Workplace Wednesday

Rehabilitation Center

You like the best of all worlds, don’t you?! Not everyone has the skill set necessary to thrive in a rehabilitation environment…but you do! A little of everything is right up your alley! Variety…check. Routines…check. Clinical skills…check. Personal care skills…check. Helping people physically AND emotionally…check and check. The icing on the cake is having the patients around long enough to get to know them, giving you the satisfaction and a great sense of accomplishment as you get to watch them improve and meet their goals. Being a part of a great team that focuses on improving a patient’s quality of life makes you a clear pick for rehabilitation.

Overview

As a rehabilitation CNA, you will be caring for people learning to live with the effects of a catastrophic injury or illness. In the beginning, they may need a LOT of care…and clinical skills. Rehabs may even resemble hospitals…it isn’t uncommon to encounter suddenly severely disabled individuals that may require a lot of additional equipment. But, because these patients stick around for weeks (or months), you get to know them on a personal level…and you get to help them through the most life-changing circumstances that would have others running for the door. And sometimes, you even get to celebrate as the patient meets their goals and gets to go home (which usually seems impossible when they are first admitted).

Rehab CNAs work very closely with a small healthcare team including nurses, doctors, physical therapy, speech therapy, occupational therapy and social workers. If you play well with others, and have no problem developing workplace connections, this is your playground! These are all potential career pathways that you might consider, so make friends and ask why they chose that career and what it takes to get there! Put those socialization skills to work!

“The best way to get started is to quit talking and begin doing!."

Walt Disney

Working in a rehab center brings very specific challenges, and great rewards. Read below for some specifics!

1. Pace

Healthcare in a rehab is moderate-paced. There are a lot of things to juggle and developing a routine is important. Helping patients get out of bed, groomed, bathed and dressed in time for therapy takes great organizational skills, especially when you have several patients with differing levels of ability. You have to be easily adaptable to work in this setting, and not mind a constantly changing workflow as patients improve and become more independent over time. But, you also have to be able to mentally handle it when others never improve because of their circumstances. It helps to understand that, unfortunately, life does not always come with a fairy tale ending. Part coach, part cheerleader, you help patients stay motivated and focus on the end goal. In the beginning, when that goal seems miles away and absolutely unreachable – the patient may require a LOT of help. But, even though they may get discouraged, you know it is totally within their reach with a little hard work because you have seen miracles before.

This is a clinical environment, and you love it! It shows in everything you do. You find joy in celebrating the small, everyday victories to the huge accomplishments. From helping patients who are too weak to get out of bed today, to answering that call light for the fifteenth time with a smile on your face, to lending a helping hand to a coworker, everyone can count on you!

2. Type of Patient

Rehabilitation patients are all different – and there is a wide variety in the type of help that each one will need. Some will come in on a stretcher and require total care but then walk out on their own 3 months later. Others will limp in and limp back out again. There are good outcomes and not-so-good outcomes, but you remain positive through it all. And you know that everyone can use a dose of sunshine on the cloudiest of days so you keep shining.

It can be exhausting, both physically and mentally. But the success stories keep you recharged and believing in the impossible. Depression over their changing health or current disability is common among rehabilitation patients, and so is anger, but you don’t take it personally because you understand grief is a personal journey. You have to be very versatile and be able to adapt to the needs of each different patient, and individual level of ability. You know that, when it comes to people, one size really does NOT fit all. Luckily, you are able to change your approach as needed.

3. Number of Patients

Since there is such wide variety in the type of patient the CNA works with, they have to be flexible. And with good rehabilitation, as the patients improve, patient assignments may change.

The number of patients you have will depend on what shift you are working. It will also be affected by what hallway you are assigned to. And finally, we have to take into consideration what kind of help each patient will need. Day shift is where all the action happens and patients require more care. Naturally, this means fewer patients are assigned to each CNA. Night shift, when most patients are sleeping, means less staff on hand. But it can also vary widely from one wing to another. Consider a CNA working with patients recovering from hip or knee replacement surgery. That CNA might a lot more patients to care for, because they have less to do with each one. Those patients can usually still feed themselves and brush their own teeth and button their own shirts. But a CNA working with stroke patients might have fewer patients on the same shift. Stroke patients may need help with all these tasks and more. It all depends on the care each one needs. CNA’s can care for a few patients that need a LOT of care, or a lot of patients that need a LITTLE care.

Overall, though, rehabilitation CNAs generally have fewer patients to work with than a CNA in a nursing home. They may initially require closer observation and a lot more care when they first come in. But, because rehabilitation patients generally require less care as their condition improves and they become more independent.

CNA’s need a high level of energy and drive to keep up this demanding pace for an entire shift. It also helps to have the patience to change and adapt when something comes along to derail your rhythm.

4. Oversight and Supervision

Rehabilitation CNA’s like being part of a healthcare team, but they also like the longer-term relationships they they might develop with patients. Because these patients change over time, they must work very closely with nurses to relay these changes to make sure the patient stays on track. A rehabilitation CNA is secure in their skill level and doesn’t mind having someone (the nurse, family members or new CNAs) watch them perform skills. They are comfortable with supervision and their role.

Rehabilitation CNA’s have to be flexible and adapt the changes as they occur. Patients may gradually improve and become more independent, or they may suffer a complication that sets them back. Just because the patient didn’t need your help to brush their teeth yesterday, doesn’t mean they won’t need your help today.

Rehabilitation CNA’s also understand that patients are individuals and will need care that is tailored specifically to that patient, so not all hip replacement patients will need the same level of care. Rehabilitation CNAs are adaptable and go with the flow.

5. Length of Patient Interaction

Rehabilitation care is usually provided over a few weeks to a few months. The Rehabilitation CNA is generally friendly and comfortable talking with strangers, but often gets to know the patients pretty well and celebrates the progress that patients make along the way.

6. Schedules and Shifts

Rehabs usually run on 12 hour shifts, which means you only have to work 3 or 4 days a week. Some will maintain a traditional 8 hour schedule (this is a great interview question: do you operate on 8 or 12 hour shifts?) It helps to think about your personal needs when deciding which schedule is best for you: a 12 hour shift means more days off, but those long hours away from home may be a problem for parents of young children. An 8 hour shift is more traditional, but now you have to decide whether 7am – 3pm, 3pm – 11pm or 11pm to 7am works better for you. Not every shift is a good fit for everyone!

With 8 hour or 12 hour shifts, there isn’t much flexibility in this schedule. Nights, weekends and holidays may be required (but usually on a rotating basis). If you commit to one of these shifts, you will have to work the entire shift (no going home early).

Schedules will vary depending on facility and department. Some will offer a set schedule that rarely varies, working the same days every week. Some will require more flexibility as the days you are scheduled will be different every week.

Rehabs may offer a position in their “Pool” system, where employees are only scheduled to work on an “as needed” basis. This is often called a “PRN” position. When this CNA is hired, they are not assigned to a particular floor or unit, they agree to work wherever they are needed, whenever they are needed. Generally, these positions are scheduled (not on-call) at least a week in advance and provide an excellent opportunity to try out different areas of a Rehabilitation center to see which one fits you.

7. Pay and Benefits

Rehabs often offer moderate to high starting rates for CNAs, but they often sweeten the deal with benefits, too!

Some rehabilitation centers are free-standing and only focus on rehabilitation services. Others are provided in a section of a nursing home. The pay scales are generally similar.

PRN workers often do not qualify for these benefits, but get a higher rate of base pay instead. This can be helpful if you need a higher pay rate to take care of your monthly obligations and don’t need insurance or other benefits.

8. Learning New Skills

Rehab CNAs may to learn new skills, depending on the patients they are working with. They may need to learn how to operate CPM (continuous passive motion) machine that moves a patient’s extremity to strengthen muscles while they are in bed. They may need to learn how to apply a prosthetic device or help a patient with adaptive equipment. Training on these devices will be provided by the employer which makes you much more valuable as an employee!

9. Opportunity for Advancement

Learning new skills is common in this setting! Rehabilitation centers generally offer some limited options for those that want to advance your career. Tuition reimbursement is sometimes available (which means they will pay for your schooling!) in exchange for a future work commitment and scholarship opportunities may be available in some corporate settings.

Summary

Not too many CNAs think about rehabilitation centers when they consider places to work. But, with high variation in patient care, better than average wages, higher acuity levels (the amount of care a patient will need), staff training for new skills, and benefits, it should really be worth considering.

It pays to pick the right workplace…and your personality will have a huge impact on your overall success. Often, we have unrealistic expectations and the reality doesn’t live up to what we THOUGHT the work would be like. Knowing what to expect and making sure you have the skill set to perform well will go a long way to ensuring your success, no matter WHERE you decide to work in healthcare!

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Patricia Laramee, RN March 31, 2023