Pt assignement of 7 or more in rehab

Specialties Rehabilitation

Published

this is my first post as far as a subject but i am at my wits end and want to know what you all think. first off i work on a 22 bed unit that is also part of a 360 bed hosp. the rehab unit is just over 1 year old. we are one of the few units in the hosp that is currently making money. our manager has this idea that she doesn't need a charge nurse even though we are full a lot of the time. she says all we need is a "lead" nurse which is what i am. now of course you know that the "lead" nurse gets no extra pay but has all the same duties of a "charge" nurse and carries a full load. their idea of a full load is up to 8 patients and occasionally more if staffing is low and we can't find any other nurses to work. (she keeps no prn or part time nurses to fill in when we need to be off.) anyway most of the time we are short on cna's too and most of the time we only have 1 cna for the whole unit. we also take higher acuity patients than we were told we'd have. i am 54 years old with lots of health problems. when i started here i was honest and brought all the up and the fact that i had also had back surgery and wanted to know if she was sure i wouldn't have to lift...she said told me no that there were plenty of people to help out. now we all know that hasn't worked out. pt and ot is busy and doesn't want to stop and help clean a total care patient when we need help. it's really miserable and i don't know what to do. please let me know how your units work ao i will have an idea if this is just rehab and i need to shut up or if you have any other ideas. by the way we have no equiptment to lift folks either. thanks!

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Specializes in Acute rehab/geriatrics/cardiac rehab.

Unfortunately for the nurses at our rehab hospital, we are often expected to lift patients....though we do have the Hoyer lift which helps if the patient is too obese for us to lift. Therapy will sometimes help, but that may be changing too. Since I'm in my 40s, I also have been concerned about my back. Wondering if I will have to find a new field of nursing if I can't lift the spinal cord injury, etc patients and get them up and ready along with the nursing assistant's help. I'm planning to try to go to a class soon on transfers since the nursing staff is being expected to do more lifting of our patients......

By the way, welcome to allnurses :)

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Eight patients and maybe more is too many. I'd be seeking another unit to work on. I wish you well.

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Welcome! I work at a LTC with a rehab unit, our rehab unit is also very new. We have only 2 LPNs at any one time with a total of 32 residents on the floor, so each nurse gets 16 residents. I think your ratio is actually very good! I do question the lack of equipment- a Hoyer lift is definately needed. If I were you, I would submit a request for one in writing to management, making a copy to keep for yourself. Protect your own health at all costs. When the patients start complaining of having to wait for people to come help lift, and the other nurses/CNAs complain that they are always getting called over to the rehab unit to help lift, it may cause management to rethink the idea of purchasing a Hoyer lift. I would also meet with management about only having one CNA. When most people are a 2- to 3-person lift/transfer and the nurse has a bad back and cannot assist, what do they think is going to happen? Are you officially on light duty? If not, I would look into it. If you end up injuring yourself, it will cost your facility far more than the Hoyer lift would. They should be able to understand that.

Lori

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Specializes in Clinical Research, Outpt Women's Health.

I think this staffing is wrong, and not having proper equipment is also very wrong. They will pull this as long as you let them. You need to take a stand. Give them your requirements in a calm and professional manner with a deadline. If they choose not to meet it then step down. One back injury can put you out of "service" for life. It is not safe for you or your patients. It really is in your hands and you do have power so use it. I wish you the best of luck. You should not be required to risk your health for your career.

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Specializes in Clinical Research, Outpt Women's Health.

Delete duplicate post - dang computer!

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Specializes in Clinical Research, Outpt Women's Health.

Delete duplicate post

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Specializes in Rehab, Med Surg, Home Care.

Whether that ratio works depends on a number of things: patient acuity, non-licensed back-up, and which shift. In our 4 unit sub-acute rehab facility the day nurses have 6-7 patients with a CNA for personal care and a charge nurse who does not take an assignment. On eves, 7-8 patients for each nurse/ CNA; the charge RN will take an assignment. On nights, 14-18 patients per nurse and CNA. Most admissions come on eves, usually 1-3. There is usually an admitting nurses and a couple of secretaries that float between the units wherever the need is greatest. Of course sometimes **** happens so it isn't without problems but this does give us a little flexibility.

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I can't imagine having 16 patients and trying to give meds, help them get ready for therapy and doing wound care etc on them. Maybe with lots of CNA's that would be ok but we are constantly chasing lights as with only one CNA she is trying to do baths and get folks ready for therapy too. Maybe our patients have more meds but I know some of them have two to three pages of regular scheduled meds not counting PRN meds. I don't know....I am trying to hang on as I only have 6 years left to retire and to go somewhere else it would be like starting over. Maybe working the floor would be better but I don't see how. My areas of experience are NICU, L&D, Hospice, Home Care and a couple of other desk jobs so see I don't have a lot of floor experience to draw from. I guess I will wait and see how it goes and if she finds someone else to work.

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ps: thanks for the welcome!

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hi there....i've worked in acute medical rehabilitation for about 20 years now..............and wouldn't do anything else. the facility i worked at previously had staffing ratios about the same as what you are talking about. we did have more cnas and that does make a difference. the facility where i am now actually has a lower nurse patient ratio (5:1). we are a "combo" center....we have all types of rehab diagnoses. we still have at least 2 cnas/pcts when we have 15 patients (we have a total of 25 beds). personally, i have no problem handling 6 or 7 rehab patients, because they are not on the unit all day....but that is with the back up of well-trained cnas and help of therapists too.

what is really unacceptable about your situation, to me, is the lack of equipment and training. all rehab staff should have extensive training in patient transfers.....how do you reinforce what your therapists are teaching patients and families if your nursing staff doesn't know how to do them correctly? and there's the issue of staff injuries. then,there's the issue of lack of equipment. hoyers are really a necessity in this day and age of the morbidly obese and extremely dependent patients that we are getting in rehab. there are also sliding boards. if used properly, they are great back savers! but, it takes practice to learn to use them correctly.

as far as your own back problems......rehab is physically taxing because it takes the whole team working together to provide these patients with the most thorough rehab experience. even if you had a hoyer lift, you still have the issue of turning and repositioning patients in bed. i'm sure i'm not telling you anything you don't already know...this can really put a strain on your back. if you really are set on continuing in rehab, i would say you need to be proactive and keep yourself as fit as possible.....if you don't already have a personal back program, get one of your physical therapists to design an flexibility/strengthening program for you.

i certainly hope things work out for you and for your unit.

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Thanks for your wisdom. I know you are right and I hate to tell you but I came from a desk job and we have yet to have any training in transfering or lifting a patient! :confused: They (administration) have talked about doing some training but we just do the best we know to do. The acuity of our patients is also great most of the time. Today we admitted a 78M with a Lt AKA, Rt transmetatarsal amputation, CVA Lt with flaccid arm, COPD, CHF, CAD, Renal failure, Severe Depression (lost his wife in August) along with a couple of more co-morbidities! Wow, when they wheeled him in on his bed, one of the nurses working with us today (a flex pool nurse with rehab experience) asked if the patient wasn't at the wrong facility. She thought they intended to take him to the LTAC that we have on the 6th floor. I got tickled at her as she never dreamed he was really coming to us. She couldn't believe that this poor fellow who has no strength or use of the left side and little strength on his right side to even use a sliding board. His amputations were old but the CVA was fresh. Anyway poor fellow was pitiful and you couldn't help but feel for the patient but just doesn't seem like there is much to do for the man. We all felt that he should have had at least 3 weeks of LTAC then to us. That way he could work in to rehab and build his strength some before getting to the last phase of his time. Now he has at the most about 2 weeks total instead of 3 weeks in LTAC and then to us for 2 weeks. Oh well, funny how no one asks me my opinion either! haha! :lol2: Anyway, I could go on forever but I'm sure everyone has their own ideas. Anyway thanks again for everyone's input. I just want to do a good job for the patients and at the same time take care of my health so that I can work for a few more years as well. Thanks again everybody!

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