I recently received quite a few heartfelt responses to a blog I wrote last year on the subject of the dreaded PTA "state board licensure exam." I feel your pain, people. I vividly remember the pre/post anxiety and panic of preparing and actually taking the test.
Many readers asked about the timeliness of receiving the test results. My case was different, since I found out I passed exactly five days after the test and I heard of a few of my classmates having found out they passed through the PSBPT website as early as three days post. You want to see your license indicate "ACTIVE."
There is also the option to find out your test score early through a nominal fee of $50. However, I opted to stew in my fear and anxiety for those few days and, well -- I spent that $50 towards a "congratulatory-either-way" dinner with my husband. Whether I had passed or not, the fact that I didn't have to hide out in my "study corner" of the house for the first night in many, was reason to celebrate in itself.
As I stated in my original blog on the subject, I was petrified that I might have failed -- which is no exaggeration. I did indeed cry on the way home from the testing center, certain of this failure. I wasn't confident walking into the test as it was. I historically struggle with test-taking and scored dismally on Scorebuilders and the PEAT pre-tests. Luckily, I did pass that day and was able to shelf the whole experience as one of the more painful/stressful of my life (second only to childbirth and moving out-of-state).
Re-reading all of the comments posted by anxious readers, I certainly hope you received the same good news. However, if not -- my advice to you is to not give up! The day before I was to take the test, I posed this worst-case scenario to one of the PTs I work with. I asked, "What happens if I fail the test?" She responded (without skipping a beat), "You'll study some more and re-take the test... until you pass."
Basically, what I want to impart to you folks out there is that your journey is really just getting started. If you passed the test, my sincerest congratulations but if not, it's only a matter of time before you will. Focus your study time on your weakest topic (that was neuro for me) and be relentless. If you survived PTA school, quitting should not be in your vocabulary. You earned it. You deserve it. You will pass it. Your career is waiting for you -- don't give up now!
I was reminded recently of how to recognize a truly good therapist. The observation came up when a PT was describing the individual therapists on our rehab team to a PT student. Generally, the obvious was mentioned, such as experience and specific knowledge in certain specialties. However, when describing one PTA, the therapist stated that "at the end of the day, he really cares about what happens to these people (patients), and they love working with him."
The therapist he referenced is not only my colleague, but also the one individual who has taken a virtually identical path to my own over the past few years. I first meet "Fred" in the dreaded physics class that I took twice (and which Fred passed the first time with an A).
From this auspicious beginning, Fred and I found ourselves side by side on the road to PTA school and beyond. We met again when observing at a skilled nursing center, where we discovered we both favored working with the geriatric population. Fred and I also sat next to each other for the two years in school and had exactly the same clinical affiliation settings.
As I was beginning a second career in physical therapy, Fred would admit this is his fourth (maybe fifth) career change. But lucky for us and the patients, it's his last. Fred was one of the older students in our class, including myself, who just made the cutoff of the "over 35 group."
Fred, with his completely gray hair, is an unapologetic "over 55'er." The combination of life experience (including surviving the ‘60s and fatherhood) and straight-up charm makes Fred one of the most popular therapists on staff -- and not just in the patients' opinion. By Fred's second week of work at the facility (he began a few months after I did), he had already established a "you fly, I'll buy" coffee group with the CNAs. (For the record, he paid for the coffee and they picked it up).)
Before long, everyone was an "F.O.F." (Friend of Fred -- which I coined much to his embarrassment when I mentioned there might be t-shirts). In the therapy gym he was simply known as "Dr. Fred," which many patients mistook him for upon first meeting him (it's the hair, I think).
The best thing about working with my friend and colleague is that our PTA histories are so similar -- we will often relay incredible observations and experiences to each other throughout the day -- akin to two kids at their first baseball game: "Did you see that transfer?" "How did the PT do that?"
Fred also happens to be our "closer" therapist. If a patient declines therapy repeatedly, bring in Fred. More often than not, Fred's sense of humor will charm the patient into supine ther-ex on the mat table. It doesn't hurt that he's incredibly patient and compassionate either.
I feel privileged to have been witness to my friend's professional growth and success. I guess Fred is the perfect example of "you're never too old to learn something new" -- applying this motto daily in the most perfect setting.
On any given day in the SNF, I might have six to 10 patients on my schedule. The rest of my colleagues have close to the same amount, depending on how many new evaluations the PTs have that same day. Having reduced my work schedule to four days a week as I've discussed in past blogs, I can now take on a typical 10-hour day without completely collapsing when I step through my front door.
Having said that, I still carry one of my biggest pet peeves around with me when it comes to co-worker behavior. The "peeve" in question is when one or two of the therapists will receive an inexplicable number of declines for participation from patients. Whether out of the facility for a doctor's appointment, sick, suddenly sent to the hospital or my favorite -- watching "Price is Right" (this happens more times than you can imagine), a therapist schedule can whittle from eight patients to five very quickly. Then the therapist dashes for the exit without so much as a "goodbye" or even a "peace out!" to the rehab team in the gym.
The remaining therapists have their allotted and agreeable patients, which leaves a busy day ending at 7 p.m. compared to the therapist with five patients who left at 3:00. Does this happen? Yes, but not often. I can honestly say that most of the therapists I work with are more concerned with the patients and their recovery -- not when they "clock out" for the day. On many occasions, one of us will announce we have an appointment in the afternoon or (in my case) a kid's function/recital that we really can't miss. In these cases, we all collectively take a patient off the therapist's schedule so that person can leave on time.
Many on staff will check in with each other throughout the day. "How's your schedule going?" is often heard during our brief lunch break. Often the answer is "Slow... I have six more patients and it's almost 2 p.m." When this happens, we pick up the slack and distribute according to whose schedule looks the lightest. I like to think that is how most rehab teams work, but I have a sneaking suspicion I'm very lucky to have such considerate colleagues. Do you have hidden resentment when a coworker breezes through the day without asking about your own? Is there an "every-person-for-himself" or a "no-therapist-left-behind" policy at your workplace?
For more than a year now, the physical therapy department at the skilled nursing facility where I work has had no staff turnover. This has enabled my colleagues and I to develop an efficient therapy team with excellent communication and interpersonal rapport. As each therapist has unique strengths to offer, from the seasoned specialist to the eager "newbie" (me), it's the patients who benefit.
Recently an additional full-time therapist was hired and the group dynamic has surprisingly not changed. Our new team member is an experienced PTA who has worked all over the country for many years at a variety of different SNFs, hospitals and PT clinics. With her vast experience comes a huge personality as well.
Immediately, I noticed this therapist was quite outspoken and much louder compared to the "team." Honestly, I was more than a little put off when she insisted on giving me her (unsolicited) clinical opinion on a patient -- in the middle of the treatment -- when I was simply trying to follow the plan of care established by the primary PT.
I wasn't the only one who noticed, since one physical therapist had to remind this PTA that she had to "tone down her voice" due to the easily over-stimulated patients. After a year of quiet efficiency, it felt like someone just did a "cannonball dive" in the therapy "hot tub." The waters were indeed churned.
It took a few months of integration and observing this new therapist in action daily but she now is one of my favorite people on staff. As I discovered, she is one tough cookie -- standing up for her patients' needs whether confronting a CNA or the rehab director. She is a wealth of knowledge for this new therapist and is generous with her time to stop and answer a clinical question. And finally, she's a "working mom" just like myself -- amazingly the only other mother working full time in the PT department. This is a huge commonality and support to have with a fellow colleague.
The new team player is working out and we're a stronger rehab department with her in it. I'll be keeping this in mind if I allow my first impressions to pass judgment on another "spirited" colleague or patient.
One day last week as I was preparing to spend my coveted "lunch break" outdoors under the elusive Northwest sun, I came across one of my regular patients sitting alone in the hallway. I have grown to really enjoy working with this particular person because although she is in severe chronic pain, I can always expect her daily participation in therapy.
I thought it odd that this woman was sitting in one of the hallway chairs since it was her lunch hour and typically she would be in the dining room. Then I realized she was crying, which was completely out of character. I approached the woman and she reluctantly explained why she was so upset.
Apparently, there had been a mix up with her lunch and she did not receive her usual "grilled cheese" in lieu of the daily entree. The aide staff became frustrated with her because she refused to eat the entree they provided and firmly told her that she could not have a sandwich since she technically did not order it through her weekly "menu."
Obviously this was a communication breakdown between the patient and the aides and I told this woman so. What I did not tell her was there was a "sensitivity" breakdown as well. The aides, albeit understaffed and underpaid for their work, simply were digging in their heels by not acquiescing to this patient's request.
I told the woman I would be back in five minutes and to please meet me in her room. It then took me less than that to walk down to the facility kitchen, request a melted cheese plate lunch and arrive back to the patient's room, tray in tow. Did the aides have time to make the trek back to the kitchen? Perhaps not. But it didn't take much effort.
The woman was extremely grateful and I was glad I had the time to help all the parties in this situation. All the staff of the large SNF where I work have the monumental job of caring for a large and complicated patient population. It's incredibly easy to become frustrated with the erratic behavior and demands of patients. However, like I have to remind myself each day, these patients are people in pain, confused at times and homesick. A little grace can go a long way.
My fellow therapists at the SNF where I work all provide a vast amount of talent to our therapy team. Whether specializing in hand therapy, lymphedema management or simply approaching therapy with years of experience, there is a clinician on staff who can provide superb care to any sort of patient.
There is one member of our team, however, who most of the patients seek out and brings a guaranteed smile to their faces. This "therapist" has the ability to charm even the grouchiest and can entice many timid patients out of their rooms for gait training. Unlike the rest of the PT staff, this therapist is not formally trained yet goes by simple animal instincts (the four-legged kind). The therapist I speak of is named "Xena" (yes, as in the "Warrior Princess") and is a dainty 105-pound female bull mastiff.
Xena has not been trained as a "therapy dog" per se, but if one could earn her diploma on experience alone, I think she would qualify. She arrives most weekdays with her owners/parents, both physical therapists on staff, who recognized early on Xena's gift for communicating with people. Like all dogs, Xena is "treat-driven," therefore she lumbers through the facility, quiet and unassuming, visiting patients in their rooms for a chance bacon treat from the breakfast tray or perhaps a simple pat on her head.
Xena's true gift is her ability to make people comfortable in the gym. Many times she'll join a patient on the mat table (with permission) and quietly snooze while respecting his space. I've found myself enticing patients down to the gym with the promise of Xena's attendance with much success. For such a large dog, I'm always surprised by patients' natural acceptance and lack of fear when they're near her. This speaks to Xena's sweet gentleness, which transcends her large frame. The "no-one-feeds-me-so-do-you-have-a-treat" look certainly helps her allure.
When Xena hasn't "come to work" for a few days, patients will worriedly ask where she is and often they'll self propel in wheelchairs to the gym, wondering if Xena is OK. "She hasn't visited recently -- can I leave her a dog biscuit?" they'll ask. Xena the therapy dog is an important component to our PT staff and her unconditional love of people allows our patients to relax and become more comfortable in the gym setting. If an effective therapist connects with and motivates her patients, then Xena has earned her doctorate.
More than four years ago, I sat my then 8- and 4-year-olds down to explain that their "Mommy" would be very busy most nights and weekends for quite a while. I explained that I would have to spend most of my "free time" studying and reading and reading... and studying some more. My goal was to become a physical therapist assistant and help people heal. They were impressed if not a little confused -- for a full year they would tell their friends I was in nursing school. As well, I told them, I would be able to help Daddy pay the monthly bills, which unbeknownst to them had a stranglehold on our finances (not to mention peace of mind).
As I would wave goodbye to my family when they left for spring break vacations and summer road trips, I felt guilt but mostly relief -- I would be able to totally focus on my next test without having to figure out a dinner plan every night! The clincher for the kids was that once I actually became a PTA and had worked for a year, I would pay for a family trip to Disneyland. Having never been, this effectively piqued their interest. When I made this promise, a few minor milestones had to be reached, including: finishing night school (Physics and Bio, oh my!), acceptance into the PTA program, passing Anatomy, surviving my clinicals, graduating, finding a job and general thriving as a therapist for a year. It was a tall order and the grand scheme of this plan seemed daunting to us all, but especially me.
Fast forward those four years and we're leaving for "The Happiest Place on Earth" next week. When I booked the trip more than a month ago, I was beyond thrilled and not just to see Mickey. I had actually accomplished this huge goal that I set for myself -- somehow. In hindsight, as a fellow former classmate so aptly described, we didn't win the race -- we finished the marathon. This is the best analogy I have heard so far describing the emotion of completing the PTA program. Even more interestingly, my kids were excited but not nearly as surprised as I thought they would be. It's as if they knew I would come through with my promise the whole time. It's their confidence in me that pulled me through this journey and continues to inspire me every day.
Working in a skilled nursing setting definitely has its benefits and drawbacks, as I am constantly discovering. There is a huge advantage to working with the same patient every day of the week. Watching him make gains and meet goals, sometimes daily, is extremely rewarding. On the other end of the spectrum, working with many who have end-stage dementia or are at the end-of-life can take its toll on morale at times.
One interesting dynamic a therapist can find herself in is when the patient becomes strong enough to be a danger to himself. Over the past few months I've been working with a CVA patient who began therapy unable to communicate or even stand. With daily intensive therapy, this same patient can now ambulate 50 feet with a hemi-walker and minimal assistance.
Our rehab team was thrilled with the patient's success. This was what physical therapy was all about -- returning functional independence back to a patient through hours of facilitation and hard work. I have to admit, the rush of excitement I felt when the patient took his first few steps with the walker outside of the parallel bars is one I'll never forget.
Unfortunately, with his newfound ability to walk, combined with poor judgment, this patient became a major fall risk overnight. The patient, though verbalizing more, still struggles with communication and insists on trying to stand up from his wheelchair every hour of the day. Nursing becomes exasperated too, as their quiet sedentary patient who used to stare out the window for hours is now pulling himself out of his wheelchair with help from the hallway rails.
The joy of the patient's gait progression becomes less exciting with the threat of a possible devastating fall with each passing day. One therapist described the irony of the situation as "making the patients just strong enough to hurt themselves." Which is depressing but true in some cases. We certainly will not withhold treatment to patients just because their cognitive judgment is compromised. So we continue to treat and progress gait along with safety awareness in the hope that the patient will be safe. I try to keep in mind the big picture of therapy -- "return to prior level of function" -- which in some cases can be synonymous with "fall risk."
Last week I finally went for my annual physical with my doctor. I was a twinge nervous, as I've been exhausted recently and well, I haven't had a doctor's appointment in more than three years. Luckily, all was fine -- and I was given some valid (if not obvious advice). She suggested that one way to curb my "low-energy" issue was to drink more water. Her analogy was to think of my job as running a marathon, in which staying hydrated was vitally important.
Sound familiar? It certainly did to me. The irony of the situation wasn't lost as I offer water (albeit sometimes thickened) to all my patients countless times a day. Often, I recognized that I hadn't drunk one sip out of my sports bottle even once during my shift. But I was busy therapist, right?
I considered what I ate and drank during a typical day. Could my 20-ounce coffee -- which I nurse throughout the day -- be the culprit of my bottomed-out energy and mild 3 p.m. headache? Well... probably, but I'm a new therapist and unwilling to give up my caffeine habit just yet.
Therefore, a few days ago I launched "Project: 64 Ounces." That is, I drink eight ounces of water every hour throughout my eight-hour work day. My findings were what you would imagine: quite a few more trips to the bathroom than my usual routine -- and often a forgotten hour here or there, resulting in me "downing" a large 16-ounce serving during a patient's treatment session. Immediately, however, I noticed my energy in the afternoon was much higher and an even more exciting result -- a quelled appetite and looser-fitting pants.
Although I've always promoted the importance of staying hydrated to my patients, somewhere along the way I forgot how important it is for me the clinician. Luckily I'm not a soda drinker, yet water has never been my go-to thirst quencher, unless I'm working out. Even so, I'm finding that I'm reaching for my water bottle (with lemon slices for flavor) more and more often during the day. Staying alert and energetic without the extra coffee and headache has been a welcome change of pace. Especially during those marathon days.
As a relatively new physical therapist assistant, I accept that I have a monumental amount of knowledge to learn. Trust me; I'm humbled every day by the vast amount of experience I'm gaining and the gap in what I have yet to master. This week alone, I've been lucky enough to work with a young man with TBI and two aphasic massive stroke patients. It's been a long and busy week at our SNF.
My one "go-to" skill that I like to think is my strength in this profession is the ability to talk with people. I can engage in conversation with most anyone at any time. I can weave a conversation with just about any type of patient when it comes to promoting a therapy session. Dementia? Chronic pain? Homeless? Sitting down and successfully chatting with a patient can make the difference between whether that person participates in therapy or not.
Well, I recently met the exception to this rule. The patient in question has end-stage cancer but has been quietly and valiantly rallying to warrant being upgraded from a palliative status to benefiting from physical therapy for potential discharge to his home.
In retrospect, the first mistake I made with this patient was to not ask what he wanted out of therapy. I bounded into his room more like a cheerleader than a therapist. I was definitely (over) enthusiastic, and worse yet, made terrible jokes, including (after seeing this patient walking the halls with his son) exclaiming: "You look great Mr. --, but you're not walking with me?!"
Thinking my charm was winning him over just happened to be the beginning of the misunderstanding between him and me. When approached for his therapy session, all jokes aside, the patient flatly stated that he didn't want "to play games and do acrobatics with a 20-year-old," as he was "fighting for his life here."
First, I communicated that I was just being facetious and I was completely informed of his medical history before I set foot in his room. Secondly, I thanked him, because that's what a 38-year-old woman does when mistaken for a 20-year-old. Lastly, I informed him of what the impact of physical therapy can have on his recovery.
His adult son caught up with me later to mention that his father has "issues" with women. I thanked him and completely understood -- we all have our hang-ups after all. Admittedly, I was still rattled that I misread the situation and that my "sunny disposition" did not win him over. But in the end, I wasn't the appropriate therapist for him, and he was the first to acknowledge this. A jolt of patient honesty, from which this therapist can learn.
As I recently blogged, I've been clinical instructor to a first-rotation PTA student. I share the duty with my colleague, who happened to graduate with me from the same PTA program our student is now attending. To say she is in sympathetic company is a humorous understatement. It was only a short two years ago that we were stressing over clinical expectations and advantageous rotation placements.
My colleague and I agreed that the stress of the first clinical, combined with the fact that the student has only received two quarters of program content, allows for many learning opportunities but perhaps not as much "hands on" with our patients. After the first five weeks flew by, we were pleasantly surprised by our student's rapport with patients and astute observations. She was shadowing and assisting with transfers and modality set-ups when the opportunity arose. We thought our clinical instructor duties were going just swimmingly until one of our physical therapists pointed out the obvious.
The PT suggested that we were providing a disservice to this student. Perhaps she wasn't qualified to provide a lone max assist to a bariatric patient, but not allowing more opportunities for her to provide independent treatment was limiting this inpatient clinical opportunity. I bristled at the PT's comment. Of course I was allowing the student to practice the skills she was learning. I was even having her lead a therapeutic exercise session with one of my patients - until I realized I was interrupting them every few seconds to correct the patient's form and offer suggestions.
This was exactly what the PT was describing and even admitted one of the hardest parts of being a CI is "sitting on your hands" and allowing the student to lead the treatment. Give the student a chance to correct the patient's mistakes and answer his questions so she can develop her own therapeutic skills. Once I realized I was being "overly helpful," I shut my mouth and quietly observed from the sidelines. The student was thorough in her treatment and asked me questions when she felt uncertain of something. Although I'm sure she appreciated my empathy and hand-holding initially, I'm confident she is ready to take on more responsibility in this clinical and start learning from experience. After all, she'll be a PTA in less than a year.
Often I find that I'll have a "favorite" patient on my schedule and will seek out that person's name on my list every morning as I begin my day. It can be something about their hard-working ethic -- knowing they'll always give me their best in therapy, or even their keen sense of humor that wins over my affection. I always assumed therapists should be like teachers; we should not have favorite "students." However, this is hard to avoid, especially in skilled nursing when you are working with the same people five days a week. Also, I have close "teacher friends" who've confessed they definitely prefer some students over others. We're only human after all.
Recently, I'd been working with a delightful patient who has a cancer diagnosis. She was motivated to gain strength for an impending operation that would probably save her life from the clutches of this insidious disease. Every day, although she was in agonizing pain, (but never complaining) we would work on gait endurance, balance and strength. I was charmed by her sweet yet strong personality and entertained by the hilarious stories she would share of her youth. She was my go-to patient; I could always depend on her giving me 100 percent of whatever energy she had for that day.
Within a few weeks, there was complete decline in her therapy. Specifically, the day she returned from her final oncologist appointment was her last day in therapy as well. She received the devastating news that the cancer has spread throughout her major organs and it was inoperable. I believe we took one short walk together the very next day as she explained she was given a less-than-six-months prognosis.
It was difficult not to cry and I came as close to tears as I have ever been with a patient, when she began to cry herself. This was so incredibly unfair! She had worked so hard toward meeting her goals. I secretly hoped she would want to continue to participate in PT every day, quality of life, after all -- but that's not what happened. She surrendered to the disease and is now in palliative care surrounded by family.
I visit her room once in a while and don't recognize this woman as the same person I treated. All she had was hope and when that was taken from her, so went the therapy. The human spirit is a powerful force and can be the deciding factor in whether a patient will improve. Although she is quietly slipping away, my experiences with her will not soon be forgotten.
My "official" one-year anniversary of being a working PTA came and went very quietly a few weeks ago. I was under the impression I would feel suddenly "experienced" and maybe given an "‘Atta girl!" from the rehab director. No on both counts. Yet, I forgot the anniversary myself due to general craziness that is my life.
On the home front, out small chicken flock has grown to more than 30, which doesn't include the 17 turkeys. Why so many turkeys, you ask? That's the same question I posed to my husband, the official poultry farmer. Apparently, we are harvesting and incubating fertilized turkey eggs in the effort to start a fledgling (literally) turkey pullet business. I've been assured, many people are interested in raising their own turkeys for culinary or simply increased farm flock purposes. I hope so; otherwise the turkey population in my back yard will reach a ridiculous bird/grass ratio. Did I also mention we have about a dozen meat birds? Well we do. But, I digress.
As you can see, distractions and responsibilities abound at home (I haven't even begun to talk about my kids yet), so it's not surprising this past year has flown by. In reflection, I am astounded by how much I have learned as a new grad. Although I still struggle with confidence issues like transferring a 6-foot-4, 250-pound patient - max assist - for the first time. (Just to clarify, I don't. Too dangerous for the patient and myself - I always ask for assistance). I'm also amazed by the abilities I've gained along the way.
My thank-you list is long and begins foremost with the truly "experienced" therapists in my facility, both PTs and PTAs, who've taken the time to share their knowledge. With many more years ahead in this career and so much more to learn and master (it literally makes my head spin), I have the feeling the years are only beginning to cruise by. Turkey farm or not.
As of the beginning of April, I reduced my work week from ﬁve to four days a week. Initially, I felt guilty that I couldn't "hack" a full-time schedule and then I realized I was being far too hard on myself. My usual work day starts around 8:30 in the morning and I'm not coming up for air until 12 or 12:30 for a quick bite to eat and then back to therapy until 6 p.m. (and sometimes 7 p.m.).
My cell phone is silenced at work and we have no Internet access. If there were to be an emergency and my husband or kids had to contact me, I would be paged. All of this is for good reason -- we're busy in the gym. Often, I'm offering assistance to a partial-weight-bearing patient or transferring a patient from his wheelchair to the mat table via slideboard. The pressing question of what I want on my pizza for dinner can wait.
In our SNF rehab, we are not given a scheduled time to see a patient. Basically, we have to hit the ground running, approaching patients, formatting our morning and afternoon to accommodate for pain med "windows of opportunity" or for those who don't rouse before 11 a.m. Many times, we'll check on patients' "availability" multiple times a day, attempting to be ﬂexible and offering encouragement to participate. This makes every day unique in terms of time management and productivity.
A few days ago, I was walking out of the facility at the same time as my colleague, another PTA. The elusive sun was out, which we don't see too much of in the Northwest, thus we were squinting like bats at the beach. "It's almost like we work in a coal mine," my coworker said. I laughed because he couldn't have been more accurate, not to mention validating my four-day work week decision.
Honestly, I enjoy this type of pace and the intensity of the work. My days are ﬁlled with teaching patients and learning from them as well, not to mention feeling like I'm doing something incredibly rewarding. However, I love my Tuesdays (the extra day off). After a day of errand running, chore-doing and running with my dogs, I'm recharged and ready to dive back into work. Leaving both myself and my patients on the best schedule
I vividly remember writing a blog nearly a year ago about the importance of being a member of the "Skilled Nursing Team" when it comes to patient care in a large facility. If I remember correctly, I was in awe of the seamless interdisciplinary networks, including nursing, aide staff, PT, OT and social services, who aid each other in the patients' plan of care. Heck, even the activity department motivated patients to get out of bed for bingo every other day.
Well, time has passed and I've seen rips in the team's "seams." There have been many instances in which the aide staff, albeit busier than a one-armed paper hanger (as one patient has noted), will not get a patient out of bed or dressed for the day before lunch -- even after multiple requests from the therapy staff. Or when a stressed nurse snaps the retort, "I will, when I can get to it!" after I request pain meds for a patient prior to therapy.
One of my "favorite" team communication breakdowns comes when a patient has agreed to physical therapy at a set time, yet when I meet him back in his room at the agreed time, he is working with a COTA in OT and has 45 minutes left of his session. Luckily, the OT and PT departments usually communicate in the mornings to avoid this issue (small reminder notes of therapy times left strategically in patient rooms work well also).
It can be frustrating - for everyone involved. Luckily, the majority of the staff is there for the same reason: to help get patients better, whether we're trying to make them more comfortable or stronger. Recently, I was transferring a bariatric patient back to bed from her wheelchair with the assist of a CNA.
He took the lead on the transfer because he was familiar and successful with the two-person maxi assist with this particular patient, who suffers from extreme anxiety and respiratory issues. The patient was physically more relaxed with this aide, as well. The transfer took at least 20 minutes and was orchestrated by all of us with great preparation, verbal cueing and safety in mind.
I found this to be an excellent reminder for myself that despite the occasional "team issues" we might face, ultimately we all have the patient's health care in mind.