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.

[smoup]

Must be nice only being required to do "billable" things so as not to get behind schedule LOL.[/quote']

You make it sound like therapists like this set up. Where I worked, the therapists wished they could do more and hated having to worry so much about what is and isn't billable, who they can and cannot see at the same time, how many minutes so and so needs today to make their RUG level for reimbursement, etc.

It's petty. 5 minutes too little in a RUG period can mean thousands of dollars to the facility. It has nothing to do with not wanting to get behind in schedule. Sh!t happens. It has to do with payment to the facility being based on RUG level and RUG level being highly dependent on time spent in therapy as that's where most of the minutes are accumulated.

~~~

Interesting about having multiple nurses scheduled to do different aspects of the job. Where I worked barely had enough nurses period, let alone a different nurse for different duties.

[BrandonLPN, LPN]

Interesting about having multiple nurses scheduled to do different aspects of the job. Where I worked barely had enough nurses period, let alone a different nurse for different duties.

See, it's all in how you look at it and how your facility is set up.

Where I work, the "med nurse" routinely passes medications to a unit of 49 residents on day shift. Many of my LTC colleagues on this board probably think that's outrageous. Its not.

You see, on this unit of 49 residents there's also a "charge" or "desk" nurse who passes no meds, and is responsible for noting orders, monitoring changes in condition, answering the phone, etc. The "med" nurse is free to focus on meds and the "desk" nurse is unencumbered by a crippling med pass.

Most LTC facilities (from what I've seen) would take these two nurses and split the 49 residents between them and each nurse would be "the" nurse for his group of 25 or so residents, responsible for meds, orders, calling pharmacy, etc. This model is a recipe for disaster. Trying to do everything only ensures next to nothing gets done. It is more efficient to assign a specific nurse to a specific role.

I don't know at what point in nursing history it was decided that assigning one nurse to a single task was outdated, but it was a foolish mistake on the part of our nursing researchers and policy makers. If you have 49 residents and 2 nurses,

assign one nurse to pass all the meds and one nurse to be the "desk" nurse. If you're lucky enough to be staffed with three nurses, have the third do all the dressing changes and help the other 2 as needed.

Whoever decided it would better to just split the unit three ways made a HUGE mistake.

[prmenrs, RN]

Seems like a "come together" meeting is in order: get the stakeholders (therapists and nurses and or leadership) together, and figure out how to work compatably w/each other so that the PATIENT gets the best care. That is the objective, right?

Also, use some visual clue--a sash, tiara, special color scrub shirt--to indicate who the med nurse is. S/he is sacrosanct! Unless there is a dire emergency, all staff need to acknowledge the seriousness of this task, and the possible consequences of a med error. If she passes prn meds, too, use a communication method of some sort--clipboard, note book--to record requests. The med passer can check it periodically to deal w/that issue. You could even use one for pain meds and a different one for less urgent needs.

Meds are important, rehab is the reason their in the facility. Both things need to happen, but preventing med errors trumps rehab in terms of potential Very Bad Outcomes.

Best wishes as you negotiate a balance between the 2 teams caring for the pt.

[BrandonLPN, LPN]

Sorry, no way am I going to wear a sash of any kind. :)

The giant pill wagon tends to tip people off.

[Bringonthenight]

Can you explain the difference between a med nurse and a rehab nurse?

[dishes, BSN, RN]

Seems to me some LTCs do not have small enough patient/nurse ratios to provide active rehab and should not be licenced as rehab providers unless they have adequate staffing.

[Dazglue, ADN, BSN, MSN, RN]

OMG. I thought this sort of thing only happened at my facility. Our entire med pass is based on the therapist schedules. Ok fine. But almost everyone is a high fall risk (visible armband on pt) thus requiring fall monitors at all times and letting someone know they're back from therapy. Or they'll let the pt go to the restroom alone and we find them on the floor. No one does either which means more falls and write ups for us. Management will make up a schedule for rehab but is terrified of an educational section about fall precautions.

[anotherone, BSN, RN]

I work in acute care but can relate. I hate to be drawing up meds and have a family member of a pt I don't even know come up to me and start asking questions or expect me to drop what I am doing. same with other staff ( not nurses usually aidea). For the pts and family I want to wear a shirt that says, " ring call bell for assistance." unless it is a real emergency leave me alone while i am pulling up zofran, dilaudid, benadryl and the other 12 meds one pt gets

[THELIVINGWORST, ASN, RN]

As a CNA, and soon to be RN in working in an acute care hospital with experience in LTC/Rehab, I would like to put my two cents in.

If we cannot do something for a patient or family, we MUST ask the nurse. We are aides, not RNs and the RN is ultimately responsible for the well being of the patients in the eyes of the law. Most of us IMHO, would rather be able to do small things that are not in our scope of practice, but we are not allowed to. PT/OT must care for the patients as well, and it is unfortunate that many nurses have the opposite experience.

These pts and family members will yell at us or feel like we are pushing responsibility off on others if we don't fulfill their requests ourselves, and we find ourselves in this same enigma time and time again bc EVERYONE is busy most of the time.

[Vespertinas]

Must be nice only being required to do "billable" things so as not to get behind schedule LOL[/quote']

Yes yes yes!

[CapeCodMermaid, RN]

My med nurses do more than pass meds. They do assessments, treatments, charting, assisting the CNAs....

In Massachusetts we do not have medication aides. The issue comes up every few years but the Massachusetts Nurses' Association goes to great lengths to make sure the law doesn't change.

[savoytruffle, BSN, RN]

Medication aides would not be a good solution in LTC. A nurse is needed to monitor these medications and the patient. Many times I'm being interrupted for therapy. I get calls from the manager to complain that the patients were not up in time for therapy in the morning. Well, we had two total beds during breakfast are are an aide short. So no, we will not be transporting them for you also today. It's not just therapy. Social work loves to drop tasks and call impromptu family meetings. No matter what I'm in the middle of. I feel I can never get anything done from start to finish. My med nurses complain about it daily. I've thought about calling a team meeting to hammer some of these things out.