It feels like just yesterday I was writing about my first clinical and now, I am finished with the second! For this experience, I traded my polos for scrubs and learned all about the world of acute care. Now that I had more coursework and one clinical under my belt, I felt more confident in many of my skills and had a better idea of what to expect. However, the acute setting is very different than outpatient so there was so much to learn! Similar to my first clinical, I was excited but nervous in the days leading up to it. Honestly, acute care was very intimidating to me at first. In school, acute care practicals stress me out more than any other kind of practical because there is so much to think about and things are constantly changing. You often have to be able to think quickly on the spot in order to keep your patient safe. Although I was nervous and wasn’t sure that I could see myself working in this setting, I put all of this aside and went in with an open mind and a willingness to learn. It turns out, I like acute care way more than I thought I would!
Overview of my clinical
In the hospital I worked at, PTs rotate units every few months. I thought this was super cool because it gives you consistency over those few months, but it also allows you to change it up and work with all different patient populations. During my rotation, my clinical instructor (CI) was on the cardiopulmonary unit, which is her personal favorite. We primarily worked on progressive and cardiac step-down units. I saw patients with conditions such as acute congestive heart failure, atrial fibrillation, hypoxia, hypertensive urgency, critical limb ischemia, and sepsis. Many of them were post-op cardiac surgeries such as valve repairs, bypass grafts, and vascular-related amputations. I also occasionally saw patients who experienced strokes or fractures. We don’t take our cardiopulmonary course until our third year so being on this unit was very challenging for me, but I learned so much!
Here are some key points I took away from my 8 weeks in acute care!
Flexibility is key!
In outpatient, there is a set schedule. I knew which patients I was seeing and when. In acute care, you have a list of patients assigned to you, but you create your own schedule and that schedule will most likely change several times throughout the day. Patients may experience complications or have procedures that make them unable to participate in therapy. You may catch them during lunch or they may not be willing to participate when you come. When this happens, you have to change plans and find another patient to see.
Not only is flexibility important when it comes to scheduling, but it is even more important when it comes to each session. Acute care PT includes a lot of new patient evaluations, so you are working with new patients every day. In fact, many of my classmates only saw evaluations during their acute care clinicals. I was able to complete a lot of treatments during my rotation, but even when I went into a session with a patient I was familiar with, I never fully knew what to expect because, once again, things are constantly changing. I had patients who were walking in the hallway one day, but then the next day they struggled to sit up in bed. When a change in status such as this happens, you have to adjust your treatment accordingly.
This more chaotic world was difficult for me to adjust to at first because I am very much a planner and thrive on routine. However, once I learned to have a plan A, B, and C in place, I grew to enjoy it. Every single day was so different and I loved the variety.
Tubes, lines, and drains aren’t as scary as they seem!
The first time I walked into a patient’s room and saw all of the lines they were attached to I was overwhelmed. I was so worried I was going to unplug something I wasn’t supposed to or pull out an IV. The majority of the patients I saw were hooked up to a cardiac monitor that monitored the electrical activity of the heart, blood pressure and oxygen. Many of them also had other lines/tubes such as oxygen, IVs, wound vacs, catheters, and chest tubes. It took me several weeks to become comfortable untangling all of the lines, removing what I can, and making sure they were all in a proper position to get the patient up and out of bed. I learned to take it one line at a time instead of looking at them all together. I also found it helpful to let the patient know that it is going to take me a minute to get everything untangled. This way, I didn’t feel as rushed because my patient knew what to expect.
Transferring real patients is much different than transferring your classmates.
We learned how to perform transfers my first year of PT school, and, like lines, they are something that can be intimidating. I practiced them so many times on my classmates, but it’s hard to be a fake patient, and performing transfers in the real world is much different than in the classroom. In school we were taught the importance of body mechanics, setting up the environment, and giving clear instructions to patients. During this clinical, I learned just how important all of this was. Many patients have not been out of bed for days, and it is up to the PT to determine the safest, most effective way to help them mobilize. This is different for every patient and depends on so many factors. I also learned the importance of taking a step back and letting a patient try (depending on the situation). I feel like this was one of the most difficult parts for me as a student because in school we are taught to never take our hands off a patient. This makes sense because they want to make sure we are practicing safely before heading off to clinicals. However, in the real world, patients may not have help at home, and a big part of acute PT is determining if they can return home safely. As I saw more patients, it was easier for me to make those clinical decisions on my own and determine how much assist my patient needed. Taking a step back also allowed me to see how a patient functioned at home. One of the most common mistakes I saw patients make was grabbing onto the walker with both hands and pulling on it to stand. This is not good because the walker will tip backwards. Early on in my rotation I would give cues before I even gave my patient the chance to show me how they normally do it. As I progressed, I would let the patient make mistakes first (in a safe environment) and then provide corrections to help them learn.
Paint a picture of the session with your documentation.
Documentation in acute care is similar to outpatient in some ways but also very different. In both settings, it is important to defend what charges you put in and why a patient needs further PT. In acute care it goes a step further and you also must justify why a patient needs a certain discharge destination. There are so many factors outside of mobility and strength that go into this such as living situation, support at home, and cognitive status. For example, I had some patients that did not require physical assist to get out of bed and walk down the hall, but they required maximum cues to do so safely. I also had patients that could walk with contact guard assist or supervision but lived alone and didn’t have someone that could be with them during the day. It’s important to include these details so insurance companies can get the full picture of the situation through your documentation.
Collaborating with the healthcare team is so important!
I loved getting to collaborate with different members of the healthcare team and learn more about what they do. We were constantly communicating with nursing staff, case managers, physicians, and other therapists. Every professional has their own role, but they all share a common goal of helping the patient, and it’s awesome to see everyone come together to achieve it. The teamwork I saw and became a part of was one of my favorite parts of acute care. During the last week of my clinical, our patient became unresponsive during treatment and we had to call a rapid response. Within 30 seconds there were multiple team members in the room, and in less than a minute they had the patient safely back in bed and were assessing them. We never want to have to call a rapid response, but it was amazing to see the teamwork demonstrated during this crucial time.
Choose joy
My CI taught me SO much about the acute care world, but one of the things I admire and respect most about her is how well she connects with her patients and her ability to bring a smile to their face. I don’t know anyone who enjoys being in the hospital, and many of the patients we worked with had been there for weeks. When a patient was feeling down or nervous about participating in PT, my CI would ask their favorite music and pull it up on her phone. Before we knew it, the patient was smiling and singing along. At the end of my clinical rotation, she gave me the cutest mug that said “Choose Joy”. I had noticed the phrase hung above her desk earlier and mentioned how I liked it. Working in acute care was not easy, especially in the beginning. These words stuck with me, and when I was having a hard day I reminded myself to choose joy. Even if a treatment session didn’t go as planned, I hoped to at least bring a bit of joy to each patient whether it be through music, a fresh cup of ice, warm blankets, or simply a listening ear.
“May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit.”
Romans 15:13
Katie Woosley 
Leave a comment