Pros
Seeing patient admitted that can really benefit from the program. Not patient you are just babysitting.
Cons
There appears to be a lack of consistent leadership, structure, and accountability throughout the organization. This has created ongoing challenges that affect both patient care and staff morale.
One significant concern is the increasing expectation that Neuro Rehabilitation Specialists (NRSs) perform duties that are traditionally within the nursing scope of practice, including wound care, burn patient care, medication-related responsibilities, and other clinical tasks. This places staff in difficult positions and creates uncertainty regarding roles and responsibilities.
Staffing continues to be a major concern. NRSs are frequently understaffed and assigned more patients than can be safely managed, making it impossible to consistently maintain required patient proximities. As a result, there have been patient falls and other preventable incidents that appear to be directly related to inadequate staffing and unrealistic assignments.
Equipment and safety are also ongoing issues. Fully incontinent patients are often placed in pull-up briefs instead of appropriate adult briefs, and many are cared for in standard beds rather than hospital beds. This requires staff to climb into beds to provide care, increasing the risk of injury to both patients and employees. Additionally, direct care staff are not routinely provided with back braces or other ergonomic support despite the physically demanding nature of the job.
Medication management continues to be an area of concern. There have been instances of missing medications, delayed medication orders, newly admitted patients not receiving scheduled medications upon admission, and patients going several days—or in some cases over a week—without prescribed medications. These issues have the potential to negatively impact patient outcomes and should be addressed with urgency.
There also appears to be a reluctance among clinic nursing staff to provide wound care and medication administration within the residential homes, resulting in temporary or agency nurses being used to fill these responsibilities. While agency staff are appreciated, relying on them to perform routine responsibilities does not provide the continuity of care our patients deserve.
Finally, there are concerns regarding leadership experience. Several recently hired supervisors and residential managers appear to have limited backgrounds in medication management, direct patient care, or brain injury rehabilitation. Historically, residential leadership positions have often been filled without individuals having significant residential or neurorehabilitation experience. While education is important, strong clinical knowledge, leadership ability, and hands-on experience are equally essential for ensuring quality patient care and effectively supporting staff.
My hope is that these concerns are viewed as opportunities for improvement. With stronger leadership, clearer role expectations, improved staffing, and greater accountability, CNS can better support both its employees and the individuals entrusted to its care.
