PT placement rant

[jesse14]

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This will be short and sweet.....
i'm on my 1st hospital based PT placement and wow i'm i hating it!!! I didn't go to school for 6 years, bust my ***** studying, and getting good grades just to walk pts around the hospital all day!!

This is my day: go room to room, wake up old sick people and beg them to go for a 2 minute walk. On occasion they will say no, sometimes with hatred in their voices, and other times i will have to transfer them to said ambulatory aid. Sometimes, i'f i'm lucky, i'll get to teach a new admission how to use an insenstive spirometer...
My other placement at an outpt MSK clinic DESTROYED this placement in terms of having to think and apply clinical reasoning skills.. you know, the stuff you learn in school.

In my opinion, hospital PT is a needed, but i do NOT at like it.. i need to use my brain and hospital based PT seems way too cookie cutterish to me

That is all 🙂

 

[kcgregor]

That sucks. How long is this rotation?

 

[jesse14]

That sucks. How long is this rotation?

its 6 weeks in total and i'm mid way done the 3rd week. I dread having to go to work in a few minutes... its sad, really. It's frustrating to know that a PTA can EASILY do this sort of job with very little education.

Is this really what inpatient PT is like??..getting people to walk and do stairs all day long??

 

[truthseeker]

jesse,

I feel your pain. I worked for 5 years in the MSK OP sexy sports med clinic, then to a rural hospital to raise a family. I have to do all of that but the majority of my practice is still OP ortho.

The moral of the story is learn something. You get more lab value, medical exposure during the hospital rotation than you do at OP clinics. take in as much as you can.

I fight a constant battle with the doctors and the nurses. We are not walking aids or the transfer team. If it is not skilled, I discharge them. Walking for fitness and pulmonary health maintenance or bowel health is not what we are here for. Your CI might be content with just being the walking guy or the transfer to the commode guy but don't ffall for it.

6 weeks seems a long time but it will be over before you know it.

 

[jesse14]

jesse,

I feel your pain. I worked for 5 years in the MSK OP sexy sports med clinic, then to a rural hospital to raise a family. I have to do all of that but the majority of my practice is still OP ortho.

The moral of the story is learn something. You get more lab value, medical exposure during the hospital rotation than you do at OP clinics. take in as much as you can.

I fight a constant battle with the doctors and the nurses. We are not walking aids or the transfer team. If it is not skilled, I discharge them. Walking for fitness and pulmonary health maintenance or bowel health is not what we are here for. Your CI might be content with just being the walking guy or the transfer to the commode guy but don't ffall for it.

6 weeks seems a long time but it will be over before you know it.

that hit the nail on the head. She doesn't seem to mind being a "rent-a-wheelchair" kind of therapist. I on the other hand want to harness my assessemnt and dx skills which i cant do in this setting! WHAT A WASTE!!

 

[DPT ATC]

So far all I am seeing in this thread are a bunch of ignorant people complaining. I'm not someone that loves the inpatient setting, I'm definitely an outpatient person. However, if all you think goes on in acute care is taking people for a walk I feel bad for your patients! You are not fulfilling the role that you should be. Are you assessing vitals and the response to getting up and moving? Are you assessing their home environment, family situation, the needs of the patients after discharge? There is a lot of decision making that should be going on to ensure that the patient is being discharge to the right setting, is going to be safe, and is going to have the correct follow up care. Plus, it will make you a better, more well rounded and more understanding PT in the future whatever setting you choose to work in. You'll get out what you put in, think about it.

 

[jesse14]

So far all I am seeing in this thread are a bunch of ignorant people complaining. I'm not someone that loves the inpatient setting, I'm definitely an outpatient person. However, if all you think goes on in acute care is taking people for a walk I feel bad for your patients! You are not fulfilling the role that you should be. Are you assessing vitals and the response to getting up and moving? Are you assessing their home environment, family situation, the needs of the patients after discharge? There is a lot of decision making that should be going on to ensure that the patient is being discharge to the right setting, is going to be safe, and is going to have the correct follow up care. Plus, it will make you a better, more well rounded and more understanding PT in the future whatever setting you choose to work in. You'll get out what you put in, think about it.

Ok, i apolagize. 6 weeks of asking people how many stairs they have to get in their house, who they live with, what activities they do is NOT why i went into physio. Yes, taking a history is very important, but from my limited experience, inpatient PT's are glorified porters. I LOVE this profession in so many ways, but after this expereince i am dismayed by the limited role PTs play in the hosp setting. Like i said, walking people around all day does not come close to utilizing the skills and abilties we are trained to use. I almost find it insulting in my opinion that PT's are delegated to having to do this job day in and day out. In my outpt MSK placement, i took detailed histories, read doctor reports, used EVIDENCE BASED tests to assess a pts problem and then come up with a solid treatment approach consisting of mobs, stretches, exercise, and education etc. I'm no expert at this early juncture in my career, but i can safely say that outpt PT is where we get to utilize the full scope of our practice. Maybe i'm wrong, but you seldom have to use any critical thought in inpt PT... who knows, maybe that's appealing to some people...

 

[callmecrazy]

This is really disheartening to hear PTs/future PTs talk like this. You are a professional, and if you aren't happy with how things are going then you need to do something about it. Ranting is understandable, but when you are done ranting you should really look at how you can be proactive. No matter what situation you are in, there is loads of information to be absorbed and an impact to be made.

In my outpt MSK placement, i took detailed histories, read doctor reports, used EVIDENCE BASED tests to assess a pts problem and then come up with a solid treatment approach consisting of mobs, stretches, exercise, and education etc. I'm no expert at this early juncture in my career, but i can safely say that outpt PT is where we get to utilize the full scope of our practice. Maybe i'm wrong, but you seldom have to use any critical thought in inpt PT... who knows, maybe that's appealing to some people...

If you have the ability to, then why are you not doing the same thing with your current patients? Your patients, even in-patients, are not from a cookie cutter! You are the therapist, and you write the plan of care. If you are just walking every patient up and down the hall, then what are you really doing for them? Is that really all they need? Do they need more? Do they need you at all? If you are not using critical thought to assess your patients, then that is only because you have chosen not to. If it's a problem with your CI telling you this is just how it is, I'd suggest talking to an advisor or clinical coordinator at your school.

Hopefully, with a proactive approach, you can make it a positive experience!

 

[truthseeker]

Ok, i apolagize. 6 weeks of asking people how many stairs they have to get in their house, who they live with, what activities they do is NOT why i went into physio. Yes, taking a history is very important, but from my limited experience, inpatient PT's are glorified porters. I LOVE this profession in so many ways, but after this expereince i am dismayed by the limited role PTs play in the hosp setting. Like i said, walking people around all day does not come close to utilizing the skills and abilties we are trained to use. I almost find it insulting in my opinion that PT's are delegated to having to do this job day in and day out. In my outpt MSK placement, i took detailed histories, read doctor reports, used EVIDENCE BASED tests to assess a pts problem and then come up with a solid treatment approach consisting of mobs, stretches, exercise, and education etc. I'm no expert at this early juncture in my career, but i can safely say that outpt PT is where we get to utilize the full scope of our practice. Maybe i'm wrong, but you seldom have to use any critical thought in inpt PT... who knows, maybe that's appealing to some people...

jesse,

I agree with what callmecrazy wrote. You are focusing too much on the way it is being done perhaps by your CI. the Tinetti and Berg balance assessments are evidence based, early ROM recovery and proper gait as factors that improve long term outcomes for TKA patients are evidence based. I think what you are failing to see is that the patients you see in the OP ortho clinic were once the people you are seeing now. You forget that the continuum of rehab starts when the surgical patient wakes up. These people are just earlier in the process.

At the OP clinic did you ever bitch about the condition of a patient when you got them because of the &$@%$* PT that saw them as an inpatient? Don't be that person.

Do not belittle PTs that like to do what you DON'T like to do. be happy that they exist. I have a therapist that works for me that loves to work at the SNF and do home health, and see pelvic floor weakness/incontenence patients. I don't. Do I think less of her? NO, absolutely not, I am glad she is here to do what I don't like. She doesn't like the MSK ortho stuff, and she is glad I am here.

Lighten up, learn something and don't be so damn judgemental. If it is skilled bring your skill. It may be a low functioning person but the will become the person seen at the ortho clinic. Make sure you do your part of the rehab.

 

[Akiramay]

@truthseeker: Wow. Well said.

 

[Cyres]

I think some here are living in "idealist land". Acute care usually involve 20-30 scheduled patients a day... my experiences anyway. Did I schedule them? No. Did I have any significant control over my schedule? No. Does jessept or his/her CI? Likely not. So assuming that they're dealing with a similar case load that alots for ~15 mintues of treatment/evaluation per patient with ~5 minute pre-treatment chart review and ~5 minute post treatment documentation. Thats just enough time to assess the patient as you get them sitting, standing, short walk/exercises, back into bed and toss some general gait or transfer instructions in to the mix. Time does not permit for detailed tests and measures. Plan of care? Pts are discharged or tranferred without input from or consult with the therapist -- making a POC almost moot. Acute physiotherapy is important, but the system reduces the skilled aspect of it and leaves the impression that it is not skilled to those who watch it. How many times on this forum have you heard people say something to the affect, "My friend is a ____ and he/she says therapists in the hosptial just transfer or walk patients up and down the halls all day, I'm not sure I want to do that so I'm thinking about _____ instead."? There is a reason.
Now you've heard from the devil's advocate.
Jessept: See if you can get some wound care worked in, that was/is the highlight of acute care for me.

 

[jesse14]

I think some here are living in "idealist land". Acute care usually involve 20-30 scheduled patients a day... my experiences anyway. Did I schedule them? No. Did I have any significant control over my schedule? No. Does jessept or his/her CI? Likely not. So assuming that they're dealing with a similar case load that alots for ~15 mintues of treatment/evaluation per patient with ~5 minute pre-treatment chart review and ~5 minute post treatment documentation. Thats just enough time to assess the patient as you get them sitting, standing, short walk/exercises, back into bed and toss some general gait or transfer instructions in to the mix. Time does not permit for detailed tests and measures. Plan of care? Pts are discharged or tranferred without input from or consult with the therapist -- making a POC almost moot. Acute physiotherapy is important, but the system reduces the skilled aspect of it and leaves the impression that it is not skilled to those who watch it. How many times on this forum have you heard people say something to the affect, "My friend is a ____ and he/she says therapists in the hosptial just transfer or walk patients up and down the halls all day, I'm not sure I want to do that so I'm thinking about _____ instead."? There is a reason.
Now you've heard from the devil's advocate.
Jessept: See if you can get some wound care worked in, that was/is the highlight of acute care for me.

This is EXACTLY what I was going to say. I see 25-35 pts a day and have very little time with them. I don't plan anything... it's written out by the Dr and you have to obey them as per hospital protocal. I don't care what you guys have said.. its NOT like that in the real world. I get 10 mins (if that) per pt and all i can do is walk them up and down the hall because that's what the transfer order has said I must do. That is ALL i did today at work. My CI and the other therapists at the hospital are content with that job... i am not. I stand by what i said. We are trained much better that how we are utilized in the hospital setting. There is no bitching or moaning about it. I can't understand why there is such delussional thinking on this forum at times. I love PT and wnat it to grow... stepping into the hospital setting has made me see that there is much more to be done.

 

[truthseeker]

Jesse,

It may be that way where you and Cyres are but it doesn't have to be that way. Gait training is a skilled service but requires that documentation indicate that you discussed stride length and/or propulsion, stance width, velocity, etc . . . correcting the patient's gait or making them more efficient or teaching them how to use an assistive device. Simply walking the patient is NOT gait training and is not skilled. If your CI is billing for gait training and documenting "pt. ambulated 150 feet with contact guard assist and a front wheeled walker" it is fraud to bill gait training. It is your CI's job to stand up and say, 25 patients per day, and 12 of them are skilled, the rest can be walked by nursing or respiratory therapy, or heck, with a family member. I tell the doctors that nursing is standard equipment but PT is an option, like a GPS in the car. If you need it, you pay extra and for the insurance companies, you have to prove that what you do is skilled and only a PT can do it.

If you are in this situation I am sorry for you. You should speak with your faculty at school and have them address the situation or maybe take that location off of their list of clinical sites.

That said, too many PTs operate that way in an inpatient setting. I believe that the determining factor is to set a bright white line between what is and is not skilled.

 

[MinnDasota]

Everyone here pretty much makes a valid point. Each setting is different but remember, in outpt ortho, the pt had to get through the initial steps of rehab to get to you. This meaning, getting the pt to learn to walk again with the appropriate assistive device, transfers, etc in preparation for a quick DC to the next phase of rehab.

In the end, it is all part of our field and must be learned at some point of our careers. The way I see it, the PTs in acute are the most important in the step towards recovery as they are the first one's to truly move and educate the pt. Even if it is just to walk or get out of bed. I have worked or trained in most settings and know how you feel JessPT.

I hope it gets better for you. If anything, I hope that you get something out of it. At least you know that acute is not the setting that you want to practice. Maybe it will give you a chance to really work on taking vital signs, or really teach you how to use a cpm, or even teach you a little about lines and leads. Even if it isn't utilizing your clinical skills to the fullest, hopefully it is exposing you to the broader spectrum of the hospital setting.

 

[callmecrazy]

Being proactive and seeking positive change is the sign of a professional that is dedicated to their field. It is probably safe to say that the dr writing the plan, the therapist doing no actual eval, and the pt being walked down the hall for 10 minutes or less is a bad situation for everyone. The patient is not getting the care that they deserve, and the therapist is not able to properly do their job. It seems that the PTs employed at this particular setting are happy to just roll with that. Any PT worth their title should NOT be ok with that. Rather than run away to a different setting though, why wouldn't you want to speak up? Your voice is limited as a student, absolutely, but that all changes once you are done with school. There will never be the growth you want if no one ever questions the status quo and instead just says "yes, ok" to whatever the MD says.

This is not how all inpatient settings work either. There are places in the "real world" where therapists spend all the time they need evaluating and treating their inpatients. It's not delusional; it really happens at good hospitals.

 

[djtrackie]

that's exactly what I did in my in-patient rotation.

Agreed 100%.