Rehab nurses-especially HealthSouth in patient

[mel1977]

we switched to a concept called PFC or patient focused care.

What we used to do:

for one hall with 21 beds-day shift. 2 RN's/LPN team leaders, 1 med nurse (RN/LPN) 3 techs. The TL does the orders, assessments,dressing changes, the med nurse all meds and related, and techs all general hands on care.

Now: same number of patients: 2 teams: Each has a team leader which is an RN or LPN and the TL has a tech (8-9 patients per team). The TL is to do all meds, dressing changes, assessments, take off physician orders and assist with patient care. And one Total Patient Care nurse, usually an LPN-who will have 4 patients and will do all care for that patient including meds, total care, orders, dressing changes and assessments.

In either case there is usually one admission nurse but that nurse will be split between all halls for a total of 60 beds.

We feel we are too stretched. I do all parts of the job-I personally love TPC with 4 patients, but even then, since our acuity is HIGH, I run the whole shift and tend to stay up to an hour after to finish all our documentations which now include FIM information on EVERY patient as well as notes regarding co-morbidities.

(and I mean FIM information in addition to the FIM SHEETS!!!!! we have to write out how much care that patient needs since medicare doesn't acknowledge FIM numbers (Medicaid???))

I over heard a patient say we were good and he liked us but we were "too busy".

What do you do where you work, and does IT work?????

If I remember, a HS I worked at previously:

tech had 10-13 patients and those were split between two nurses.....

[lpnflorida]

Our rehab hospital does it much the same as your facility. I often have 4 patients primary care. I happen to like it. There are also times there is myself with a CNA for 7-8 patients. Keeps us busy. I do not have a problem with this. The Rn's on the floor sign off the orders. We call for our own orders ,however we cannot sign off the orders. All nurses do their own meds and treatments on thier own patients. We all chip in to help each other.

Again our patients are busy with therapies, we catch them as we can in between. Years ago we had larger teams, the CNA had up to 10-15 patients. It was entirely too much for them.

Yes the patients are sicker than in the past. It just makes us stay very organized.

[mel1977]

I think for us, it is a hard transition. We deal with pretty heavy patients-my hall is mostly brain injury. They come straight from acute to us-mostly at the lowest level and stay with us as long as they can. Trachs, PEGS, foleys etc....

South hall is spinal cord, debil, ortho and east hall is stroke. I am an LPN and I do take orders off-I wonder why some places allow the LPN to do so and others are restrictive? Anyway, I am glad this is working well for you. Of course, we have nurses who haven't really touched a med cart in 15 years and they are used to doing just assessments, dressing changes and TL duties and now they are picking up meds and JCHAO has decreased the med window from one hour to 30 mins. Now, I used to pass meds FT so for me I can TL and pass meds with my eyes shut. I think the harder part is getting all the documentation down now that has been thrown on us at the same time all this changed. If we can't show the patient needs 24 nursing care and makes improvements etc.. they can deny pay from now all the way to Oct 2007 and of course to the future.

Thank you for your repy btw!

[lpnflorida]

Are you a rehabilitation hospital? Or is this a LTC facility which happens to call one end of the building Rehab?

Ours is a 60 bed Rehab Hosp, all of our patients come directly from acute care We are divided into 2 floors One of our floors are primarily TBI, para's, quad's etc. Our other floor is primarily strokes, otho's who have enough comorbidities to meet requirement to be in our hospital. both floors have many isolation patients. Thankfully we do not have patients on tele, but it has been discussed to have at some future date. Our acuity level is very high. Thankfully as we are attached to the trauma hospital, when a code happens we have the resources to get the help we need for our patients and if need be quickly transfer them over to the acute care side of the building.

Those who are unable to keep up with the required 3 hours on therapies daily, end up going to longer term Rehab units in the LTC facilites.

Yes, our charting can be overwhelming, and GOD knows I hate FIMS, I hate having to be yearly or( maybe it is every 2 years. I forget at the moment )tested on our ability to score FIMS accurately, but as our payment is based on the FIMS, so be it.

[mel1977]

We are a full rehab facility. Our corporation is HealthSouth. We used to be owned by the university of missouri hospital and clinics but HS bought Rusk where i work, and now we are a joint venture with the university, but we are healthsouth employees. So no, not LTC. We do the same thing pretty much-very cool. We have three wings: TBI has 21 beds, stroke 12, and the other wing is debil, sci, etc..with 27 beds. we have 8 private rooms. Though not attached, we are very close to the hospital. We also have the 3 hours of required therapy and so forth.

Do you do team nursing? (like our TBI team has two physicians, one case manager, two RN's, and team therapists special to the TBI team. The RNs have primary patients and do all the weekly paperwork and go to the case conferences held once a week). One HS I worked at didn't do that, it was very very different. Same goes for SCI and stroke and so forth.

Well, gotta hit the hay

[lpnflorida]

Use to be which ever nurse assigned to the patient for the day is the one who went to the weekly confenernces. It use to make for a very hectic morning. Now we have a admit/dc nurse who also covers going to all of the weekly conferences. This has been a big help to us. Other than that we function much as you do.

[mel1977]

other HealthSouth facilities I have worked in have RN case managers. They are the primary nurse and case manager/social worker wrapped into one. My mom is one of the TBI primary nurses. She will have roughly 1/2 of the hall, but is assigned to only one team. So, depends on the number of patients that doc has. She could have up to 11 patients she follows at any given time. So, she would go to the weekly meeting. I like this concept bc she has every idea of what her patient is doing week to week. This doesn't work for every place though. Our docs specialize and that is the only way it works. Other places don't have docs that take one kind of patient. One takes stroke, two will do TBI, two debil/ortho, one spinal cord.

It is a stressful job but I think it would be harder if you don't know your patients as well. Like the way you do it. On the other hand I'd hate following patients OFF the unit while taking care of insurance and stuff as well. I like the way we do it. Seems more personal, ya know? But, you do what works for what you do. does that make sense????