I have neglected this blog for the last few months due to an increasingly hectic schedule filled with studying for my specialist exam, preparing a presentation for Combined Sections Meeting of the APTA, and working long hours at my last assignment. I am now two weeks into my second travel assignment, and with my exam and presentation complete, I am enjoying a bit more spare time for adventuring and catching up on all the things I’ve put on the back burner.
I finished up my Louisiana assignment near the end of March, and after a few days of vacation spent seeing the sites in New Orleans, we packed up and moved to Oklahoma.
When I decided to become a traveling therapist the main draw for me was the traveling. I like exploring new places, and getting to spend a few months living in an area is a much better way to really see that sights and get a taste of the local culture than just being a tourist for a week. One of the other reasons I was excited to travel was getting to experience being a PT in many different parts of the country, and more specifically how PTs operate and fit into the interdisciplinary team in the hospital setting (I am trying to stay in acute care and inpatient rehab for the moment).
Between my clinical affiliations as a student, my residency, and my two travel assignments thus far, I have worked in four different hospitals. Looking at my work as a licensed PT and independent member of the interdisciplinary team (my residency and two travel assignments), I am starting to notice the interactions between the PT staff and the rest of the team, and how they influence my work.
I believe that the best care is delivered by an integrated interdisciplinary team who are in frequent and ongoing communication, and who have good working relationships with each other. Some facilities do this better than others, and sometimes it is variable even within a single facility. For me as a PT, I want support from and cooperation with the nursing staff, a direct line of communication with the case managers/discharge planners and also the physicians. As cardiopulmonary PT, I also want good communication with the respiratory therapy staff. And then of course the rest of the rehab team: OT and Speech.
In school, we learned that we should always check with the nurse before treating a patient, and that we should update the nurse after our session about how the patient did. In most hospitals, the nurse is like the gatekeeper for the patient: they know everything that is going on with the patient, and are in the best position to tell you if the patient is appropriate for therapy right at that time. Unfortunately, not all PTs check with the nurse every time, and as a result that culture of communication is not cultivated. One of the biggest impacts that this has for me coming in as a traveler is whether I am having to dig for information versus having the nurse provide information up front, and the reception I get when providing information about the PT session afterwards. I find it challenging when I ask if it is okay for me to work with a patient and I am treated like my asking is an annoyance, and am given no information about the patient’s status. What I love is when I ask if I can see the patient and the nurse gives me a clear yes or no, followed by a summary of how the patient is doing, such as: “yes of course you can work with her, she got her pain meds 45 minutes ago, she’s in bed now but has already been up to the chair earlier. Let me know if you need anything, I’ll be coming in to do her breathing treatment soon.”
From my side, I always like to know if the patient has been out of bed yet, how they are moving with nursing, and if they are okay to leave up in a chair. This gives me an idea what to expect when I walk into the room, and it also allows me to be in a position to assist the nursing staff (who are often being pulled in many directions at once!). If the patient needs to be in the bed to start an IV, or be transported for a test, then I will know that and be able to leave the patient back in bed. Sometimes I might be asked to call when I’m about to stand the patient so that the nurse can look for skin breakdown, or the nurses aid can bring in the scale for a standing weight. If I get the patient up to a chair, then the aide can come an change the bed sheets, which is much easier to do when the patient is not still lying in the bed.
A good relationship with the nurses aides can also make a huge difference to me as the PT. My job is much more difficult if the nursing aides are unwilling to assist me or act like my requests are unreasonable. Having good communication and a good relationship with them makes my job as a PT much easier. I can call them to be an extra set of hands if I am by myself and need help to get the patient up or back to bed. If my patients needs to use the commode (a fairly frequent occurrence) and I need to keep both hands on them, I can call the aide to come an help me, which also makes less work for them because they now don’t have to deal with a bedpan.
When there is good communication with the nursing staff both before an after the PT session, it can make all of our jobs easier.
This post is getting quite long, so I think I will stop here and return later for the rest of my thoughts on a team approach to patient care in the hospital.