Rehab needs to get a clue

[CapeCodMermaid]

This might be something of a vent, but I am very tired of rehab people thinking they are the be all and end all of skilled care. I have rehab staff interrupt the med nurses for a variety of reasons and get ***** if the nurse doesn't drop what they're doing.

We have rehab people walk down the hall and say to the nurse , who is in the middle of a med pass, that the lady in room 15 has leg pain. They then stroll away without even making sure the nurse has heard. THEN they complain that the nurse did nothing with the information.

Really? Do any of them have a clue about the concentration needed to pass meds to 20 residents who take an average of 15 meds each?? One break in that concentration and a huge med error could occur. Our rehab manager seems to enjoy trying to throw the nurse under the bus. He only backs down when I intervene. I think I've had enough of this.

[BrandonLPN, LPN]

I don't care for the attitude of some rehab staff have that the nurse is "just" passing meds, so it's okay to interrupt. Ditto for CNAs who interrupt med pass for relatively trivial things.

I never cease to be amazed how oblivious non licensed staff can be when they're interrupting the nurse. I was busy transferring a resident to the ER just this morning and a CNA interrupted me twice, first to complain about 3rd shift not making a bed, and then to ask if I knew where Mr Xyz's shoes are. And she knew I was sending someone out.

[BrandonLPN, LPN]

And another thing that bugs me is when rehab aides tells me a resident requested pain meds and then stands a glares at me if I don't drop everything right then and there. I told a rehab aide once, "OK, I'll get him soon." as I was hustling to give coverage to my diabetics. I medicated the man 10 minutes after being told. This aide took it upon himself to "report" me because I finished medicating the diabetics before addressing the PRN pain med seeker. My supervisor told him to jump in a lake.

Some of these people certainly do take a weird joy in reporting nursing staff. Kinda like a "gotcha" mentality.

[smoup]

I have to ask as I'm now curious. I see posts referring to "med nurse" as opposed to. . . ? At the SNF where I worked there were RN's that handed out narcs and meds like that and an certified medicine aide to do the other medication. Granted, sometimes the RN did ALL the meds due to there being no CMA for whatever reason.

[HippyDippyLPN]

I know some facilities have a nurse just for treatments, a nurse just for desk work, and then the nurse that passes meds, etc. maybe this is what they are referring too.

[kz020]

I work PRN as a tech and our PT/OT staff is wonderful. However, I was in my last clinical rotation which was ortho. One day I had 4 patients and I was passing meds. OT set one of my patients up for their bed bath. Got him/her seated on the edge of the bed after ambulating and set bath supplies on bed side table. Did not tell me or primary nurse. Pt was 1 day post op knee. Needless to say, the patient tried to stand up to clean herself and promptly fell! We were both upset about it and the NM ended up talking to their supervisor. I will track down pt/ot now when I know they are taking one of my patients. Lol

[dream'n, BSN, RN]

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 :)

Must be nice, only being required to do "billable" things so as not to get behind schedule LOL. In a previous position I had some Rehab therapists/techs needing to be reminded that nursing is concerned with the 'whole patient' and that unfortunately rehab time is NOT at the very tip top of the priority list. The rehab patients medical condition, IVs, medications, wound treatments, pain, assessment, and safety are. We are monitoring their appointments, VS, intake/output, skin, etc. Nurses are short-handed, along with CNAs and are pulled in diverse directions. Rehab needs to get that nursing is an Art and Science of prioritization...and that the therapists priority certainly may NOT be the nurses at a particular point in time. (Just to add that of course Rehab is important, but it needs to be understood that nurses should not have to answer to therapists for prioritizing)

[bluegeegoo2, LPN]

I have to ask as I'm now curious. I see posts referring to "med nurse" as opposed to. . . ? At the SNF where I worked there were RN's that handed out narcs and meds like that and an certified medicine aide to do the other medication. Granted, sometimes the RN did ALL the meds due to there being no CMA for whatever reason.

In my current facility, we have a LVN that passes all of the meds while another LVN does "desk duty" as well as breathing tx's, finger sticks, and monitors the dining room. They choose to employ an LVN for meds because she/he can do the pt assessments for pain/behavior monitoring, etc., and medicate with PRN's accordingly. There are approx 50 residents on those halls, and there is no time for the "desk nurse" to complete all of those assessments in addition to the charting, pulling orders, labs, finger sticks, breathers, etc.

[Pat2012]

i have been very annoyed with interruptions during med pass, and I've started a paper sheet communication, for people to WRITE IT DOWN, because I'm sick and tired of "so-and-so needs butt cream".

[dream'n, BSN, RN]

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.

Tell that gleeful rehab manager that NURSES AND CNAs are THE backbone of the facility. Of course everyone is important and every job makes a contribution, but the nurses along with nursing management are the only ones that have the "Big and Total Picture" of the patient (and all the other patients on the floor that need their attention and care) and are able to truly prioritize.

[kbrn2002, ADN, RN]

i have been very annoyed with interruptions during med pass, and I've started a paper sheet communication, for people to WRITE IT DOWN, because I'm sick and tired of "so-and-so needs butt cream".

Isn't that about the most annoying thing!! I hate that as well. I don't like coming off as uncaring when people approach me with these things, and I do know that if so-and-so needs butt cream it is way more convenient for the CNA or OT to have it now when said butt is exposed but...sorry, butt cream is pretty low on my priority list.

[dirtyhippiegirl, BSN, RN]

I work in acute care but we work very closely with PT/OT (burn unit).

Several of our PT and OT assistants have been caught charting that a patient refused treatment when it wasn't possible -- ie the pt was in surgery, or intubated, etc. I work nights now and don't have to deal with them but it was so frustrating on days where I might be doing a direct recovery with one patient, the techs are in a major dressing in another room, and PT is asking *me* to walk a patient to the bathroom. Is PT going to come in and monitor my patient's vitals?

[BrandonLPN, LPN]

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

A good thought, but easier said than done.

Trying to time a med to such a specific time in LTC is simply a exercise in futility. Even the very best, most efficient nurse will never, ever, be able to give a specific med at that specific a time every day. Maybe within a rough, half hour either way window most days. Even that's being optimistic.