So far, in this interdisciplinary communication series, we’ve looked at the interaction of physical therapists with:
Respiratory Therapists– by Musi Nde
Athletic Trainers– Sarah Parker and Keller Galpin
This week, we’ll look at the interaction between physical therapists and registered nurses.
I’m 95% sure I’m going to marry a nurse so I’m hoping this post will help me avoid ticking a bunch of them off over the next few years.
Throughout my acute care rotation, I learned the importance, and difficulty, associated with communicating with nurses. Overall, I absolutely loved the communication between different disciplines, both through documentation and conversation. But there were many instances where I felt like a lack of communication was very evident.
Some, maybe even many, healthcare providers in the hospital don’t have even the slightest concept of teamwork. I’m hoping this post, by my good friend Ashleigh Steinmeyer, can play a small part in helping improve interdisciplinary communication specifically between physical therapists and registered nurses.
Ashleigh Steinmeyer, NP-C
Ashleigh has been a registered nurse (RN) for 7 years now. She graduated from the Medical College of Georgia in 2009 with her Bachelor’s in nursing. She she went on to graduate with her Master’s in 2013 to become a nurse practitioner. She also worked as an aide/tech during nursing school so she has a firm grasp of nursing from a variety of angles.
I remember texting her when I was in my last year of PT school about how I could work more effectively with nurses. I asked several other nurse friends this same question and, overall, their answers were lame and not very well thought out.
She sent me this very long text about a lot of things I didn’t even consider. That was long before I intended on starting a blog. But based on that conversation, I knew she would be the perfect person to ask for this job.
Even though Ashleigh functions as a nurse practitioner now, this post will be primarily focused on her interaction with physicals therapists as a RN.
What is the educational background, licensure/certification, test to become a nurse? What is the difference between RN and LPN?
RNs go through at least a four year program to obtain a bachelor degree in nursing, some have master degrees as well. After you complete your program of study in order to be licensed with the state and eligible to work you must pass a board exam (NCLEX). LPNs complete about a 2 year program and also must pass a board exam. They essentially do the same job as a RN, but do not paid as much and some places give restrictions as to medications a LPN can administer and procedures that can be performed (ex. Some places do not allow LPNs to hang blood).
What settings do nurses commonly work in?
You can find nurses all over the place- hospitals are probably the largest employer- inpatient floors/ICUs, you can also find them in outpatient clinics, in schools as the school nurse, and some large companies employ them for their occupational health centers. They can also work in home health settings or phone triage centers like “Ask-A-Nurse” lines.
What does your typical day look like? What are some of your job duties?
From an inpatient RN perspective, days can be long and hectic. Shifts usually are 12 hours scheduled but often end up lasting an hour or two longer. When you first clock in for your shift you receive your patient assignment from the charge nurse and receive report from the nurse you are relieving. Then you go around and introduce yourself and start the paperwork. Nursing physical assessments must be done on each patient (most nurses will have a patient load of 4-6 patients each), as well as skin integrity assessments, fall risk assessments, neuro assessments (these will all vary depending on the specialty). The amount of paperwork is insane (you will hear us complain about it often). Medications must also be pulled from pharmacy system and given. It is not uncommon to have to bathe, change, and feed at least a couple of your patients, as the nursing assistants are often overwhelmed and short staffed. It is not a very glamorous profession, it is certainly one of servitude to others (if you have a true nurse’s heart and are doing a good job). There are many days where lunch break is late in the afternoon or you don’t have time to take one at all.
What kind of interaction do you have with physical therapists?
Inpatient RNs probably have the most day to day interaction with PT, when I worked on an adult neuro floor nearly all patients had a least a PT consult, most had daily therapy with PT/OT and speech.
In what ways could PTs help to make your job easier? Or how could PTs and nurses work together more effectively to improve patient care?
It is always nice to know when PT is coming to work with a patient that is otherwise bedridden or requires a lot of assistance to get out of bed, so if the therapist could just drop by and say “I’ll be working with so-n-so this afternoon” it makes a huge impact on the workload. It is way easier to change bed linens when the therapist is walking a patient down the hall or teaching them to use their wheelchair than it is to have to change them while they are in the bed 🙂 If we know they will be getting up later in the day with PT we can plan accordingly to have their bed clean and ready. We also always appreciate help getting patients into and out of chairs, into the shower, ect so if you can ever incorporate those activities into part of a PT session just let us know so we can be on board. We don’t expect you to give the bath, but our backs thank you greatly for helping us get our patients up!
Was there ever a time where a PT did something to tick you off or interfere with your treatment session?
Thankfully, I worked with an awesome team of therapist who were always helpful! But let’s just say you are not in the helping kind of mood on any particular day…in order to avoid ticking of your nurses…. DON’T leave the confused patient in the chair, unrestrained, and not tell anyone….the paperwork involved after a fall sucks and if you are unsure of how we feel about paperwork refer to question #3… DON’T come find us and tell us the patient needs to be changed and then stand there and watch us struggle to do it. Helping roll, pull the clean linens under, ect are a huge help- you don’t have to wipe the butt, just lend a hand with the roll….DON’T leave patients all discombobulated in the bed, all slid down with pillows all over the place and sheets a hot mess…please try to leave them better than you found them and certainly not worse.
Finally, if there was some sort of information that you wish the general public and PTs knew more about nursing that you would like to share?
Especially with financial strain and reimbursement for services low, staffing ratios for patients and nurses are often pretty bad. It is already a hard job and to have to do it short staffed makes it very frustrating and all the more difficult. Just like any profession there are some people that have the heart to do it and there are some people that don’t. The ones that don’t need to leave the profession, but unfortunately, bad working situations have some good nurses coming to work with a bad attitude. They dread going to work because they feel like they don’t have the support to do their job. While the ultimate fix for this must come from administration above, a smiling face and initiating the “hello” can really turn the day around, so don’t be scared to talk to your nurses. If some do not return your politeness, it’s not you, it’s probably a personal problem, but overall I think you will find you can develop a great working relationship with them and together can improve patient outcomes and safety.
Image Credit: Live Clinic