mainly strokes and joint replacments. Is this good, bad or just right? ANY suggestions, advice, warnings etc would be very much appreciated. Thank you in advance and Happy Thanksgiving to you all.

My blanket statement would be it's good for the hospital, bad for your license, so just show me right out the front door to the next hospital. Of course my knowledge of a rehab unit within a regular hospital is that it's the dumping grounds when the other specialty floors are full. I don't know much about free standing units, but I might be inclined to stick with my previous statement. Also, you didn't mention what shift, but if you're talking about it being days, I'd say don't wait for them to show you the front door; rather run to the light.

kek · Nov 26, 2004

It would be 7am to 7pm shift and it would be me, the RN, and one aid for eight patients.

RNKITTY04 · Nov 27, 2004

I also work in a free standing rehab, our ratios are 5:1 with 1 CNA.

kek · Nov 27, 2004

I also work in a free standing rehab, our ratios are 5:1 with 1 CNA.

WOW! one nurse AND one CNA for five patients ???? and in Florida too ! That's great - where abouts in Florida are you? What type of rehab patients do you care for mainly? I would be jumping into the job off with those ratios. Good for you! ( unless of course they all have a very high acuity)

Or - is that CNA for the whole floor ? or as I read it first - just with you for your 5 patients?

Thanks

RNKITTY04 · Nov 28, 2004

I work in Jacksonville Florida, and we have 1 CNA to each nurse. We both share the same 5 patients. I work on the stroke floor so most of my patients are CVA's. Lots of heavy lifting. Mostly PO meds, once in awhile an IV but thats rare.

rngreenhorn · Nov 29, 2004

I work in an acute rehab unit in a 250 hospital.

Our nurse/ patient is somewhat the same as rnkitty. The RN can sometimes have up to 8 patients, but the CNAs never has more than 4 patients (and they work very hard). So, if the RN has 8 patients, she has 2 CNAs. If the RN has 2-3 patients, she has total patient care, with no CNA.

We have a mixture of CVAs, TBIs, SCIs, ortho and neuro. Some of the patients are highly functional, needing help with few ADLs. And some e.g. quadrapalegics need help with all ADL's. The charge nurse makes assignments based on acuity and never gives all the "hard patients" to one RN or one CNA.

We stay very busy with this set up, but I seldom feel overwhelmed. Also, the therapy schedules are very strict i.e. the patients have to be dressed and ready for therapy by 0800. This would be impossible without the help of the CNAs. And getting the meds passed, checking off doctors, dressing changes etc. would be hard without the CNA because the nurse would constantly be toileting, feeding, changing linens, etc.

I think I would question a ratio of 8 patients with only one CNA. But, I think I could handle a group of 8 high functioning patients with one CNA. I certainly would be making some further inquiry before accepting that job.

kek · Nov 29, 2004

thanks rngreenhorn for your reply. I would love to find a job around here where the ratio was more like 1:5 or like you said - 1:8 but with two CNAs then. I don't think that is going to happen around here though. I used to work med/surg and was often charge for the 44 bed floor while having my own 8 patient load and no CNAs at all - this was on nights - I guess patients are supposed to sleep then right ? On days the nurses would have 6 patients each - sometimes up to 7 and on odd occasions 8 if a nurse had called in. Also on days they would only have 1 CNA for the whole 44 bed floor. I guess I'm wondering then if 1:8 with a CNA might seem okay to me after those days? I don't know though - I've never done rehab. Also, this is a rehab hospital to which patients are discharged to following their stay in a hospital. I'm wondering if these patients will be as sick as the ones I cared for on med/surg. These nurse patient ratios are what's bothering me the most - I really really really don't want to go back to a place that was as hell to work at as that med/surg floor was - now that was crazy!

Are there ANY nurses out there that think these ratios are do-able?????

I am wondering how two people can get 8 people dressed before 8am ..........especially when one of the people doing the dressing is also supposed to get all the meds given and the docs orders noted etc etc etc....

hoping - begining to feel panicy - 'where is the HELP ME button' ?

:confused: :confused: :confused: :confused: :confused: :confused: :confused: :confused: :confused: :confused:

ShortyLPN · Nov 29, 2004

I'm not in rehab..but I should say consider yourselves lucky :) I've got 24 Alzheimers residents, approx 10 are heavy lifting...all the rest are wanderers with one aide....sometimes two if I'm lucky!

rngreenhorn · Nov 29, 2004

I'm new to nursing and have only worked at two hospital: a small rural 70 bed hospital in AZ and this one in Oregon. Neithor place had ratios as you decribed. I can't even imagine being charge on a med-surg unit with my own 8 patients. Not sure I would stay in nursing.

I often float to a surgical unit at my current hospital. In that unit we have 5-8 patients (usually 5-6, occasionally 8), but the RN always has a CNA if she has more than 3 patients. The difference between the rehab and the surgical unit is the RN and the CNA have the same group of patients. So the RN won't have 2 CNA with 8 patients. It is tough with 8 patients with one CNA, thank goodness that doesn't happen that often.

Although the patients we get in rehab are less acute and more stable than a med surg floor, that doesn't mean they are less work. Most still require maximum help with ADL's. And that stuff takes time. It would be physically impossible to pass my morning meds, do my assessments, take vital signs, deal with doc orders etc, if I also had to have the patients dressed, washed, toileted and up; even with only 4 patients and no CNA (in a timely manner I mean). Yes, this could be done if the patients didn't need to be up at a certain time.

Anyway, I'm not sure I helped much. Rehab nursing is definatly different than med-surg. But, I like seeing the same patients day after day. I like getting to know the families, and watching the patient's progress. I'm not sure I would like it as much if a constantly overwhelmed.

Where do you live? Maybe you should think about moving west, if that is a possibility. I know the hospital in AZ, that I left, was working on implementing a 4:1 ratios on med-surg. It could be I just happened upon descent hospitals with good ratios? I definetly feel better about my situation after hearing your story. Maybe, I'll refer to this post when I have a rough day in the future.

kek · Nov 29, 2004

Hello again rngreenhorn and thanks again for your reply. It is actually good to read that some nurses do have it 'fair' in some places. I don't mind being busy, in fact I prefer it - what I don't like is feeling overwhelmed and that is how I did feel pratically every night on that med/surg floor. In the end it burned me out - I was admitted to my own hospital with chest pain and when I was discharged (all things cardiac were ruled out) I never went back. I worked out patient for a while and now I'm looking at other options. To tell the truth I'm seriously considering leaving nursing now. I think if I had found places to work like you are describing I might have wanted to stay. I had heard that Oregon has some pretty decent nurse patient ratios a long time ago. I live in Florida right now and I can't move right now because of children in school etc etc. If I could move though - Oregon is one of the main places I would love to see. I don't know why - it just has been for years. Once again though - thanks for letting me (and others) know that some nurses somewhere in the country are getting a fair deal - that is really good to hear.

I'm still waiting to hear from other nurses that have these same ratios that I'm considering and are able to do it okay. Can anyone out there do this withOUT feeling OVERWHELMED? If I don't do this then it will have to be home health and that's got its downsides too.