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Rehabilitation Nursing: A Specialty In Its Own Right

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

Kate, a nurse who works on an adequately staffed acute rehab unit inside a specialty rehabilitation hospital, says, "This shift has been so busy!" She also adds, "I became so excited when one of my patients walked for the first time since the motor vehicle accident six weeks ago!" The purpose of this article is to discuss rehabilitation nursing, which is a specialty in its own right.

Rehabilitation Nursing: A Specialty In Its Own Right

Rehabilitation nursing is a fast-paced specialty that involves helping patients and their families deal with short-term, progressive, or long-term impediments and disabilities in ways that constructively facilitate the highest level of function possible. Rehabilitation nurses manage the care of patients, perform a wide array of nursing skills, respond to changes in condition, and bestow psychosocial support upon patients and their families.

In most rehabilitation facilities, the rehab nurse collaborates with physicians, physical therapists, occupational therapists, dieticians, social workers, case managers, pharmacists, speech language pathologists, respiratory therapists, and other members of the disciplinary team to help patients deal with limitations in an adaptive manner, reach their full potential, restore their previous level of function, and maintain or increase modified levels of independence.

Rehab nurses provide care to patients across the life span with numerous afflictions and diagnoses. Patients who are recovering from strokes (also known as cerebrovascular accidents), heart attacks (also known as myocardial infarctions), pneumonia, multiple trauma, fractures, spinal cord injuries, traumatic brain injuries, and general deconditioning often end up on rehabilitation units.

Rehab nurses also care for patients who need extended recovery after surgical procedures such as knee replacements (also known as total knee arthroplasties), hip replacements, limb amputations, hysterectomies, back surgeries, coronary artery bypass grafts, colectomies, and laryngectomies. Patients who have chronic disease processes such as uncontrolled diabetes, chronic obstructive pulmonary disease, Parkinson's disease, morbid obesity, and exacerbation of congestive heart failure frequently receive care provided by rehab nurses.

Depending on the type of facility, rehab nurses may perform skills such as vital sign checks, intravenous therapy, wound care, continuous positive motion (CPM), range-of-motion exercises, administration of blood products, respiratory therapy, cardiopulmonary rescuscitation (CPR), ostomy care, and medication administration. Rehab nurses also help patients ambulate, provide education, demonstrate the use of adaptive equipment, and document all care that has been provided.

A person who wishes to become a rehabilitation nurse must have completed an approved nursing program. Licensed practical nurses (LPN) and registered nurses (RN) may secure employment as rehab nurses. Rehab nurses are employed at acute care hospitals, specialty rehabilitation hospitals, long term acute care (LTAC) hospitals, long term care facilities, and outpatient rehabilitation centers. They function as bedside nurses, case managers, nurse managers, chief nursing officers, supervisors, infection control nurses, wound clinicians, and nurse educators.

Certification in rehabilitation nursing is optional, but highly desirable. Registered nurses (RNs) are eligible to attain professional certification. A rehab nurse who has attained certification is called a certified rehabilitation nurse (CRRN). The Rehabilitation Nursing Certification Board (RNCB) develops, administers, and evaluates programs for certification in rehabilitation nursing (ARN 10).

Rehabilitation nursing is a rewarding specialty that requires scientific knowledge, quick thinking, and a passion for helping people maintain or recover their independence. The rehab nurse is a multifaceted professional who encounters multiple challenges, triumphs, setbacks, and successes during the course of a routine shift. Therefore, rehabilitation nursing is a specialty in its own right.

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TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

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27 Comment(s)

Great article. Reading this makes me even more excited about starting my new position as a rehab nurse.

NurseKatie08, MSN

Specializes in Geriatrics, Transplant, Education. Has 13 years experience.

Thanks for reminding everyone about the rehab specialty...I feel it is often overlooked!

whoa-now

Specializes in trying to figure it out. Has 5 years experience.

My first position as an RN after passing State Boards was on a Rehab. wing in a LTC facility. I stayed close to three years. I had 24 patients most days (depending on census). We admitted patients 2-3 post op. Hips, knees, open heart, stroke etc. etc. With hospital stays shorter these days, the acuity of care for these patients was high and gave me a solid foundation. I really enjoyed it. Helping my patients either regain their indepemdence, or adjusting to a knew level of indepencence. Unfortunately with most of my patients being geriatric, it was usually to a lower level of indepedence which is a hard time for elderly folks who have enjoyed doing everything for themselves. Teaching the family and patients ways to cope and adapt was a very important part and I think the part I liked the best. Then mgmt. starting adding more and more and MORE tasks and busy work that took me away from patients and their loved ones. So time to move on. Well I'm here to say it's that way everywhere. Good patient/family care is less and less politics and paperwork more and more. *sighs* something is just wrong with this picture. :banghead: Rehab though certainly can be a good specialty at it's core.

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

My first position as an RN after passing State Boards was on a Rehab. wing in a LTC facility.
I've done rehab in both the LTC setting and the freestanding rehabilitation hospital setting. I prefer the rehab hospital setting because the nurse/patient ratios tend to be more reasonable.

swirt1958

Has 40 years experience.

As the current President of the Association of Rehabilitation Nurses, I want to thank you for this very informative overview of rehabilitation nurses. The author is correct, rehabilitation nurses practice in a variety of settings, but with an emphasis and focus on improving independence and quality of life for our patients and their families/caregivers. As the population ages, often with one or more chronic medical conditions, the demand for rehabilitation nurses is growing.

Edited by TheCommuter

mom2cka

Specializes in FNP.

As a rehab nurse, I'd like to thank you for highlighting our specialty.

mom2cka

Specializes in FNP.

Although - the paperwork isn't a piece from our managers - it's a result of tighter and tighter controls on the rehab units and hospitals (at least the inpatient side) so that we can continue to accept patients who can benefit from the services of a rehab facility / unit. I fear that too many nurses don't understand that side and continue to push against the need for increased documentation - I didn't until my role changed, and now can better appreciate the pressures those managers are under. As the highest cost post-acute venue, we need to prove our worth on a continuous basis and be prepared for what could be thrown at us in the future (think a change from the IRF PAI to the CARE tool and a return to the 75% rule, as well as RAC audits, core measures, readmissions, etc). It's important for all staff *nursing and therapists* to understand the regulatory piece of the rehab world.

The great thing about being a rehab nurse is the opportunity to see a patient's improvement, both physical and emotionally.

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care. Has 27 years experience.

good article. i briefly worked for a little over a year as a nurse practitioner in a carf-accredited, free-standing acute rehabilitation hospital with an academic physical medicine and rehabilitation physician group. i have a lot of respect for the field and what rehabilitation nurses do. improving quality of life amid the physical effects of disability in a collaborative approach between patient and the rehabilitation team has been the utmost goal of rehabilitation. the true spirit of collaboration is so much more evident in the way the team conducts frequent conferences to discuss the plan of care and progress for each individual patients.

it is worth noting too that aside from the professionals you mentioned in the article, neuropsychologists are also an integral member of this team. the interplay between the human mind and the physical body is an important consideration in rehab and these professionals provide valuable input on maximizing this area. it is indeed, a specialty with a happy ending in most cases. nothing beats being part of a team responsible for helping a person achieve his or her maximum potential after a disability resulting from disease or injury.

p.s. not to be nitpicky, but cpm actually stands for continuous passive motion. the cpm equipment provides passive rom.

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

p.s. not to be nitpicky, but cpm actually stands for continuous passive motion. the cpm equipment provides passive rom.
thanks for the correction and your insight! :)

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 9 years experience.

I didn't know there was specific certification for Rehab nurses. I am working in a Rehab facility attached to LTC. I love it. I was going to look into the Gerontology specialty, but now have a new view. Thanks!!!!!

I am A CRRN who worked on a rehab unit and I was dismayed to find that the Hospital I worked at seemed to value the specialty of Rehab nursing less and less. In 1987, when I started there, we were a closed unit and no other nurses floated in or floated out. When Iowa health System took over our hospital in 1995' things began to change. We were floating out to other units and even worse' non-rehab nurses were floating in. Many of these nurses felt that rehab was beneath them and were not expected to do any of our rehab paperwork, such as FIMs scoring or to attend patient staffings. Most did not know proper transfer techniques and were used to their patients being in bed all day. In 2010 there were 3 CRRNs on the Rehab unit. Now there are none. In an effort to decrease payroll costs, they fired 2 of us last year. We both suspect that it was because we had been there many years and were both near the top of the pay scale. Our certifications seemed to have no value for management. It is sad that Hospitals are allowed to fire good nurses that have certifications and many years of experience, in order to hire new grads at a lower rate of pay, but as they reminded us, we were "at will employees". At present I am hunting for a job, but a 58 year old that has been fired is not seen as a good catch. I know whatever job I find will not pay near what I was making. DOES ANYONE VALUE REHAB CERTIFICATION? DOES ANYONE VALUE EXPERIENCE?

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

I didn't know there was specific certification for Rehab nurses. I am working in a Rehab facility attached to LTC. I love it. I was going to look into the Gerontology specialty, but now have a new view. Thanks!!!!!
Yes, the certification for rehab nurses (CRRN) definitely exists, and nurses at my workplace who have this certification receive a pay raise and are promoted to the level of 'CRRN.'

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

DOES ANYONE VALUE REHAB CERTIFICATION? DOES ANYONE VALUE EXPERIENCE?
My place of employment, a freestanding rehabilitation hospital, gives all CRRNs a pay raise and promotes them. In addition, nurses who have many years of experience receive a significantly higher rate of pay per the HR wage grid. So, to answer your question, some facilities still do value certification and experience.

I am A CRRN who worked on a rehab unit and I was dismayed to find that the Hospital I worked at seemed to value the specialty of Rehab nursing less and less. In 1987, when I started there, we were a closed unit and no other nurses floated in or floated out. When Iowa health System took over our hospital in 1995' things began to change. We were floating out to other units and even worse' non-rehab nurses were floating in. Many of these nurses felt that rehab was beneath them and were not expected to do any of our rehab paperwork, such as FIMs scoring or to attend patient staffings. Most did not know proper transfer techniques and were used to their patients being in bed all day. In 2010 there were 3 CRRNs on the Rehab unit. Now there are none. In an effort to decrease payroll costs, they fired 2 of us last year. We both suspect that it was because we had been there many years and were both near the top of the pay scale. Our certifications seemed to have no value for management. It is sad that Hospitals are allowed to fire good nurses that have certifications and many years of experience, in order to hire new grads at a lower rate of pay, but as they reminded us, we were "at will employees". At present I am hunting for a job, but a 58 year old that has been fired is not seen as a good catch. I know whatever job I find will not pay near what I was making. DOES ANYONE VALUE REHAB CERTIFICATION? DOES ANYONE VALUE EXPERIENCE?

The same thing is happening to the rehab unit I worked at for many years. The nurses and aides who float in don't want to be there, don't do the required charting, don't have the specialized knowledge.

I was fired two weeks ago, and now, at my great age, I have no insurance, and am not quite able to get social security, and who will hire me?? I have been certified since 95, keep up with my CEUs, but I think the only place I will be able to work will be one of the stores that has "greeters." Sad and scary. Good luck to you in your search..

I am A CRRN who worked on a rehab unit and I was dismayed to find that the Hospital I worked at seemed to value the specialty of Rehab nursing less and less. In 1987, when I started there, we were a closed unit and no other nurses floated in or floated out. When Iowa health System took over our hospital in 1995' things began to change. We were floating out to other units and even worse' non-rehab nurses were floating in. Many of these nurses felt that rehab was beneath them and were not expected to do any of our rehab paperwork, such as FIMs scoring or to attend patient staffings. Most did not know proper transfer techniques and were used to their patients being in bed all day. In 2010 there were 3 CRRNs on the Rehab unit. Now there are none. In an effort to decrease payroll costs, they fired 2 of us last year. We both suspect that it was because we had been there many years and were both near the top of the pay scale. Our certifications seemed to have no value for management. It is sad that Hospitals are allowed to fire good nurses that have certifications and many years of experience, in order to hire new grads at a lower rate of pay, but as they reminded us, we were "at will employees". At present I am hunting for a job, but a 58 year old that has been fired is not seen as a good catch. I know whatever job I find will not pay near what I was making. DOES ANYONE VALUE REHAB CERTIFICATION? DOES ANYONE VALUE EXPERIENCE?

Same thing happened to me. We were a closed unit, no floats, we did a good job with the patients.

It does seem like other nurses look down on us, they don't realize that we have to use every bit as much of our nursing expertise as they do, and perhaps more. I am a CRRN, have been for 15 years, and in an irf, you can get patients that slide down that slippery slope to being critical fast. I loved my job, though. The actual rehab nursing part, working with patients and families to achieve their goal of going home. It bothers me that some of the nurses in the other parts of the hospital don't seem to realize that rehab nurses are really excellent nurses, and we actually do care for the biophysical and psychosocial aspects of the patients.. Our unit got a new manager, and I am the first one that was fired. I'm 61,have been working in rehab for all 20 years of my career. We had started getting floats in, they didn't wan't to be there, so they would pass meds, and daily assessments, but no teaching, no answering lights, really, no giving the other nurses a hand.. then they would go to the manager and say how mean we were..

so, I am getting unemployment, and I am going to download the form from EEOC and file an age discrimination suit. Lacking a joyful feeling is not a good reason to fire someone. And now I have no insurance. Cobra is so expensive, I will probably have to go live in a discarded washing machine box.

Or, with all of our experience, you could come over and we could start our own business.. what do you think??? The too much experience thing, it gets in the way when someone wants the nurse to ignore policy. the old bags know better,they don't go quietly into that good night.. Hey, you could probably go get my old job.. there's an opening now.. LOL nightime rambling. but it's all true.

Edited by Wise Woman RN
corrected the incoherencies

So are these same skills used on the rehab floor in the hospital?