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Nursing Home Rehab Units

Geriatric   (5,876 Views 18 Comments)

TheCommuter is a BSN, RN and specializes in Case mgmt., rehab, (CRRN), LTC & psych.

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What do y'all think of the rehab units located inside nursing homes?

I've been working at the same facility for the past year and a half, but was involuntarily transferred to the rehab unit about 6 weeks ago. Am I the only one who thinks that nursing home rehab is dangerous?

Here's my rationale for thinking that it is risky. Geriatric rehab patients tend to be much sicker than traditional LTC patients. They usually have PICC lines, IV ABTs, complicated wound tx, CPM machines, and so forth. Virtually all of my rehab patients are recent postsurgical cases that are being admitted to us from the hospital after undergoing knee replacements, hip replacements, amputations, heart surgery, rib fractures, CVA, MI, or any number of other acute problems. I simply think it is dangerous to have 20 of these higher-acuity patients, because they require more monitoring and care than the typical geriatric nursing home patient.

30 traditional geri patients are fine by me, but 15-20 of these very sick rehab patients has been challenging...

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NurseElaine specializes in Hospice.

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I totally agree, it is dangerous to have that many high acuity patients in Geri rehab. I worked on a unit such as this before and to say that it was challenging is really stating it mildly (next to impossible to really give the kind of care that is necessary). New grad nurses that started on the unit didn't last beyond 2 wks. As far as the more experienced nurses, after a day of working on the unit, refused to accept an assignment there any longer. It is a very stressful environment. I stayed for about 3 mths before being transferred to LTC unit. Most miserable work environment ever. I know exactly what you are dealing with. Good luck.

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289 Posts; 9,973 Profile Views

That's way too many geriatric rehab patients... I work inpatient rehab, and it's all I can do to get my stuff done with 5 or 6 patients... of course, we don't have a secretary, and only one to two techs, so the nurses do all of the secretary stuff, phone, as well as pass meds, teach, admit, discharge, etc, etc... my heart goes out to you...

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917 Posts; 16,434 Profile Views

patients are suppose to be medically stable, but they are sent to the nursing home for skilled care like wound care, tube feeding, iv abt, physical therapy, but we are not equipped for emergencies like chest pain, renal failure. so if there are any change in condition, just ship them out to the hospital.

what i'm having a problem with rehab unit are hospital send actively dying patients, or patients who are so confused that they had 1:1 cena to be with patient all the time, so they send patients from psychiatric unit. we are rehab units, not a morgue or psychiatric hospital!!!! :angryfire:angryfire

 

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TheCommuter is a BSN, RN and specializes in Case mgmt., rehab, (CRRN), LTC & psych.

1 Follower; 228 Articles; 27,607 Posts; 316,705 Profile Views

of course, we don't have a secretary, and only one to two techs, so the nurses do all of the secretary stuff, phone, as well as pass meds, teach, admit, discharge, etc, etc... my heart goes out to you...
In nursing home rehab, we don't have techs or a unit secretary. Therefore, the nurse must complete the admission paperwork, obtain vitals on every patient, obtain blood glucoses, answer call lights, pick up the phone, etc. We typically have 1 to 2 CNAs to care for 30-34 patients, but our facility does not permit CNAs to obtain fingersticks or vital signs. If census drops, we only get 1 CNA...

By the way, I had 9 diabetics last night!

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3,727 Posts; 21,510 Profile Views

Commuter...that sounds like mine. We only have 48 beds (2 halls) and of my 26 pts...at least 16-18 of them are highly skilled rehab pts. GRRR. Of course I also have the other LT dementia res thrown in for fun.

What is up with all the diabetics lately. I had 12 last time I worked. 10 of them were qids. No unit sec. The nurses do everything including answering the phone down to fixing a broken toilet.

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Dolce is a RN and specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

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I did that for a while and hated my job. I just felt like I did not provide good care to the patients at all. With rehab nursing a huge key component is time. Patients need staff to be able to have time to allow the patient to do what they can for themselves. This is especially true for the CVA/brain injury patients in rehab. Well, when a nurse has 20 such rehab patients the last thing they have is time. I felt even worse about the poor patients who were working with PT or OT and I had not gotten them pain medication prior to their therapy. The pathetic looks on their faces as they came up to me asking for pain medication during therapy was heartbreaking. I did all that I could and just couldn't do it all. Rehab doesn't really have a place in nursing homes unless they staff more appropriately.

The facility where I staff occasionally for agency work has a ratio of 5-7 patients for 1 nurse. The CNAs usually have about 6-8 patients. This is appropriate staffing and allows the patients to be well cared for. If I had to undergo rehab for any condition, it would not be in a nursing home.

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12 Posts; 1,116 Profile Views

I totally hear where you all are coming from, as a new LVN grad I worked in LTC/rehab, 99 bed facility. Started out in the LTC section, then when another new RN grad came in, I was involuntarily volunteered for the rehab/medicare section which was near impossible to do on your own. As well, their was no unit sectretary to answer phones, etc. so mornings were extremeley hectic, with family calling right at med pass and such. Extremely demanding work, usually lunch break was cut short to finish charting on the 10-12 medicare residents. Also had actively dying pt. with picc lines, PC pumps and such. I stayed for about 8 months and said thats enough of that!

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tatgirl specializes in Geriatric and now peds!!!!.

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I too work in LTC with a rehab unit. I am on the LTC side, but I do have a couple of residents that should be on the rehab side. I have pt who sustained 3rd degree burns to over 50% of her body who receives complicated dressing changes q day. I also have a pt who receives peritoneal dialysis 5x a day. My pt ratio is 24 on that unit. Plus all of the g-tubes, diabetics who require qid fingersticks etc. It can be hectic even on 3-11. Add to that mix demanding family members, no unit manager, no secratary, answering the never stop ringing phone. some days I feel like pulling my hair out!!!!!

Wendy

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BoopetteRN specializes in LTC since 1972, team leader, supervisor,.

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Our Medicare unit is a tough unit to work on, but our DON and unit coordinator are very picky on who comes to the unit, which helps acuity. The most that I have ever seen on Medicare for each team is six Medicare residents, but that is on top of the 25 general geriatric residents so it is difficult, and at times I agree it is unsafe.

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CapeCodMermaid is a RN and specializes in Gerontology, Med surg, Home Health.

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People who make the rules and set the staffing need to get it --- we are taking care of sick old people who need and demand a lot of care and having one nurse for 20+ short term residents is outrageous....typical but outrageous none the less.

Just a comment...hardly any long term diabetic needs fingersticks and coverage 4 times a day. Talk to the docs. It's time consuming for the staff and painful for the patients.

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5 Posts; 452 Profile Views

I agree with basically everything already said.

I am a new grad. and was hired at a large LTC facility. I was initially hired for LTC floor but but when I showed up for my first day the DON was pleased to inform me of the good news that they managed to find a place for me on the rehab unit, which would be wonderful experience for me. Ha!

I soon figured out why this unit is staffed with about 50% new grads and travel nurses. All the other nurses in the building hate it with a passion and will do almost anything to get out of being floated to it, for the reasons everyone's already mentioned.

Sometimes I think I'm holding my own and sometimes I think I'm in a very dangerous situation.

Recently the acuity level has shot through the roof. I think it's worse right now than it's ever been. I have 18-20 pts. on my hall, fresh hips and knees, TWO peritoneal dialysis pts. requiring three exchanges between them on my time, 9 diabetics with fingersticks, a trache. that requires frequent suctioning and of course q shift trache. care, a g-tube pt. that gets bolus feedings twice on my time, a wound vac, a PICC line getting IV abx., a post CVA who thinks she can walk by herself and frequently falls. There are the dsgs. It's just crazy. I have to do all my own admissions and discharges pass meds., assess, do my own treatments, fingersticks and vitals, apply cream/skin prep to the heels (and what's with the skin prep? Do other facilities do this for heels, and do you think it works? I am not finding it very effective to prevent breakdown on the heels...) of just about everyone. It's very overwhelming bordering on scary sometimes.

Then almost everyone is medicare and requires charting.

I agree about the qid fingersticks. I keep asking WHY certain people get them qid...there is at least one getting them qid who doesn't even have coverage ordered and has been between 100-120 every single time since admission, yet they wont stop the qid fingersticks. I don't get it.

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