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Interdisciplinary
Team Members:
Nursing

Sophie Grossnickle
 Registered Nurse (R.N.)

• Must complete a Bachelor of Science in Nursing, Associate of Science in Nursing (ASN)*,

and/or Associate Degree in Nursing (ADN)*
• 2–4-year program

Educational Licensed Practical Nurse (L. P. N.)

Background1 • Different than a R.N., as they have a more limited scope of practice
• 1-2-year

Advanced Nursing Degrees/Advanced Practitioners

• Masters of Science in Nursing (MSN)

• Nurse Practitioner (N.P)
 Nursing scope of
Evaluation
• Screen and assess patient
• Perform medical history taking & assess for the presence of injury
or conditions then seek physician direction/supervision
• Documentation of summaries (must be signed by the doctor)
practice 2
Monitoring
• Education regarding therapeutic procedures, especially pre-op and
post-op care
• Monitor vitals, wounds, etc. Assessing for the effectiveness of
current plan of care, reporting to the supervising healthcare provider
(i.e.., physician, PA, etc.)
• Documentation of findings during monitoring phase
• Aid in admitting and discharge process to healthcare facilities
Nursing Scope of Practice2

Therapy Other

• Applying infection control measures • Train and education other nurses/healthcare professionals
• Assessing/managing wounds • Refer to other HCP, advanced practice nurses and RNS
• Applying heating/cooling devices • Delegate tasks to other nurses or HCPs; may supervise other nurses or HCPs
• Applying and teaching proper positioning/mobility techniques including ROM exercise and • Order labs
use of ADs
• Providing comfort and pain reduction measures (including positioning • Initiate/change orders in charts
and therapeutic touch) • Perform noninvasive physical exams
• Providing respiratory care (including chest PT)
• Use/order use of medical devices and equipment
• Performing accurate intake and output measures
• Providing hygiene maintenance • Prescribe non-controlled meds
• Implementing pt mgmt plans as devised by physician, • Manage a professional nursing practice
• Admin therapies directed by supervising health professionals,
• Perform routine health care and office studies
• Admin medication as directed by supervising health professionals
Limitations to Nurse's
Scope of Practice2

• Nurses cannot diagnose medical conditions and then treat them

(they may identify them during routine care for stable patients)
• Ex. A nurse can identify sacral wounds on a patient and
then develop a mobilization routine for them
• Nurses cannot perform surgical or invasive procedures
• Should be noted those with advance practice nursing degrees may
have a wider scope of practice than RNs given their more advance
degree; however, this scope of practice is not as wide as physicians
Licensure and
Registration 3

• All states:
• Must complete RN, ASN, or ADN degree and National Council Licensure Examination
(NCLEX-RN)
• The licensure process/license is then passed off to the state the individual will practice in
• Michigan requirements form the Michigan Board of Nursing
• Pass background check
• Be of good moral character (verified via filling out "Good Moral Character"
questions)
• Complete human trafficking training
• Provide Social Security Number, proof of graduation, (i.e., transcripts)* and
passing of NCLEX*
• Demonstrate English language proficiency
• Re-licensure occurs every 2 years
 Tests/measures/procedures done with
patients4
Subjective history
• Fall Risk assessment scale: Morse Fall Scale
• 6 questions: falls past 3 months, 2ndary diagnosis, use of AD,
IV/Heparin Lock, Gait/transfers, and mental status
• 82.9% of nurses report it is “quick and easy to use”
Objective data
• Cardiovascular, respiratory, GI, genitourinary, neuromuscular, and
integument components of examination
• Measure include the Braden Risk Assessment, Glasgow coma
scale, and AVPU level of consciousness assessment
• Vital signs assessed include BP, HR, SPO2, temperature, and pain
Role in patient/family education 5

Pre-operative and post-operative care such as dressing and drain changes

Preventative measures to minimize risk of diseases such obesity, diabetes, and heart disease

Recognizing warning signs (i.e., low blood glucose) and steps to follow after identifying warning signs

Medications/prescription drug possible complications

Self-care/caregiver education occurs to improve self-sufficiency, so individuals do not have to rely on healthcare providers

Community outreach possible depending on branch of nursing

 Federal Level:6
• ICAN Act
• Proposes legislation that will remove Medicare and Medicaid barriers to patients receiving care from the
provider of their choice (i.e., advanced practice registered nurses)
• Workplace Violence Prevention for Health Care and Social Service Workers Act
• Proposes legislation to prevent workplace violence and protect healthcare workers (1/4 nurse have been
assaulted at work)
Professional • National Nursing Workforce Centers Act

Advocacy
• Proposes legislation to create a pilot program for current nursing workforce centers to evaluate and improve
recruitment and retention
• The Black Maternal Health Momnibus Act
• Proposes legislation to reduce black maternal mortality rates in the US

State Level:7
• Safe patient care
• Safer workplaces for nurses
• Protect collective bargaining rights
 Medication administration

Vital sign assessment

Positioning changes
Contribution Wound care management
to the care
Engaging in discharge planning
team8-14
Communicating patient’s progress/status changes to the team as they occur

Monitoring and assessing for further/additional/progressing medical complications

Patient/family education
 Promoting mobility is part of both fields’ scope of practice

• Nursing has other components as we’ve discussed, but fostering a shared collaborative effort may be
beneficial in terms of many components (e.g., better outcomes, lowers the cost of healthcare, etc.)

Nursing
Addressing wounds when present and integrity of the integument also shared tasks

• We may be able to utilize a dressing change or bedding change to facilitate a co-treatment, as the nurse
and PT15 works to change the bedding, positioning of a patient, or their dressings we could co-treat to work on bed
mobility, balance tasks, range of motion or strengthening

Communication is KEY!

We could also work together in terms of knowledge sharing (more on this during the
article reviews)
 Article Review 1
Article Title: ”Identifying Barriers to Nurse-
Facilitated Patient Mobility in the Intensive Care
Unit”16
Methods:
• Qualitative content analysis of 2 nurses (>5 years of experience
and <2 years of experience) and a clinical technician
Background:
• While nurse facilitated mobility has been shown to improve
patient outcomes and decrease the duration of a stay in the
ICU, time is often sited as a barrier.
Results:
• 10% of a nurse’s shift is considered “down” time, so time is
truly a barrier to implementing additionally patient care time
to facilitate mobility.
• During patient care tasks there was three conditions (in bed,
out of bed, and edge of bed) in which nurses could have
facilitated patient mobility.
Purpose:
• Better understand how time may be a limiting factor to
nurse-facilitated mobility in the ICU
Conclusion:
• While nurses have little ”extra” time, they may miss
opportunities to facilitate mobility during current patient care
activities
• Level VI evidence given that is a single qualitative study, but
there was several articles sited in the results/conclusion with
similar findings.
 Article Review 2
Article Title: “Nurse-Led Mobility Program Driving a
Culture of Early Mobilization in Medical-Surgical
Nursing”17
Methods:
• Bedside Mobility Assessment Tool Training/implementation during
every shift
• 60-minute classroom education sessions to improve knowledge
regarding safe mobilization
• Hiring a ”mobility champion” to promote, implement strategies, and
assess nursing-facilitated patient mobility
Background:
• While in their scope of practice, mobility is not often addressed by
nurses, as demonstrated by the fact that a surgical patient was only
mobilized 1.75x/day.
• 22% of physical therapy referrals were inappropriately made to
routinely mobilize patients
• Nurses reported lacking knowledge and confidence to safely mobilize
patients as a barrier to mobilization.
Results:
• Patients were mobilized significantly more following implementation
of program, there were less bed rest orders, and an 8% reduction in
inappropriate physical therapy orders at the 1-year mark
Purpose:
• Determine if a quality improvement project would impact nurse-led
mobility, promoting a culture in the hospital to promote safe and early
mobilization to prevent/reduce the effects of immobilization, reduce
the number of total bed rest orders (with a lack of clinical support),
and reduce the number of inappropriate PT referrals
Conclusion:
• Nursing led mobility is feasible, reduces healthcare costs, and promotes
a culture of safe early mobilization.
• Frees PT up to treat the more complex patients who need more than
basic mobilization.
• Quality improvement project, so not the highest level of evidence
 Article Review 3
Article Title: “Nurse’s perceptions of physiotherapists
in critical care team: report of a qualitative study”18
Methods:
• 15-minute interviews were conducted and analyzed to identify
themes
Background:
• Interprofessional relationships are ever evolving and becoming
much more standard with critical care and the complexity of
patient presentations
Results:
• 5 themes were identified: the role/image of a physio, the
effectiveness of a physio’s treatment on the patient’s outcomes,
communication, interactions with physios, and
teamwork/interprofessional relations
Purpose:
• Examine critical care nurse’s perceptions of the role of
physiotherapists on the critical care team
Conclusion:
• Nurse perceived physiotherapists as an integral part of the
critical care team and recognized the value of mobilization of
patients through the physio's role
• Level VI evidence, however good to recognize that each
healthcare provider sees value in another individual's part of the
care team
References
1. Occupational Handbook Registered Nurses, U.S. Department of Labor. Updated September 8, 2022. Accessed June 5, 2023. https://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-4
2. L Katz, P Pratt. Scope of Practice of Health Professionals in the State of Michigan, Public Sector Consultants. 2001, 20-24. Accessed June 5, 2023. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.msms.org/portals/0/documents/scopepracbook.pdf
3. LARA Bureau of Professional Licensing, Nursing Licensing Guide. Revised January 20, 2023. Accessed June 5, 2023. https://www.michigan.gov/-/media/Project/Websites/lara/bpl/Nursing/Licensing-Info-and-Forms/Nursing-Licensing-
Guide.pdf?rev=ee41df65fedc4e5bae492ceb77a647dd
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14. Armstrong M. Postdischarge nursing care of stroke patients. American Nurse. February 11, 2014. Accessed June 5, 2023. https://www.myamericannurse.com/postdischarge-nursing-care-of-stroke-patients/
15. Verma S, Paterson M, Medves J. Core competencies for health care professionals: what medicine, nursing, occupa
16. Young DL, Seltzer J, Glover M, et al. Identifying barriers to nurse-facilitated patient mobility in the intensive care unit. Am J Crit Care. 2018;27(3):186-193. doi:10.4037/ajcc2018368
17. Jones RA, Merkle S, Ruvalcaba L, Ashton P, Bailey C, Lopez M. Nurse-led mobility program: driving a culture of early mobilization in medical-surgical nursing. J Nurs Care Qual. 2020;35(1):20-26. doi:10.1097/NCQ.0000000000000404
18. Gupte P, Swaminathan N. Nurse's perceptions of physiotherapists in critical care team: Report of a qualitative study. Indian J Crit Care Med. 2016;20(3):141-145. doi:10.4103/0972-5229.178176