New Nurse in Rehab Experiences

DrkCocoMurse215 · Jan 30, 2015

Anyone?

DrkCocoMurse215 · Jan 30, 2015

Hey everyone, Im a new LPN and I will be starting my first job soon in a sub acute rehab facility. I've been informed that I will have 15-30 patients on average with short stays and will do all meds, treatments, paper work, etc. I'm very excited and nervous at the same time. I'd just like to hear some of your experiences as a new nurse in subacute rehab or LTC facilities with high patient to nurse ratios and any advice. Thanks.

TheCommuter, BSN, RN · Jan 31, 2015

Although I now work in acute rehab as an RN, I used to work in subacute/SNF rehab as an LVN several years ago. I am very task-oriented, so when I worked in subacute/SNF rehab I wrote my tasks on a to-do list at the beginning of each shift and crossed them off as I finished each task.

Back then I worked 16 hour weekend double shifts from 6am to 10pm every Saturday and Sunday. I'd typically have a patient load of about 15 residents. At the beginning of every shift I'd flip through the MARs and TARs and jotted down all the tasks that needed to be done in my notebook. My handwritten to-do list in my notebook was how I organized my shift, and as a result, it reduced the likelihood of forgetting to do something.

Look below to see how an old notebook page from late 2007 appeared (resident's names have been changed to comply with HIPAA):

9-23-2007

DIABETICS, FINGER STICKS: June (BID), Norma (AC & HS), William (AC & HS), Mamie (AC & HS), Margaret (BID), Jack (BID), Ethel (AC & HS), Marjorie (0600, 1200, 1800, 2400), Wilma (AC & HS)

NEBULIZERS: Marjorie, Ethel, William, Jack, Pauline

DRESSING CHANGES: Pauline, William, Fred, Jack, Merle, Rose, Lucille

IV THERAPY: Pauline (Vancomycin), June (Flagyl), Fred (ProcAlamine)

COUMADIN: June, Rose, John, Lucille

INJECTIONS: June (lovenox), Merle (arixtra), Fred (heparin), William (70/30 insulin), Ethel (lantus), Pauline (vitamin B12 shot), Wilma (Levemir)

ANTIBIOTICS: Pauline (wound infection), Rose (UTI), Fred (pneumonia),

1200, 1300, 1400 meds: Marjorie, Merle, Rose, John, Mamie, Jack

1600, 1700, 1800 meds: Rose, John, Fred, Lucille, Mamie, Pauline, Ethel

REMINDERS: assessments due on June, Mamie, and Rose; restock the cart; complete all Medicare charting, fill all holes in the MAR; follow up on Norma's recent fall, fax all labs to Dr. Smith before I leave, collect a UA specimin from Wilma, order a CBC on Fred...

NCBeachRN · Feb 5, 2015

I'm a new RN, beginning my career in sub acute rehab. I'm excited and ready to work. I'm a little nervous, but more excited. I think that was great advice about having a task list. That's worked for me as a student, and most of the nurses I've worked with have used a similar technique.

jojo489 · Feb 6, 2015

In SNF, be sure to know who's a blood sugar, who needs a blood pressure, who you need vitals on, who's on neuro checks, and who gets meds with meals. It's also helpful to know who will have labs drawn.

Add on to your to do list as you go, as someone may want ibuprofen and not have an order for it.

I used different color ink on my report sheet for different things as it got quite full. I used black for report I got, red for things needing to be done, green for vitals I took, and blue for assessment notes. It really helps while you're charting after finishing the med pass 3 hours ago or getting what needs done..done.

Baloo · Feb 6, 2015

I'm a big fan of the 'checkbox' method. At the bottom of the brain sheet we use is enough space to jot down things that need to be done (things that need looking into, orders to put into the system, etc). I draw a square and then a few words about the task...when completed, I check the box. This also helps when giving report to the oncoming nurse and when charting.

Another thing I do with my brain sheet is fold it in almost half, so that the top right corner is nearly touching the top left corner...this way, I can see the room number that's on the front of the page, but with the sheet folded over I have the blank back of the page. This way, I can write down the treatments that need to be done and other patient-specific tasks without using the space on the front of the brain...but it's in sequential order (ours go by room number), so it's easy to track and for quick reference. of course, this is also done with the checkboxes to keep track of progress throughout the shift. It might be hard to visualize (easier to show than describe), but when I learned this method it freed up SO much space on the front of the brain sheet and made things a LOT easier.

Hope this helps!