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Toni Talks about PT Today

What About Acute Care?

Published November 5, 2007 10:22 AM by Toni Patt

Something is bothering me. I want to know who is going to treat acute care patients in the future. No one I know wants to work there. None of the students I've talked to want to go there. Some of the therapists I know who work there want to change to something else. Then there's me, always different. I love acute care but can't do it anymore. I feel it at the end of the day. After a few days like that I'm not at my best. If I'm going to be sore the next day, I prefer it to be from something fun.

In my case I've moved to an outpatient setting where there is less lifting and more help when lifting is required. I'm getting older (40+) and feeling more with less effort. Acute care patients can be hard. Some of them can practically jump out of bed. Many others can take two or three people and be unable to assist. A fresh hip replacement or a recent CVA can be minimally involved or dead weight.  

What about the other person? Frequently there are one or two aides for an entire department. Administrations are moving in the direction of fewer people doing more work. Let's not even mention obesity. The bottom line is the patient doesn't get the appropriate care. I've had many experiences where I did bed level therapy due to lack of assistance.

We have two PT schools in Houston. Both require one rotation in an acure care setting. Of all the students I've met this year, all but one want to work in an orthopedic outpatient clinic. The other one wants to work in neuro outpatient. The reasons I was given were: "anyone can walk a patient," "I don't clean patients" and "that's too much work." I'm curious where those ortho wannabes end up if they don't get one of the limited jobs available. It's not any better to have someone working in acute who doesn't want to be there.

I have another question. What if that was your loved one who didn't get therapy because there weren't enough therapists to see everyone? I know of at least one hospital in Houston where that is true. Seeing someone for 10 minutes and doing bed exercises because you can charge a unit doesn't count as therapy. Walking someone 100 feet and putting them back to bed doesn't count either if they can do more.

As PTs we know the value of early intervention. We know the value of therapy to improve outcomes and functional status. What is going to happen with those patients?  Who is going to treat them? The therapy community as a whole will have to address this question. Something is going to have to change. Increasing salaries to attract therapists won't be enough. Change will have to come from therapists, administrations and elsewhere. We need to start asking ourselves these questions.


I have just changed from Acute to Home Health. I loved the energy, the nurses, the PCT's and just working with all the people in the hospital. Always changing and fast paced. However I got burnt out- Increased patient load, removal of our own techs, shortage of nurses and PCT's, increase in productivity required while adding paperwork (computerwork), working more and more frequent weekends. Physically, mentally and emotionally you just cannot go on. So here I am, somewhat lonely, slow paced, minimal weekends, off all holidays, yet missing acute care but just not able to return.

Linda, Home Health - P.T., TLA November 21, 2007 6:21 PM
Deltona FL

Thanks Toni,

  I appreciate the fact that you raised this issue about acute care.  In my facility , I am expected to go to the acute foor occasionally. I personally prefer not working in acute care and my reasons are as follows:

- I am always looking for new ways to meet the needs of my patients. However, acute care( especially the medical floor) is not for me.

- Sometimes, I feel the Nurses try to dictate what needs to be done. I respect them for choosing their profession, but they are not Physical Therapists.

- I know early intervention is beneficial, but sometimes these patients could do without the skills of a PT.

- Sometimes , the patients are so medically involved and all that the MD or Nurse wants is for the patient to sit up in a chair and I believe this can be accomplished with the help of a Nursing assistant.

- Sometimes, I go to the medical floor to eval an acute care patient and there's already a D/c note from the MD saying it's ok for the patient to return home.

- For patients on the orth/ surgical and neuro floors, I can see the need for skilled PT for the most part.

- In trying to avoid injury, It is good to use the various kinds of lifts that are available. However, I know of therapist who believe they are superman, but I would feel bad for any one who gets hurt. Some of the patients in acute care are very obese and need more than the availble Lifts that are available.

- I know there's the push for evidence based outcomes. I therefore believe that the Delivery of PT services in Acute Care Settings, needs to be addressed. Increasing the salaries to attract Physical Therapists,will not do it.

Thanks for the discussion.

Jackie, PT, DPT, MSc.

Jackie November 6, 2007 7:02 PM

Thank you for giving PT's a place to talk!  We are all facing similar issues and it really helps to know we're not alone out there.  I loko forward to many great discussions!  I agree 100% with Toni.  

Marilyn, PT November 5, 2007 10:52 AM
Minneapolis MN

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