Panel Discussion: Rehab Nursing

On the show this week, we have a panel discussion on rehabilitation nursing and the impact this area of nursing care has on patients. On the panel with me are Kristen L. Mauk, Professor of Nursing and Kreft Endowed Chair at Valparaiso University, and Michelle Camicia, President of the Association of Rehabilitation Nurses. Here’s that panel discussion.

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PANEL DISCUSSION

Jamie Davis:         Kris and Michelle, welcome to Nursing Notes Live. So let’s start with Kris. Just out of curiosity, I always ask our panelists to share a little bit about their background in nursing. Tell us a little bit about why you decided to become a nurse and your career path through nursing.

Kris:                      Sure. Well, I was raised in a medical family. My dad and my brother are doctors and my mom was a nurse. So choosing something in healthcare was logical just from my upbringing but I really love just caring for people and especially I had a passion for caring for older adults. I was very close to my grandparents growing up. As they age, I just like to be around them and hear their stories and just feel kind of protected and wish that I had some more knowledge to kind of help them as they age. So that really influenced my career path into going – I went to Valparaiso University and obtained my BSN and then went on and get a Master’s and then nurse specialty in Gerontology and kept going on for more and more education related to Gerontology and Rehabilitation. So when I worked as a nursing assistant in a nursing home, I just felt like, “Wow, there’s got to be more than just custodial care.” That, for me, is where the rehabilitation piece came in. So that kind of really influenced my whole career path after – for quite a few decades now.

Jamie:                   Michelle, how about you?

Michelle:             Well, I actually started in a skilled nursing facility. My first job was working in a nursing home kitchen. I always wanted to be a veterinarian my whole entire life and I was very interested in science and caring for animals, so different kind of animals. I made friends with a nurse’s aide who work in a nursing home and they said, “Why don’t you come in and work on the unit as a nurse’s aide. So the facility paid me to go to become a nurse’s aide and I went for the training and I absolutely loved working with people. I loved working with people and, like Kris, I also very much enjoyed working with older people. And I loved helping the residents maintain their function and restore their function as a nurse’s aide and that was my early rehabilitation nursing days. Then I went to the ICU for a few years. I had a little distraction though I still, looking back, was rehabilitation nurse in that even in the ICU with post-op open heart patients and transplant patients and complex medical patients I was still working on maintaining function and promoting function even in the critically ill. Then I got back and realized that my passion was more in working with people for longer periods of time. That’s when I got into rehabilitation nursing where you spend a longer amount of time working very closely with the patients and their families and just loved watching people improve and maintain their function as well as helping them to adapt to their new lifestyle that may have resulted some disability or a disabling medical condition.

Jamie:                   You know it’s interesting how rehab nurses really are becoming so important in our current healthcare system. I know that they’ve always been important as an important part of the healthcare continuum but as our aging population continues to grow and people are facing major life incidents and illnesses and events that really rehabilitation and bringing them back to become functioning members of society again is just a hugely important part of that process.

Kris:                      Yes, it really is. I’m so happy that we have a very strong parent organization in the Association of Rehabilitation Nurses that provide so many resources and networking and educational programs that kind of help all of us who need to be providing that care. There is a huge need to have more nurses specialize in rehabilitation because, like you said, as the population is aging, we have more older adults and they’re living longer and they’re having chronic illnesses and they’re also active. So we see more brain injury, more spinal cord injury in people who are not as young anymore also. So there is a huge need for that specialty to grow.

Michelle:             They’re actually – we don’t just practice in rehabilitation hospitals. We practice in all settings. More and more, it’s wonderful actually to see the rehab nursing concepts integrated into acute care hospital, into intensive care units and the med-surg unit as there is a greater focus as you said on improving people’s function in this stage in life and realizing the value of maintaining function even during an acute or chronic illness situation in the acute care setting.

Jamie:                   Michelle, how does the rehab nurse integrate with that care team in an acute facility because I think so often we think of the rehab nurse, as you said, in either a rehab hospital facility or even in a long-term care setting but there really is a place as you said for that?

Michelle:             Yes. Actually, the vision of the Association of Rehabilitation Nurses is to transform healthcare by integrating rehabilitation nursing concepts and to care for all people. When we achieve our ultimate vision, rehabilitation nurse will not be associated with a setting as much as it is today. Really, it’s about the philosophy of rehabilitation nursing that the nurse embraces in providing care to our patients. So, as I said, in working in the ICU, I was practicing as a rehabilitation nurse when I was having my patient get out of bed as soon as possible post-op cardiovascular surgery. And looking at early mobilization, really, the true essence of patient family-centered care. It’s kind of fun because right now there’s – a lot of the buzz in healthcare are things that are really core to rehabilitation nurses and things that we’ve been doing for many years and things that we’re actually expert in. Patient Family-Centered Care is something that is the essence of our practice with our patients and families. So it’s been wonderful to watch our concepts become integrated into the acute care setting.

Jamie:                   Kris, what are your thoughts? Because I really think that, as Michelle said, it is really like the rehabilitation nurse’s role is the realization of the full nursing care process. It has to go that full process and rehabilitation nursing is really the end of that process.

Kris:                      Yes. I think you have really hit that right on the head. I am very fortunate to work in the university where we have always been able to, as part of our curriculum, teach rehabilitation nursing. So we have a course where a big portion of the course is dedicated to teaching nursing students how to manage people with brain injuries, spinal cord injury and neuro across multiple settings like Michelle said. So part of our vision at Association of Rehab Nurses too is also to integrate those concepts into the basic nursing curricula so that when nurses graduate, they’re all prepared to embrace those concepts of rehab. Whether they work in acute care like Michelle said or in patient rehab or in a skilled nursing facility, that it is more philosophy and a mindset than just the setting.

Jamie:                   So what are some of the things that you’re looking forward to, Michelle, in rehab nursing in the future? I know looking at your website there’s a lot of great information there and you have such a pretty – I wouldn’t say “ambitious” – but really exciting goals for your organization as a group to look forward to. But there are some things changing in the healthcare setting right now, how does rehab nursing fit in with the ongoing changes we’re seeing in healthcare here in the United States?

Michelle:             Well, as you could see from our website, www.rehabnurse.org, we do have a robust strategic plan and it is intended to position the association to effectively contribute to the health of the nation. And some of these ways include participating in health policy. We are just about to release a white paper on the rehabilitation nurse’s essential role in facilitating care transition. So of the work around care transitions we do have a specific expertise in in our specialty practice. So we’d like to contribute to that. As Kris said, we’re also looking to integrate the rehabilitation nursing content into nursing schools and Kris is really doing a great job of championing that. We also are looking at helping develop nurses to assume leadership roles within our profession. There’s such an amazing opportunity now for nurses to participate in policy development and really setting the standard for the healthcare in our country. It’s just a wonderful time to be a nurse leader and so we want to participate in developing nurse leaders to be able to be engaged in this great time in history. We’re also looking to contribute to research and we have a research agenda to really validate the work that we do as rehabilitation nurses and contributing to health promotion. Kris, do you want to add anything?

Kris:                      Well, I don’t know if you mentioned this but you kind of alluded to. We also have a task force that’s just going to be meeting for the first time in October. It’s looking at delineating a little bit more the competencies that we hope that people who work in rehabilitation or even basic rehab nursing competencies for nurses, all nurses in their basic programs, that we hope we can develop those and put those out there so that we can see people who are competent practicing in rehab nursing. We have had some competencies but we’re feeling like we need to focus on that a little bit more and have some wider dissemination of what basic competencies, someone who is working with people who need rehabilitation should have.

Jamie:                   Kris, you are leading the charge it sounds like in getting more of this into the curricula in various nursing programs around the country. What are some of the challenges you’re meeting with that? I’m sure that programs are chockfull of information in standards they already have to meet. Are they just resisting having to add something else to the project or program or is it more fundamental than that?

Kris:                      Well, I think part of it is curricula are pretty full and, as you’ve been a nurse for a while, you’ve noticed that you at least have smaller textbooks. Now our textbooks are getting fatter and fatter and we have more and more competencies of things. ARN has looked at what model would work best for us as far as leading a charge to integrate rehab concepts more so into the curriculum. We looked at models like the “ELNEC” (End of Life Nursing Consortium) or “GNEC,” that the Hartford Foundation has put out where they have taken – if we looked at ELNEC, we would say, “Well, End-of-Life concepts have been integrated across curricula and there’s people going to win awards for doing things like that.” So it’s really hard to do it on a national level but we’re kind of exploring what kind of model would fit best for us to get our rehab concepts out there better. I think some of the challenges, as I mentioned, are the curricula are already full and everybody wants their specialty to be emphasized. But we see rehab as being one of those very broad specialties that really does need to be integrated. So we’ll be examining those barriers even more fully if we looked at what model will work best for disseminating our information.

Jamie:                   Now I see you all have a conference coming up I think in just a couple of weeks, is that correct?

Michelle:             Next week.

Jamie:                   Next week. Wow. I always ask this question because I think that a lot of nurses just don’t get to their specialties’ conferences in the course of nursing of their nursing careers and I really think they should because of the networking opportunities and the educational opportunities that you find there. But what are some of the things or reasons you all find for going to attending these types of conferences in your professional endeavors?

Michelle:             It’s one of my favorite events of the year. It is so wonderful to get together with almost 1,000 nurses who have the same passion that I have and who share the same interests and share similar patient population. We come together and we learn a lot from the content, the educational content at the conference. But the best part about it is actually getting together, talking with other people, learning about what they’re experiencing. Problem-solving challenges that I may be having in my own practice. The synergy of that – that synthesis of information and of sharing and of networking is just so incredibly energizing. I always believe it recharges me through the year and so it reinforces my passion for nursing.

Kris:                      I would agree with that. I feel like it’s almost like a spiritual retreat every time I go to the conference because, it’s like what Michelle said, it’s more than just the educational piece which is wonderful. There are motivational speakers. But it’s the networking and it’s the empowerment that you feel and the encouragement. I feel like I can ride like the whole year till the next conference just on the enthusiasm and the energy and the passion that we get from our big group of rehab nurses. It’s really amazing to see.

Jamie:                   So if someone is listening to this, Kris, and they say, “Hey, I want to be a rehab nurse.” Maybe they’re in nursing school. Maybe they’ve been a nurse for a while and are looking for a change of venue, what are some of the skills or some of the things they need to do to prepare themselves for moving into rehab nursing?

Kris:                      Well, rehab nursing is a specialty just like oncology or orthopedics or pediatrics. So I think a good place to start is joining our organization so that you have support and access to educational material. If you really want to work in the specialty, you can become certified after working for a period of time and reviewing our core curriculum and taking an exam to get your certification. There’s many steps in that process to becoming a rehab nurse but the first one I think would be joining your parent organization and then finding a job in rehab where you can start to learn those skills. Michelle, would you add anything to that?

Michelle:             No, I think that covers it. As a matter of fact, [crosstalk 0:17:35.8] networking that can happen. We do have a Listserve and we also have a LinkedIn site. So that would be another venue to get connected.

Jamie:                   Are there particular set of skills that someone should be working on developing or is it just the general nursing skills of good solid patient assessment and things like that?

Michelle:             Well, there’s a big team component to rehabilitation nursing. So people have to have very strong interpersonal conflict resolution and team functioning skills. So those skills, some people think that are natural to some people but they really can be developed. So those are some skills that I think are really important in a rehabilitation nurse.

Kris:                      Yes. And I would add, there’s another big – even though we have competencies, like I said before, we are developing those to kind of really specify what are those key things that our rehab nurse should be able to do. Like Michelle pointed out, the communication, the teamwork and also the philosophy that, in rehab, we are teaching people to take care of themselves again, so that whole concept of self-care lesson. If a student had or a practicing nurse worked in say acute care med-surg for a long time, they may be more used to doing for the patient. But in rehabilitation, our mission is to like work ourselves out of the job. We want our patients to go home having adjusted and adapted to maybe a catastrophic life event that happened or their life will never be the same. But what the rehab nurse does is to equip that person along with the whole interdisciplinary team to be able to go home and still have a quality of life and fulfilled and satisfying life. So that’s a little bit different mindset that we would have than just your general acute care. We are teaching people to care for themselves for the rest of their lives with a disability or with a chronic illness.

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Make sure you check out the entire September, 2013 issue of Nursing Notes, where we look at rehabilitation nursing and it’s impact on patient care. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month bringing you a very special interview with 2013 Amazing Nurse Gloria Kindzeka, a pediatric home care nurse nominated by one the mothers of one of her patients. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes