rnmelody

Rehab nursing is very complex. The caseload is now evolving into more complex situations such as strokes with accompanying co morbid issues. We now take care of patients with TBIs, multiple sclerosus, craniotomy and worst, drug dependent hips and knees. I dont mind caring for patients who has multiple needs and total assists with ADLs but for me, my biggest challenge is caring for bipolar, narcissistic and drug seeking patients with uncomplicated orthopedic surgery who takes too much time and emotional effort to keep them satisfied with their care. Esp now that patient satisfaction is driver of medicare reimbursement. I also advocate for bladder and bowel training to promote continence and toileting regularity; Purposeful rounding while taking care of pain, potty, personal possessions and position should promote patient satisfaction and prevent falls. Being proactive in toileting schedule at least every 2 hours especially for impulsive and incontinent patients would help prevent falls. Doing the interdisciplinary team meetings also is beneficial for patient safety because Speech, Occupational and Physical therapists would be able to share insights into patient's tranfers, ADLs and Cognition. Overall, Rehab nursing focuses more on developing patient's independence, safety awareness and get them ready to take care of themselves at home.

What I love about HHC is knowing how patients are when they go home and care for themselves. I work in rehab IP and do HHC on my days off. I get more info on what are the teaching that these pt needs when they get discharged to home. I love the scenic drives when I have to travel in between patients. The compensation is good too. You can your visit with your patients. It t usually takes me more than 30-45 minutes to do regular visits. You are required to do health teachings, as indicated on the RN visit flowsheet. Dont wait to do your notes til you get home, do it while you are visiting. OASIS intake is really a pain when you are asking questions and your pt veers off to a different topic and all you wanted to do is get done. Prioritizing is the key. Good luck.

I agree with the Commuter. Therapeutic range is between 2-3 , just a small difference . Nevertheless, the dosage should have been addressed either through your coumadin dosing protocol or doctor's order. The PM shift nurse who gave a high risk medication such as Coumadin should check INR result. That is why there is a flow sheet. Now, with regards to getting a high alert result, your laboratory cannot give you the numbers over the phone? I mean, there is a reason why they are calling you- to report an abnormal result which could direct the care or treatment of the patient. You mentioned that your manager is very effective, right? I suggest , go to him/ her and review your policy on taking high alert results from Lab and also your policy on administering High risk meds like Coumadin. Im pretty sure your company has a policy on both. Good luck to you.

I work 12 hour day shift. I normally have 6-7 patients in the rehab unit. At times, we do have a charge nurse without patients but it is usually a big deal when I have to work with the normal patient load and be charge nurse as well. Usually it is a very challenging day when I have to deal with phone calls from admissions, deal with patients/ family , do room switching when necessary, do pt

Change in mental status definitely signals cva or hypoxia the brain. In order for the doctor to treat the pt accordingly,he has establish a dianosis. Find the immediate family to get consent quick!