Rounds and patient expectations

[Matt8700, RN, EMT-B]

Hello!

Question for everybody who works in rehab. I recently began working in a Post acute Care facility which is really a skilled nursing facility that focuses on Post acute Care only, no long-term care patients. when I am receiving a new patient from the hospital and going over the admissions paperwork with them I trying to explain to them how the facility works. At my facility the ratio is 1 nurse to 19 patients, so clearly nurses are not rounding on the patients every hour which is what the patients are used to in the hospital. I have been trying to find a way to explain to patients that the nurses are always on standby should you need them but that rounds are not completed like they were in the hospital, but sometimes I feel like I am letting them down or in some way telling them that they won't have as much accessibility to the nurse as they did in the hospital. How do you orient patients to the facility without making it seem as though the nurse will only see them for medications? I always tell them if they need me to turn on the call light and I will come and check on them but sometimes I feel like they expect me to be coming into the room every hour just like what was happening at the hospital. Any suggestions on how to make this more clear. Thanks so much!

[pmabraham, BSN, RN]

"At my facility the ratio is 1 nurse to 19 patients"

My wife and I were recently at a rehab unit visiting a relative. Their unit has a ratio of 1 nurse to 5 patients on the worse of days and 1 nurse to 3 patients on the best of days. 1:19.... ouch

[Beachesandthrees, BSN]

On 8/23/2019 at 1:43 AM, Matt8700 said:

Hello!

Question for everybody who works in rehab. I recently began working in a Post acute Care facility which is really a skilled nursing facility that focuses on Post acute Care only, no long-term care patients. when I am receiving a new patient from the hospital and going over the admissions paperwork with them I trying to explain to them how the facility works. At my facility the ratio is 1 nurse to 19 patients, so clearly nurses are not rounding on the patients every hour which is what the patients are used to in the hospital. I have been trying to find a way to explain to patients that the nurses are always on standby should you need them but that rounds are not completed like they were in the hospital, but sometimes I feel like I am letting them down or in some way telling them that they won't have as much accessibility to the nurse as they did in the hospital. How do you orient patients to the facility without making it seem as though the nurse will only see them for medications? I always tell them if they need me to turn on the call light and I will come and check on them but sometimes I feel like they expect me to be coming into the room every hour just like what was happening at the hospital. Any suggestions on how to make this more clear. Thanks so much!

Worked acute rehab. Hospital A patient nurse ratio was 4-5 : 1, 1.5 hourly rounding required, no boards in rooms to update during rounds, no phones assigned during shift, and short on PCAs from time to time. The work was no cake walk, but doable.

Hospital B ratio of 7 : 1, hourly rounding with electronic and hard boards in rooms to update at rounding, staff assigned phones for the shift. If a patient/ family is disgruntled because the staff does not respond in an actual or perceived timely manner, a sheet of paper is placed at that client's door and staff write the time and task completed each time the person is seen. The latest implementation is a device that's mandatory to have, (can be worn on ID holder) which picks up your exact location on the unit, and certain areas off the unit. They are often short on PCAs, and it's not uncommon for the charge nurse to have 2 patients.

Some facilities will often be short on staff and other resources, have the most unrealistic expectations, yet usually find money for other implementations. When I'm with a patient, I try to address their needs including medication, 4 Ps (realistically, you can't do this this for all your patients). I then nicely tell them I am going to see my other 6 patients, but the # for me/ the PCA is ... in case they need assistance. Some patients are 'fixed' on calling the nurse for everything. Educate them on their other contacts, as appropriate. I empathize with you. It hurts when you want to give so much, but you have so little.