Don't Touch That Patient
I had an unusual conversation with a nurse last week. I was in the neuro ICU preparing to evaluate a patient. I always check with a patient's nurse prior to doing so to make sure the patient is medically stable. Normally the nurses are very helpful and happy to see therapy. Not this time. This nurse refused therapy for the patient because she didn't know what the patient was able to do physically.
That pretty much stopped me in my tracks. Why would that matter to the nurse at that point in time? I thought the purpose of a physical therapy evaluation was to find out the patient's functional status. As part of my evaluation I'm going to assess motor function, strength, sensation and, of course, mobility. I thought it should be me telling the nurse the patient's functional level.
Obviously in the course of caring for a patient a nurse is going to have the patient move around. That would provide some insight into mobility. I can see where a nurse would have some idea of what a patient can do. What I can't understand is why this particular nurse thought she knew more about the subject than I did.
Yes, I want her input on all medical matters. I want to know if the patient is awake, how the BP is trending, if any commands are being followed, what the patient has done so far that day, pending labs/procedures and numerous other things. I don't want to know how the patient transfers or walks. I will figure that out for myself. I realize sometimes nurses request PT consults because they were unable to mobilize a patient, but that wasn't the case.
I don't think I've ever had a nurse tell me that before. I've had plenty tell me they can't mobilize a patient. I've had others tell me the patient isn't moving for them or is moving sporadically. I wonder what that nurse was thinking. She wasn't going to assess the same things I do. I've seen numerous nursing neuro exams and they're completely different from what I do. Assessing whether someone can lift a limb against gravity isn't the same as observing how the limb is used functionally.
Sometimes the lines between disciplines become blurred. In the course of a day, I do many things that might be considered more OT-ish. I've been known to perform a few nursing procedures as well, but only after nursing has already initiated them and I've asked permission. I don't think this was an instance of nursing trying to push the envelope into PT territory. I think this was simply a nurse who thinks she knows more than everyone else.