Rehab work day....how to get it all done?

[Allison RN]

I work on an IRF that averages 8 patients to 10 patients. My co-workers and I generally find it very difficult to get everything done that's expected of us. Obviously there are the usual things that are consistant from unit to unit: VS, meds, assessments, admissions, discharges, etc. In addition to those things we have unit specific documentation to complete: FIM scores, narrative shift summaries, updating pt treatment plans (in addition to medical care plans), making narrative notes daily re: morning stand-up meeting, weekly progress notes, etc. And, or course, we're getting patients up, bathed, and dressed. We're to get the patients to the dining room for three meals a day, we do BP checks during tilt table exercise, occasional wheelchair follows when PT is ambulating a pt; take off orders and enter them into the computer when there's no secretary, manage medical issues, talk to doctors....etc, etc, etc.

I'm sure all of you do these exact same things. My question is: How do you get it all done? We work through breaks, rarely if ever get lunches, and still leave past the end of our shift. We feel as if we have very little interaction with our patients and we're frustrated by all the repetitive documentation that takes up that time. I feel as if we are staffed fairly well--typically 2 nurses, usually RNs, and an aide for 8 to 10 patients--but we can't seem to be the nurses we want to be to our patients. Obviously it's easier with a lower census or patients with fewer medical issues, but that doesn't happen often. We get no help from our manager when we're swamped and only have a secretary for part of the day so we answer the phones, do the orders, etc. And we aren't a group of people who have time management issues so we're not sure what to do.

How involved are your managers? How much, if any, therapy involvement is there in getting pts to and from the dining room? Does night shift get anyone up or does day shift do all the patients therapy doesn't get up? Any and all help is greatly appreciated!!!!!

[TheCommuter, BSN, RN]

I work at a freestanding rehab hospital and must also do the FIMs, narrative notes for each patient, wound care, medication pass, assessments, and much of the things you describe. However, our ratios run much higher: 1 nurse and 1 tech for every 7 to 11 patients on both day shift and nights.

As soon as I receive report, I pull meds from the pyxis, check for any new orders, start the med pass, do all wound care at the same time, and try to be done providing all care within a three hour time frame. Our techs collect all vital signs and do all finger stick blood sugars, which saves the nurses plenty of time. Our house supervisors do help when they are not busy, which is also appreciated.

I should mention that I work on night shift. People mistakenly assume that night shift has a bunch of downtime where we can listen to mp3 players, surf the internet, and waste time. However, we work from start to finish.

[mamac0805]

I also work at a similar acute rehab unit, we avg 8-to patients with a staffing mix of 2 nurses and an aide. This is an ongoing struggle we have as rehab nurses that I fear is only going to worsen as CMS increases their regulations for getting "apropriate rehab patients". That is one of the major challenges as a rehab nurse is to document why your patient needs IRF as opposed to a nursing home, and with that it takes a lot of time to sit and chart. I usally block out the first three hours of my day completing assessments and medications as well as pulling FIMS for our team meeting. If i am having a good day, i chart my assessments as I do otherwise i play catch up all day. Then from 10-12 I sit and chart (while hopefully a good majority of my patients are in therapy.) and rely on my aide to answer lights. the patients then eat at 12 (i attempt to scarf my lumch in 5 minutes flat--that in itself is an artform :) Then again spend the next hour rounding on my patients and passing noon medications/dressing changes etc. We have our interdisciplinary team meetings at 2-330 usually. Then I return from the meeting, do quick rounding then cath up on my charting. Usually for us, we focus on the evening to update careplans/problems and goals etc as well as our narrative shift summary. I think a lot of it depends on your team that works with you as well. I will be honest, I have to fight very hard to get out of work at 730 each night and usually return the next day with a list of things to follow up on.

[kismet02]

I work in a subacute rehab unit right now for day shift. I have 18 patients if the unit is full, with a treatment nurse doing all the treatment in the building. I pass all the medications, write the orders, and do skill charting for these 18 patients. However, when we have low census in our building, I can have 14-16 patients but with no treatment nurse. I have to manage my time passing my meds, assessing patients, writing orders, ordering meds with pharmacy, following up on orders, charting, talking to patients and family. And upper management expects us to finish all these in 8 hours. They encourage us to take our break, but when we do clock out, we usually end up writing orders or giving meds to patients who needs pain pills, etc. Oh, we also do admission and discharge. We are required to check the hospital discharge orders with the orders that were printed by medical records which has some differences. So, you have to keep an eye clearly to make sure that it is all correct. We are expected to leave after our 8 hours but we usually end up staying just to finish our work. Management says that it's because we signed up for it so we shouldn't complain and just do our job. Right now, a nurse I know is being cancelled for her regular schedule days and being replaced by a different nurse. Why? Because she overtimes due to the load of her work. She comes early to work and doesn't clock in and works through her break just to provide the best care for her patients. But, management is punishing her because she is doing her job as a nurse to provide the best service for the patients. I thought that we are in the service of caring. This incident makes me wonder if that really is the case.

[TheCommuter, BSN, RN]

I thought that we are in the service of caring. This incident makes me wonder if that really is the case.

From the vantage point of upper management, healthcare is very much a business. If it doesn't make dollars, it doesn't make sense.

[OlderRNinGA]

It helps me to hear that caring for 18 patients with meds, treatments, etc. is unreasonable for one nurse to finish everything in 8 hours. I thought I was too slow. I hate it most when a family member or doctor asks questions about a patient that I cannot answer because I've barely had any time with the patient! And when families are upset because their mama isn't running a marathon by the end of week one, it's hard to state the "party line" and not say, "are you serious? Mom is not rehab material and you need to yell at the doctor who told you she was!" Ridiculous.

[taramb7263]

Hats off to subacute/ rehab nurses. I just started as an RN in subacute I left a hospital psych position because I wanted to get exposed to things, wounds, colostomies etc. each nurse has a max of 20 the census for each of the 2 RN is 17 right now.. Just from my first week I think this is nuts! The nurse I with us horrible and has been there two years. Clearly cuts corners and is very unorganized and not efficient- there are 4 cnas , 2 per RN some good some need a kick in the pants! The facility is struggling and they are cleaning house! I am new along with a whole bunch if others because the new adm. Fired all of the old staff including the uppers. They want big changes. How can these nurses possibly do it all and leave by 3:30! My preceptor was still there at end if shift and hadn't even done her charting? I already came up with an organizational plan but they are so busy that I don't even know where things are, who everyone is, what I'm responsible for! No computers whatsoever! I'm a newer nurse and I wonder how with only 4-6 weeks of orientation and preceptors who are to busy to teach will I learn all that I need to know!