I am a nurse in NC at a small hospital on a medical-surgical floor. We also have telemetry patients as well. Our facility is implementing "swing" beds which according to our administration only counts as "half of a patient" in regards to nurse to patient ratios. This is a status change on a patient so they can stay in their same room to continue with rehab therapies until ready to go home. Well, we have decided that the care is not changing, they are still patients that require nursing care as well.
That's only the beginning...
They have now done away with a house supervisor and a charge nurse.
They gave us 7-8 patients each yesterday on day shift. HELP!!
Can I refuse this patient load? Can I just not clock in? This is UNSAFE for patients.
Swing bed patients are skilled rehab patients. They require the same type of care as an acute patient, only one "encourages" independence. It is multi-disciplinary, with PT/OT/recreational therapy, etc.
For most of these patients, they are either coming from acute rehab, or are acute patients within the unit that then "swing" to skilled rehab. The term swing means nothing more than how the hospital is reimbursed. Examples are hip repair, knee replacement, s/p CVA, S/P cardiac surgery...with hospitals having to discharge patients at quicker intervals, this bides time that otherwise would not be paid care.
There are lots of rules. Patients have to show progress. Nurses have to document even more than a usual acute care patient. Pain control is an issue. So they (meaning the powers that be) may believe that one should be able to just leave the patient to their own devices as they are rehabbing with the goal of being independent at home, this is never the case. Hence the "half a patient" reference. The first few days are just like any other acute patient--only "survey says" they only need 2 acute days. They are no less acute, no less needy, and 9 times out of 10 the nurse then has the obligation to assist PT/OT in a patient safety/fall prevention issue.
Some units have nurses specific to swings just for that purpose. And no, contrary to "popular belief" having a swing patient is no less demanding, they still have needs (because if they did not, they would be at home) and perhaps (PERHAPS) the day or so before discharge they are completely independent--except for those pesky meds, and all the documentation.....
These patients boost the income for the unit and facility. And the admissions can last for months. Because as long as Bertha can play bingo, walk with a walker, then a CANE, then she can also participate in the sing along, and now, today she can do her own personal care with stand by assist.....wait, now her back hurts, she needs more work on the walker to get to a cane....as long as insurance pays for it, the longer the patient stays.....and the more the nurse has to document....
Tell me again why many nurses are opposed to unions that fight for safe ratios? Just a thought.
As others have said, it sounds like a decision between a good reference/leaving your job in a good way or potentially your license. The patients are the ones who suffer the most, regardless.
It disgusts me how much these corporations (because that's what hospitals have become) will keep chopping and chopping just to maintain their bottom line. And chopping at hospitals = more falls, more medication errors, etc etc etc.
Specializes in Peds ED, Peds Stem Cell Transplant, Peds.
Why am I opposed to unions? Still saw unfair nurse to patient ratio with unions, but less money because I had to the dues. When there was a problem the union gladly took my money but never helped with anything else. That is why.
6 weeks notice?? Are you kidding me....I'd be so outta there their heads would spin and next a call to the BON and anyone else I could thing of....Dangerous for patients and staff!!!!
Interesting that everyone's agreeing that skilled/rehab pts can be more work than acute pts. Imagine how us LTC nurses feel with up to 30-40 skilled pts on a regular basis.
Rather than having "swing" beds, why don't hospitals just have a skilled unit that they can send their "not sick enough to be in med/surg, but too sick to go home" folks to? Mixing acute and skilled pts seems like a horrible idea..
Interesting that everyone's agreeing that skilled/rehab pts can be more work than acute pts. Imagine how us LTC nurses feel with up to 30-40 skilled pts on a regular basis.
Rather than having "swing" beds, why don't hospitals just have a skilled unit that they can send their "not sick enough to be in med/surg, but too sick to go home" folks to? Mixing acute and skilled pts seems like a horrible idea..
Our facility did have a skilled nursing unit but according to them they were losing money on these patients. I understand wwhere you're coming from about the ratios at LTC facilities which is why I would not go into that. Mixing acute and swing patients is very challenging. It's really sad what healthcare is becoming.
Interesting that everyone's agreeing that skilled/rehab pts can be more work than acute pts. Imagine how us LTC nurses feel with up to 30-40 skilled pts on a regular basis.
Rather than having "swing" beds, why don't hospitals just have a skilled unit that they can send their "not sick enough to be in med/surg, but too sick to go home" folks to? Mixing acute and skilled pts seems like a horrible idea..
Because as a "swing" patient a great deal more is reimbursed. And most are in small hospitals that don't have the room to dedicate units for rehab. And 10-15 years ago, these would continue to be acute patients. It is with the "xyz diagnosis=QRS number of days" that has encouraged this. And even more so with the push to not have readmissions.
At one hospital I worked at a nurse on the telemetry floor refused an assignment of 8 patients and was fired on the spot. ;-/ Needless to say I did my two years (sign on bonus) and booked it!
At one hospital I worked at a nurse on the telemetry floor refused an assignment of 8 patients and was fired on the spot. ;-/ Needless to say I did my two years (sign on bonus) and booked it!
jadelpn, LPN, EMT-B
9 Articles; 4,800 Posts
Swing bed patients are skilled rehab patients. They require the same type of care as an acute patient, only one "encourages" independence. It is multi-disciplinary, with PT/OT/recreational therapy, etc.
For most of these patients, they are either coming from acute rehab, or are acute patients within the unit that then "swing" to skilled rehab. The term swing means nothing more than how the hospital is reimbursed. Examples are hip repair, knee replacement, s/p CVA, S/P cardiac surgery...with hospitals having to discharge patients at quicker intervals, this bides time that otherwise would not be paid care.
There are lots of rules. Patients have to show progress. Nurses have to document even more than a usual acute care patient. Pain control is an issue. So they (meaning the powers that be) may believe that one should be able to just leave the patient to their own devices as they are rehabbing with the goal of being independent at home, this is never the case. Hence the "half a patient" reference. The first few days are just like any other acute patient--only "survey says" they only need 2 acute days. They are no less acute, no less needy, and 9 times out of 10 the nurse then has the obligation to assist PT/OT in a patient safety/fall prevention issue.
Some units have nurses specific to swings just for that purpose. And no, contrary to "popular belief" having a swing patient is no less demanding, they still have needs (because if they did not, they would be at home) and perhaps (PERHAPS) the day or so before discharge they are completely independent--except for those pesky meds, and all the documentation.....
These patients boost the income for the unit and facility. And the admissions can last for months. Because as long as Bertha can play bingo, walk with a walker, then a CANE, then she can also participate in the sing along, and now, today she can do her own personal care with stand by assist.....wait, now her back hurts, she needs more work on the walker to get to a cane....as long as insurance pays for it, the longer the patient stays.....and the more the nurse has to document....