Re: Some help please- Nursing vs. PT!

February 2, 2011

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.

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

> >

February 2, 2011

I stand by my first answer, and add that PT is not an " ordered service "

( like lab) but a skilled intervention requiring the knowledge of the

evaluating therapist to determine if therapy is necessary.

Sounds like you need to do a little education for your superiors,

including the MD's. I'd come prepared with the definition of skilled

intervention as defined by CMS guidelines. That is a good start.

In this case I would suggest that an evaluation (or screen) be ordered

(only.)

You can then make the treatment/intervention decisions

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/

>

February 2, 2011