Tasked with helping patients maintain or recover their independence, nurses in rehab settings say changes in recent years require they possess more focus, flexibility and education. A speedier turnover, multitasking and caring for more medically complicated patients are some of the biggest challenges rehabilitation nurses say they face.
One of the biggest things I have noticed is that people leave the acute care hospital much sooner and a lot sicker than in the past, said Denise Scott, RN, CRRN, WCC, staff nurse with Main Line Health, Bryn Mawr Rehabilitation Hospital in Philadelphia. They have more comorbidities … that come into play with how their rehab will progress. Even the trauma patient comes sooner and we dont get to keep the patients as long as we used to, so we really, really have to hit the ground running to determine realistic goals and levels of function. The whole team has to work really hard to meet those goals so this person can go home.
Less rehab time is a challenge for everyone, but especially for patients. Just because the policy has changed doesnt mean their bodies do things faster, Scott said.
Scott cares for patients after orthopedic surgery, spinal cord injury, amputee surgery or those in a deconditioned state from a neuromuscular disorder. She assists with providing timely skin and wound assessments for patients on admission, which plays a direct role in their treatment plan.
Helping patients adapt and work toward productive, independent lives while the clock ticks requires cohesion and communication, Scott said. Our team will always advocate for more time if warranted … it just means we have to pay very close attention to how we are documenting a persons progress and communicating that to the whole team so everyone is on the same page, she said.
Multitasking for rehab nurses is crucial, said Stephanie Campbell, BSN, RN, CRRN, assistant director of nursing at Burke Rehabilitation Hospital in White Plains, N.Y. Nurses often find themselves focusing on rehab nursing as well as the acute healthcare issues that have not been resolved and providing patient education, she said.
Not only are you focusing on rehab nursing, which is why they are coming here, but you are working on other things, Campbell said. The teaching aspect has become vital [as we are] reinforcing what the patient is doing. Computerization has added to the nurses role as well. Multitasking is a huge role.
Education for the rehab nurses is key, too, as more patients arrive with numerous afflictions and diagnoses. For example, nurses are seeing an increasing number of patients with wounds that require vacuum-assisted closure, a negative-pressure wound therapy to promote healing in acute or chronic wounds and enhance healing of some burns.
We had to educate staff on how to care for patients with wound VACs and they are getting good at taking care of them, Campbell said. We will accept patients as long as they are stable enough to go to therapy, and if they have special needs we will work with our staff in educating them in meeting those special needs.
Another major change is that rehab nurses need to assess wounds upon admission, said Conchita Rader, MA, RN, CFCN, CWCN, wound care coordinator for the Kessler Institute for Rehabilitation in West Orange, N.J.
Medicare regulations changed as of October 2014, Raider said. They now expect us to identify a wound upon admission when in the past they werent interested in stage 1, 2, 3 and 4. Now you need to know what kind of wound a patient has and exactly what you are documenting.
The rehab nurse has to be much more informed about prevention measures like moisture management and support services like special mattresses and the importance of nutrition as many patients are malnourished, said Rader, who developed a wound care program at Kessler.
At Kessler, nurses are equipped with the knowledge to be able to identify the wound and learn to manage it despite all of the conditions and issues of the patients, she said.
Some patients such as individuals with spinal cord injuries and brain injuries are high risk and require extra attention. They are unable to feel whether there is pressure on a particular part of their bodies and sometimes they lack upper body strength.
Another challenge is that patients arrive with more complex wounds. Rader recalls five years ago her hospital did not even have a wound care program. Back then, she saw stage 1 and stage 2 pressure ulcers, which were not complex.
Now wounds are huge, like 17 centimeters long by 17 centimeters wide. It cost a lot of money to treat these wounds with the type of medications we are using. Its getting to be much more complex and the nurses competency has to be so beefed up to the point they can actually take care of the patients.
Its very challenging and so different from many years ago, Rader said.