SNF rehab unit 25 patients to one nurse

[mellster, LPN]

I've been lurking for a while. I like to read this board to remind me that others have the same struggles as me on a daily basis. I am a restorative/float nurse in my facility. When I float to the floor, I sometimes have to work the rehab unit. I know that 25 residents is not unheard of in long term care, but this is a rehab unit with no support. We do not have a desk nurse, treatment nurse, or even a secretary to answer the phone. We get patients post surgery, orthos, CHF, COPD, IV abt. Thank god they haven't started giving us trach patients yet, but I wouldn't be surprised if that isn't coming. I have let my DON know that I do not feel this is safe, but I am just told "we are still working on it" or it "isn't in the budget." If I could afford to quit, I would. I cannot give the safe quality care that I want to give on this unit. By the way, we get no help with admissions or discharges or orders either. I'm looking for another job, because I want out!!!

[SuesquatchRN, BSN, RN]

It is the same everywhere. Really.

[Salisburysteak, BSN, RN]

25 to 30 is the norm. You will get used to it once you get to know your residents. There is a Tx nurse where I work, but charge nurses do everything else. And a charge nurse in LTC is not the same in the hospital.

We also have trachs & g-tubes. It really isn't that bad. LTC will teach you excellent time management skills though.

[mellster, LPN]

I would kill for a treatment nurse. My point is this unit is ALL REHAB with high acuity. I have been a nurse for 17 years and have worked on LTC units with 40 residents-difficult but doable. There is no "getting to know my residents". They come and go constantly with admissions and discharges daily.

[mellster, LPN]

I would like to work for an acute rehab for better nurse/patient ratios, but I cannot find one in my area that hires LPNs. In my facility, the halls with the stable long term care residents all go to the RNs and the LPNs get the halls from hell. Two of the halls have only 18 residents that are all stable long term care-no rehab and they are RN halls. The RNs don't have any additional responsibilities. We have RN unit manager/supervisors. None of the RNs will work on the rehab hall since they say they will not risk their license. I think I will need to move to another job. I don't mind having 20-30 patients if they are long term with maybe a few rehabbers in the mix.

[bloodspatters]

I've had more patients when I was still working in a SNF. The good thing was at least we had ward clerks, TX nurses.

Good luck in finding for another job. But I feel it's going to be the same anywhere you move.

[cienurse]

I have 2 nurses on the day shift for 32 residents but am budgeted only for one nurse on the 3-11 shift for the same 32. I have tried to get my point across that most of the admissions come on 3-11, and that's when the labs come back as well. Also, this is the time of day when all the "sundowners" come to life!! My requests for a 4-8 nurse has fallen on deaf ears. I tried staggering dayshift hours so that someone was there til at least 5:30 pm to help out but the day nurses eventually dug their heels in and refused to continue. I then cut one day nurse's hours to 7a-1p in order to have the hours to put onto the 3-11 shift but then the much-needed Medicare documentation suffered as well as assessments getting done and nurses getting out on time. There's just no easy answer or way of doing it-and it's not going to change, from what I'm told. This is true in many of even the largest of long term care provider companies. We just have to deal with it and do the best we can.

[mellster, LPN]

I wish there was a way to fix long term care, but I know that with the way things are not there are no easy answers.

[wyogypsy, RN]

25 to 30 is the norm. You will get used to it once you get to know your residents. There is a Tx nurse where I work, but charge nurses do everything else. And a charge nurse in LTC is not the same in the hospital.

We also have trachs & g-tubes. It really isn't that bad. LTC will teach you excellent time management skills though.

Really????? You may get used to it because you have no choice but that doesn't make it right, and the patients are not getting what they need. 25 rehab patients is soooooo much different than 25 LTC patients. So many more admissions/discharges, physician and specialty appointments, they are off the floor at therapy so have to hunt them down to do their meds/treatments or give the meds/treatments late. The patients are more demanding, their families are more demanding. They have more labs, and more phone calls from providers. Not to mention the never-ending changeing therapy orders. So yes, it is different. And though we may get to know the patients after they are there a bit; there are always new ones coming and going. You can come back from your days off to a hall with half of the residents new since you worked last week - this doesn't happen in LTC.

I do great time management skills, but I cannot manage what is humanly not possible. I also hate that I cannot get everything done, or give the patients an extra few minutes when they are lonely or scared - because the work is piling up by the minute.

Rehab units and LTC units are two different animals, and should not be staffed the same. Give me the LTC units anyway - that is where my heart is.

[HippyDippyLPN]

This is why I have steered away from rehab. 25 ltc with 5 rehabs, pretty doable if all goes well but all 25 rehab patients, ugh recipe for disaster. I enjoyed rehab for the more complex patients but between therapy, assessments, wounds of all sorts, it's just TOO much. Everyone knows LTC/rehab needs to change but even the DON's who get it still have their hands tied due to budget constraints. It's just one big tangled web that I don't see getting cleared up any time soon. I imagine it will get worse.