Each month, the CSP's professional advisers share advice and guidance on a topical matter.
Physiotherapists working as part of a ward-based nursing establishment
This is a great opportunity for the profession, but it needs to be right for patients and a good experience for staff. Find out how our professional advisers believe this situation should be approached
We see that in the right circumstances and with the right approaches, this staffing model has the potential to contribute to improved patient experience and outcomes. It can also provide physiotherapists with a rewarding opportunity to influence ward culture. That means moving from a care-based model towards one of rehabilitation and en-ablement.
If you are asked to consider this model in your services, or if as an individual physiotherapist you are asked to join a ward nursing team, it’s vital to success that the following issues are considered:
Identify and understand the problem or driver
It could be that a new approach to care is needed in a particular setting. For example, there is increasing evidence of the detrimental physical and emotional impact of a hospital stay on patients, particularly those who are older or living with frailty. Embedding physiotherapists in ward nursing teams, to directly lead and influence care that is more focused on rehabilitation, may be a really effective way to address the issue of hospital de-conditioning.
However, where the initial driver for change is a desire to manage significant nursing vacancies, care should be taken to ensure that the proposed altered skill mix brings something new and better to the team.
Could this change contribute to reduced length of stay for patients, or a reduction in clinical incidents that are likely to be linked to the effects of de-conditioning such as reduced mobility, falls, and pressure ulcers?
Define the job purpose and objectives
How will individuals in this role be required to work? It is highly unlikely that an individual will continue to work to a traditional physiotherapy job description and a number of traditional nursing duties will inevitably fall within the scope of this role.
- what will an individual be required to do?
- what behaviours, values, knowledge and skills will be required? Use the physiotherapy framework to map these to an appropriate level of clinical practice
- what additional competencies might be required? How will these be developed?
A particular issue to highlight is the additional time it might take to provide care when care is co-produced as more rehabilitative in nature. Nurse managers supporting the initiative must be clear on this; without this understanding expectations of the role may be unrealistic.
Scope of practice
Do the duties and responsibilities of an individual working in the role fall within the scope of the physiotherapy practice?
The CSP’s Professional Advice Service gives advice and support to members on complex and specialist enquiries about physiotherapy practice, including professional practice issues, standards, values and behaviours, international working, service design and commissioning, and policy in practice. Find out more at bit.ly/2D2tg3G
Read our information on scope – see box on right.
Most additional competencies required to work successfully in the role will fall within ‘kindred treatments’ such as medicines administration and wound care.
New ways of working often require new governance arrangements or enhancement of those that already exist. This will include arrangements to assure the new role functions within:
- legal frameworks, e.g. record keeping and duty of care
- the Health and Care Professions Council regulatory framework for physiotherapists
- the CSP code of members’ professional values and behaviours
Also think about:
- the possible risks of replacing a registered nurse with a physiotherapist. Undertake a risk assessment and consider how you will mitigate any risk identified
- how managerial and professional lines of accountability and responsibility will be put in place. There may need to be two separate reporting lines
- how support and supervision will be provided
- how changes to staff working patterns and implementation of adapted ways of working will be managed. Do this as early as possible and engage with CSP stewards
Measurement for improvement
Our final word: don’t forget to capture the impact of this approach. Has it improved patient safety? Has it reduced length of stay? Has it been a good experience for staff? Remember if you don’t count, it won’t count.
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