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PTA Blog Talk

Training the Staff

Published July 3, 2012 9:16 PM by Jason Marketti

As new nursing staff members begin to work, I will often introduce myself to them and explain that certain patients would need pain medication prior to therapy. One nurse I spoke with told me he had assessed pain on several people and they did not want to have anything for pain. The brief conversation went something like this.

"Can we get these people medicated prior to therapy?" I asked, showing him a list of patients.

"I already assessed pain on some of these people and they did not want anything for pain," the nurse replied.

"Did you get the patients up out of bed to assess their pain?"

"No, why would I do that?"

It is easy for patients to say they are not in pain when they are not moving and snugly in bed with the blankets tightly wrapped around them in an 80-degree room. The moment a therapist comes in and assists/instructs the patient with bed mobility or LE exercises is when the pain will begin. To be fair, most veteran nurses will accommodate their schedule of "passing pills" to ensure therapy patients are properly medicated, because they know orthopedic patients will require something to decrease their pain level during therapy.

It is the new nurses we end up having to educate the most. Hopefully they have been through a good orientation and realize that therapy is the most important aspect of a SNF, so therapists always come first when a request is made. (I am joking, people). However, since therapy makes the facility money through reimbursement of our skilled services, our requests for pain medication should not be curtailed or delayed because it could cost the facility in lost revenue.

Other aspects of training nursing staff include ensuring patients have footwear available (socks, shoes, non-skid socks etc.), cups at their sink, towels, briefs and wipes (if appropriate), as well as enough blankets. Often I am delayed in my schedule and skilled treatment of patients because I end up walking to the other end of the facility to the laundry room looking for clothes and socks for the patient. All of this is non-billable time for patient care and if I do this with three patients, the time adds up -- especially if the laundry room is locked and I have to look for someone to unlock the door.

Fifteen minutes times three equals 45 minutes in lost patient care time that could be used as a treatment of another person to reach a higher RUG category, which will equal more revenue for the facility. A domino effect can easily take place, but as therapists we can stop it before it begins by educating the nursing staff about what we want and especially why we need it. And if the bottom line is involved, everyone understands the color green.


Another comment on this scenario; the PT goals/treatments often include or should include pain management.  Pain meds alone rarely do the trick for some of our more complicated patients, ...adjunct with PT tx is the way to go.  There is also an opportunity with this teachable moment with nursing, to discuss PT and OT's role in pain management.  

Lisa July 6, 2012 1:35 AM

Mr New Nurse at least gave you the open door to educate him about why assessing for pain whilst snug in bed isn't really very effective.

We are so dependent upon support workers and aides taking care of the needs of patients. If you are performing the work of a CNA, that is a very high hourly rate to be paying for you to perform that task! Rather inefficient. Sometimes we do what we must to get the work done, but if this is a pattern, then there is a flaw in the system.

Has anyone tried educating the nurse managers/supervisors so that they can then cascade the information to newer staff?

Dean Metz July 4, 2012 12:08 PM

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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