Re: Some help please- Nursing vs. PT!

[Guest guest]

, it is your clinical decision, not nursing. Your evaluation of

the patient determines skilled therapy intervention, no one should do

that for you.

Ron Barbato PT

Administrative Director, Rehabilitation Services

Program Director, Cancer Support Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

that is privileged subject to attorney-client privilege or attorney work

product, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it

and be aware that any disclosure, copying, distribution, or use of the

information contained herein (including any reliance thereon) is

STRICTLY PROHIBITED. If you received this transmission in error, please

immediately advise me, by reply e-mail, and delete this message and any

attachments without retaining a copy in any form. Thank you.

Some help please- Nursing vs. PT!

Recently, there has been a conflict at my place of work in regards to PT

roles and Nursing. I was asked to give a patient a bath in the Rehab

Department whirlpool for dry skin. I have always been told that, if it

is something that Nursing can take care of (transferring a patient to a

chair, giving baths, etc...), that PTs should not get involved and

charge PT units for such services.

What is this group's take on this? Does dry skin fall under the category

of " skin integrity impairment " to the point that PT should get involved?

Or should this strictly be Nursing's role?

Thank you for your advice!

------------------------------------

In ALL messages to PTManager you must identify yourself, your discipline

and your location or else your message will not be approved to send to

the full group.

Physician Self Referal/Referral for Profit {POPTS} is a serious threat

to our professions. PTManager is not available to support POPTS-model

practices. The description of PTManager group includes the following:

" PTManager believes in and supports Therapist-owned Therapy Practices

ONLY "

Messages relating to " how to set up a POPTS " will not be approved

PTManager encourages participation in your professional association.

Join APTA, AOTA or ASHA and participate now!

Follow Kovacek, PT on Facebook or Twitter.

PTManager blog: http://ptmanager.posterous.com/

[Guest guest]

, it is your clinical decision, not nursing. Your evaluation of

the patient determines skilled therapy intervention, no one should do

that for you.

Ron Barbato PT

Administrative Director, Rehabilitation Services

Program Director, Cancer Support Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

that is privileged subject to attorney-client privilege or attorney work

product, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it

and be aware that any disclosure, copying, distribution, or use of the

information contained herein (including any reliance thereon) is

STRICTLY PROHIBITED. If you received this transmission in error, please

immediately advise me, by reply e-mail, and delete this message and any

attachments without retaining a copy in any form. Thank you.

Some help please- Nursing vs. PT!

Recently, there has been a conflict at my place of work in regards to PT

roles and Nursing. I was asked to give a patient a bath in the Rehab

Department whirlpool for dry skin. I have always been told that, if it

is something that Nursing can take care of (transferring a patient to a

chair, giving baths, etc...), that PTs should not get involved and

charge PT units for such services.

What is this group's take on this? Does dry skin fall under the category

of " skin integrity impairment " to the point that PT should get involved?

Or should this strictly be Nursing's role?

Thank you for your advice!

------------------------------------

In ALL messages to PTManager you must identify yourself, your discipline

and your location or else your message will not be approved to send to

the full group.

Physician Self Referal/Referral for Profit {POPTS} is a serious threat

to our professions. PTManager is not available to support POPTS-model

practices. The description of PTManager group includes the following:

" PTManager believes in and supports Therapist-owned Therapy Practices

ONLY "

Messages relating to " how to set up a POPTS " will not be approved

PTManager encourages participation in your professional association.

Join APTA, AOTA or ASHA and participate now!

Follow Kovacek, PT on Facebook or Twitter.

PTManager blog: http://ptmanager.posterous.com/

[Guest guest]

, it is your clinical decision, not nursing. Your evaluation of

the patient determines skilled therapy intervention, no one should do

that for you.

Ron Barbato PT

Administrative Director, Rehabilitation Services

Program Director, Cancer Support Services

Ephraim McDowell Health

Voice:

Fax:

rbarbato@...

PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

that is privileged subject to attorney-client privilege or attorney work

product, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it

and be aware that any disclosure, copying, distribution, or use of the

information contained herein (including any reliance thereon) is

STRICTLY PROHIBITED. If you received this transmission in error, please

immediately advise me, by reply e-mail, and delete this message and any

attachments without retaining a copy in any form. Thank you.

Some help please- Nursing vs. PT!

Recently, there has been a conflict at my place of work in regards to PT

roles and Nursing. I was asked to give a patient a bath in the Rehab

Department whirlpool for dry skin. I have always been told that, if it

is something that Nursing can take care of (transferring a patient to a

chair, giving baths, etc...), that PTs should not get involved and

charge PT units for such services.

What is this group's take on this? Does dry skin fall under the category

of " skin integrity impairment " to the point that PT should get involved?

Or should this strictly be Nursing's role?

Thank you for your advice!

------------------------------------

In ALL messages to PTManager you must identify yourself, your discipline

and your location or else your message will not be approved to send to

the full group.

Physician Self Referal/Referral for Profit {POPTS} is a serious threat

to our professions. PTManager is not available to support POPTS-model

practices. The description of PTManager group includes the following:

" PTManager believes in and supports Therapist-owned Therapy Practices

ONLY "

Messages relating to " how to set up a POPTS " will not be approved

PTManager encourages participation in your professional association.

Join APTA, AOTA or ASHA and participate now!

Follow Kovacek, PT on Facebook or Twitter.

PTManager blog: http://ptmanager.posterous.com/

[Guest guest]

Thank you, Ron. However, it was a physician asking me to do this and my Rehab

Director (an O.T.) telling me that I " had to " . I feel that it was wrong to tell

me that I " had to " do something that was potentially fraudulent. I don't believe

in charging for skilled P.T. services for something that nursing could have

easily done. Is it wrong to feel this way?

~~

>

> , it is your clinical decision, not nursing. Your evaluation of

> the patient determines skilled therapy intervention, no one should do

> that for you.

>

> Ron Barbato PT

> Administrative Director, Rehabilitation Services

> Program Director, Cancer Support Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@...

>

>

>

> PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> that is privileged subject to attorney-client privilege or attorney work

> product, confidential and/or exempt from disclosure under applicable

> law. If you are not the intended recipient, then please do not read it

> and be aware that any disclosure, copying, distribution, or use of the

> information contained herein (including any reliance thereon) is

> STRICTLY PROHIBITED. If you received this transmission in error, please

> immediately advise me, by reply e-mail, and delete this message and any

> attachments without retaining a copy in any form. Thank you.

>

>

> Some help please- Nursing vs. PT!

>

> Recently, there has been a conflict at my place of work in regards to PT

> roles and Nursing. I was asked to give a patient a bath in the Rehab

> Department whirlpool for dry skin. I have always been told that, if it

> is something that Nursing can take care of (transferring a patient to a

> chair, giving baths, etc...), that PTs should not get involved and

> charge PT units for such services.

>

> What is this group's take on this? Does dry skin fall under the category

> of " skin integrity impairment " to the point that PT should get involved?

> Or should this strictly be Nursing's role?

>

> Thank you for your advice!

>

>

>

>

>

> ------------------------------------

>

> In ALL messages to PTManager you must identify yourself, your discipline

> and your location or else your message will not be approved to send to

> the full group.

>

> Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> to our professions. PTManager is not available to support POPTS-model

> practices. The description of PTManager group includes the following:

> " PTManager believes in and supports Therapist-owned Therapy Practices

> ONLY "

> Messages relating to " how to set up a POPTS " will not be approved

>

> PTManager encourages participation in your professional association.

> Join APTA, AOTA or ASHA and participate now!

>

> Follow Kovacek, PT on Facebook or Twitter.

> PTManager blog: http://ptmanager.posterous.com/

>

[Guest guest]

Thank you, Ron. However, it was a physician asking me to do this and my Rehab

Director (an O.T.) telling me that I " had to " . I feel that it was wrong to tell

me that I " had to " do something that was potentially fraudulent. I don't believe

in charging for skilled P.T. services for something that nursing could have

easily done. Is it wrong to feel this way?

~~

>

> , it is your clinical decision, not nursing. Your evaluation of

> the patient determines skilled therapy intervention, no one should do

> that for you.

>

> Ron Barbato PT

> Administrative Director, Rehabilitation Services

> Program Director, Cancer Support Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@...

>

>

>

> PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> that is privileged subject to attorney-client privilege or attorney work

> product, confidential and/or exempt from disclosure under applicable

> law. If you are not the intended recipient, then please do not read it

> and be aware that any disclosure, copying, distribution, or use of the

> information contained herein (including any reliance thereon) is

> STRICTLY PROHIBITED. If you received this transmission in error, please

> immediately advise me, by reply e-mail, and delete this message and any

> attachments without retaining a copy in any form. Thank you.

>

>

> Some help please- Nursing vs. PT!

>

> Recently, there has been a conflict at my place of work in regards to PT

> roles and Nursing. I was asked to give a patient a bath in the Rehab

> Department whirlpool for dry skin. I have always been told that, if it

> is something that Nursing can take care of (transferring a patient to a

> chair, giving baths, etc...), that PTs should not get involved and

> charge PT units for such services.

>

> What is this group's take on this? Does dry skin fall under the category

> of " skin integrity impairment " to the point that PT should get involved?

> Or should this strictly be Nursing's role?

>

> Thank you for your advice!

>

>

>

>

>

> ------------------------------------

>

> In ALL messages to PTManager you must identify yourself, your discipline

> and your location or else your message will not be approved to send to

> the full group.

>

> Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> to our professions. PTManager is not available to support POPTS-model

> practices. The description of PTManager group includes the following:

> " PTManager believes in and supports Therapist-owned Therapy Practices

> ONLY "

> Messages relating to " how to set up a POPTS " will not be approved

>

> PTManager encourages participation in your professional association.

> Join APTA, AOTA or ASHA and participate now!

>

> Follow Kovacek, PT on Facebook or Twitter.

> PTManager blog: http://ptmanager.posterous.com/

>

[Guest guest]

Thank you, Ron. However, it was a physician asking me to do this and my Rehab

Director (an O.T.) telling me that I " had to " . I feel that it was wrong to tell

me that I " had to " do something that was potentially fraudulent. I don't believe

in charging for skilled P.T. services for something that nursing could have

easily done. Is it wrong to feel this way?

~~

>

> , it is your clinical decision, not nursing. Your evaluation of

> the patient determines skilled therapy intervention, no one should do

> that for you.

>

> Ron Barbato PT

> Administrative Director, Rehabilitation Services

> Program Director, Cancer Support Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@...

>

>

>

> PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> that is privileged subject to attorney-client privilege or attorney work

> product, confidential and/or exempt from disclosure under applicable

> law. If you are not the intended recipient, then please do not read it

> and be aware that any disclosure, copying, distribution, or use of the

> information contained herein (including any reliance thereon) is

> STRICTLY PROHIBITED. If you received this transmission in error, please

> immediately advise me, by reply e-mail, and delete this message and any

> attachments without retaining a copy in any form. Thank you.

>

>

> Some help please- Nursing vs. PT!

>

> Recently, there has been a conflict at my place of work in regards to PT

> roles and Nursing. I was asked to give a patient a bath in the Rehab

> Department whirlpool for dry skin. I have always been told that, if it

> is something that Nursing can take care of (transferring a patient to a

> chair, giving baths, etc...), that PTs should not get involved and

> charge PT units for such services.

>

> What is this group's take on this? Does dry skin fall under the category

> of " skin integrity impairment " to the point that PT should get involved?

> Or should this strictly be Nursing's role?

>

> Thank you for your advice!

>

>

>

>

>

> ------------------------------------

>

> In ALL messages to PTManager you must identify yourself, your discipline

> and your location or else your message will not be approved to send to

> the full group.

>

> Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> to our professions. PTManager is not available to support POPTS-model

> practices. The description of PTManager group includes the following:

> " PTManager believes in and supports Therapist-owned Therapy Practices

> ONLY "

> Messages relating to " how to set up a POPTS " will not be approved

>

> PTManager encourages participation in your professional association.

> Join APTA, AOTA or ASHA and participate now!

>

> Follow Kovacek, PT on Facebook or Twitter.

> PTManager blog: http://ptmanager.posterous.com/

>

[Guest guest]

Hi, --

Thank you so much for bringing up the question of, fundamentally, " Who are

physical therapists, and what do they do? " This is addressed in chapter one

of the APTA's Guide ot Physical Therpist Practice. The concept of physical

therapist as an " order taker " is not persent in that reference. However,

the concept of physical therapist as autonomous practitioner is described

there.

Even though many, many, many physicians, administrators, clinicians of other

disciplines, government regulators, insurors, and especially corporate

higher-ups are utterly unaware of the changes of the last thirty years or

so, this is the new reality in the physical therapy profession. Today's PTs

legitimately belong on " the doctor's side of the table " , not on the

technicians'.

In the real world, our work relationships are what we have allowed them to

become, and it may be time to have a professional conversation with the MD.

Today, I re-read Kovacek's old article questioning whether a physical

therapist can function properly as a subordinate employee in any clinical

setting. Apparently, your supervisor is comfortable sending a

$50,000-$70,000 professional to do a task which could be performed by a $10/

hour aide.

Here's a reference to the new APTA Code of Ethics, which may be informative:

Principle #3: Physical therapists shall be accountable for making sound

professional judgments.

3A. Physical therapists shall demonstrate independent and objective

professional judgment in the patient's/client's best interest in all

practice settings.

3B. Physical therapists shall demonstrate professional judgment informed by

professional standards, evidence (including current literature and

established best practice), practitioner experience, and patient/client

values.

3C. Physical therapists shall make judgments within their scope of practice

and level of expertise and shall communicate with, collaborate with, or

refer to peers or other health care professionals when necessary.

3D. Physical therapists shall not engage in conflicts of interest that

interfere with professional judgment.

3E. Physical therapists shall provide appropriate direction of and

communication with physical therapist assistants and support personnel.

I sincerely hope that this will be useful to you and many others.

Dr. Dick Hillyer, PT,DPT,MBA,MSM

_____

From: PTManager [mailto:PTManager ] On Behalf

Of kitiara_99

Sent: Tuesday, February 01, 2011 7:21 PM

To: PTManager

Subject: Re: Some help please- Nursing vs. PT!

Thank you, Ron. However, it was a physician asking me to do this and my

Rehab Director (an O.T.) telling me that I " had to " . I feel that it was

wrong to tell me that I " had to " do something that was potentially

fraudulent. I don't believe in charging for skilled P.T. services for

something that nursing could have easily done. Is it wrong to feel this way?

~~

>

> , it is your clinical decision, not nursing. Your evaluation of

> the patient determines skilled therapy intervention, no one should do

> that for you.

>

> Ron Barbato PT

> Administrative Director, Rehabilitation Services

> Program Director, Cancer Support Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@...

>

>

>

> PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> that is privileged subject to attorney-client privilege or attorney work

> product, confidential and/or exempt from disclosure under applicable

> law. If you are not the intended recipient, then please do not read it

> and be aware that any disclosure, copying, distribution, or use of the

> information contained herein (including any reliance thereon) is

> STRICTLY PROHIBITED. If you received this transmission in error, please

> immediately advise me, by reply e-mail, and delete this message and any

> attachments without retaining a copy in any form. Thank you.

>

>

> Some help please- Nursing vs. PT!

>

> Recently, there has been a conflict at my place of work in regards to PT

> roles and Nursing. I was asked to give a patient a bath in the Rehab

> Department whirlpool for dry skin. I have always been told that, if it

> is something that Nursing can take care of (transferring a patient to a

> chair, giving baths, etc...), that PTs should not get involved and

> charge PT units for such services.

>

> What is this group's take on this? Does dry skin fall under the category

> of " skin integrity impairment " to the point that PT should get involved?

> Or should this strictly be Nursing's role?

>

> Thank you for your advice!

>

>

>

>

>

> ------------------------------------

>

> In ALL messages to PTManager you must identify yourself, your discipline

> and your location or else your message will not be approved to send to

> the full group.

>

> Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> to our professions. PTManager is not available to support POPTS-model

> practices. The description of PTManager group includes the following:

> " PTManager believes in and supports Therapist-owned Therapy Practices

> ONLY "

> Messages relating to " how to set up a POPTS " will not be approved

>

> PTManager encourages participation in your professional association.

> Join APTA, AOTA or ASHA and participate now!

>

> Follow Kovacek, PT on Facebook or Twitter.

> PTManager blog: http://ptmanager.posterous.com/

>

[Guest guest]

Hi, --

Thank you so much for bringing up the question of, fundamentally, " Who are

physical therapists, and what do they do? " This is addressed in chapter one

of the APTA's Guide ot Physical Therpist Practice. The concept of physical

therapist as an " order taker " is not persent in that reference. However,

the concept of physical therapist as autonomous practitioner is described

there.

Even though many, many, many physicians, administrators, clinicians of other

disciplines, government regulators, insurors, and especially corporate

higher-ups are utterly unaware of the changes of the last thirty years or

so, this is the new reality in the physical therapy profession. Today's PTs

legitimately belong on " the doctor's side of the table " , not on the

technicians'.

In the real world, our work relationships are what we have allowed them to

become, and it may be time to have a professional conversation with the MD.

Today, I re-read Kovacek's old article questioning whether a physical

therapist can function properly as a subordinate employee in any clinical

setting. Apparently, your supervisor is comfortable sending a

$50,000-$70,000 professional to do a task which could be performed by a $10/

hour aide.

Here's a reference to the new APTA Code of Ethics, which may be informative:

Principle #3: Physical therapists shall be accountable for making sound

professional judgments.

3A. Physical therapists shall demonstrate independent and objective

professional judgment in the patient's/client's best interest in all

practice settings.

3B. Physical therapists shall demonstrate professional judgment informed by

professional standards, evidence (including current literature and

established best practice), practitioner experience, and patient/client

values.

3C. Physical therapists shall make judgments within their scope of practice

and level of expertise and shall communicate with, collaborate with, or

refer to peers or other health care professionals when necessary.

3D. Physical therapists shall not engage in conflicts of interest that

interfere with professional judgment.

3E. Physical therapists shall provide appropriate direction of and

communication with physical therapist assistants and support personnel.

I sincerely hope that this will be useful to you and many others.

Dr. Dick Hillyer, PT,DPT,MBA,MSM

_____

From: PTManager [mailto:PTManager ] On Behalf

Of kitiara_99

Sent: Tuesday, February 01, 2011 7:21 PM

To: PTManager

Subject: Re: Some help please- Nursing vs. PT!

Thank you, Ron. However, it was a physician asking me to do this and my

Rehab Director (an O.T.) telling me that I " had to " . I feel that it was

wrong to tell me that I " had to " do something that was potentially

fraudulent. I don't believe in charging for skilled P.T. services for

something that nursing could have easily done. Is it wrong to feel this way?

~~

>

> , it is your clinical decision, not nursing. Your evaluation of

> the patient determines skilled therapy intervention, no one should do

> that for you.

>

> Ron Barbato PT

> Administrative Director, Rehabilitation Services

> Program Director, Cancer Support Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@...

>

>

>

> PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> that is privileged subject to attorney-client privilege or attorney work

> product, confidential and/or exempt from disclosure under applicable

> law. If you are not the intended recipient, then please do not read it

> and be aware that any disclosure, copying, distribution, or use of the

> information contained herein (including any reliance thereon) is

> STRICTLY PROHIBITED. If you received this transmission in error, please

> immediately advise me, by reply e-mail, and delete this message and any

> attachments without retaining a copy in any form. Thank you.

>

>

> Some help please- Nursing vs. PT!

>

> Recently, there has been a conflict at my place of work in regards to PT

> roles and Nursing. I was asked to give a patient a bath in the Rehab

> Department whirlpool for dry skin. I have always been told that, if it

> is something that Nursing can take care of (transferring a patient to a

> chair, giving baths, etc...), that PTs should not get involved and

> charge PT units for such services.

>

> What is this group's take on this? Does dry skin fall under the category

> of " skin integrity impairment " to the point that PT should get involved?

> Or should this strictly be Nursing's role?

>

> Thank you for your advice!

>

>

>

>

>

> ------------------------------------

>

> In ALL messages to PTManager you must identify yourself, your discipline

> and your location or else your message will not be approved to send to

> the full group.

>

> Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> to our professions. PTManager is not available to support POPTS-model

> practices. The description of PTManager group includes the following:

> " PTManager believes in and supports Therapist-owned Therapy Practices

> ONLY "

> Messages relating to " how to set up a POPTS " will not be approved

>

> PTManager encourages participation in your professional association.

> Join APTA, AOTA or ASHA and participate now!

>

> Follow Kovacek, PT on Facebook or Twitter.

> PTManager blog: http://ptmanager.posterous.com/

>

[Guest guest]

Hi, --

Thank you so much for bringing up the question of, fundamentally, " Who are

physical therapists, and what do they do? " This is addressed in chapter one

of the APTA's Guide ot Physical Therpist Practice. The concept of physical

therapist as an " order taker " is not persent in that reference. However,

the concept of physical therapist as autonomous practitioner is described

there.

Even though many, many, many physicians, administrators, clinicians of other

disciplines, government regulators, insurors, and especially corporate

higher-ups are utterly unaware of the changes of the last thirty years or

so, this is the new reality in the physical therapy profession. Today's PTs

legitimately belong on " the doctor's side of the table " , not on the

technicians'.

In the real world, our work relationships are what we have allowed them to

become, and it may be time to have a professional conversation with the MD.

Today, I re-read Kovacek's old article questioning whether a physical

therapist can function properly as a subordinate employee in any clinical

setting. Apparently, your supervisor is comfortable sending a

$50,000-$70,000 professional to do a task which could be performed by a $10/

hour aide.

Here's a reference to the new APTA Code of Ethics, which may be informative:

Principle #3: Physical therapists shall be accountable for making sound

professional judgments.

3A. Physical therapists shall demonstrate independent and objective

professional judgment in the patient's/client's best interest in all

practice settings.

3B. Physical therapists shall demonstrate professional judgment informed by

professional standards, evidence (including current literature and

established best practice), practitioner experience, and patient/client

values.

3C. Physical therapists shall make judgments within their scope of practice

and level of expertise and shall communicate with, collaborate with, or

refer to peers or other health care professionals when necessary.

3D. Physical therapists shall not engage in conflicts of interest that

interfere with professional judgment.

3E. Physical therapists shall provide appropriate direction of and

communication with physical therapist assistants and support personnel.

I sincerely hope that this will be useful to you and many others.

Dr. Dick Hillyer, PT,DPT,MBA,MSM

_____

From: PTManager [mailto:PTManager ] On Behalf

Of kitiara_99

Sent: Tuesday, February 01, 2011 7:21 PM

To: PTManager

Subject: Re: Some help please- Nursing vs. PT!

Thank you, Ron. However, it was a physician asking me to do this and my

Rehab Director (an O.T.) telling me that I " had to " . I feel that it was

wrong to tell me that I " had to " do something that was potentially

fraudulent. I don't believe in charging for skilled P.T. services for

something that nursing could have easily done. Is it wrong to feel this way?

~~

>

> , it is your clinical decision, not nursing. Your evaluation of

> the patient determines skilled therapy intervention, no one should do

> that for you.

>

> Ron Barbato PT

> Administrative Director, Rehabilitation Services

> Program Director, Cancer Support Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@...

>

>

>

> PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> that is privileged subject to attorney-client privilege or attorney work

> product, confidential and/or exempt from disclosure under applicable

> law. If you are not the intended recipient, then please do not read it

> and be aware that any disclosure, copying, distribution, or use of the

> information contained herein (including any reliance thereon) is

> STRICTLY PROHIBITED. If you received this transmission in error, please

> immediately advise me, by reply e-mail, and delete this message and any

> attachments without retaining a copy in any form. Thank you.

>

>

> Some help please- Nursing vs. PT!

>

> Recently, there has been a conflict at my place of work in regards to PT

> roles and Nursing. I was asked to give a patient a bath in the Rehab

> Department whirlpool for dry skin. I have always been told that, if it

> is something that Nursing can take care of (transferring a patient to a

> chair, giving baths, etc...), that PTs should not get involved and

> charge PT units for such services.

>

> What is this group's take on this? Does dry skin fall under the category

> of " skin integrity impairment " to the point that PT should get involved?

> Or should this strictly be Nursing's role?

>

> Thank you for your advice!

>

>

>

>

>

> ------------------------------------

>

> In ALL messages to PTManager you must identify yourself, your discipline

> and your location or else your message will not be approved to send to

> the full group.

>

> Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> to our professions. PTManager is not available to support POPTS-model

> practices. The description of PTManager group includes the following:

> " PTManager believes in and supports Therapist-owned Therapy Practices

> ONLY "

> Messages relating to " how to set up a POPTS " will not be approved

>

> PTManager encourages participation in your professional association.

> Join APTA, AOTA or ASHA and participate now!

>

> Follow Kovacek, PT on Facebook or Twitter.

> PTManager blog: http://ptmanager.posterous.com/

>

[Guest guest]

- When I hear things like this I definitely understand the reason for

conflict and I know it creates tension. I spent 30 years in an acute care

hospital and had plenty of opportunity to work through these kinds of

situations. Here is some advice- since you asked! If you can look at this in

a patient centered way then I think the question is how does your organization

take care of this patient's skin vs. is skin care a PT or nursing role. I am

very well aware of the challenges related to billable time, productivity,

respect for roles, etc. In reality your organization does not have to issue a

charge for a whirlpool bath that is used to for skin care as PT and then it

only matters who can do it safely and effectively.

I realize that you may have internal policies and procedures that get in the

way, and that depending on where you are practicing your licensure law should

be reviewed but I would encourage you to look at the patient's need first and

then figure out the best way to meet them.

Obviously since we don't have any clinical data on this patient it isn't

possible to tell if a " whirlpool bath " would be helpful, harmful, make the

patient feel better or worse. We don't know what your workload is in order to

tell if taking time for this patient would keep a patient who has higher

priority needs from being seen. Those (along with a few others that others

would think of) are the things that should be considered with less focus on

turf.

Good luck!

Keehn, PT, DPT, MHPE

Chicago, IL

________________________________

To: PTManager

Sent: Tue, February 1, 2011 6:20:40 PM

Subject: Re: Some help please- Nursing vs. PT!

Thank you, Ron. However, it was a physician asking me to do this and my Rehab

Director (an O.T.) telling me that I " had to " . I feel that it was wrong to tell

me that I " had to " do something that was potentially fraudulent. I don't believe

in charging for skilled P.T. services for something that nursing could have

easily done. Is it wrong to feel this way?

~~

>

> , it is your clinical decision, not nursing. Your evaluation of

> the patient determines skilled therapy intervention, no one should do

> that for you.

>

> Ron Barbato PT

> Administrative Director, Rehabilitation Services

> Program Director, Cancer Support Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@...

>

>

>

> PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> that is privileged subject to attorney-client privilege or attorney work

> product, confidential and/or exempt from disclosure under applicable

> law. If you are not the intended recipient, then please do not read it

> and be aware that any disclosure, copying, distribution, or use of the

> information contained herein (including any reliance thereon) is

> STRICTLY PROHIBITED. If you received this transmission in error, please

> immediately advise me, by reply e-mail, and delete this message and any

> attachments without retaining a copy in any form. Thank you.

>

>

> Some help please- Nursing vs. PT!

>

> Recently, there has been a conflict at my place of work in regards to PT

> roles and Nursing. I was asked to give a patient a bath in the Rehab

> Department whirlpool for dry skin. I have always been told that, if it

> is something that Nursing can take care of (transferring a patient to a

> chair, giving baths, etc...), that PTs should not get involved and

> charge PT units for such services.

>

> What is this group's take on this? Does dry skin fall under the category

> of " skin integrity impairment " to the point that PT should get involved?

> Or should this strictly be Nursing's role?

>

> Thank you for your advice!

>

>

>

>

>

> ------------------------------------

>

> In ALL messages to PTManager you must identify yourself, your discipline

> and your location or else your message will not be approved to send to

> the full group.

>

> Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> to our professions. PTManager is not available to support POPTS-model

> practices. The description of PTManager group includes the following:

> " PTManager believes in and supports Therapist-owned Therapy Practices

> ONLY "

> Messages relating to " how to set up a POPTS " will not be approved

>

> PTManager encourages participation in your professional association.

> Join APTA, AOTA or ASHA and participate now!

>

> Follow Kovacek, PT on Facebook or Twitter.

> PTManager blog: http://ptmanager.posterous.com/

>

[Guest guest]

- When I hear things like this I definitely understand the reason for

conflict and I know it creates tension. I spent 30 years in an acute care

hospital and had plenty of opportunity to work through these kinds of

situations. Here is some advice- since you asked! If you can look at this in

a patient centered way then I think the question is how does your organization

take care of this patient's skin vs. is skin care a PT or nursing role. I am

very well aware of the challenges related to billable time, productivity,

respect for roles, etc. In reality your organization does not have to issue a

charge for a whirlpool bath that is used to for skin care as PT and then it

only matters who can do it safely and effectively.

I realize that you may have internal policies and procedures that get in the

way, and that depending on where you are practicing your licensure law should

be reviewed but I would encourage you to look at the patient's need first and

then figure out the best way to meet them.

Obviously since we don't have any clinical data on this patient it isn't

possible to tell if a " whirlpool bath " would be helpful, harmful, make the

patient feel better or worse. We don't know what your workload is in order to

tell if taking time for this patient would keep a patient who has higher

priority needs from being seen. Those (along with a few others that others

would think of) are the things that should be considered with less focus on

turf.

Good luck!

Keehn, PT, DPT, MHPE

Chicago, IL

________________________________

To: PTManager

Sent: Tue, February 1, 2011 6:20:40 PM

Subject: Re: Some help please- Nursing vs. PT!

Thank you, Ron. However, it was a physician asking me to do this and my Rehab

Director (an O.T.) telling me that I " had to " . I feel that it was wrong to tell

me that I " had to " do something that was potentially fraudulent. I don't believe

in charging for skilled P.T. services for something that nursing could have

easily done. Is it wrong to feel this way?

~~

>

> , it is your clinical decision, not nursing. Your evaluation of

> the patient determines skilled therapy intervention, no one should do

> that for you.

>

> Ron Barbato PT

> Administrative Director, Rehabilitation Services

> Program Director, Cancer Support Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@...

>

>

>

> PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> that is privileged subject to attorney-client privilege or attorney work

> product, confidential and/or exempt from disclosure under applicable

> law. If you are not the intended recipient, then please do not read it

> and be aware that any disclosure, copying, distribution, or use of the

> information contained herein (including any reliance thereon) is

> STRICTLY PROHIBITED. If you received this transmission in error, please

> immediately advise me, by reply e-mail, and delete this message and any

> attachments without retaining a copy in any form. Thank you.

>

>

> Some help please- Nursing vs. PT!

>

> Recently, there has been a conflict at my place of work in regards to PT

> roles and Nursing. I was asked to give a patient a bath in the Rehab

> Department whirlpool for dry skin. I have always been told that, if it

> is something that Nursing can take care of (transferring a patient to a

> chair, giving baths, etc...), that PTs should not get involved and

> charge PT units for such services.

>

> What is this group's take on this? Does dry skin fall under the category

> of " skin integrity impairment " to the point that PT should get involved?

> Or should this strictly be Nursing's role?

>

> Thank you for your advice!

>

>

>

>

>

> ------------------------------------

>

> In ALL messages to PTManager you must identify yourself, your discipline

> and your location or else your message will not be approved to send to

> the full group.

>

> Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> to our professions. PTManager is not available to support POPTS-model

> practices. The description of PTManager group includes the following:

> " PTManager believes in and supports Therapist-owned Therapy Practices

> ONLY "

> Messages relating to " how to set up a POPTS " will not be approved

>

> PTManager encourages participation in your professional association.

> Join APTA, AOTA or ASHA and participate now!

>

> Follow Kovacek, PT on Facebook or Twitter.

> PTManager blog: http://ptmanager.posterous.com/

>

[Guest guest]

Thank you all so much for the advice. I am at a loss at how to defend myself at

work right now. I refused to do the whirlpool and was given a written warning

for it. I really am on the verge of being fired over it and I am really at the

end of my rope.

Does anyone have a written definition for " skin integrity " and how it applies to

P.T.?

Thank you!

~~

> >

> > , it is your clinical decision, not nursing. Your evaluation of

> > the patient determines skilled therapy intervention, no one should do

> > that for you.

> >

> > Ron Barbato PT

> > Administrative Director, Rehabilitation Services

> > Program Director, Cancer Support Services

> > Ephraim McDowell Health

> > Voice:

> > Fax:

> > rbarbato@

> >

> >

> >

> > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> > that is privileged subject to attorney-client privilege or attorney work

> > product, confidential and/or exempt from disclosure under applicable

> > law. If you are not the intended recipient, then please do not read it

> > and be aware that any disclosure, copying, distribution, or use of the

> > information contained herein (including any reliance thereon) is

> > STRICTLY PROHIBITED. If you received this transmission in error, please

> > immediately advise me, by reply e-mail, and delete this message and any

> > attachments without retaining a copy in any form. Thank you.

> >

> >

> > Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

Thank you all so much for the advice. I am at a loss at how to defend myself at

work right now. I refused to do the whirlpool and was given a written warning

for it. I really am on the verge of being fired over it and I am really at the

end of my rope.

Does anyone have a written definition for " skin integrity " and how it applies to

P.T.?

Thank you!

~~

> >

> > , it is your clinical decision, not nursing. Your evaluation of

> > the patient determines skilled therapy intervention, no one should do

> > that for you.

> >

> > Ron Barbato PT

> > Administrative Director, Rehabilitation Services

> > Program Director, Cancer Support Services

> > Ephraim McDowell Health

> > Voice:

> > Fax:

> > rbarbato@

> >

> >

> >

> > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> > that is privileged subject to attorney-client privilege or attorney work

> > product, confidential and/or exempt from disclosure under applicable

> > law. If you are not the intended recipient, then please do not read it

> > and be aware that any disclosure, copying, distribution, or use of the

> > information contained herein (including any reliance thereon) is

> > STRICTLY PROHIBITED. If you received this transmission in error, please

> > immediately advise me, by reply e-mail, and delete this message and any

> > attachments without retaining a copy in any form. Thank you.

> >

> >

> > Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

Thank you all so much for the advice. I am at a loss at how to defend myself at

work right now. I refused to do the whirlpool and was given a written warning

for it. I really am on the verge of being fired over it and I am really at the

end of my rope.

Does anyone have a written definition for " skin integrity " and how it applies to

P.T.?

Thank you!

~~

> >

> > , it is your clinical decision, not nursing. Your evaluation of

> > the patient determines skilled therapy intervention, no one should do

> > that for you.

> >

> > Ron Barbato PT

> > Administrative Director, Rehabilitation Services

> > Program Director, Cancer Support Services

> > Ephraim McDowell Health

> > Voice:

> > Fax:

> > rbarbato@

> >

> >

> >

> > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> > that is privileged subject to attorney-client privilege or attorney work

> > product, confidential and/or exempt from disclosure under applicable

> > law. If you are not the intended recipient, then please do not read it

> > and be aware that any disclosure, copying, distribution, or use of the

> > information contained herein (including any reliance thereon) is

> > STRICTLY PROHIBITED. If you received this transmission in error, please

> > immediately advise me, by reply e-mail, and delete this message and any

> > attachments without retaining a copy in any form. Thank you.

> >

> >

> > Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

Have you figured out the cost to the facility of having a patient brought to

your whirlpool, have it prepared, then put in and then cleaned then returned to

the room versus a nurse or CNA accompanying a person to the shower room on the

floor? If it is a a medicare patient you should also use the conditions of

partiicaption that say what we do has to be skilled and cannot be done by

others, otherwise it cannot be put in as a PT cost for that inpatient episode of

care.

Jim Dunleavy PT, MS

Trinitas Regional Medical Center

Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

Have you figured out the cost to the facility of having a patient brought to

your whirlpool, have it prepared, then put in and then cleaned then returned to

the room versus a nurse or CNA accompanying a person to the shower room on the

floor? If it is a a medicare patient you should also use the conditions of

partiicaption that say what we do has to be skilled and cannot be done by

others, otherwise it cannot be put in as a PT cost for that inpatient episode of

care.

Jim Dunleavy PT, MS

Trinitas Regional Medical Center

Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

Have you figured out the cost to the facility of having a patient brought to

your whirlpool, have it prepared, then put in and then cleaned then returned to

the room versus a nurse or CNA accompanying a person to the shower room on the

floor? If it is a a medicare patient you should also use the conditions of

partiicaption that say what we do has to be skilled and cannot be done by

others, otherwise it cannot be put in as a PT cost for that inpatient episode of

care.

Jim Dunleavy PT, MS

Trinitas Regional Medical Center

Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

Hi ,

I guess I am confused. Is your objection that you had to do the whirlpool

or that you were asked to bill for it?

If you want to fight the billing portion, you have to educate yourself on

insurance billing for this patient. Whether Medicare or private insurance,

I don't ever remember being able to bill for a whirlpool just to remove dry

skin. By presenting the facts to your superiors, you may smooth out the

situation. I was most concerned about the billing situation as it sounds as

if your superiors were asking you to bill for something that is not billable

just to account for your time. As I said, your option in this case is to

prove that what you were doing is not billable. If they disregard the

evidence, you will have to decide to go over their heads or quit and move

on.

If your objection is about doing a nursing activity, what I learned to do ,

when I did Acute Care and unfortunately ran into many turf battles, was to

focus on what I could do at that point and time for the patient. Could I

work on transfers, was what I was doing going to make the client more

comfortable (and potentially more amenable to other treatments like

therapies), could I develop a rapport with this patient that may help if I

were to treat them, could I teach them an exercise or provide education

while in the whirlpool and so on. The insanity of the turf battles as

unethical as they can be, tended to melt away. Ultimately the whirlpool

potentially made this patient feel better and there is something positive

about that no matter who is doing it.

That being said, we all have the obligation to stand up for our professional

selves and find ways to effect change when the environment around us pushes

us into situations of questionable ethics or duties. Take the opportunity

to suggest a Quality Improvement project relating to this incident that

would streamline personnel uses and free up PT's for more billable time.

Suggest a study to see how nursing and PT time is used then see how it could

be improved.

If all else fails, you have the advantage of generally being in a great job

market to move on and find your dream job. Many of us that have been in the

field for a long time have been through many job changes so moving on is not

a bad thing to do.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of its

attachments, please be advised that you have received this email in error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

_____

From: PTManager [mailto:PTManager ] On Behalf

Of kitiara_99

Sent: Tuesday, February 01, 2011 8:40 PM

To: PTManager

Subject: Re: Some help please- Nursing vs. PT!

Thank you all so much for the advice. I am at a loss at how to defend myself

at work right now. I refused to do the whirlpool and was given a written

warning for it. I really am on the verge of being fired over it and I am

really at the end of my rope.

Does anyone have a written definition for " skin integrity " and how it

applies to P.T.?

Thank you!

~~

> >

> > , it is your clinical decision, not nursing. Your evaluation of

> > the patient determines skilled therapy intervention, no one should do

> > that for you.

> >

> > Ron Barbato PT

> > Administrative Director, Rehabilitation Services

> > Program Director, Cancer Support Services

> > Ephraim McDowell Health

> > Voice:

> > Fax:

> > rbarbato@

> >

> >

> >

> > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> > that is privileged subject to attorney-client privilege or attorney work

> > product, confidential and/or exempt from disclosure under applicable

> > law. If you are not the intended recipient, then please do not read it

> > and be aware that any disclosure, copying, distribution, or use of the

> > information contained herein (including any reliance thereon) is

> > STRICTLY PROHIBITED. If you received this transmission in error, please

> > immediately advise me, by reply e-mail, and delete this message and any

> > attachments without retaining a copy in any form. Thank you.

> >

> >

> > Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

Hi ,

I guess I am confused. Is your objection that you had to do the whirlpool

or that you were asked to bill for it?

If you want to fight the billing portion, you have to educate yourself on

insurance billing for this patient. Whether Medicare or private insurance,

I don't ever remember being able to bill for a whirlpool just to remove dry

skin. By presenting the facts to your superiors, you may smooth out the

situation. I was most concerned about the billing situation as it sounds as

if your superiors were asking you to bill for something that is not billable

just to account for your time. As I said, your option in this case is to

prove that what you were doing is not billable. If they disregard the

evidence, you will have to decide to go over their heads or quit and move

on.

If your objection is about doing a nursing activity, what I learned to do ,

when I did Acute Care and unfortunately ran into many turf battles, was to

focus on what I could do at that point and time for the patient. Could I

work on transfers, was what I was doing going to make the client more

comfortable (and potentially more amenable to other treatments like

therapies), could I develop a rapport with this patient that may help if I

were to treat them, could I teach them an exercise or provide education

while in the whirlpool and so on. The insanity of the turf battles as

unethical as they can be, tended to melt away. Ultimately the whirlpool

potentially made this patient feel better and there is something positive

about that no matter who is doing it.

That being said, we all have the obligation to stand up for our professional

selves and find ways to effect change when the environment around us pushes

us into situations of questionable ethics or duties. Take the opportunity

to suggest a Quality Improvement project relating to this incident that

would streamline personnel uses and free up PT's for more billable time.

Suggest a study to see how nursing and PT time is used then see how it could

be improved.

If all else fails, you have the advantage of generally being in a great job

market to move on and find your dream job. Many of us that have been in the

field for a long time have been through many job changes so moving on is not

a bad thing to do.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of its

attachments, please be advised that you have received this email in error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

_____

From: PTManager [mailto:PTManager ] On Behalf

Of kitiara_99

Sent: Tuesday, February 01, 2011 8:40 PM

To: PTManager

Subject: Re: Some help please- Nursing vs. PT!

Thank you all so much for the advice. I am at a loss at how to defend myself

at work right now. I refused to do the whirlpool and was given a written

warning for it. I really am on the verge of being fired over it and I am

really at the end of my rope.

Does anyone have a written definition for " skin integrity " and how it

applies to P.T.?

Thank you!

~~

> >

> > , it is your clinical decision, not nursing. Your evaluation of

> > the patient determines skilled therapy intervention, no one should do

> > that for you.

> >

> > Ron Barbato PT

> > Administrative Director, Rehabilitation Services

> > Program Director, Cancer Support Services

> > Ephraim McDowell Health

> > Voice:

> > Fax:

> > rbarbato@

> >

> >

> >

> > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> > that is privileged subject to attorney-client privilege or attorney work

> > product, confidential and/or exempt from disclosure under applicable

> > law. If you are not the intended recipient, then please do not read it

> > and be aware that any disclosure, copying, distribution, or use of the

> > information contained herein (including any reliance thereon) is

> > STRICTLY PROHIBITED. If you received this transmission in error, please

> > immediately advise me, by reply e-mail, and delete this message and any

> > attachments without retaining a copy in any form. Thank you.

> >

> >

> > Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

Hi ,

I guess I am confused. Is your objection that you had to do the whirlpool

or that you were asked to bill for it?

If you want to fight the billing portion, you have to educate yourself on

insurance billing for this patient. Whether Medicare or private insurance,

I don't ever remember being able to bill for a whirlpool just to remove dry

skin. By presenting the facts to your superiors, you may smooth out the

situation. I was most concerned about the billing situation as it sounds as

if your superiors were asking you to bill for something that is not billable

just to account for your time. As I said, your option in this case is to

prove that what you were doing is not billable. If they disregard the

evidence, you will have to decide to go over their heads or quit and move

on.

If your objection is about doing a nursing activity, what I learned to do ,

when I did Acute Care and unfortunately ran into many turf battles, was to

focus on what I could do at that point and time for the patient. Could I

work on transfers, was what I was doing going to make the client more

comfortable (and potentially more amenable to other treatments like

therapies), could I develop a rapport with this patient that may help if I

were to treat them, could I teach them an exercise or provide education

while in the whirlpool and so on. The insanity of the turf battles as

unethical as they can be, tended to melt away. Ultimately the whirlpool

potentially made this patient feel better and there is something positive

about that no matter who is doing it.

That being said, we all have the obligation to stand up for our professional

selves and find ways to effect change when the environment around us pushes

us into situations of questionable ethics or duties. Take the opportunity

to suggest a Quality Improvement project relating to this incident that

would streamline personnel uses and free up PT's for more billable time.

Suggest a study to see how nursing and PT time is used then see how it could

be improved.

If all else fails, you have the advantage of generally being in a great job

market to move on and find your dream job. Many of us that have been in the

field for a long time have been through many job changes so moving on is not

a bad thing to do.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of its

attachments, please be advised that you have received this email in error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

_____

From: PTManager [mailto:PTManager ] On Behalf

Of kitiara_99

Sent: Tuesday, February 01, 2011 8:40 PM

To: PTManager

Subject: Re: Some help please- Nursing vs. PT!

Thank you all so much for the advice. I am at a loss at how to defend myself

at work right now. I refused to do the whirlpool and was given a written

warning for it. I really am on the verge of being fired over it and I am

really at the end of my rope.

Does anyone have a written definition for " skin integrity " and how it

applies to P.T.?

Thank you!

~~

> >

> > , it is your clinical decision, not nursing. Your evaluation of

> > the patient determines skilled therapy intervention, no one should do

> > that for you.

> >

> > Ron Barbato PT

> > Administrative Director, Rehabilitation Services

> > Program Director, Cancer Support Services

> > Ephraim McDowell Health

> > Voice:

> > Fax:

> > rbarbato@

> >

> >

> >

> > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> > that is privileged subject to attorney-client privilege or attorney work

> > product, confidential and/or exempt from disclosure under applicable

> > law. If you are not the intended recipient, then please do not read it

> > and be aware that any disclosure, copying, distribution, or use of the

> > information contained herein (including any reliance thereon) is

> > STRICTLY PROHIBITED. If you received this transmission in error, please

> > immediately advise me, by reply e-mail, and delete this message and any

> > attachments without retaining a copy in any form. Thank you.

> >

> >

> > Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

I just received this youtube video from a PT friend.  It relates to the nursing

vs. PT thing.  Please note there is some swearing in the video so if you are

offended you may not want to watch it. 

 

 

 

 

Egbert DOR

Draper, Utah

Subject: Re: Some help please- Nursing vs. PT!

To: PTManager

Date: Wednesday, February 2, 2011, 3:40 AM

 

Thank you all so much for the advice. I am at a loss at how to defend myself at

work right now. I refused to do the whirlpool and was given a written warning

for it. I really am on the verge of being fired over it and I am really at the

end of my rope.

Does anyone have a written definition for " skin integrity " and how it applies to

P.T.?

Thank you!

~~

> >

> > , it is your clinical decision, not nursing. Your evaluation of

> > the patient determines skilled therapy intervention, no one should do

> > that for you.

> >

> > Ron Barbato PT

> > Administrative Director, Rehabilitation Services

> > Program Director, Cancer Support Services

> > Ephraim McDowell Health

> > Voice:

> > Fax:

> > rbarbato@

> >

> >

> >

> > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> > that is privileged subject to attorney-client privilege or attorney work

> > product, confidential and/or exempt from disclosure under applicable

> > law. If you are not the intended recipient, then please do not read it

> > and be aware that any disclosure, copying, distribution, or use of the

> > information contained herein (including any reliance thereon) is

> > STRICTLY PROHIBITED. If you received this transmission in error, please

> > immediately advise me, by reply e-mail, and delete this message and any

> > attachments without retaining a copy in any form. Thank you.

> >

> >

> > Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

I just received this youtube video from a PT friend.  It relates to the nursing

vs. PT thing.  Please note there is some swearing in the video so if you are

offended you may not want to watch it. 

 

 

 

 

Egbert DOR

Draper, Utah

Subject: Re: Some help please- Nursing vs. PT!

To: PTManager

Date: Wednesday, February 2, 2011, 3:40 AM

 

Thank you all so much for the advice. I am at a loss at how to defend myself at

work right now. I refused to do the whirlpool and was given a written warning

for it. I really am on the verge of being fired over it and I am really at the

end of my rope.

Does anyone have a written definition for " skin integrity " and how it applies to

P.T.?

Thank you!

~~

> >

> > , it is your clinical decision, not nursing. Your evaluation of

> > the patient determines skilled therapy intervention, no one should do

> > that for you.

> >

> > Ron Barbato PT

> > Administrative Director, Rehabilitation Services

> > Program Director, Cancer Support Services

> > Ephraim McDowell Health

> > Voice:

> > Fax:

> > rbarbato@

> >

> >

> >

> > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> > that is privileged subject to attorney-client privilege or attorney work

> > product, confidential and/or exempt from disclosure under applicable

> > law. If you are not the intended recipient, then please do not read it

> > and be aware that any disclosure, copying, distribution, or use of the

> > information contained herein (including any reliance thereon) is

> > STRICTLY PROHIBITED. If you received this transmission in error, please

> > immediately advise me, by reply e-mail, and delete this message and any

> > attachments without retaining a copy in any form. Thank you.

> >

> >

> > Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

I just received this youtube video from a PT friend.  It relates to the nursing

vs. PT thing.  Please note there is some swearing in the video so if you are

offended you may not want to watch it. 

 

 

 

 

Egbert DOR

Draper, Utah

Subject: Re: Some help please- Nursing vs. PT!

To: PTManager

Date: Wednesday, February 2, 2011, 3:40 AM

 

Thank you all so much for the advice. I am at a loss at how to defend myself at

work right now. I refused to do the whirlpool and was given a written warning

for it. I really am on the verge of being fired over it and I am really at the

end of my rope.

Does anyone have a written definition for " skin integrity " and how it applies to

P.T.?

Thank you!

~~

> >

> > , it is your clinical decision, not nursing. Your evaluation of

> > the patient determines skilled therapy intervention, no one should do

> > that for you.

> >

> > Ron Barbato PT

> > Administrative Director, Rehabilitation Services

> > Program Director, Cancer Support Services

> > Ephraim McDowell Health

> > Voice:

> > Fax:

> > rbarbato@

> >

> >

> >

> > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> > that is privileged subject to attorney-client privilege or attorney work

> > product, confidential and/or exempt from disclosure under applicable

> > law. If you are not the intended recipient, then please do not read it

> > and be aware that any disclosure, copying, distribution, or use of the

> > information contained herein (including any reliance thereon) is

> > STRICTLY PROHIBITED. If you received this transmission in error, please

> > immediately advise me, by reply e-mail, and delete this message and any

> > attachments without retaining a copy in any form. Thank you.

> >

> >

> > Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

> > PTManager blog: http://ptmanager.posterous.com/

> >

[Guest guest]

is obviously hurting here, and I'm wondering if the you're-in-charge

advice is really what she needs, or even appropriate at all. Yes, there are

responsibilities to payers and to patients. And therapists, and frankly everyone

else, ought to be concerned and careful to make right decisions with the best

available information. But we should never forget that all work---ALL work---is

relational. Because we are humans we depend upon each other, and therefore ought

to work first and foremost to build and maintain mutually respectful

relationships. It sounds to me that the real problem here is the absence of

those mutually respectful relationships, and I would suggest that recalcitrant

positioning based on professional standing is not an effective way to create

them. That sounds more like a husband refusing to wash a dish or change a

diaper.

Now charging of PT units is of course another story, but it's not at all clear

from 's post that she was being asked to bill anyone for non-skilled care,

and we shouldn't assume that was the case. Perhaps she could clarify that, but

in the meantime, why not give the benefit of the doubt and assume that nursing

was requesting nothing more than the execution of a good idea. (Most every

patient in our acute care hospital, by the way, is DRG reimbursed, so we collect

nothing extra for " added " services.)

I am copying Keehn's response to below, because I think it is

important to hear from someone with education, experience, and if I could be so

bold, heart. She said it as well as anyone could:

- When I hear things like this I definitely understand the reason for

conflict and I know it creates tension. I spent 30 years in an acute care

hospital and had plenty of opportunity to work through these kinds of

situations. Here is some advice- since you asked! If you can look at this in

a patient centered way then I think the question is how does your organization

take care of this patient's skin vs. is skin care a PT or nursing role. I am

very well aware of the challenges related to billable time, productivity,

respect for roles, etc. In reality your organization does not have to issue a

charge for a whirlpool bath that is used to for skin care as PT and then it

only matters who can do it safely and effectively.

I realize that you may have internal policies and procedures that get in the

way, and that depending on where you are practicing your licensure law should

be reviewed but I would encourage you to look at the patient's need first and

then figure out the best way to meet them.

Obviously since we don't have any clinical data on this patient it isn't

possible to tell if a " whirlpool bath " would be helpful, harmful, make the

patient feel better or worse. We don't know what your workload is in order to

tell if taking time for this patient would keep a patient who has higher

priority needs from being seen. Those (along with a few others that others

would think of) are the things that should be considered with less focus on

turf.

Good luck!

Keehn, PT, DPT, MHPE

Chicago, IL

Dave Milano, PT, Rehabilitation Director

Laurel Health System

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

kitiara_99

Sent: Tuesday, February 01, 2011 10:40 PM

To: PTManager

Subject: Re: Some help please- Nursing vs. PT!

Thank you all so much for the advice. I am at a loss at how to defend myself at

work right now. I refused to do the whirlpool and was given a written warning

for it. I really am on the verge of being fired over it and I am really at the

end of my rope.

Does anyone have a written definition for " skin integrity " and how it applies to

P.T.?

Thank you!

~~

> >

> > , it is your clinical decision, not nursing. Your evaluation of

> > the patient determines skilled therapy intervention, no one should do

> > that for you.

> >

> > Ron Barbato PT

> > Administrative Director, Rehabilitation Services

> > Program Director, Cancer Support Services

> > Ephraim McDowell Health

> > Voice:

> > Fax:

> > rbarbato@

> >

> >

> >

> > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> > that is privileged subject to attorney-client privilege or attorney work

> > product, confidential and/or exempt from disclosure under applicable

> > law. If you are not the intended recipient, then please do not read it

> > and be aware that any disclosure, copying, distribution, or use of the

> > information contained herein (including any reliance thereon) is

> > STRICTLY PROHIBITED. If you received this transmission in error, please

> > immediately advise me, by reply e-mail, and delete this message and any

> > attachments without retaining a copy in any form. Thank you.

> >

> >

> > Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> > In ALL messages to PTManager you must identify yourself, your discipline

> > and your location or else your message will not be approved to send to

> > the full group.

> >

> > Physician Self Referal/Referral for Profit {POPTS} is a serious threat

> > to our professions. PTManager is not available to support POPTS-model

> > practices. The description of PTManager group includes the following:

> > " PTManager believes in and supports Therapist-owned Therapy Practices

> > ONLY "

> > Messages relating to " how to set up a POPTS " will not be approved

> >

> > PTManager encourages participation in your professional association.

> > Join APTA, AOTA or ASHA and participate now!

> >

> > Follow Kovacek, PT on Facebook or Twitter.

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[Guest guest]

is obviously hurting here, and I'm wondering if the you're-in-charge

advice is really what she needs, or even appropriate at all. Yes, there are

responsibilities to payers and to patients. And therapists, and frankly everyone

else, ought to be concerned and careful to make right decisions with the best

available information. But we should never forget that all work---ALL work---is

relational. Because we are humans we depend upon each other, and therefore ought

to work first and foremost to build and maintain mutually respectful

relationships. It sounds to me that the real problem here is the absence of

those mutually respectful relationships, and I would suggest that recalcitrant

positioning based on professional standing is not an effective way to create

them. That sounds more like a husband refusing to wash a dish or change a

diaper.

Now charging of PT units is of course another story, but it's not at all clear

from 's post that she was being asked to bill anyone for non-skilled care,

and we shouldn't assume that was the case. Perhaps she could clarify that, but

in the meantime, why not give the benefit of the doubt and assume that nursing

was requesting nothing more than the execution of a good idea. (Most every

patient in our acute care hospital, by the way, is DRG reimbursed, so we collect

nothing extra for " added " services.)

I am copying Keehn's response to below, because I think it is

important to hear from someone with education, experience, and if I could be so

bold, heart. She said it as well as anyone could:

- When I hear things like this I definitely understand the reason for

conflict and I know it creates tension. I spent 30 years in an acute care

hospital and had plenty of opportunity to work through these kinds of

situations. Here is some advice- since you asked! If you can look at this in

a patient centered way then I think the question is how does your organization

take care of this patient's skin vs. is skin care a PT or nursing role. I am

very well aware of the challenges related to billable time, productivity,

respect for roles, etc. In reality your organization does not have to issue a

charge for a whirlpool bath that is used to for skin care as PT and then it

only matters who can do it safely and effectively.

I realize that you may have internal policies and procedures that get in the

way, and that depending on where you are practicing your licensure law should

be reviewed but I would encourage you to look at the patient's need first and

then figure out the best way to meet them.

Obviously since we don't have any clinical data on this patient it isn't

possible to tell if a " whirlpool bath " would be helpful, harmful, make the

patient feel better or worse. We don't know what your workload is in order to

tell if taking time for this patient would keep a patient who has higher

priority needs from being seen. Those (along with a few others that others

would think of) are the things that should be considered with less focus on

turf.

Good luck!

Keehn, PT, DPT, MHPE

Chicago, IL

Dave Milano, PT, Rehabilitation Director

Laurel Health System

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

kitiara_99

Sent: Tuesday, February 01, 2011 10:40 PM

To: PTManager

Subject: Re: Some help please- Nursing vs. PT!

Thank you all so much for the advice. I am at a loss at how to defend myself at

work right now. I refused to do the whirlpool and was given a written warning

for it. I really am on the verge of being fired over it and I am really at the

end of my rope.

Does anyone have a written definition for " skin integrity " and how it applies to

P.T.?

Thank you!

~~

> >

> > , it is your clinical decision, not nursing. Your evaluation of

> > the patient determines skilled therapy intervention, no one should do

> > that for you.

> >

> > Ron Barbato PT

> > Administrative Director, Rehabilitation Services

> > Program Director, Cancer Support Services

> > Ephraim McDowell Health

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> > rbarbato@

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> >

> > Some help please- Nursing vs. PT!

> >

> > Recently, there has been a conflict at my place of work in regards to PT

> > roles and Nursing. I was asked to give a patient a bath in the Rehab

> > Department whirlpool for dry skin. I have always been told that, if it

> > is something that Nursing can take care of (transferring a patient to a

> > chair, giving baths, etc...), that PTs should not get involved and

> > charge PT units for such services.

> >

> > What is this group's take on this? Does dry skin fall under the category

> > of " skin integrity impairment " to the point that PT should get involved?

> > Or should this strictly be Nursing's role?

> >

> > Thank you for your advice!

> >

> >

> >

> >

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