New Grad Rehab Nurse

TheCommuter, BSN, RN · Sep 15, 2012

I work the night shift at an acute rehab hospital, so my suggestions may or may not be useful to you. Here is what I have to offer:

1. Know the signs and symptoms of an impending CVA. Many of your patients who are admitted for s/p CVA are prone to have recurrent CVAs, especially in the inpatient setting. It might happen during your shift.

2. Know the behavioral differences between a right-side CVA patient and a left-side CVA patient (hint: one is going to be impulsive, overestimate their physical abilities, and therefore be a high fall risk).

3. Familiarize yourself with orthopedic issues (hip ORIFs, knee arthroplasties, knee arthroscopies, fractures, splints, casts, braces, CPM machines, therapeutic use of ice, pain management issues, etc.).

4. You might encounter plenty of debility cases after lengthy illness due to pneumonia, CA, COPD exacerbation, CHF exacerbation, acute coronary syndrome, and so forth.

5. Familiarize yourself with tramautic brain injury, spinal cord injuries, multiple trauma secondary to motor vehicle accidents, behavioral changes due to frontal lobe damage, quadriplegia, paraplegia, quadriparesis, paraparesis, etc.

6. Bowel and bladder issues are huge, such as in-and-out catheters, indwelling urinary catheters, rectal tubes, incontinence of bowel and bladder, ostomy appliances, bowel and bladder training, etc.

Keep in mind that I am only scratching the surface, and that you will see a whole lot more in rehab. Good luck to you!

Godismystrength · Sep 16, 2012

Thank you sooo much for your reply! I will be working nights as well, and it will be in a hospital so I believe I will be able to to take all the advice you have given and relate it to my own area. Thanks again, it relieves a little anxiety as to what i have to look forward to.

NewRehabRNSara · Sep 17, 2012

Hello there! I am a newer nurse (Feb 2012) and also started in Rehab. I am not tiny as you are; and I assure you that you will hear your patients say often "oh no honey, you can't lift me"... and most of the time they are right. On my floor, we always have help with transfers/bathroom ect. Our tech's and other nurses are great and we all work together and help out!

The commuter got it spot on- those are mainly the patients you will be taking care of; I would just add to review medication classes for pain meds and such. That is a biggie on my floor. We also sometimes have dialysis patients (that have other things going on also)- good to review things like BP meds and dialysis days....

Also on our unit- we are still drawing labs often and doing diagnostic testing. Review your labs, what they mean, so you know an abnormal when you see it. You'll be ahead of the game here b/c that was the hardest part for me knowing when to call and when not to. I have learned that if you are asking if you should call- you prob should. :)

9-10 patients is a HUGE load in my opinion. I have max of 6-7, and usually 5-6 (although we do get admissions throughout the day and discharges obviously). You need a good report sheet- if you are that type. Mine is my brain; although we aren't supposed to carry them anymore with all the computer med records...However, that is what keeps me comfortable and sane.

If you have any specific questions feel free to ask me. I'm in the same boat you are, just have tugged along for a little bit by now! Welcome.

I must say as a side note that rehab was NEVER on my mind as I went through school; I got placed there in a residency program...and God sure knew what he was doing because I absolutely love it...and can't imagine doing any other type of nursing.

TheCommuter, BSN, RN · Sep 17, 2012

9-10 patients is a HUGE load in my opinion. I have max of 6-7, and usually 5-6 (although we do get admissions throughout the day and discharges obviously).

9 to 10 patients is a huge load, but I have had to contend with more. I will receive anywhere from 7 to 12 patients, depending on the current census. I have received 6 patients on a few rare nights, and one night I was stuck with 13 patients due to extremely short staffing. I work at a freestanding acute rehabilitation hospital owned by a national for-profit chain.

Indy B · Sep 24, 2012

A lot depends on your hospital's level of acuity. Inpatient vs outpatient vs freestanding vs long term...they're all so different. My system has two hospitals with acute rehab units. I work in the lower education/income area location so I see much sicker people and a lot more IVs, PEG tubes, O2, transfusions, transfers to acute care and surgery, rapid responses, pressure ulcers, etc, so I have a bit of med-surg I have to keep up on.

However, my best advice is GET TO KNOW AND LOVE YOUR THERAPISTS! Physical, occupational, and speech therapists are an invaluable resource. It might be harder to do while working nights, but it's the best way to find out the patients' physical abilities so we can encourage them when they're not in therapy. Look at the notes, ask details of the day shift, whatever it takes. For example, if you have a patient that is ambulating 30 feet and continent during the day but is demanding the bedpan every time she calls at night (when she's not asking to be changed), you know you have some teaching to do to get her to practice what she truly can do so she can go home with the highest level of function. The physical therapists can also teach you about transferring patients safely, for both the patient and yourself. I was required to train with a PT to learn how to transfer during my orientation. If that's not standard at your hospital maybe it's something you can request. I'm a small girl too but I have no problem safely assisting the majority of my patients in transferring now.

And all the advice from Commuter is gold, of course.

Godismystrength · Sep 25, 2012

NEWREHABRNSarah:

thank you so much for you reply. I followed some nurses for a few day shifts, and kind of got an idea of what my unit will be like. Today I will be starting my night shift, not sure how it will go , kind of anxious about taking care of nine patients, not sure if I will be able to handle all of them. How can I remember everything that is going on with that many patients? I have been looking for a good report sheet, and a sheet to organize my meds. Can you give me your tips on organization? also if you have a good report sheet, would be able to share it with me? I'm the kind of person who likes to write things down, and see it in front of me on paper , instead of relying on the computer all the time. Also as I was following the day shift, I was told by the day nurse while giving report, "these night nurses don't know what they are talking about sometimes". I DO NOT WANT TO BE THAT NIGHT NURSE! I want to be able to pass on good report and important information off to the day nurses.

I definitely will be looking into all the advice you gave, thank you for being so kind and offering to help if I have further questions.

Godismystrength · Sep 25, 2012

IndyB:

Thank you! Ya unfortunately there is no interaction with the therapists during night shift, but worked a few days and really saw the team work it takes to get the patients back to a functional lifestyle. The therapists provide invaluable experience. So far , I haven't gotten much opportunities to do anything, at night most of them are sleeping , and there rarely has been any meds. Gave my first fleet enema, and drew labs from a PICC. These are all new experiences for me, and grateful I got that opportunity but still wish there was more to do. I think day shift nurses have more of an advance when it comes to that. But I like nights, because you have more time to know your patients, and get work done. It's a calmer environment and I feel safer that way especially having nine patients. I'm sure more opportunities will come by. Thank you for your advice and reply.

<3RehabRN · Jan 8, 2013

Size does not matter! I work on a rehab unit and it is true, you do do A LOT more transfers in rehab than most any other nursing specialty. However, I know big women who can't move a small 90 year old, and I also know tiny women who can move 300 pounders with no problem. You just need to learn proper transfer techniques for the types of pt.'s your facility will acquire. Good luck!

1KoolRN · Nov 17, 2014

Thanks for starting this thread!! And thanks for all the great advice!!

I would also love to hear how y'all organize your day. I work days and have been trying to put a brain together myself. We have 2 different computer programs: 1 for meds, orders, labs, records, etc and 1 specifically for assessments. We also update kardexes throughout the day, make a copy of each and then write up our reports for shift change on the back. So, there's already alot to keep up with! I've been experimenting with a task sheet with room to write down changes, new orders, etc. Just feels like there's still so much to keep up with. Also, if anyone has any tips or pointers for CBE, I would love you forever!! I was told day shift always needs to do a full assessment and address everything, regardless if there weren't any changes. Time management has been a big focus for me, as I'm sure it is for most nurses (esp new ones). Thanks so much for all the advice!!

thevez · Jan 8, 2015

Hello everyone! I too am a rehab nurse for not longer than 5 months now. New grad as well.

Thank you for TheCommuter. Your advices are gold. I have developed my one brain for on how to organize my days. If you would like to get a copy just let me know!!!!

Hooray to Rehab nursing!

Baubo516, RN · Jan 18, 2015

I am starting my first job as an RN on a Rehab/Skilled floor this Wednesday, and I am glad I found this thread! I have been working as a CNA on the same unit, but I am a hard worker and kept busy with aide duties, so I know I will have lots to learn in my new role. Thanks for the suggestions!