suggestions for my meeting

[lllliv]

hello. i have been working rehab at the same place for many years. i've seen the unit go from good to crappy. part of it is because our staffing has been cut but part of it is because the therapy departments stink.imho.

the occupational therapy dept. in particular refuse to do any adls with the patients. they used to work with many patients in the morning for showers, dressing, etc... but now they claim they have paperwork during that time. then everyone complains that nursing doesn't have the patient ready for therapy. they want them in the chair and they push them to their dept and give them some type of game or exercise to do.

i have usually 6-7 patients to do everything for(no cna). we(the nurses) are the wound team, iv team, resp therpist, phlebotomist, transporters(off the unit for xrays), ekg techs, and you name it.(showers, toileting, feeding)

im so frustrated. the therapies won't even help the pt. to bed when asked. they tell them to call the nurse (let alone to the toilet). they refuse to touch diapers or ted hose. i know it is not this way in other rehabs. i have worked others and i know ours used to be different.

in the morning they stand around watching all the goings on. sometimes if they feel like it they help the kitchen staff to serve trays to those that made it to the dining room. the majority eat in bed cause there is no time to get them up.

they start work at 0630 and don't see a pt til 0830. then they have an hour lunch(supposed to be 30 min and two 15 min breaks but they rolled it into one break) cause they complained they couldn't get their breaks. i still see them getting breakfast and outside smoking.

we are having a meeting concerning these issues this week. any ideas on how to address these issues in the best way. many of our newer staff think if a therapist does something like get a patient a juice that they are "helping the nurses." how can i get them to realize it is all supposed to be about what's best for the patient?? they are not helping the nurse but doing their job and helping the patient.

the therapists encourage the pts to complain about nursing care. even interview them about what went on with their nurse that morning or the night before looking for something to report.. patients have told me this.

i know it's a toxic environment and most all of us nurses hate it there anymore but we all still love working together and would like to stay. any suggestions for my meeting???????

[meownsmile, BSN, RN]

Frankly, i think the OT need to go back and learn what OT is. While it isnt their job to be getting people up, feeding, bathing etc., it is their job to teach the patient how to help make these tasks easier for the patient to do, or help with. They should at least be in there with the patient when they are getting their bath, eating, etc to encourage and help evaluate whether there is another way someone can do something to help themselves. Then practice the task with the patient. Sounds like you have a uphill battle. Good luck.

[kurtzmobile]

Hi there,

I would like to add some advise on how to handle this situation which sounds to be very frustrating. First of all, I am a true believer that the ethical standards in any profession tend to directly reflect upon management. Not in all circumstances, but many for that matter. I think that the source of the issue should be directly addressed. What went wrong? When did the downward negative spiral start? And who needs to be addressed directly. Whenever you're encountering a sensitive topic which involves any number of people and their general code of practice regarding teamwork and pt care, it has to be approached in a non-threatening manner. Otherwise you're going to meet resistence.

I think that it would be helpful to have a list of issues you'd like to be addressed, a list of how to implement positive change, optimal outcomes, and how it can be made a group effort (b/w nurses and OTs). That way they (OTs) can have the chance to have a voice in it and not feel as if they are being "ganged-up-on" as many people tend to become defensive when approached regarding these standard of care or lack of issues. Hope this helps!! Any questions, I'd be glad to answer. Let me know how everything turns out. Good Luck!!

[lllliv]

thanks for the replies. i have made a list and will try to focus on what is best for the patient as opposed to who should do what job.

i'm afraid there is already too much bad blood for anything to be worked out easily.