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Toni Talks about PT Today

Resolving to Work as a Team

Published January 8, 2009 12:38 PM by Toni Patt
The beginning of a new year is a time for change. It's a time to make resolutions and strive to be better. Even though I'm not much of a resolutions person, I'm making one this year. My resolution is to search nursing texts to find where it is written that nurses don't help mobilize patients. It has to be in there somewhere. Why else would nurses everywhere think that "OOB with assist" and "ambulate with assist" are PT orders.  Physical therapy is not found in those phrases. Yet, somehow those orders find their way to the rehab department.

I'm not picking on nurses. They have a hard job with lots of responsibility and little appreciation. Being overworked and understaffed is a universal problem in health care. This is confusing to me. Why do nurses think I have so much extra time that it is my responsibility to get every patient in the hospital out of bed? Why should I drop whatever I'm doing to go immediately to the nursing floor when summoned to help a patient get into/out of bed? It's much easier for a nurse to get help than it is for me to do so. And I really don't understand why nurses call me when the patient "is too big and I don't want to hurt my back" and then disappear because I can do it by myself? Do they think I want to hurt my back? I don't have the luxury of refusing to get someone up because he or she is "too big."

Everyone in health care knows patients need to mobilize. There are numerous studies supporting the benefits of early mobilization in terms of shorter stays and lower costs. Being out of bed is therapeutic. However, just because being out of bed is therapeutic, it doesn't necessarily follow that the transfer was also therapeutic. There is nothing therapeutic about a dead lift. Nor is there anything therapeutic in sliding someone into a neuro chair. Physical therapists work on transfers because there is a therapeutic benefit of increased independence, increased strength or increased balance. I admit I'll get low arousal patients out of bed a few times to see what happens. I don't continue it unless I see positive changes from the action. Yet, for some reason these transfers seem to fall to PT. Where is the skill in that?

Alright, I've gotten that off my chest. I feel better. I don't expect much success with my resolution but some progress in the right direction would be nice. I'm lucky in a way. On my neuro floor we all work together to mobilize the patients. I help the nurses. They help me. Every other floor is the problem. Some of the nurses I work with on the rehab unit on the weekend are also very good. I also know a few PTs who are worse than nursing about not helping mobilize patients. The PT profession needs to make a resolution. We need to resolve to work as a team to make everyone's job easier.

2 comments

Toni,

Great blog.  

Christie, I like the contest idea.  

Along the lines of getting people up, if we don't, who does?  The "problem" of getting people up for the first time is that NSG doesn't want to put in the effort due to demands of their positions.  They do an assessment and are more than capable to get people up but they don't want to.

PT's, OT's and Assistants HAVE TO get people up because that is what we do.  And when the MD asks if the patient is getting up - NSG points the finger and says "Aks PT".

So, MD asks us and we tell what the patient is doing.  I have seen horrible administration but NSG and PT working together can make a building work efficently.   It is about ownership of the task.  

Our profession has become the movement experts with the knowledge of a doctorate so we are the only ones capable to make the patient move better.  We have become the self proclaimed experts in the field of walking someone.  

Now, if NSG moves a THA patient and dislocates it - why didn't we educate them on the proper positioning and movement?

On one hand we want the owership of movement,exercises, gait, but we complain about others not getting people up OOB.  What if NSG began to bill for their services to the PT budget for their transfer skills and gait?  I think then we would take more ownership in becoming the "expert" at gait/mobility.

Karen January 11, 2009 10:25 PM

Toni...you so frequently post what many of us are asking ourselves everyday.  

Having been a CNA in high school, I can tell you that ambulation and transfers was definetely a part of our training...yet, it's one that many CNAs, PCTs and RNs convienently like to forget.  

I think the real problem lies in administration...how are PTs, RNs and CNAs really being used? Is the skill they are being asked to do really consistent with their level of education and job description.  While I do think it is everyone's responsibility to make sure that the patient is being mobilized, it rarely takes someone with a master's or doctorate degree to mobilize a patient. At the heart of it, this is really a PCT's job. Yet, the RN has to take ownership over that task...making sure the PCT does, in fact, complete that assignment.  Maybe this just happens where I work, but nothing annoys me more than to see PCTs chatting on the phone or with their collegues.  Sure, we all chat and take breaks, and I fully recognize that at any given moment, a PCT could be asked by three different patients to go to the bathroom. However, everytime I see PCT just taking a personal call or browsing the internet, I say to myself...maybe that nice lady down the hall would like to go for a walk...all she needs is help to push the IV pole.  Does an PT or RN, for that matter, really need to be involved other than to properly delegate this task?  In my opinion, both PTs and RNs could work more efficiently if administration could realize that one PCT for nine patients just isn't enough.  Add one more PCT to each floor, and you could save the cost of having to hire a PT and a PTA. Furthermore, PTs, PTAs and RNs can spend the time doing the jobs they are really trained for.  

In my opinion, RNs need to take more ownership of mobility...overseeing that it gets done...period...it's no different that making sure they got their medication. PTs on the other hand, should really only be required to see a patient whose functional status has changed as a result of their illness or if the feasibility of the mobility plan is in question.  

Another hurdle I think has been the movement to a PPS system. Everything was great when patients were charged on a fee-for-service paradigms. There was no question as to whether to hire more rehab staff as long as they found patient to see...patient were seen two or three times a day regularly.  The change to a system where PT is a cost to the system has certainly, in my opinion, led to to really examine who is really appropriate to mobilize a patient. And I agree, it doesnt' take 6-7 years of education to "walk" a patient.

In the end, however, it all comes down to administration.  I'd like to commend our administration at our facility for being receptive to the idea present by our inpatient manager.  If patients aren't really needing "PT", but just to mobilize, why not create a position designed for just that?  We now have two PCTs at our facility who go from floor to floor seeing our patients who just really need to walk and get out of bed daily.  They've already been screening by PT to found to be able to be at a functional level appropriate for the mobility team...now someone is taking ownership for that piece of their care.  I think this was an excellent decision...and they are paid out of the nursing budget!  This allows RNs and PTs to do the job they really need to be doing.  

Another good example is a local facility who decided to have a "contest" to see how many times patients were mobilized on the unit.  This REALLY motivated PCTs to get their patients up and about.  

...I, too, feel your frustation Toni.  In the end, it requires cooperation with administration for creative solutions.  

Christie January 11, 2009 2:52 PM
Streamwood IL

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