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.

[chrisrn24]

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.

So they're just a nurse then haha

[NurseGuyBri]

Good morning! Here is what I'm gathering out of this post and comparing it to my facility. We all have the *exact* same staff! Now, since that is not true, perhaps something else is going on here. If this is the case in so many different facilities, then there must be more to the story. Perhaps we need to look at some internal systems and come up with solutions? Our rehab has become the prime money maker for the facility, without them I don't think we would stay in business, especially with the recent cuts. What we need to work on is the communication between the departments and the managers of those departments. No, I'm not good at doing this yet, but our facility is working on it. Improving the management relationships and stoping the b*tching about what the other department does or doesnt do won't help the problem. I've recently gotten into attempting to always explain why I have the expectations that I have. For instance, if a OT asks for pain medication for a patient, I expect the nurse to complete their current patient and then medicate the patient. No questions. If OT asks for assistance to the bathroom, I expect them to either help provide it or get the CNA, not the med nurse. The assignment is posted, and they can help. Explaining WHY I do this has made a difference. I don't know what it's like to be a PT/OT/ST, and they don't know what it's like to be a nurse. There are things I'm willing to work on, there are things that I refuse to, and explaining why I feel that way sheds light on it. Now, let me disclaim here that I know this is a vent post (although has turned into more) and I COMPLETELY AGREE lol!! This is a much needed vent. Now that the vent is open, perhaps we can figure out how to control the temperature coming out? If anyone is interested in using a chat room for discussion, please let me know because I love to talk and hash these things out, it's of great importance for me as a manager.

I think the moral of the story is to not assume what they are responsible for, do not assume they understand what we are responsible for, share the information professionally and kindly, and when that isn't possible, find out why and fix it. I could go on for days.. ;-)

[Forever Sunshine, ASN, RN]

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

The giant pill wagon tends to tip people off.

Anyone with functioning vision should be able to see that I'm passing meds.. I agree with you a sash is not needed.

I'm so happy to see this thread because the other day at work I was thinking (during a med pass of course.. after being interrupted for something stupid) if I had a penny for each time these therapy staff interrupted me I wouldn't have work anymore. Thankfully they all are friendly and polite (except for one) but I just would like them to not interrupt us for things they could either look up or do themselves.

I also find the location of me and the cart is related to how many times I'm interrupted. I find when I go room to room and bring the cart and put the cart in front of the patients door ... I'm less likely to be interrupted. If I keep the cart in one location against the wall, I get more interruptions. If I keep the cart at the desk and walk back and forth.. forget it.. I'm not getting anything done.

[smoup]

Yes yes yes!

Two words: RUG level

Sad but true.

[Nascar nurse, ASN, RN]

Had a speech therapist, that I know has been in the business at least 20 years, working on a G-tube resident transitioning to oral feedings. She was discussing her plan with me that stated that only a nurse could feed her - no CNA could feed the resident and she suggested maybe the nurse could provide the feeding "while she is giving everyone else their medication. She can just make it part of her med pass routine". (Smiles like she has come up with the best idea of the century). I literally smacked myself in the forehead (to keep from smacking her).

[kbrn2002, ADN, RN]

Had a speech therapist, that I know has been in the business at least 20 years, working on a G-tube resident transitioning to oral feedings. She was discussing her plan with me that stated that only a nurse could feed her - no CNA could feed the resident and she suggested maybe the nurse could provide the feeding "while she is giving everyone else their medication. She can just make it part of her med pass routine". (Smiles like she has come up with the best idea of the century). I literally smacked myself in the forehead (to keep from smacking her).

I wish there was an easy solution, because this happens way more than it should. I would suggest politely educating her that there is no way a nurse can incorporate feeding a resident into a med pass, and that same nurse would be very hard pressed to fit that probably time consuming task into the day at all...but, been there done that and it didn't work.

[DoGoodThenGo]

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

It is happening all over the country and (surprise) the main reason being money from another census source.

With more and more seniors choosing to age in place LTC/nursing homes are scrounging around for other butts to put in those beds if you pardon the phrase.

Even the famous Mary Manning-Walsh home here in Manhattan now offers rehab: About Us - ArchCare at Mary Manning Walsh Home - ArchCare

[BrandonLPN, LPN]

Had a speech therapist, that I know has been in the business at least 20 years, working on a G-tube resident transitioning to oral feedings. She was discussing her plan with me that stated that only a nurse could feed her - no CNA could feed the resident and she suggested maybe the nurse could provide the feeding "while she is giving everyone else their medication. She can just make it part of her med pass routine". (Smiles like she has come up with the best idea of the century). I literally smacked myself in the forehead (to keep from smacking her).

I would have pleasantly suggested she could provide feeding while going about her SLP duties.

[sallyrnrrt, ADN, RN]

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.

in my LTC no level of therapy would ever try that, as I defend safe nursing boundaries..... they know to come to me....i also freq. inservice no interupting the nurse doing med pass...

[ktwlpn, LPN]

Our entire med pass seems to be scheduled around everything BUT the RESIDENT'S wishes.We have rehab,clinic,outside follow up appts,activities,beauty shop and even family coming in to viist and requesting their loved one by up and dressed by a particular time (sometimes in a particular outfit) I pity the poor resident who is not a morning person....We do get a rehab schedule weekly and they usually stick to it,however there was a time when they scheduled a dozen or more resident at 8 am in the morning.We have EMR and we don't start our morning med pass until 8 am-you can't admin meds to three residents at once.Add in your fingersticks,insulins,early meds,vital signs on anyone unstable,giving report to the cna's and getting the transfer papers together for anyone going out during the morning and you have a busy day ahead of you.

[jrbl77, RN]

At one point our Pyxis machine was in the center of the nurses station. If you were pulling out meds, people would feel free to call you to the phone, MD's ask questions etc. Finally a block of red tape was placed in front of the pyxis- that meant don't talk to the person in the red box. Now our Pyxis is moved to a room with a locked door, you are not accessible for questions etc. I find the portable phones we have to carry a bigger distraction. You are in a pt's room and the phone rings, you are expected to answer. It isn't alwys a good time to answer. Just another change in nursing!

[Galaxy1]

You and sally are one of those.....