Blurring the boundaries

Lauren Urch took on a role that eased pressure on nursing colleagues and helped her develop too.

In April 2017 I started as ‘ward therapist’ on a respiratory ward at the Royal United Hospital (RUH), Bath. The role is a response to increasing staff nurse vacancies and is a way to assist with the caseload.  
The idea is that a more therapeutic approach will assist in reducing length of stay, change discharge pathways and improve patients’ experiences of care. In doing so it will alleviate pressure on acute wards. 
As ward therapist, I did early or late nursing shifts, Monday to Friday,but continued my weekend working responsibilities on the physio rota.I was managed by the band 7 nursing grade but supervised by the physiotherapy band 7.
I was given a lot of trust and autonomy, which was flattering but also overwhelming, although I was well supported by our CSP stewards.
Initially, I spent time shadowing different members of the ward team and upskilling in areas specific to the ward, including end-of-life care, inhalers, nebulisers and chest drains. I was trained in the high dependency bay and am now able to set up and adjust non-invasive ventilation (NIV) and high-flow oxygen. We do not run a physiotherapy-led NIV service so this was invaluable in terms of my respiratory and on-call responsibilities. 
The aims of the project were to promote patient independence and flow by adopting a rehabilitative approach and to release time to care. It wasn’t easy getting the balance right every day. Sometimes tasks had less therapeutic value and when they did I tried to focus on helping patients get out of bed to sit and eat, for example, as opposed to helping to serve meals, and promoting independence with personal care. 
I also focused heavily on reducing ‘pyjama paralysis’ and promoting the ‘home first’ motto, while supporting nursing and therapy staff by being heavily involved in managing patients’ stays. I kept mobility charts and walking aids up to date and ensured patients had the correct seating. I carried out ad hoc assessments and treatments while supporting new admissions and answering buzzers. This was all crucial in early screening and discharge planning, and reduced deconditioning while patients waited for community hospital rehabilitation.  
Ultimately, supporting patients to wash and dress themselves might take more time at first but saves time later because ward staff no longer need to do it. In turn, this reduces inappropriate referrals to physiotherapy.  
I left with ward staff feeling more confident about positive risk-taking and empowering patients.
As a result of this trial there are now eight ward therapists across the RUH. I feel these roles are the future in terms of ensuring high quality, efficient patient care in the acute setting. And they are brilliant for learning new skills. I have developed enormously, personally and professionally.
  • Lauren Urch is a band 5 rotational physiotherapist, Royal United Hospital, Bath

Lauren Urch band 5 rotational physiotherapist, Royal United Hospital, Bath

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