Rehab needs to get a clue

loriangel14, RN · Jun 7, 2013

So how would you suggest they deal with communicating to the nurses that soemone has requested a pain med? I don't see what you are complaining about. I am grateful when someone lets me know when my patient needs something.You sound very hostile towards them and I don't see why.

dishes, BSN, RN · Jun 8, 2013

It is difficult to be interrupted during a med pass, but since patients cannot actively participate in therapy if they are in pain, can the pain medication be scheduled to be given 15 minutes prior to their therapy instead

pyrazen · Jun 8, 2013

The problem seems to me that non-nursing staff interupt nurses for EVERYTHING. If a person is qualified to do OT or PT, then they are qualified to take someone to the bathroom, help them call their family, fluff the pillow or any of not critical thinking stuff. I totally got your point Mermaid, but it might have gotten a different response from other posters if you didn't use a pain example.

mvm2 · Jun 8, 2013

I can see your frustration. I personally don't see why so many of our LTC facilities are changing over to being half Rehab. Personally I think that Rehab and LTC should be totally seperate. I'd hate to be a Nurse or CNA having to deal with a mixture of Residents, and Rehab. Now if they can be on seperate wings of a building where you have residents on one side of the building and Rehab on the other the flow of the jobs may feel better to me. You are either working as a Rehab Nurse/CNA or you are working as a Resident Nurse/CNA. Especially for residents, I can see how seeing new faces every single week if not day can be bothersome to them. It would make me feel like I could never feel comfortable because instead of having friends and other people around you where you know them day in and day out you feel misplaced and around strangers all the time. Just my personal take on these new LTC/Rehab facilities

kbrn2002, ADN, RN · Jun 8, 2013

I work in a LTC/Rehab and the pt mix isn't a problem. The rehab pts are on one unit, though there are a few long term residents on that unit as well. We have a "rehab referral" form that is basically just a sheet of paper with a line for the residents room number and initials and a small communication section where the therapist writes what the person needs, or updates nursing on new equipment, transfer protocol etc. [whatever therapy needs to tell nursing]. The therapist leaves the sheet on top of the med cart for the nurse to follow up on [upside down so it needs to picked up to read] .

Wise Woman RN · Jun 8, 2013

This. Med pass should not be interrupted.. I work in a snf/rehab, and am a rehab nurse.. I know the game, and play accordingly. I get last med times from report, know when they are due, and give them. However, if I haven't gotten to the particular patient yet, please, just know that this is standard procedure.. to know when they are due and to give them.. I was interrupted about 10 times the other day, finally talked to my DON... thank you for advocating for your nurses, Cape Cod Mermaid.

HippyDippyLPN · Jun 8, 2013

Oh lord the rehab staff where I previously worked were famous for 'Hey I just finished up in room 212, mr. X needs assistance to the restroom.". I usually say (because my cna's were always swamped and I was in the middle of my 32 person med pass) " Great this will be a great time for you to help him since your the OT.". Ha that got a snarky look but c'mon that's lazy.

bluegeegoo2, LPN · Jun 8, 2013

I'm so very glad to hear that I'm not the only nurse in LTC who feels like therapy expects us to jump RIGHT NOW just because they spoke. I have found myself under that bus more times than I care to count because I didn't immediately run down the hall to assess the resident and medicate accordingly. I will get there. I always do. Imagine the reaction if a nurse walked into the gym and announced, "Hey guys! Mr. Smith and Mrs. Jones have had their pain meds, and should be ready to go in therapy! You can come get them now!" I am fairly certain there would be a sea of flabbergasted faces while they looked at each other thinking, "...and just who in the HELL does she think SHE is?!?!" Same concept applies to me. They are busy with their schedule, and so am I. If I have an emergent situation on my floor, that's one thing. But to be expected to drop everything on their say-so is laughable at best.

smoup · Jun 8, 2013

Just for a different viewpoint coming from a former rehab tech/to be nursing student this fall:

We've done toileting for nursing because there was no nurse or CNA to be found, even on patients who were not on our caseload. (They could usually be found in the nurses station and lounge, though that's another issue.)

The only time we left a patient who needed toileting was if they needed to be completely washed up, and even then we'd normally do it unless it was the end of their therapy time. Also, some activities cannot be billed for and therapists are discouraged from doing them because it takes away from their productivity time, time spent with patients who are paying, etc.

Also, I don't know about your SNF's, but we had a schedule, posted to all the nurses stations, daily. We do this so everyone can plan accordingly. We tried to have the more difficult ADL patients later in the day or have the OT do ADL's with them. We would try to make sure we weren't asking 1 CNA to get ready 4 patients for the same time. When patients aren't ready, it can mess up everything. Not every patient can be seen with another patient, so the order/timing we had patients in were for a reason, not arbitrary.

If nursing came in to rehab to tell us a patient on our schedule at that time was ready, we'd come get them. We often would get patients who weren't on the schedule at that time if they were ready and the one we needed wasn't ready, IF they could be seen with the patient(s) currently in the gym.

It's a failure in how payment is set up and the pressure put on therapy to only do activities that are billable. This was made even more difficult when laws were passed instructing what type of patients can and cannot be treated together depending on how many days they've been in therapy for. It isn't necessarily laziness or not wanting to help.

Just giving a different perspective, not trying to stir things up.

And, back to lurking :)

CapeCodMermaid, RN · Jun 8, 2013

I am not hostile and truly believe in team work. But, we've gone to great lengths to arrange the med pass around the schedule of the rehab patients. The rehab staff , however, can't seem to follow the schedule THEY'VE posted. I have no objection to the information they give and welcome their input, but there is always someone at the desk they can share information with. The resident will get what they need without disrupting the med nurse. If the PT tells us Mr. W will need to be ready for rehab at 9:30 and then comes up and annoys the nurse at 8:30, that is unacceptable to me.

If something is an emergency, then for sure, interrupt the nurse. If it's not emergent, write it on a piece of paper and hand it to her. Or come tell me. My office is steps away from the rehab floor.

What bothers me the most is the glee they take when they percieve the nurse has done something wrong.

TiffyRN, BSN, PhD · Jun 8, 2013

I know I have read several articles about nurses wearing sashes that identify them as med pass nurses that are not to be interrupted. Maybe thus could be implemented. Rehab (and other staff) could leave a post-it in a designated area (on the med cart maybe) for such requests. The med nurse could check the post-its between patients and prioritize them without interrupting his/her train of thought.

http://m.innovations.ahrq.gov//content.aspx?id=1799