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Toni Talks about PT Today

I Lift Patients For a Living

Published January 23, 2008 4:07 PM by Toni Patt

This week I started wondering about something. When did physical therapy become synonymous with getting people out of bed? For the last week it seemed like all I did was get patients out of bed. Now out of bed is a good thing. It increases alertness, allows for greater lung expansion, increases endurance and facilitates head and trunk control among other things. It's important that patients get out of bed daily. That isn't my problem. My problem is that it seems like PTs are the only ones who do this.

Yes, we get people out of bed. I admit I've gotten up some nearly comatose ones. I had reasons. One of which was to assess how the patient transfers. Another is to incorporate the transfer into something therapeutic. Transfer training is only one modality performed by PTs. I can treat a person without doing a transfer. If I want to work on balance I might sit the patient on the edge of the bed or stand at bedside.  That patient will still need to get up that day. If all of my treatments are transfers, I'm short changing those patients in what therapy they receive.  Mechanical lifts exist to make transferring involved patients easier. There's nothing therapeutic about it. Anyone on a nursing floor should be able to operate one.

That is the basis of the age old turf war between therapy and nursing. Who is responsible for getting the patients out of bed?  There seems to be a belief that possession of a gait belt provides its owner with superhuman powers including the ability to lift small automobiles. I wish. If that were true I'd be handing gait belts out to everyone.  My biggest pet peeve is being asked to help get someone out of bed. Then when I go to help, the asker disappears. Or, the asker then tells me she can't help because she doesn't want to hurt her back. I'm not sure I understand why it's OK for me to risk hurting my back. I'm sorry to say it's almost always women who ask and walk away. Men will try to help.

This week I was nearly pushed over the edge by two OTs. I like OTs. I respect OTs. Not being one, I can't speak with complete confidence to what they are taught. But I would guess somewhere in there is some transfer training. These two ladies must have forgotten. For the entire week they sat at their table and waited for the PT to get the patients up and bring them to the department. This wouldn't really surprise me from another discipline. When I confronted these two they said, "These patients are heavy and I don't want to hurt my back."

Physical therapists are caught in the middle. We know patients need to get up. We also know that in many cases, if we don't do it, the patient won't get out of bed that day. The only one who suffers in that scenario is the patient. So we get people up. I only have so much time with patients. I hate to waste it getting them up when there is so much else to work on.

Patients have gotten bigger and sicker. They are more involved. They require more care than previously.  The same treatment principles apply now as did 10 years ago. Patients get better faster when they get out of bed. It would be nice if all the disciplines could work together on this. I know it does in some places. In the mean time, I did not go to school solely for the purpose of getting patients out of bed. If a patient needs help, I will help them.  That's what PTs do. I would gladly hand over my magic gait belt and all its superhuman powers to anyone who would like to borrow it.

5 comments

I have had this same problem daily since I became a PT.  I have also performed the "cross discipline" education on every "difficult" transfer.  I get the response, we don't know how, so I gladly educate the RN or CNA how to perform the transfer correctly.  Yet, this does not fix the situation, and I end up getting a call later that day to put them back to bed.  We even passed out the magic gait belts to "fix" the no gait belt problem, but, this did not fix the problem either.  When someone finds the solution, please let me know!  

Matt, Acute Care - PT April 21, 2008 3:49 PM
Decatur IL

Hi Toni,

I am about to address the annual Australian Physiotherapy Association Congress about our need to learn and work better with other health professionals. The issues you raise are not unique to the States but may I ask you respectfully, what do you think would happen if you suggested to the designated nurse for the patient that you would instruct her in how to efficiently get that person out or back into bed? Also perhaps the OTs may also benefit from some manual handling expertise passed on by the physical therapist? Do you teach across disciplines? We so need to collaborate for the sake of better service delivery and I really hear your frustration when you feel that there are discipline specific skills which you are not being efficiently used when you are taking up time doing transfers. I guess the best case scenario is doing what you are and making that transfer part of the management plan but perhaps adding a teaching component may empower your colleagues to be more collaborative? We wish...

Regards,

Susan

Susan Waller, Physiotherapy - Academic Coordinator, Rural Clinical School February 26, 2008 1:10 PM
Toowoomba IT

Right On Toni.

I currently work SNF and the same thing occurs everywhere.  One comment I heard from the nurse was, "I don't know the patient."  This was supposed to excuse her from assisting the patient.

So, after several times of the nursing staff refusing to get patients up I told one of them "If you can't lift this patient you are in the wrong job and you need to find another one"

This of course went over real well with the administration but my point was well recieved from the therapy department.  If nursing, CNA, LPN, RN are unable to lift, reposition, or otherwise assist a patient they should not be in their current position of patient care.

Jason, PTA February 10, 2008 1:18 AM
CA

The issue is really about money. The hospitals in a short sighted effort to reduce cost elimiated the "Man"ual labor years ago when they terminated all Orderly or male patient care attendant positions.

Now either the Nursing or PT staff have to get patients out of bed along with other very important patient care activities. So should the hospitals use a $10/hr staff member to assist nursing  with these activities or a $70,000+ PT.

Both the Nursing and PT staff shortage should make the hospitals re-think this. All they need to do is hire more CNA/Male patient care attendants. Then the PTs could evaluated the patients and as part of the plan of care the CNAs would be getting the patient OOB as often as needed.

Problem solved

Russell Porter, Physical Therapy - PT February 3, 2008 11:20 PM
Mobile AK

Toni,

Wonderful article- I think I own the same gait belt that has superpowers!

I will be sharing your article with the rest of our staff.

Debbie, acute care - PTA February 2, 2008 6:40 PM
Roseburg OR

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