The Who's Who of Your Healthcare Team

As a nurse, even I have a hard time keeping track of who's who in the hospital. With everyone wearing scrub uniforms, it is hard to tell if someone is part of the nursing staff or the housekeeping team. Even after you are able to read the title on their badges, you may still not know the who's who of your healthcare team.

Knowing what each person does is important when you are asking for help.

In addition to your primary care physician, here is a breakdown of the other members of your healthcare "team" and how they may be involved in your care.

The Team:

Your healthcare team is made up of nursing staff, physical rehabilitation, respiratory therapy, social services, dietary/nutritionist, and discharge planning.

Your team of nurses consists of a Registered Nurse (RN), a Licensed Vocational Nurse(LVN) (also called a licensed practical nurse LPN) and a Certified Nurse's Assistant (also called a Certified Nurse's Aide CNA).

To be licensed, Nurses and LPN's must meet educational and clinical requirements in addition to passing an examination administered by the Nursing Board for the state, country and/or province. To maintain their license, they must complete a specific number of continuing education course hours.

Nursing assistants are not required to pass a test. They may have received their training on the job, through a vocational school or they may be students within the nursing profession.

Nursing assistants are forbidden to give any medications and are restricted from providing treatments such as wound care.

It is important to know that, while both RN's and LPN/LVN's are able to administer medications, only RN's are licensed to administer medications via some form of intravenous (IV) access.

Registered nurses practice under the orders of a physician while Licensed Vocational Nurses and Aides are directed by the Registered Nurse.

Your Physical Rehabilitation Team:

While your nursing team is part of the rehabilitation process, (the process of recovery from your injury or illness), when you say "rehab team" typically the who's who that you are referring to is the physical therapist, occupational therapist, and speech therapist.

Physical Therapists:

Your physical therapy team is made up of Physical Therapist (also known as licensed physical therapist/LPT, registered physical therapist RPT or PT) Physical Therapy Assistants (PT Assistants or PTA's) and Physical Therapy aides.

In generally, physical therapy is designed to help improve your strength, mobility and over-all fitness.

They are also responsible for evaluating and instructing you in the use of mobility devices ranging from which cane is right for you, to determining a suitable wheelchair or motorized mobility device. Each device is measured by the RPT to insure they meet your individualized needs.

Physical therapists are also responsible for measuring, fitting and instructing you in the use of any prosthetic devices (a prosthetic leg, for example). Depending upon state regulations, and with further training, physical therapists can use a scalpel when performing wound care when ordered by a physician (unless they have special certification, nurses are restricted from using scalpels).

While the physical therapist and assistants must meet educational and clinical requirements to be eligible to sit for their licensing examination, physical therapy aides receive their training on-the-job, via a vocational school or are students of a therapy program.

Registered Physical Therapists are responsible for evaluating your needs, establishing a plan of treatment based on their evaluation, making changes to your treatment plan and/or discharging you from physical therapy services.

Physical Therapy assistants are licensed to carry out the RPT's "orders". PT aides must work directly with either an RPT or PT assistant. Their function is to provide support to the RPT or PT assistant.

Occupational Therapists:

If you are having problems performing your own "activities of daily living" (ADL's) such as bathing, cooking, feeding and dressing yourself, your physician may request an Occupational Therapist to help in your rehabilitation.

Some may think of physical therapists as working with your gross motor function (big muscles ...walking, lifting etc.) while occupational therapists focus on fine motor tasks (including any tasks involving your hands). However, there can be some overlap between the physical and occupational therapists in the care and treatment they provide.

In the who's who of the hospital team, like nurses and physical therapists, Occupational Therapists (OT's) may be assisted by Certified Occupational Therapy Assistants (COTA's) and/or an aide. OT's and COTA's must meet both the educational and clinical requirements before they are able to sit for their licensing examination.

Like the RN and RPT, the OT is responsible for the initial evaluation and creation of a personalized plan of treatment. They are also responsible for making any changes or adjustments in your treatment plan and discharging you from their care.

Certified Occupational Therapy Assistants are responsible for carrying out the established plan of treatment set up by the OT. Occupational therapy aides are often trained on-the-job and may be "shared" between the physical therapist and the occupational therapist. The aide's role is to support both the occupational therapy assistant and occupational therapist.

Speech Therapists:

Speech therapists (speech language pathologists or SLP's) are solo acts! Unlike physical therapists and nurses, speech therapists do not have assistants or aides. Speech therapists utilize computers, picture boards, or various electronic devices to help restore your ability to communicate. They help you to learn how to move food around in your mouth, co-ordinate the process of swallowing to prevent choking and teach you how to prevent food and fluids from entering your lungs. They also work with people who have voice disorders, and cognitive (thinking) impairment.

They too must meet educational and clinical requirements before being allowed to sit for their licensing examination, in most states are governed by state regulation, and have requirements for continuing education to maintain their license.

Who's Who in Additional Healthcare Team Members :

Additional healthcare team members who may be involved in your care and recovery include registered dieticians, registered respiratory therapists, and social workers, in addition to members from case management and utilization review (who usually are licensed nurses and/or social workers).

Respiratory therapists are not only responsible for providing you with breathing treatments, they are also responsible for managing ventilators, incubators, oxygen masks (or cannula devices which fit in your nose), obtaining arterial blood gas samples (ABG's) which aid in evaluating how well your body is able to bring oxygen into your body, training and assisting you with breathing exercises, in addition to evaluating patient's respiratory needs and discharging them from care once they have stabilized.

Respiratory therapists may be aided by Respiratory Technicians. Respiratory technicians maintain and test respiratory equipment and may provide breathing treatments to less critical patients. Unlike the respiratory therapists, they are not able to evaluate or discharge patients.

Dieticians/nutritionists help plan your meals and assess your nutritional needs. If you have any dietary restrictions, or have any difficulties swallowing or chewing, the dietician will assess each meal to insure it meets your dietary and caloric requirements. They will also provide you with instructions if the dietary restrictions are new to you.

Social workers wear multiple "hats"/job duties depending on the hospital's job requirements. Their primary function is to evaluate your social and psychological needs.

Discharge Planning Team is made up of utilization review nurses, and case managers/discharge planners. The discharge team works behind the scene interfacing with nurses, members of the rehab team, physicians and your insurance carrier to insure that you receive the right care in the right setting.

If you are concerned about going home alone or if you feel you have special needs that should be addressed before you go home, you will want to speak with the discharge planner and/or case manager assigned to your care to help you address these needs.

A Brief Word About Shortages:

I am sure you are aware of the shortage of nurses as well as the shortage of other healthcare team members.

Because of the educational and clinical requirements usually taking well over four years to complete, sadly, I am afraid, there will always be more of "you" (patients) than there will be of "us" (the who's who).

There are very few schools which are able to provide programs for nurses, therapists (whether they are speech, physical, occupational, or respiratory therapists) nutritionists and social workers. As a result, the education and clinical training tends to be very costly.

While the number of schools is limited, the number of individuals enrolling in the schools is even smaller. The physical and emotional demands also tend to shorten the "life expectancy" of most healthcare professionals.

I am mentioning this with the hope that you will have patience with your healthcare team. Please know that we are trying to give 150% of ourselves to you and the other patients in our charge.

The best thing you can do is help us help you!

Don't be a passive participant in your healthcare. Be pro-active. Follow through with your exercises; learn as much as you can about your healthcare condition(s); write things down whether they be questions or observations of things that make you feel better and/or worse.

You are the most important member of your healthcare team!

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