Rehabilitation nursing comes second nature to nurses at all levels at the Rusk Institute of Rehabilitation Medicine at NYU Langone Medical Center in New York City. But they say rehab nursing knowledge is by no means limited to rehabilitation settings and is especially integral to advanced practice nursing.
I think every encounter can be a rehab encounter, regardless of where you are in the transition of care of the patient, says Ana Mola, RN, MA, ANP-BC, CTTS, program director at Rusk.
Advanced practice nurses orchestrate care and integrate the team members that participate in patient recovery, she says.
According to Linda Pierce, RN, PhD, CRRN, CNS, FAHA, president of the Association of Rehabilitation Nurses, rehabilitation nursing touches all specialties. We really work with people with chronic illnesses and physical disabilities, Pierce says. We help those people [and their families] adapt to disabilities and achieve their greatest potential and work toward being productive, independent human beings.
The specialty can be practiced in almost all medical settings. Its really a philosophy of care. Its not just in the hospital setting on rehabilitation units; its not just done in clinics, Pierce says. The strategies and skills that we share with people can be [shared] at home, in the intensive care unit … across all specialties and all places.
The role of the rehabilitation nurse is especially vital today, says Shirley Ackerman, RN, PhD, CRRN, CDE, nurse clinician and education coordinator at Rusk. The role is ever expanding because of patient- and family-centered care, which really talks more about returning people to the community, Ackerman says. Rehabilitation nursing is about that process.
Nurses are ideal leaders in the process. Occupational and physical therapy have very specific roles, Ackerman says. Nursings role is 24/7 … and covers all areas.
Team EffortAna Mola, RN
All rehabilitation nurses practice multidisciplinary care. We work with the whole team: physical therapists, occupational therapists, speech therapists …, says Janet Mooney, RN, BSN, CRRN, staff nurse on the stroke unit at Helen Hayes Hospital in West Haverstraw, N.Y. For example, we have patients for most of their meals, so if theyre working on a particular swallowing strategy, we have to follow through to make sure that the aides follow through with the swallowing strategies. Its interconnected. I like that, and I think its satisfying. You see a lot of progress … and hopefully discharge patients in pretty good shape.
Advanced practice nurses take that a step further, educating patients and families, as staff nurses do, as well as referring patients for specific therapies and care.
As a nurse practitioner in New York state, I can prescribe medications, prescribe different forms of therapy, make mental health referrals …, Mola says. So we can really do everything that the physician does but with the nursing background [which emphasizes patient education].
The Rehabilitation Nursing Certification Board, a unit within the Association of Rehabilitation Nurses, is the organization that provides the Certified Rehabilitation Registered Nurse credential. Still, nurses can practice rehabilitation nursing without the certification, and many do.
Mary McDermott, RN, MS, NE-BC, assistant vice president of nursing at the Hospital for Special Surgery in Manhattan, says the hospital encourages certification and rewards nurses who achieve national certification. However, APNs on staff who are not dedicated to rehabilitation might opt instead for certifications in orthopedic nursing or, in the case of nurse practitioners, certification by the American Nurse Credentialing Center.
McDermott agrees that the knowledge, gained formally through certification or on the job, is valuable. With the aging population and the incidence of mobility limitations in the elderly, an advanced practice nurse, either an NP or CNS, who specializes in rehabilitation, would be an asset to the interdisciplinary team, both from a patient management perspective and a staff education perspective, McDermott says.
Rehabilitation nursing experience applies to inpatient and outpatient settings, the community and to people of all ages.
The opportunities are really unlimited, Ackerman says. Certainly, rehabilitation nurses have a place in the community, through any of the visiting nurse organizations, in sub-acute care … and in acute rehab nursing, which is what we do at Rusk.
The role is evolving with the complexities of care and ever-changing technology, says Piedad Angeles, RN, MA, NE-BC, nurse manager of the musculoskeletal unit at Rusk.
Rehab nurses are now challenged with learning new skills because of our patient populations, Angeles says. An example is we now do heparin drip titration. In the past the doctors managed that. Now, you also have ventilator patients who are non-ventilator dependent.
Rehab nurses have to have a global view of patient care, Ackerman says, by taking in all the elements that affect a patients recovery, sorting them out and synthesizing them into a plan of care.
Rehabilitation nursing also applies to pediatrics. Paula Reynolds, RN, MA, nurse manager of pediatric rehabilitation at Rusk, focuses on patients 2 months and older. She works closely with family members and others, such as teachers, to determine patients attitudes and behaviors to maximize recovery. What we do is before the patient is admitted, we work with the family to find out about special needs, Reynolds says.
For Pierce, who also is a professor at The University of Toledo (Ohio) College of Nursing, the value of rehabilitation nursing became crystal clear when her mother suffered a stroke years ago. Pierces backgrounds in advanced practice and rehabilitation nursing helped her mobilize members of her family to help her mother rebound, despite disability.
I think I was able to help not only mom and dad navigate the system but also help my dad care for my mother in the best possible way and to help her be all that she could be, Pierce says. The stroke affected the left side of her body. Yet, we were able to help her learn to feed herself and write using her right hand. My mother had a really good five years because we were able to work with her and help her learn other ways of doing things.