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

monicatn · Nov 30, 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.

Hi kek - I am reading these posts with great interest as I am looking at taking a rehab job as well. I,too, am nervous but mostly because I have been out of bedside nursing for about 15 years (doing quality, JCAHO, etc.- but still in the hospital setting). I have decided that I need to get out of management and the BS for awhile. I have researched several avenues of nursing (in trying to decide what I want to do when I grow up- HA!) and rehab nursing keeps coming to the top. It seems that it would be very rewarding -although physically taxing. At the free-standing hospital that I am considering the nurse/pt. ratio is 5:1 on days and 7:1 on nights. I didn't think to ask about CNA's (duh!). Thanks everyone for the education - it helps me to go into this thing with a litte more knowledge and less trepidation!!

Chaya, ASN, RN · Nov 30, 2004

I work eves in an inpatient Rehab; we get cardiopulmonary and some ortho (post CABG, COPD, knee and hip replacement/ fractures). We usually have one RN or LPN plus one aide for 5-6 patients on days, about 7-9 patients on eves and 15-18 nights. Because the patients stay about 2-3 weeks in Rehab they run the gamut in acuity according to how long they've been with us. I usually have one or two "train wrecks", 2-3 "walkie-talkies" and the rest somewhere in between. Because they do stay with us for a longer time we usually have the same patients and get to know their individualized care fairly well. That ratio works for me on eves as I'm past the learning curve stage with all but the newest patients in my group.

mattsmom81 · Nov 30, 2004

I did some agency at rehab and my night ratio (7p-7a) was about 10 to 1. I did have my very own CNA/PCT who was very helpful. I didn't find the work too taxing coming from acute care. I would have to say this ratio would be difficult if there were lots of dressing changes, treatments and ambulations, etc to do...most of these pts were postop knees and hips, CVA's, deconditioning... and only a few would be totals. Most were so tired out by the end of the day's therapies they wanted their painkillers and sleepers and to be just left alone...LOL!

RNKITTY04 · Dec 3, 2004

very true MattsMom. By the time I get to work at 3 most if not all of my pts are in bed waiting for their pills and dinner. They get a shower every other day(CNA assisted) and then they just fall into bed and are sound asleep by 6p. Not everyday is wonderful but the majority of my days are good, I like my job I like most of my pts and I like the staff I work with.

Downside- Many family members at this time of day.

But all in all its not a bad way to make a living.

cilky · Jan 24, 2005

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

Hi, from snowy cold friggid Massachusetts. Is this free standing rehab in Florida, i have current florida license and need to get down there soon

thanks lauri

kek · Jan 25, 2005

OK - time for an update I think. I accepted the job and have since found out that eight patients is the minimum I (with a nurse's aid) would have. It can often be 9 patients and it's not that unusual to have 10 patients. I don't want to go on too much but basically it's not what I was hoping for. Obviously it is still early days and I do have to give it some more time before I make any hasty decisions. I mean new jobs in new areas are always stressful at first so I want that to ease and then I will know .....

That said - right now .... I want to quit nursing all together :crying2:

kek · Jan 25, 2005

OK - time for an update I think. I accepted the job and have since found out that eight patients is the minimum I (with a nurse's aid) would have. It can often be 9 patients and it's not that unusual to have 10 patients. I don't want to go on too much but basically it's not what I was hoping for. Obviously it is still early days and I do have to give it some more time before I make any hasty decisions. I mean new jobs in new areas are always stressful at first so I want that to ease and then I will know .....

That said - right now .... I want to quit nursing all together :crying2:

CHATSDALE · Jan 25, 2005

I worked rehab.6a to 6p we had 1rn. 1lpn and for 7 pts each..sometimes we had one cna .this was on weekends...on monday morning when the rehab was to start p breakfast the CNAs would come in at 5a and help get pts dressed baths were in evening p rehab..the patients ran the range of total care to independent ..10 pts would be an unreasonable load it seems to me

CHATSDALE · Jan 25, 2005

I worked rehab.6a to 6p we had 1rn. 1lpn and for 7 pts each..sometimes we had one cna .this was on weekends...on monday morning when the rehab was to start p breakfast the CNAs would come in at 5a and help get pts dressed baths were in evening p rehab..the patients ran the range of total care to independent ..10 pts would be an unreasonable load it seems to me

Foxfour · Jan 25, 2005

I used to work in a rehab unit with 8 pts.. one aide and a high acuity with one more twist--about 95% of my pts didn't speak english and I didn't speak spanish. I'm dumbfounded that I lasted 2.5 mons. I hated every single minute of it.

Foxfour · Jan 25, 2005

I used to work in a rehab unit with 8 pts.. one aide and a high acuity with one more twist--about 95% of my pts didn't speak english and I didn't speak spanish. I'm dumbfounded that I lasted 2.5 mons. I hated every single minute of it.

TracyB,RN, RN · Jan 27, 2005

OK..... I worked on an Inpatient Acute Rehab Unit within a hospital. We were frequently the "dumping ground" for all the patients that the other units just couldn't deal with.... 15 bed unit, Day & Eves.... 3 nurses/ 2 aides (which sometimes were LPN's). Nights, the shift I worked was 2 nurses/ 1 aide (usually an LPN). Every shift was busy in their own special way, but I found it assanine that nocs was expected to work with half the staff, for patients that were usually confused at night. We were also expected to have the early therapy group (ranged anywhere from 5-9 pt's) washed, dressed, & ready for breakfast. NOT an easy task with 3 people doing the work. Majority of our pt's were Bilat TKR's, CVA's, the occasional brain injury, & LOTS of folks detoxing.. that usually made for a fun night, NOT!!! In addition, we did the MAR's, CPM removal when oncoming, & CPM application when offgoing. OOOH, how could I possibly forget the 12am & 0600 med passes, PVR's, toileting, the miscellaneous pain meds, dressing changes, & other non-essentials, like cleaning, re-stocking, etc, etc, etc that was expected on night shift.. 8-1 is a ridiculous ratio for a Rehab nurse, on any shift, especially when you get your FIM training.

FIM's are the paperwork that allowed us to bill for our rehab services, so EVERY TIME, a little ol' lady with the broken hip & UTI had to go pee every thirty seconds, we had to "score" according to the FIM regulations & then chart it... Was pt able to pull pants up & down, do self peri-care, etc, just to name a few.... IT SUCKED! The only thing that saved us was that pts were required to be "medically stable" before being accepted to our unit and we were NOT required to wake pt's for routine vitals, but those were usually replaced with Q2hr bladder scans & straight cath's over 300cc's.... Well, we all know "medically stable" means something different to every doc. The nurses I worked with on nights were all very good at what we did & we were an awesome team, helping each other out. It helped that we all worked so well together. It would have been the death of the 3 of us, if we didn't.

So, in my opinion, your new job has absolutely RIDICULOUS pt ratios & you should run for the hills!!!! It is impossible to get a pt to return to home with some functional ability with ratios like that. You won't have time to accurately "score" your pts, your assessments will not be accurate, b/c you will be spending all your time monitoring your CVA feeders, & assisting your aid with ADL's. On our unit, most of our patients were in therapy for a minimum of 3 hours per day, unless they required speech, so it was a longer therapy day for those pts & they were usually pretty pooped out. Depending on which nurses we relieved when we came in at 10:45pm, we had to IMMEDIATELY round, even before getting report to make sure every one had fresh water, was clean, dry, & breathing & off their CPM's. It was insane!!!!! UUUGGHGH!!!! I DON'T miss that kind of crap for one second.

The plus side of rehab nursing.... when appropriately staffed, your pt's get better & go home, able to take care of themselves. THAT was the cool part about Rehab nursing.