Tips for a new grad on short term rehab unit

x28y31 · Jun 11, 2015

Hello! I have worked at an acute rehab hospital for the past year, and I stated there as a new grad. How exciting for you! Congrats! I thought being a new grad at my hospital was fantastic. I had a lot of opportunity to learn and use nursing skills. I don't know about your unit, but on my floor, we get around 6-10 patients on days. Every shift, I do assessments, wound care (general wound care and wound V.A.C.s), any blood draws that need to be done, any IVs that need to be started, helping the CNAs transfer patients or helping patients with some ADLs, etc. etc. etc. You do a ton and are always busy! Time management is KEY! Some tips I'd give you: ASK QUESTIONS IF YOU'RE NOT SURE. It's never wrong to ask questions, especially as a new RN. I still ask tons of questions -- there's always more to learn. Don't stress out, and enjoy your new title as RN! Other tips: Esp on a rehab unit, keep an eye out on your patient -- notice any changes...drop in BP? HR going a little higher than normal? low grade temp? They just aren't feeling or looking "right"?. Sometimes, even the smallest things could mean the patient is going bad...so it's always good to keep a close eye on this thing. I see a ton of patients on my rehab floor. PLENTY of ortho patients s/p surgery, CVA patients, MVA patients, TBI patients....and they all need help to get back on their feet, and you and the rehab team are there to help them!. I think I rambled a lot, but hope I gave you sometime to take away. I'm happy for you! Take things in, and remember, ask questions and know the learning curve is going to be a big one as a new RN! Congrats again!

Baloo · Jun 12, 2015

Congrats on the new title you've earned and the new job! I'm also in my first year of licensure and also work in-patient rehab.

Learn your orthopedic precautions, so you know how your patients can and cannot move, turn, position, etc.

Co-morbidities is a big deal in rehab, so while we're treating people for a knee replacement, they may also have uncontrolled HTN or DM. Also, you won't just have "hips and knees", people are in rehab for new ostomies, post CVAs, Resp Failure, UTI, general Weakness, pacemaker placement, etc. So refreshing yourself on CHF, COPD and other respiratory issues that would cause a decline in health status would help. A

lso, refresh on S/Sx of PEs & blood clots would help as well. Patients are less-mobile then normal and are more prone to those.

For the orthopedic patients, pain control is a big deal, as if they are in pain they won't be able to participate in PT/OT and may delay their healing process. So keep pain control in mind when doing your med pass. I've found it best (for me) to do my med pass based on PT schedule...After diabetics, priority goes to those that go to PT first.

And as the previous poster said, don't hesitate to ask questions...it's a really great area to gain experience as you see a good variety of types of patients. Good luck!

AlwaysLearning247, BSN · Jun 13, 2015

Hello! I have worked at an acute rehab hospital for the past year, and I stated there as a new grad. How exciting for you! Congrats! I thought being a new grad at my hospital was fantastic. I had a lot of opportunity to learn and use nursing skills. I don't know about your unit, but on my floor, we get around 6-10 patients on days. Every shift, I do assessments, wound care (general wound care and wound V.A.C.s), any blood draws that need to be done, any IVs that need to be started, helping the CNAs transfer patients or helping patients with some ADLs, etc. etc. etc. You do a ton and are always busy! Time management is KEY! Some tips I'd give you: ASK QUESTIONS IF YOU'RE NOT SURE. It's never wrong to ask questions, especially as a new RN. I still ask tons of questions -- there's always more to learn. Don't stress out, and enjoy your new title as RN! Other tips: Esp on a rehab unit, keep an eye out on your patient -- notice any changes...drop in BP? HR going a little higher than normal? low grade temp? They just aren't feeling or looking "right"?. Sometimes, even the smallest things could mean the patient is going bad...so it's always good to keep a close eye on this thing. I see a ton of patients on my rehab floor. PLENTY of ortho patients s/p surgery, CVA patients, MVA patients, TBI patients....and they all need help to get back on their feet, and you and the rehab team are there to help them!. I think I rambled a lot, but hope I gave you sometime to take away. I'm happy for you! Take things in, and remember, ask questions and know the learning curve is going to be a big one as a new RN! Congrats again!

Thank you so much!! I will be on a short term rehab unit in a skilled nursing facility. The DON said I will learn how to do IV's and all of the stuff you mentioned. Thanks for all the tips, I am nervous but will definitely ask questions. I have to care for 15-20 patients, but I will be on orientation for 6 weeks so hopefully I'll feel comfortable then :)

AlwaysLearning247, BSN · Jun 13, 2015

Congrats on the new title you've earned and the new job! I'm also in my first year of licensure and also work in-patient rehab.
Learn your orthopedic precautions, so you know how your patients can and cannot move, turn, position, etc.
Co-morbidities is a big deal in rehab, so while we're treating people for a knee replacement, they may also have uncontrolled HTN or DM. Also, you won't just have "hips and knees", people are in rehab for new ostomies, post CVAs, Resp Failure, UTI, general Weakness, pacemaker placement, etc. So refreshing yourself on CHF, COPD and other respiratory issues that would cause a decline in health status would help. A
lso, refresh on S/Sx of PEs & blood clots would help as well. Patients are less-mobile then normal and are more prone to those.
For the orthopedic patients, pain control is a big deal, as if they are in pain they won't be able to participate in PT/OT and may delay their healing process. So keep pain control in mind when doing your med pass. I've found it best (for me) to do my med pass based on PT schedule...After diabetics, priority goes to those that go to PT first.
And as the previous poster said, don't hesitate to ask questions...it's a really great area to gain experience as you see a good variety of types of patients. Good luck!

Thank you for the tips, very helpful! You made a good point about med passes and I will be sure to keep that in mind. The DON told me that we will be adding a CHF program so we will be doing IV push lasix and stuff so it will be interesting! I feel much better after hearing about your experience and x28y31's experience :)

TheCommuter, BSN, RN · Jun 15, 2015

Firstly, what kind of rehab will you be working? Is it SNF rehab within in a subacute facility or short-term Medicare wing of a nursing home? Is it acute rehab at a freestanding rehab hospital? If you do not know, it's alright.

Here is my advice for both types of rehab nursing:

1. Be sure not to spend too much time with any particular patient unless they're experiencing an emergent condition (read: chest pain, respiratory distress, etc). Some patients and families will attempt to monopolize your limited time, but you must establish firm boundaries unless you enjoy staying behind two hours after your shift ends.

2. At the beginning of your shift, generate a to-do list that lists all your finger stick blood sugars, dressing changes, CPM machines, nebulizer treatments, oxygen therapy, injections, and so on.

3. Ensure you are familiar with common medications in the rehab setting such as Metoprolol, Amiodarone, the various insulins, Ferrous Sulfate, Lovenox, Coumadin, Heparin, Clonidine, Lisinopril, Milk of Magnesia, Colace, Senna, Synthroid, Pepcid, Prilosec, Protonix, Xanax, Metformin, Lasix, Bumex, Spironolactone, Lidocaine patches, Fentanyl patches, Hydrocodone, Morphine, Tramadol, Nitroglycerin, Digoxin, etc.

AlwaysLearning247, BSN · Jun 16, 2015

Firstly, what kind of rehab will you be working? Is it SNF rehab within in a subacute facility or short-term Medicare wing of a nursing home? Is it acute rehab at a freestanding rehab hospital? If you do not know, it's alright.
Here is my advice for both types of rehab nursing:
1. Be sure not to spend too much time with any particular patient unless they're experiencing an emergent condition (read: chest pain, respiratory distress, etc). Some patients and families will attempt to monopolize your limited time, but you must establish firm boundaries unless you enjoy staying behind two hours after your shift ends.
2. At the beginning of your shift, generate a to-do list that lists all your finger stick blood sugars, dressing changes, CPM machines, nebulizer treatments, oxygen therapy, injections, and so on.
3. Ensure you are familiar with common medications in the rehab setting such as Metoprolol, Amiodarone, the various insulins, Ferrous Sulfate, Lovenox, Coumadin, Heparin, Clonidine, Lisinopril, Milk of Magnesia, Colace, Senna, Synthroid, Pepcid, Prilosec, Protonix, Xanax, Metformin, Lasix, Bumex, Spironolactone, Lidocaine patches, Fentanyl patches, Hydrocodone, Morphine, Tramadol, Nitroglycerin, Digoxin, etc.

Thanks for the advice! I will be working in a SNF. I definitely have to work on not talking too much, I always feel bad to leave the patient/family mid conversation. I am glad you mentioned the common meds, my school luckily focused on all of them! The to do list also sounds like a good idea, I used that when I was a CNA for time management. Thanks again :)

caseyuptonurse · Jun 16, 2015

I work in a freestanding acute rehab hospital that I started as a new grad so it's a little bit different but...

A good report sheet is necessary. Get a formatted sheet that you write everything down such as age, code status, diagnosis, past medical history, how the patient transfers (very important), type of diet (also very important some patients are on aspiration precautions or NPO!), bowel and bladder information, wounds, IVs, blood sugars, and respiratory.

You could add more to your sheet but I make sure that I have those as spots on my report sheet so that I get most of the necessary information.

I advise just being willing to learn and ask questions!

I didn't do much of outside studying and learned primarily everything on the job besides for articles my educator wanted me to look up.

AlwaysLearning247, BSN · Jun 18, 2015

I work in a freestanding acute rehab hospital that I started as a new grad so it's a little bit different but...
A good report sheet is necessary. Get a formatted sheet that you write everything down such as age, code status, diagnosis, past medical history, how the patient transfers (very important), type of diet (also very important some patients are on aspiration precautions or NPO!), bowel and bladder information, wounds, IVs, blood sugars, and respiratory.
You could add more to your sheet but I make sure that I have those as spots on my report sheet so that I get most of the necessary information.
I advise just being willing to learn and ask questions!
I didn't do much of outside studying and learned primarily everything on the job besides for articles my educator wanted me to look up.

Thank you! I am going to make my own report sheets if the ones provided aren't as detailed. I will definitely be asking tons of questions. Thanks again!

blondestyles · Aug 7, 2015

xobritney24- Any places you recommend for a new grad with an ADN to apply to? I recently moved to Boston and have been putting out applications to anything I can find. Any suggestions that maybe I missed?

ErinDel, ASN, BSN, RN · Sep 30, 2015

How are you liking your rehab job so far? What types of patients do you deal with most, and how have u managed your time?

AlwaysLearning247, BSN · Oct 1, 2015

How are you liking your rehab job so far? What types of patients do you deal with most, and how have u managed your time?

Hi Erindel!

It has been a great experience. I have been getting a lot of experience with gtubes, trachs, PICC lines, etc. Time management took a while to get down because I have 15-20 patients. I actually just got hired at an acute rehab hospital so I am glad. Thanks for asking!