Nursing Home Rehab Units

Specialties Geriatric

Published

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...

Specializes in Gerontology, Med surg, Home Health.

Here's where sticking to it gets you somewhere.

The patient with the bolus feedings? Why can't he get his tube feeding at night so it doesn't interfere with his day? It's all about the calories NOT when he gets them but how many. Call the doc.

QID fingersticks without coverage and in normal range...absurd! Call the doc.

I love wound vacs...instead of TID or BID dressing changes it's usually Monday Wednesday and Friday.

If you find ways to cut down the unnecessary things--and we all know most patients have unnecessary meds and treatments they don't need--you'll have more time to deal with the sick ones.

I worked in a place where they skin prepped the heels. Did it work...not really. The only way to prevent pressure sores is to relieve pressure.

Good luck.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Wow...I'm astonished that so many of you agree with my assessment that LTC rehab units can turn into dangerous places to work. Thanks to all of you who responded!

Hi,

I work in a SNF and I would like to share with you some of our practices in Miami. In our community we have about 18 SNF within 20-40 miles radius. Majority of these SNF's carries about 40 % of their census that are short term care patients that came from the acute setting and with higher acuity. Our facility is over 200 bed free standing facility with over 100 beds Rehab hospital. We admit about 200 in the SNF monthly. Our process, we have the admission nurse on 3-11, wound care nurses and superviors. We are JCAHO accredited and we accept all those patients that you mentioned. We do blood tranfusion and short term, stable trached patients. Our nursing ratio on the average is between 14-16 patients on 3-11. Unfortunately, with the population getting sicker, insurance capitation patients are being transferred to the " Rehab facility". This is the market, the demand is there and I don't think it will change. Rehab facility are not for old people anymore.

Specializes in geriatrics-LTC/clinics/med surg/psych.

:monkeydance:I recently started working prn (night shift)at a LTC/REHAB facility. The DON ensured me that I would get an adequate orientation and pay for my I.V. cert. class(The rehab unit takes pt.s with I.V'S/TRCH'S and it's sort of a mini-med/surg unit-but the pt.s are more stable) . After 3 days of orientation, the ADON asked me if I would be interested in working the 2nd shift because she had already scheduled the other prn nurses for the rest of the month on the night shift. I accepted because I was eager to start working. I now wish I had read this post before accepting the prn position.Unlike other facilities, this rehab floor has 1 nurse,2 aides and 30 pt's(2ND SHIFT)/1 NURSE(2 HALLS),1 AIDE/PER HALL(NIGHT SHIFT).I was sooo swamped with work:angryfire:uhoh3: !!!Every time I worked the 2nd shift I would leave 1-2 hrs after the shift ended(I have to finish charting). Between all of the dr.s orders, family request, call lights, med pass, treatments etc..., I barely had time to breathe or take a break:madface:. I worked the night shift 2 days ago, and the 2nd shift nurse was still charting at 1:30 am!!! I need some advice!!! I've learned from other nurses that they haven't been able to keep a 2nd shift nurse on the rehab floor, yet the one's who say this rarely work on the rehab floor.Since I'm prn and havent worked there very long (3 weeks ), should I stay and improve my time management or find another prn position? BTW the rehab floor isn't currently at full pt. capacity yet and I'm concerned that 1 nurse to 40 rehab pt's is too much to handle!!!

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Since I'm prn and havent worked there very long (3 weeks ), should I stay and improve my time management or find another prn position? BTW the rehab floor isn't currently at full pt. capacity yet and I'm concerned that 1 nurse to 40 rehab pt's is too much to handle!!!
Even with superb time management skills, 40 rehab patients is excessive. An assignment of 40 traditional long term care patients is manageable, but 40 rehab patients is too much. I would switch to night shift (graveyards), or give this job up altogether. All of the skilled nursing facilities in my area also have extreme difficulty with retaining nurses for evening shifts in rehab (2-10pm or 3-11pm), because that's the time frame when the majority of the new admits arrive. That's the time frame when the majority of your demanding family members visit and bother you with petty requests.
Specializes in Skilled nursing@ LTC.

Wow, I guess I'm lucky. I work on a 27 bed rehab at a LTC facility. 4 of those beds are stable long term patients. I have a second nurse that works 9-5 ( I work 7-7). At least 2-3 STNA's and an additional one who helps out with whatever is needed.(Admissions, pt. care, etc.) Most of my surgical patients have spent at least some time in the hospital's rehab unit. The last fresh surgical pt we had went right back out- very unstable. Granted, I do get a few who belong over in the locked unit, but for the most, our admissions dept. is very good about what they will accept. I do seem to get a lot of diabetic residents-though not as many as some of the rest of you!

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