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

Foxfour · 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.

Your reply rushes memories back to me as I worked in a 18-bed unit at night with 2 nurses/1 aids. We also had a lot of admissions at 2000 and 2100. I never had the luxury of seeing a pt get better, but then again I didn't stick around to long. Ditto on the UUUUUUUgghh!!!

Wise Woman RN · Feb 2, 2005

I work in a 13 bed inpatient rehab unit. When we are full, we have 3 nurses, one tech or aide. No secretary. Patients have to be up and dressed, fed and pills in them by 9am.. admissions are a nightmare, 20 pieces of paper, fim scores, skin sheets, etc. etc. the interview for admission takes an hour... meanwhile, we still have to get the meds to our other patients in a timely manner, chart on everyone, answer lights and the darn phone, enter orders in the computer, put the charts together, deal with family members, thicken the liquids for dysphagia patients, bladder scan for pvrs, cath if needed, do bowel programs, make sure we are keeping up with our patient satisfaction, send meal orders down... the techs we have don't do the computer, always ask the nurse to come to do the transfers, won't go in rooms if they don't like the patient... the phone and secretary issue is nuts... if we get a secretary, then we lose a nurse, which means 8 and 7 patients each... we have to make sure that the charts are completely in order before sending to medical records, they don't like having to do that... and deal with doctors orders, assisting them with procedures... and management says perhaps we should float to a med surg unit if we want to see what busy is.... not helpful at all... I go to those units, the nurses are not running, the secretary is putting in orders, all they have to do is treatments, assessments, meds and note orders... it makes me crazy... seems like the rehab is the dumping ground to me, also, as we get patients who are so sick that they can't even get up, let alone go to therapy... or they get DVT's, PE's... and through this mess, management throws yet more paperwork, more competencies, and more demands that the nurses do it all for every other department... but I need to work, so I will hang on... 53 years old, and doing all the transfers on the heavy patients, the techs can't or won't... and our patients need emotional support, no time to stay with a crying patient, too many other things to attend to... it really isn't nursing anymore... more like being in a madhouse...

mom and nurse · Mar 2, 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

Hi Kek - I was wondering - How are you making out with your nurse to patient ratio. Where I work, we have 1 RN to anywhere from 7 - 8 patients days and nights, though we do have 1 CNA that works with us.

kek · Mar 3, 2005

Hi mom and nurse,

I always have a nurse tech working with me, every shift. It is only the odd day I have eight patients, it is often nine and sometimes even ten. I work the 7am to 3pm shift and also work the 7am to 7pm shift. It is hard going even with the lowest - eight patients - but it is worse first thing in the morning when I have to rush to get the meds passed and assesments done before patients leave for therapy. That is the time I feel the tightness across my chest! I'm getting used the routine and the system so it's not as hard as it was at first but I don't like it. It's just too much to do in too little time and therapy rules and nurses drool it seems. I honestly think if I had six patients then I could quite enjoy my job .... that is not going to happen though. I am just doing my best in the system - trying to hang in there and do what I can do. I really just think I can't be a nurse for much longer if this is what it's like.

thanks for asking how I'm getting on. I hope everyone elses nursing shifts are better than mine.

annjune · Mar 3, 2005

hi I work in rehab and if I give meds it is to 24 patients and know the therapy deal.We went to 12 hours but a few nurses remained on 8 so I hardley give meds any more they work us as cna"s with a full assignment of any where from 10 to 12 to 13 patients Have to give out breakfast trays in am and pick them up do 2 to3 showers a day and have 4 to 5 people ready for 9am therapy and 5 more for 10:00 am.showers are done before 9am. and I am 64 working the floor just pray from day to day I make it to retirement without hurting myself last week had 3 patients who weighted over 250 I am a L.P.N.

mom and nurse · Mar 3, 2005

Hi Kek - We rarely have 10 patients, even on evenings. I know that must be hard with 10 during the day. When I have 8 during the day, I rarely leave on time. You must have great organization skills....(to juggle all the assessments and paperwork)..... :)

mom and nurse · Mar 3, 2005

hi I work in rehab and if I give meds it is to 24 patients and know the therapy deal.We went to 12 hours but a few nurses remained on 8 so I hardley give meds any more they work us as cna"s with a full assignment of any where from 10 to 12 to 13 patients Have to give out breakfast trays in am and pick them up do 2 to3 showers a day and have 4 to 5 people ready for 9am therapy and 5 more for 10:00 am.showers are done before 9am. and I am 64 working the floor just pray from day to day I make it to retirement without hurting myself last week had 3 patients who weighted over 250 I am a L.P.N.

annjune - Welcome to allnurses. :) Twenty-four patients is indeed scary. Do you always have this number of patients and how long does each patient stay (2 - 3 weeks)?

mattsmom81 · Mar 4, 2005

Wow I see some rehabs are very scary...guess I was fortunate to have had a few decent shifts in the rehab close to me. Granted these were agency shifts and I might have just lucked out those nights.

unknown99, BSN, RN · Mar 4, 2005

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.

I work at a 12 bed inpatient rehab unit. We always have 2 nurses and an aide or 3 nurses. If it is known that admissions are going to be increased, an extra person--aide or nurse is added. Plus we have the physical therapist, the occupational therapist, and the rehab aide. We also have the speech therapist.

I would have to say that 8:1 ratio is pretty poor.

maggimay · Mar 4, 2005

I work at a 12 bed inpatient rehab unit. We always have 2 nurses and an aide or 3 nurses. If it is known that admissions are going to be increased, an extra person--aide or nurse is added. Plus we have the physical therapist, the occupational therapist, and the rehab aide. We also have the speech therapist.
I would have to say that 8:1 ratio is pretty poor.

Reading about the patient nurse ratios posted here I feel very lucky. I work on a 10 bedded neuro rehab unit. We have our own physios, OT, part-time Psychology and speech therapist. From a nursing point of view we normally work with 6 staff in the morning 2 or 3 of those being qualified nurses and the remainder Support workers. Even with this amount of staff at times we are very busy. It really depends on the dependancy of the patients at the time. One of the best things I like about my area of work, apart from the fact it is very rewarding, is that you have the time to give patients and their families the time they deserve and so can give high standards of care all of the time. After all that is why most of us came into nursing in the first place.

oramar · Mar 29, 2005

I work 8:1 all the time, that is one aide and one RN for eight patients. I am busy with it but it is managable. Somedays I only have 6 or 7 and that is nice. It is those days when I do 9:1 or 10:1 that really slay me. It is a 24 bed unit and very soon we are getting a bunch of new help and then we are never supposed to go over 8:1 again. Promises, Promises!!

RNKITTY04 · Mar 30, 2005

Since I orginally posted I moved to the 11p-7a shift and now my average is 10 patients, sometimes 11.

I totally agree with other posters in that there is NO WAY I can acurately score my FIMs. Most of the time I feel like I am neglecting my patients.

If my patient is not in a netbed or is a tubefeeder, for the most part they rarely see me.

I do not want to be a job hopper but I am not happy, this is not what I want to do.

Same day surgery sounds better and better.