RN providing total care for 4-5 patients

Nurses General Nursing

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Hi, I just felt like I needed to vent and this site has always been the only place I know where to.

I work in an acute inpatient rehab hospital. It's a newly built 3-story facility. This week, our census hit the lowest with 20-ish and the census in the floor I'm assigned to is only 9. They want to "maximize" staffing, so what they're doing right now is putting 2 RNs on that floor, with 4 and 5 patients respectively, but no CNAs. They resorted to that because they don't want to have only one RN working on a floor even if there's a CNA with them. We usually have a maximum of 8 patients with a CNA.

So for the past two days, I'm having 5 or 4 patients and I'm the one doing total care for those patients (toileting, passing trays, setting them up to eat, feeding, etc-except showering). And it was tough, especially with the patient rooms being spread apart. They're all private rooms) and management does not want to move patients around. My colleague and I tried our best to work together, especially with the ADLs, and our unit secretary helps out whenever she can. Even then it's still hard for us. Having 8 patients with a CNA to do the ADLs is barely doable, though I can manage. But this? I find it ridiculous if I'm being honest.

I've never worked in other health care settings, but I know ICU RNs also provide total care for their patients. IMO though, that type of set up just isn't possible with 4-5 acute rehab, high-fall risk patients. These are the types of patients who need to be toileted, lifted, transferred from bed to chair/vice versa on a constant basis. It's too much physical labor for a nurse and we're already swamped with other demands on the medical side of things. Perhaps I'm just tired, but I'm having a difficult time convincing myself that this is supposed to be an "effective" staffing strategy. I did not feel safe for my patients or myself at all.

Am I just exaggerating? Is this actually feasible?

Thank you all for taking the time to read this.

0 Votes
Specializes in school nurse.

It's not reasonable if you want to provide decent care. Doing real ADLs for total care patients takes time. Also, while you're up to your elbows in one room, inevitably poop of one kind or the other is going down in the others.

If only the Powers That Be would cover the floor and take an assignment like this just once or twice- well, maybe they'd think differently...

9 Votes
Specializes in New Critical care NP, Critical care, Med-surg, LTC.

That does sound like an unreasonable work load, and as you mentioned it is not safe for patients. If you are using mechanical lifts that requires two people are all times itself. Which would leave you with no one on the floor while anyone is being transferred. You could always call your state board and make an anonymous complaint if you can't get anywhere with management. Godd luck.

2 Votes
Specializes in NICU/Mother-Baby/Peds/Mgmt.

What do you mean it's not an effective staffing strategy? It most certainly is for the admin who only thinks about money and doesn't care about or understand about safe patient care.

7 Votes
Specializes in Critical Care.

I would agree that 8 patients is an excessive workload if they all require total care (they can't do anything independently), but I'm not really seeing how a workload of 4 patients for one person is all that different from 8 patients for two people.

0 Votes

Thank you everyone for your feedback!

3 hours ago, MunoRN said:

I would agree that 8 patients is an excessive workload if they all require total care (they can't do anything independently), but I'm not really seeing how a workload of 4 patients for one person is all that different from 8 patients for two people.

That's mostly what our management think, but I'm not sure they know how much time it takes to do most of the ADLs like linen changes or transferring a maximum-assist patient, take them to the toilet, clean them up, and return them to their bed. I'd be lucky if they wished to stay on their wheelchair for a bit. Some of them stay on the toilet for 15 minutes and I can't leave them because they're high fall risk. We couldn't start our 8-9 meds because we had to pass breakfast trays and set patients up for meals.

I always help my CNA out with ADLs on a normal work day whenever I can, but when issues start piling up that require RN intervention, there's no one to delegate these tasks (adl's) to if I'm all by myself. Perhaps, I can handle 4 total care patients on my own without a CNA, but 5 is pushing it.

1 Votes
Specializes in Travel, Home Health, Med-Surg.

Yeah I agree with you. Going from 4 pts with a CNA, to 4-5 with no CNA is way too much for these types of pts. I have worked rehab and would not be happy about this at all. It is not safe for pts or staff. These pts take an extra long time for everything! Sorry to hear the changes, hopefully temporary?!

1 Votes
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Totally serious question — aren't acute inpatient rehab patients supposed to be a little higher functioning? Are they actually able to participate in their required hours of therapies?

4 Votes
28 minutes ago, Pixie.RN said:

Totally serious question — aren't acute inpatient rehab patients supposed to be a little higher functioning? Are they actually able to participate in their required hours of therapies?

I don't know how it is everywhere, but when I worked in ortho, we'd send surgically repaired, hip fracture patients to rehab on the day of surgery sometimes. They were completely helpless. And even the ones who stayed a day or two left needing a LOT of assistance.

1 Votes
Specializes in oncology, MS/tele/stepdown.

I work on a unit that doesn't staff a tech unless we are short a nurse. So it's 4 patients, total care, or 5 patients, with a tech. Make just one of those patients a confused jumper, or start to circle the drain, or just have cdiff, and you don't have time to ambulate, bed bath, order food for, feed, toilet everyone (on top of nursing responsibilities) if you don't have a tech. I sympathize. I would certainly tell your manager how you feel, but I wouldn't hold your breath that anything will change, because it's all about the budget.

1 Votes

Sorry you are going through this. It’s very difficult to do your job as it is, without help it can feel impossible. If I were in your situation, I would be finding a new job ASAP (one who values their employees and gives them proper resources). It’s not fair to the patients and it’s certainly not fair for you and your coworkers.

I am in the ICU and I do assist with ADLs (we have CNAs and many other nurses to help). It’s easier to do ADLs on 1-2 patients, definitely not 4-5. I wish you the best of luck!

0 Votes
Specializes in Rehabilitation.
15 hours ago, Pixie.RN said:

Totally serious question — aren't acute inpatient rehab patients supposed to be a little higher functioning? Are they actually able to participate in their required hours of therapies?

I also work acute inpatient rehab and they're "higher functioning" as in they're not considered "sick enough" to be in a med surg/stepdown but they're not healthy enough to go straight home. They're being managed medically by nursing to be able to handle their three hours (in my case) of therapy per day. Sometimes I wonder why there's even a stepdown unit when ICU sends their patients straight to rehab. This probably isn't helpful at all but I'm just ranting cause we're getting patients who go straight back to the hospital cause they're too sick to participate in rehab and end up deteriorating. We're basically a med surg now plus their needed three hours of therapy so it's just HARD.

0 Votes
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