Is Rehabilitation Nursing Hard?! - Search. Enter.
So you want to know if rehab nursing is hard, eh? That's an interesting question. The question is interesting because the answer is uniquely subjective, but that is what people want to know. Ever wondered what is actually one of the top most asked questions in the search bar of Google when the subject is rehabilitation nursing? The top question asked is “Is rehab nursing hard?” Take that thought one step further, and ask this, is rehab nursing supposed to be easy? Is any nursing specialty easy? Is nursing in general easy? I’m sure if I took a poll of all the nurses who have worked in rehab nursing, and they were asked this question, the majority would say yes, it is hard, but nursing is hard. Nursing is a unique beast, with ways it feels to figure out how to precisely challenge you. All of the different specialties highlight various aspects of nursing in which people thrive. My personal opinion would also be yes, rehab nursing is hard but not in the ways most would probably think. I am proficient at my work now as I have more experience under my belt. The job may seem easier but that doesn't necessarily make the job responsibilities any easier. I should be getting better and better, right?! The job overall takes some getting used to and some finesse like any nursing specialty would. Most of all it takes time and experience to do it well. Below is a list, my best attempts in describing areas I believe nurses find most difficult about working in acute or sub-acute rehabilitation.
Increasing Acuity of Care in Patients - We take care of the unwell either with acute or chronic medical conditions. As medicine advances, people as a whole are living longer with these chronic more compounding illnesses. Naturally, we as nurses take care of these people. In a weird way though it seems the acuity is ever increasing. Patients need more and more support to live. We are giving more medicine, more combinations thereof, more treatments - and therefore monitoring the patient more closely for side effects. We are dealing with more complications, more infections, more extensive wound care. This is becoming the patient norm not just cases that we see few and far between. Be as prepared as you can for these conditions because they're not changing. You will hear it from nurses who have worked even longer than I have in this field and see the changes in patient care first hand. Acute rehabilitation may have looked like a simple straight forward hip fracture or knee replacement at some point in time, but not any more.
Constant Need to Assess and Reassess Patients - The need to assess and reassess nursing care for individual patients is constant through the work shift in rehabilitation and in general nursing. You have to be flexible. You have to plan accordingly. You have to maximize your time. You need to keep circling back around to your patients and be able to switch up your plans to save time where you can. You need to be able to see problems arising and intervene before it becomes a issue. I have observed some nurses struggle with this, if they have come from other specialties, have been a nurse a long time or may have taken a break from nursing. You have to be well organized without being so regimented that any little interruption or change in plans will throw you off your game. Also you need to identify and utilize all resources to your benefit while exhausting your possible nursing interventions. Also, critical thinking is an important skill to develop, it will help you think through issues that may arise and plan the right intervention. For those wanting to work on their critical thinking skills - check out my guide in the shop!
Large Amount of Coordination of Care Is Managed by Nursing - There are so many disciplines and things going on a rehabilitation floor. The nurse is at the center of the coordination of patient care. It’s all for the patient but the nurse is at the center because that is the only discipline with the patient 24 hours a day for their entire stay. The nurse is responsible to be aware of and help coordinate all of the care. This includes the orders, meals, therapy, radiology, labs, doctor visits, social services, activities of daily living (ADLs) ie: bathing, grooming, toileting, plus also administering the medications, completing nurse treatments and ensuring everything is documented accurately. It is a lot of responsibility and some people get easily overwhelmed by getting pulled in so many directions especially during the day shifts. That is why personal organization, time management, communication, prioritization, delegation skills are crucial for success.
Varying Amount of Emotional Behaviors from Patients - Dealing with adult patients comes with the whole variety of attitudes and behaviors. Maybe you have noticed when people get sick, their emotional needs increase. If the patients stress and anxiety is through the roof, it is going to transfer to you in different ways. They may be needing more encouragement, more emotional support, they may call you for more things, they may do things they would normally not do. My best advice as you navigate would be to already have solutions, and interventions in mind, also educate and explain how you can assist the patient. That usually helps. Be neutral and be helpful, most people are understanding when you communicate honestly and openly with them. Everything is a balance, you need to know what energy to bring to every situation and this often times comes with experience. A difficult part is when patients don't follow safety measures or MD orders. All you can do is continue to keep the patient safe, educate and document your efforts. Traumatic brain injuries are the most difficult for me, often times the person is physically okay but they lack cognitive control and we see quite a lot of major safety awareness deficiencies, impulsiveness or being quick to anger. You as a nurse are trying to keep everyone safe, yourself, other staff, as well as other patients. In this example, experience, communication, delegation and de-escalation techniques are crucial for success. You need to be prepared and have a game plan from the start when dealing with these types of patients.
Patient Care That Is Physically Demanding - Nursing is a very physical profession, moving, pulling, turning and caring for patients. In rehabilitation, it is even more intense for patients with the goal of getting them to do as much for themselves as possible. You want them to get up out of bed and go to the bathroom if possible. You want the patient to be continent if they were before. You want them to utilize the time in rehab to get the strongest they can be. The brain and body need time and repetition to rebuild. If we are talking about a stroke patient, a person who can't control the entire left or right side of their body, for example, they technically will fall over when you sit them up. During their stay in rehab we will be teaching their brain and body how to move that weakened side of the body again. The goal is the same, you want the patient to be as independent as possible. You want the them to have time to build these strengths. Therefore if the patient has to go to the bathroom, you need to get the patient out of the bed, into the wheelchair, into the bathroom and onto the toilet. No you are not completely lifting up the patient, but you are doing some of the work until the patient can do all of the work. Then repeat of course for other patients similar on your work assignment and then potentially to other patients on the floor you may be assisting coworkers with.
Focus on Patient Satisfaction - Currently patient satisfaction is closely considered in facilities. Patients will voice their satisfaction about all services provided during their stay. From patient care, to food service, to the comfort of their bed, we see it all. Satisfaction is not only limited to issues that the patient feels could improve, but often patients write about the excellent care they have received too. Healthcare workers need to be mindful of the importance of client satisfaction, and realize this tool is used frequently to improve service delivery.
So with all this being said, there is a nursing specialty out there for everyone. I enjoy rehabilitation for all the above reasons. I have put together a unique wheel house of experience to bring confidence and success with me on the job. Yes, nursing is hard but if you enjoy it, it should get easier. In time you should become more productive and confident at your job. You will be able to perform all of your responsibilities and still help out other staff when needed. Don’t settle for something you don't enjoy. Choose a specialty that you will love and one that you will thrive in.
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