How To Better Communicate With Co-workers: Communication skills with nurses, social workers, case managers

The previous editions of the weekly newsletter have focused more on research and data driven conversation, in this edition I’d like to take more of a subjective approach to the topic and make this more of a “food for thought” topic and maybe clue in to some of the things that I’ve talked to the nurses, case managers and social workers about at my particular hospital. Maybe you have a similar experience, maybe you can take something here and utilize it in your own place or work, or maybe this will just be something to think about in your day to day work that maybe you hadn’t though of before.

Promoting Better Communication​

I’ve gotten feedback that sometimes the abbreviations we use in PT may be intuitive and understandable to use because we learned them in school and consistently use them. But think about someone who may not have had that same schooling and is reading our notes trying to understand them for discharge purposes. Right off the bat someone may not understand SBA stands for stand by assist, or SPT for stand pivot transfer, HHA for hand hold assist, GB for grab bars. These are things we would easily understand but maybe a case manager or social worker who’s trying to set up an appropriate discharge destination or home equipment may not understand. So it may increase the ease of our documentation and speed, but just keep in the back of your mind, would this acronym be something that may be difficult to understand to someone with limited hospital or PT experience?

The contents of your note are important, not just for liability or for your fellow therapist that may be following you, but nurses will sometimes read your note to see what level of function the patient is able to safely achieve and if they could safely mobilize them to the commode or bathroom if needed, if they would require a walker to do so and if they should bring oxygen or have a second person for safety. This is another reason why our notes are helpful and important, if in your note it is just a short note stating you walked the patient 10 feet with a walker but you leave no details or any information about the quality of the patient’s walking like how unsteady they were, if they had a loss of balance you had to correct, if the had a significant forward lean, if they had trouble negotiating the walker, where that 10 feet of walking occurred, these are things that make a big difference in safety of the patient and staff, where they just see the patient is able to walk 10 feet and try to walk the patient to the bathroom which is 10 feet away where you just walked the patient 10 feet total along the edge of bed because of a posterior lean or instability that made walking away from the bed unsafe, or you walked 10 feet but they had a lot of instances of LOB along the way and you only feel safe with a PT or OT working with that patient, if you don’t communicate that to the nurse or put that in your note there is no way that gets passed to the next nurse or night shift and could ultimately result in a fall if not careful.

These details also help with discharge planning, the more details in your note and in your discharge recommendation the easier it will be for the case manager and social worker to work on discharge planning, along with this would include timely note writing so they can start working on insurance authorization and contacting facilities for bed availability as soon as possible and don’t have to wait on our note or ask for our note to be in the system.

Respectful Communication

You will work closely on a daily basis with the nursing staff so having a good relationship with them and being able to communicate in a professional way is very helpful. If you have ever worked in the ICU the nurses may include more advanced information such as names or types of medications, lines the patient has, or alertness scores, things like arterial lines, pressors, sedation medication, or RASS score for sedation and awareness level. If you understand what these things mean for how the patient will be able to perform or participate with PT and how they clue in to their appropriateness for PT you can have a more informed and professional dialogue with them about maybe they can lower some of the sedation medications since they are on multiple or lower the level of the one they are on, if they are on 4 pressor medications and on high levels you can realize the patient is very critical and likely not appropriate to be seen for mobility at this time and know when not to push for mobility.

When you have this better level of communication and relationship you can feel more comfortable pushing for mobility when it is appropriate and when the nurse may feel slightly unsure about the appropriateness but you feel confident with your knowledge of the patient’s current status and chart review so you can reassure the nurse and they will be more likely to trust you because of the knowledge they have that you have a good understanding of the risks and their medical concerns.