OT vs NURSE

[SneakySnake]

An OT at my facility told me today that I could NOT assess my patient because they were resting. Now anyone who knows me would describe me as pretty laid back and hard to anger but this OT really ticked me off:devil:

I held it together and didn't snap her head off like I wanted to I replied (still sweat at this point) "I think I can disturb her for just a moment to be sure she is still breathing and her heart is still beating:)". I then got my things together and headed down the hall to do my assessment. She turned followed me and said "well I guess you can go in because you are not doing anything invasive".

EXCUSE ME!!! Since when can an OT tell me when I am able to enter my patients room? Last time I checked it wasn't up to therapy to give me permission to take care of my patients.

I decided to handle this privately with her and asked her into an empty room to speak. I am sure she could tell I was upset but I was able to keep my voice at a normal tone and my body language was relaxed. I said "I really appreciate our working relationship and I appreciate the way we have been able to collaborate in the past. I know you are having a rough day (she had told me this earlier) but you can not speak to me that way. You can not tell me not to assess my patient. I get to decide when and how to care for my patient even if there is an "invasive" procedure....you don't".

I was really proud of myself for staying calm and for standing up for myself.

She became belligerent and began waving her arms wildly claiming she never said such a thing (uh....yea you did, I have witnesses) and that she has a right to voice her opinion on a patients care. At that point I realized the conversation was not going to work out like I had planned. I told her I had said what I needed to say and that I was leaving. I told her she could come talk to me if she felt she needed to when she had calmed down.

She continued to try and escalate the situation.

I was absolutely floored by her behavior.

[midlife101]

Newbie here.

What's an "OT"?

Thanks

[Sparrowhawk]

Newbie here.

What's an "OT"?

Thanks

Occupational therapist

[JenniferSews]

Oy. I LOVE the PT and OT that I work with, but have on occasion had incidents where a certain individual felt they could dictate the care a patient was receiving over nursing and the Md. In the incident you mention, I would speak both the the director of nursing and the director of therapy. In my field, OT and PT are extremely important. Their skill and services are an integral part of patient care. However a therapist cannot limit a nursing assessment or nursing care without a DRs order. On the other hand if you come to me and say that a particular patient is extremely worn out after therapy and can you please wait until later to assess them, I'm happy to oblige when possible.

[ThePrincessBride, MSN, RN, NP]

How unprofessional. I would have talked to HER boss about her unprofessional behavior. There is already so much drama in the healthcare industry and among nurses...we don't need overly dramatic OTs added to the mix as well

[nerdtonurse?, BSN, RN]

Okay, watched too many murder mysteries this weekend, so first thing I thought was, 'what did she do to the patient that she didn't want you to see?'

[SneakySnake]

I haven't decided if I will take it to the DON or her boss yet but I did have the three people who saw what happened write down what they saw and sign it for me.

The thing is this patient just had a CVA and she is drowsy all the time. I know she needs her rest. I know she is worn out after therapy. I also know her family left her with a snack in her room that she ate unsupervised and that they have been giving her regular liquids not nectar thick. She needed a through respiratory assessment.

When I got there she wasn't asleep. I had my assessment done quickly and quietly and was able to treat the pain she was experiencing after therapy.

The OT reported to me that she told the family to stop visiting because they were keeping the resident up too much. I wonder if the administrator will hear from the family?

[netglow, ASN, RN]

Wow. I'd nip that one.

[liz0105]

Stick to your guns. You did the right thing. From a liability perspective, it was necessary that you had to perform that assessment. What would have happened in a worst-case scenario? You would have been the one to answer for it. You did your job with the patient's safety and well-being in mind. Kudos to you!

[GreyGull]

Not taking sides but I take it this to be a rehab facility.

There seems to be a lack of goals developed with a multidisciplinary approach and team communication meetings which also fosters mutual respect.

It should be determined how much stimulation the patient requires and downtown will have to be respected by all disciplines except in a valid assessment need. This including all PT/OT/SLP, Respiratory Therapy and Nursing. Rounds and care meetings should include all to get whatever conflicts out into the open so the patient's schedule can be adjusted. Allowances should be made for exceptions and those exceptions should be clearly communicated. Was there an activity and downtime schedule in place? Did the OT know you were concerned about the patient's respiratory status?

Also, part of plan is to include the family as much as possible unless they start to interfere with care. The frontline providers are within their responsiblity for the patient to ask the family to cooperate with the schedule and if disruptions continue to be an issue, it goes up the ladder to enforce whatever might be necessary and hopefully without offending the family or patient. The patient must be considered but with a brain injury, the patient may also not be able to process why his or her family is no longer there and will feel it is their fault. Depending on the injury, some patients require minimal stimulation. This definitely includes some TBI patients during rehab who may spend several days to weeks in a darkened quiet room with only one or two professionals in at one time just long enough to get some exercise, assessment or treatment done. Make any noise even accidentally and expect someone to jump all over you later with a stern reminder. When working rehab I've just accepted this but also make sure I attend any care plan meeting I can and most good units will see the RN or their representative is there to express concerns and keep the lines of communication open. This usually prevents situations such as this where now you have to get "your side" of people for an us against them issue which eventually will hinder patient care with hurt feelings everywhere or some feeling like they are walking on egg shells around others.

[MN-Nurse, ASN, RN]

I spent over a year as a therapy tech and work very well with therapists of all disciplines. I enjoy talking to the therapists about their sessions and always, always, always read their progress notes.

I have never seen an OT, PT, or ST give an RN orders or direction like you describe. If one ever did, I would honestly just ignore them.

[SneakySnake]

Everywhere I have worked I really enjoyed the therapy staff. I wasn't just being nice when I told her how much I appreciated our professional relationship how I had enjoyed collaborating with her. I like knowing what therapy is doing. I have family who are OT's and often talk with them for ideas and insight.

I would have had no problem with her "voicing her opinion on patient care" but that is not what she was doing. It really was bizarre.

Looking back I really probably should have just ignored her. There is such a fine line between letting stuff go and becoming a door mat. I tend to be the door mat type.

Even though our conversation did not have a positive outcome I am glad I calmly and professionally stood up for myself. I am glad that even though I felt like blowing a gasket I kept it together until I could duck into another room to blow off steam.

A nurse on duty today called me to let me know that one of the witnesses called the administrator and told them what happened. So, we will see what happens.