I don't want to offend anyone by asking this question, but it has been on my mind for sometime, so don't flame me please!
I find that when certain physical therapists or assistants come into a patients room they tend to be very...picky. They make comments like, "His pad has a stain, that needs to be changed", "I think his IV is leaking", or "Her foley needs to be emptied". Just little nit-picky things. Do they really think that we don't have the patients best interest in mind? And it is only with the PT/OT people. Respiratory doesn't do it, other nurses don't do it.
It just seems to me like there is a "How to annoy nurses 101" class in PT school!
Well just from this brief thread we've seen the varying role of the PT dept. I've had personal and professional encounters with them. So understand that I work in an ICU. The role of the PT dept. is determined by hemodynamic paramaters and our goals are short... dangle for 20 minutes... walk to the chair. Because I only have two or three patients... while the PT person is wonderfully getting my patient to the chair and MY back isn't breaking I take that opportunity to change linens (it's so much easier with an empty bed) and my back its resting. My brief stint on day shift had our PT dept. walking patients to a commode or the toilet to teach them how to navigate. So I've never experienced a "no my job" reply... it was part of the plan of care and we celebrated the advancement of activity.
My only beef with PT at work is with that "fragile" patient the complains up a storm and does not want to do for themselves and PT will allow it, when encouragement is needed. I simply put my foot down with the patient and PT and say ... "you will walk to that chair and sit for half hour if you want to get home any time soon, so start walking, now go on while I change your bed... (said nicely with a smile)"
last, my daughter spent over a month in inpatient rehab after an injury. So briefly, they adapted to her severe headaches and not wanting to do anything and got my daughter with 5 hip fractures and two thoracic fractures and an ankle fracture up and walking normally in 5 weeks and they rode her hard, she still loves them and she recovered 6 weeks sooner than expected because of their dedication and hard work. And she was one pain in the patootie the entire time, refusing to go, and they always found SOME way to get her to work.
So I've not experienced it personally or at work. I'm thinking you may have some over zealous newbies that have way too much get go and want to branch out with their knowledge. It seems way over the boundaries of your relationship with the PT dept. and it's an ongoing issue.
I strongly suggest you get management involved, hold a meeting with the manager and discuss how you can address it. Then ask to be allowed to have a meeting with the PT dept (like three nurses, three PT staff). Plan an agenda... like three bullet points each of how you can work better together to achieve patient goals and identify three behaviors that negatively impact those. Next meeting work on resolutions to those... have yes another meeting to follow up and ensure that positive change is occurring and change the plan if there are those stubborn people. By this point, those that are impeding care and interfering with yours will be pointed out in private and everyone works together to form a plan of change.
The last thing you want is a person that you described to mentor and train newbies into thinking this is acceptable. It needs to be stopped quick. Get a team together. That way you are not one against one.. you're all working together and you have your strength in numbers.
I wouldn't have that either, but please re-read and remember how great the PT department CAN be, with the right peeps. Smooch...a bit of work, but with good management it can be stopped quickly.
I wasn't so much commenting on just the personalities of the PT's, GreyGull. I have worked in several different facilities, and what I have noticed goes for all the facilities. There are some GREAT PT/OT personel who are very helpful, and share their knowledge with the nurses humbly. I have just noticed that a majority of them come in and start acting like they now run the show, and they need to tell the other staff what to do. I have really not seen this in other professions, which is why I brought it up at all.
share their knowledge with the nurses humbly. I have just noticed that a majority of them come in and start acting like they now run the show, and they need to tell the other staff what to do. I have really not seen this in other professions, which is why I brought it up at all.
My suggestion for both you and Zookeeper is to have your facility establish multidisciplinary rounds or at least a multidisciplinary care plan for high needs patients. Rather than trying to nitpick each other or try to make another profession humble itself to nursing. These sessions should be about the patient rather than egos. If a PT has a suggestion about medications, which is within their scope for concern when it comes to the patient's therapy, maybe it should be considered or at least discussed. Or, if communication is perceived as difficult, the PT could just bypass the RN and go straight to the physician. In many hospitals is actually just a courtesy to include you in the discussion but not a requirement. They would also be considered neglective of their duties if the PTs did not evaluate and address all aspects of the patient's care including medications. Again you have to separate personality traits and the profession. People who are coming across as rude or bossy may not be outside of their scope for making medication recommendations but rather need to work on the delivery of their message.
they need to tell the other staff what to do.
This comment always makes me chuckle. Not a day goes by when I don't hear an RN telling lab, radiology, RT, PT, SLP, dietary, environmental services, engineering or some other department how to do their job STAT. I just heard one RN call for a STAT swallow study from Speech Therapy which truly does not need to be done within the next 5 minutes. When the SLP said he would be there after he finished two other patient evals which he promised other RNs, the patients and the physicians, the RN said a few unprofessionals comments and slammed the phone. The SLP will probably not do anything about that out burst but accept it as just another day of dealing with some difficult personalities in nursing.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
our pts will help you pull up the patient in bed, get them to a chair, etc. the only issue i have with them is that when they're here, they want the patient right now -- nevermind that you're in the middle of a bath or changing iv lines or whatever.
the rts, however . . . one particular respiratory therapist had a propensity for writing orders for lab draws (electrolytes, heme panels, etc., not just abgs which would be in their purview). he wrote a verbal order for a transfusion and lasix 20 mg. iv. when asked, the doctor said "i talked to him about it, but i didn't know you could give verbal orders to an rt." you can't. he didn't. the rt (i'll call him bob not because that was actually his name) was attempting to re-time my balloon pump when i walked into the room one time. i hit the ceiling! among other things, i told him that if he wanted to write orders, play with balloon pumps and nitpick my job he ought to go to pa school and learn how to do it right. interestingly enough, he did. that was 20-some years ago, and in a different part of the country than i'm in now. bob died a few years ago. wish i could get our current "dr. respiratory therapist" to back off the suggestions about lab draws, meds and transfusions!
our pts will help you pull up the patient in bed, get them to a chair, etc. the only issue i have with them is that when they're here, they want the patient right now -- nevermind that you're in the middle of a bath or changing iv lines or whatever.
that can be easily remedied if nursing and pt communicate for a schedule. pt is required to spend x amount of time with each patient and just like any other appointment schedule, they are expected to stay on time so it does not inconvience others who have asked to coordinate the times.
the rts, however . . . one particular respiratory therapist had a propensity for writing orders for lab draws (electrolytes, heme panels, etc., not just abgs which would be in their purview). he wrote a verbal order for a transfusion and lasix 20 mg. iv. when asked, the doctor said "i talked to him about it, but i didn't know you could give verbal orders to an rt." you can't. he didn't. the rt (i'll call him bob not because that was actually his name) was attempting to re-time my balloon pump when i walked into the room one time. i hit the ceiling! among other things, i told him that if he wanted to write orders, play with balloon pumps and nitpick my job he ought to go to pa school and learn how to do it right. interestingly enough, he did. that was 20-some years ago, and in a different part of the country than i'm in now. bob died a few years ago. wish i could get our current "dr. respiratory therapist" to back off the suggestions about lab draws, meds and transfusions!
what's wrong with suggestions? don't you regularly engage in patient care discussions with members of other disciplines? there are many things concerning labs, meds and transfusions that affect the cardiopulmonary systems which the rrt must know about or be allowed to offer input on.
our rts take both verbal and telephone orders. they runs the lytes on their abg machines and at times have had to take orders for them. the iabps are also part of rt. they insert and maintain the a-lines. lab draws are also coordinated between rts and rns so the line is not entered as often. if he came from a hospital similar to the one i am at now, he probably is having a difficult time adjusting to what sounds like a very backward or nonprogressive rt department. here, the rt medical director (also the critical care medicine director) would never allow an rrt inside the unit who could not contribute in a discussion about patient care or one who did not look at lab values and meds daily before initiating their own set of protocols. however, it sounds like some are still expected to function just at a "tech" level and only set up equipment without asking why or what is going on with their patient. that does not sound too safe considering the technology and meds available today.
I have rarely if ever had any issues with PT. Love them.
With any profession there's always someone who wants to have an extra special relationship with the doc, and impress them with how smart they are. (Not just PTs or RTs, it even affects RNs) This comes across are exasperating to anyone who is actually buzzing around getting work done instead of using the patient as a science project. Asking questions to increase your knowledge level is great. If you want to change any part of the therapy except what is in your specialty knowledge it is only polite to discuss it with the team. So a med change may well be a good idea, but please run it by the doc AND the nurse (the nurse is always there). I might have some input, or I might want to ask you some questions to understand what you are seeing. If a team member is available and you make changes without mentioning, it's just a little offputting.
Anyone who asks me to empty a Foley, or change a bed will probably get compliance the first time, and also teaching on where the equipment is. Just so they don't have to wait for me the next time they come. Of course, if a dressing is saturated, or a Foley is bursting it's my bad, and they get an apology. But if they are nitpicking they are welcome to fix the problem themselves, and back off a bit next time. If we work together long enough they will know my usual standards...and our relationship generally improves the longer we work together.
Zookeeper3
1,361 Posts
Well just from this brief thread we've seen the varying role of the PT dept. I've had personal and professional encounters with them. So understand that I work in an ICU. The role of the PT dept. is determined by hemodynamic paramaters and our goals are short... dangle for 20 minutes... walk to the chair. Because I only have two or three patients... while the PT person is wonderfully getting my patient to the chair and MY back isn't breaking I take that opportunity to change linens (it's so much easier with an empty bed) and my back its resting. My brief stint on day shift had our PT dept. walking patients to a commode or the toilet to teach them how to navigate. So I've never experienced a "no my job" reply... it was part of the plan of care and we celebrated the advancement of activity.
My only beef with PT at work is with that "fragile" patient the complains up a storm and does not want to do for themselves and PT will allow it, when encouragement is needed. I simply put my foot down with the patient and PT and say ... "you will walk to that chair and sit for half hour if you want to get home any time soon, so start walking, now go on while I change your bed... (said nicely with a smile)"
last, my daughter spent over a month in inpatient rehab after an injury. So briefly, they adapted to her severe headaches and not wanting to do anything and got my daughter with 5 hip fractures and two thoracic fractures and an ankle fracture up and walking normally in 5 weeks and they rode her hard, she still loves them and she recovered 6 weeks sooner than expected because of their dedication and hard work. And she was one pain in the patootie the entire time, refusing to go, and they always found SOME way to get her to work.
So I've not experienced it personally or at work. I'm thinking you may have some over zealous newbies that have way too much get go and want to branch out with their knowledge. It seems way over the boundaries of your relationship with the PT dept. and it's an ongoing issue.
I strongly suggest you get management involved, hold a meeting with the manager and discuss how you can address it. Then ask to be allowed to have a meeting with the PT dept (like three nurses, three PT staff). Plan an agenda... like three bullet points each of how you can work better together to achieve patient goals and identify three behaviors that negatively impact those. Next meeting work on resolutions to those... have yes another meeting to follow up and ensure that positive change is occurring and change the plan if there are those stubborn people. By this point, those that are impeding care and interfering with yours will be pointed out in private and everyone works together to form a plan of change.
The last thing you want is a person that you described to mentor and train newbies into thinking this is acceptable. It needs to be stopped quick. Get a team together. That way you are not one against one.. you're all working together and you have your strength in numbers.
I wouldn't have that either, but please re-read and remember how great the PT department CAN be, with the right peeps. Smooch...a bit of work, but with good management it can be stopped quickly.