Tell me about your Sub-Acute Rehab floor..please!

NotFlo · Sep 10, 2011

Let's see. Every facility is different but these are my experiences.

On the rehab floor you have less patients per nurse but they are more acute. Most are medicare/private insurance which means assessments, vitals and charting have to be done on each patient more often. Usually on my floor I have fifteen patients and all fifteen require a daily skilled summary sheet plus nursing note which first and second shift have to complete.

The doctors are in more often and the orders are changing WAY more often. The patients have many, many more appointments than in long term care and will be coming and going more. You'll have to be ready with their w-10s and consult sheets. If your unit has a secretary you are golden, if not you might be stuck making appts. and booking transportation for people with appts.

Another difference between subacute and LTC is (at least on first shift) you will be competing with PT/OT for time with the pts. I don't know if this is an issue everywhere, but in my facility PT/OT does not stick to their posted schedules and often takes many of my pts to the gym before I've even seen them, assessed and medicated them for pain, given them their morning meds, etc. It is very frustrating trying to complete the morning med pass with half the pts. being pulled off the floor every time I turn around.

My floor has a lot of s/p ortho surgery so a lot of PRN pain meds, CMP machines, help with ambulation and transfers and toileting, etc.

We also do a lot of IVs on my floor, and we take a lot of people with wound vacs and other complicated dressing changes, skin grafts, etc.

Also a lot of cardiac/respiratory/trache pts.

Family members tend to be more involved and very vocal. The pts. were usually led to believe they would be coming to a resort to recover from their illness or surgery by the admissions people who go out to the hospitals to get business and with the staffing levels I am left dealing with impossible to meet expectations a lot of the time. Many people who thought they would be in a private room, would have much better quality of food, much more private time with their PT/OT, much more nursing attention than we are able to give (unfortunatley) etc. It can be tough sometimes to provide that "customer service" we are expected to provide.

JenniferSews · Sep 11, 2011

Family members tend to be more involved and very vocal. The pts. were usually led to believe they would be coming to a resort to recover from their illness or surgery by the admissions people who go out to the hospitals to get business and with the staffing levels I am left dealing with impossible to meet expectations a lot of the time. Many people who thought they would be in a private room, would have much better quality of food, much more private time with their PT/OT, much more nursing attention than we are able to give (unfortunatley) etc. It can be tough sometimes to provide that "customer service" we are expected to provide.

:lol2: So true!

But I have worked LTC, a blended cart, and now straight sub acute. I definately prefer sub acute. It's fun to me, I have to be on my toes because even the most straightforward, healthy patient can go down the tubes in a few hours. Since we are not acute care I need to catch those changes early before we have a real problem on our hands. But I enjoy the challenge and something different instead of giving Mrs X her same 20 pills every morning for the rest of her life. I really get to know my patients, and I LOVE that part, but at the same time if they make me crazy I know they will discharge eventually.

The therapy aspect doesn't bother me much. We work as a team in my building and the therapists often ask me if I need the patient before taking them. I go out of my way to build a relationship with the therapists so they know me well. Otherwise I find them in the gym and give them their meds there. Plus I've had therapists really save me before by notifying me of a change in condition we wouldn't have otherwise noticed. If you have a good team environment it may be fine.

Overall I LOVE what I do now. I hope I can do this until I retire. I joke all the time I will be working my cart until they give me a bed.

sbostonRN · Sep 11, 2011

I am a new grad working on a subacute floor. So far I love it but it's a VERY stressful environment sometimes. We have less patients than the LTC floors (20 vs. 45), but it's by no means easier. On the LTC floors, the med nurses are strictly responsible for meds. On my floor I'm responsible for meds, assessments, interventions, treatments, scheduling appts and p/u's as needed, and coordinating with PT & OT.

I do think I'd be bored on a LTC floor because I think it would be much more repetitive, but some nurses may prefer that. I like that any day could be different, but at the same time it is stressful when everything goes wrong all at once. The other day I had one patient with a fever of 101.2, one patient whose wound vac wouldn't stop beeping, and two who were going out for appts and needed to be medicated first. In addition to the regular interruptions! The work is very rewarding because in subacute you do see people go home or back to their ALF. We have a few people who come to our floor for hospice/comfort care, and we're able to help give those people a good quality of life in their final days. So it's an interesting mixed bag.

NotFlo · Sep 12, 2011

So true!
The therapy aspect doesn't bother me much. We work as a team in my building and the therapists often ask me if I need the patient before taking them. I go out of my way to build a relationship with the therapists so they know me well. Otherwise I find them in the gym and give them their meds there. Plus I've had therapists really save me before by notifying me of a change in condition we wouldn't have otherwise noticed. If you have a good team environment it may be fine.
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Yeah I've been doing straight sub-acute for about four years now and could never do straight LTC (just not my thing).

We have had groups of PT/OTs that are good at working with the nurses and some that are not. I always approach it as a team thing, and I always listen when they tell me something isn't right with a pt (because they do spend a whole hour with them uninterrupted and may pick up on something I didn't) but some are just too much.

We aren't allowed to admin. meds in the gym. The PT department head has had multiple nurses written up over this and even made a huge stink when the medical director went into the gym to give a pt. a nitro once...she wanted that pt. taken back to their room behind closed doors before anything was done.

Once I was sending a patient out 911 and one rather brilliant PT aide decided she could get in one more workout with him while we were waiting. I had left another nurse with the pt. and stepped out to get the paperwork, I get back and pt. isn't in bed. The other nurse (also rather brilliant) tells me the OT put the patient in the wheelchair and took him. I found him ON THE MAT ON THE FLOOR in the gym getting stretched out by the therapist, because the pain was probably musculoskeletal and she could probably stretch it out. This pt.s chief complaint was chest pain!

What they do at my facility is a big giant group exercise class in the AM. The group is at 9:30 am and they like to have most of the medicare pts in it because they can bill minutes for all of them at once for being in the group. They start trying to get people in early and my med pass is 8-10 so I have to cruise around like a maniac trying to medicate people before they're taken away to group.

I actually went to my nurse manager on Friday because the PT aide took someone in a johnny, before they'd had AM care, and after the CNA said to please wait because the pt was soiled with poop and needed at least to get washed before they go.

Another memorable incident was when they took a lady to the gym for her initial eval after I told them she was incredibly weak with a severe COPD exacerbation, s/p intubation, and NEEDED her neb treatments before attempting any activity. This is a lady getting out of breath just trying to talk to me or trying to eat. They got her up, had her walk in the gym, then deposited her back in her room and stopped me to say she's "looking for her breathing tx when you get a chance". I found a woman in sever resp. distress sat in the upper 70s. She came within a hair of having to be sent out.

I know they are the money makers and I guess every minute of their day is accounted for but when they start trying to take people who are half dead to the gym, people in severe pain to the gym without waiting for them to be medicated, etc. it does start to annoy me. The almighty PT minute does not come ahead of every thing, although some of them seem to think it does.

JenniferSews · Sep 12, 2011

Holy cow Notflo! The therapists I work with wouldn't dream of working with a patient without the nursing staff saying it was okay. In the situation I mentioned the pt's sats were fine at rest, but she was desatting during therapy. Add a dry non productive cough and the Dr sent her out, positive PE. If I had only gone off the sats my CNAs were reporting she would have been in the facility much longer.

I can only say that learning which therapists to listen to, and which to take half seriously has helped. Plus listening to each one and doing at least a quick assessment based on their report. When they respect you and you respect them appropriately things work better. Maybe just my facility though, I love where I work.

Tired nurse · May 31, 2023

Most LTC is staffed with mostly LPNs no RNs were is it they use RNs in LTC never see this and I am a travel nurse Only RNs I see are the bosses! And not only that the LPNs are not trained to care for these hospital pts. who seem to think it is a hotel!