Badge of honour


Rehabilitation nursing has made the big leagues.

Recognizing the unique knowledge and skills required to work with patients who need rehabilitation, the Canadian Nurses Association has elevated rehabilitation nursing to the level of specialty, joining 13 other areas of specialization such as critical care, oncology (cancer) and emergency nursing. Starting in 2005-2006, nurses can write a national exam to earn a specialty certification in rehabilitation nursing.

In January, Toronto Rehabilitation Institute welcomed 12 nursing students to the country’s first university-based rehabilitation nursing course, a joint effort of the hospital and the University of Toronto. A part of the undergraduate nursing program, the course includes clinical education for the students at Toronto Rehab.

The excitement is palpable among those who have strived to see rehabilitation nursing given specialty status and recognized as a unique area of study in the nursing school curriculum. Karima Velji, Toronto Rehab’s vice president, professional practice and chief nursing officer plays a lead role in the certification process and undergraduate university program.

“These changes will start to bring rehabilitation and complex continuing care nursing into the forefront where they belong. If rehabilitation is going to be effective, it has to be 24-hours a day, seven days a week, and the 24/7 care provider is the nurse,” says Karima. “How nurses work with patients who have altered abilities due to illness or injury will determine how well each patient recovers.”

Nursing care has been shown to be a key determinant of patient satisfaction. “So, if you want to be a nurse and really want to make a major difference to a patient’s outcome through the therapeutic nurse-patient relationship, you’ll see that in the rehabilitation and complex continuing care settings.”

Nurses are integral members of the interdisciplinary team at Toronto Rehab. Of the 900 health professionals employed by the hospital, more than 700 are nurses. They coordinate care and therapies among members of the team, assess patients’ progress, and help them to integrate the exercises and skills learned in their therapy sessions with other health professionals, including occupational therapists, physiotherapists and speech-language pathologists. “I think the work of nurses should get special attention,” says Mike Janjevich, who was an inpatient in Toronto Rehab’s spinal cord rehabilitation program following a car crash in 2001 that left him with a diagnosis of incomplete quadriplegia.

Given little hope of walking again, Mike was “determined to get back on my feet, and I wouldn’t have done as well if it weren’t for the nurses.” Once he began walking with assistance, “they were there whenever I wanted to walk up and down the halls and practice. They do it all.” When discharged, Mike walked out of Toronto Rehab’s Lyndhurst Centre using only canes for balance.

Even more overwhelming than the physical challenges Mike faced was the devastation he experienced when his 5-year-old grandson, Justin, was killed in the crash. “Justin was my life,” an emotional Mike recalls. “I took him to school. I coached him in soccer, I took him to hockey and taught him to swim.”

Mike was supported by family, friends and community, but one of the people he credits most for emotional support is nurse Peggie Gairy. “There were times when I was so emotional that Peggie would drop everything, give me a hug and cry with me. She gave me permission to grieve and get on with my life.

“You’ve got to heal from the inside out and Peggie understood that. She was mother, sister, friend; it takes all that to make a very special nurse. She would be a good teacher for young people who want to be rehabilitation nurses.”

A nurse since 1985, Peggie has worked in acute care and in Toronto Rehab’s spinal cord rehab and complex continuing care programs. She prefers rehabilitation over acute care nursing because her patients stay for more than a few days and she can have a greater impact on their lives.

“We give holistic care that encompasses the physical, social, spiritual, emotional and psychological aspects of a person’s life. We teach independence and self-care. It puts people back in control of their lives,” says Peggie. “I feel fulfilled because I have done something important.”

“Rehabilitation nurses also work with very complex patients, so we do a lot of complex assessments and care,” adds Hyacinth Elliott, a nurse in Toronto Rehab’s geriatric rehabilitation program. “As part of the interdisciplinary health care team, we help patients accomplish their rehabilitation goals, and this is very exciting.”

Developing a rapport with families is “vital because eventually the patient will be discharged and those family members may be the primary caregivers,” explains Angella Anderson, also a nurse in the geriatric rehabilitation program. “This involves teaching the family and providing them with emotional support.”

Rehabilitation and complex continuing care nursing are about restoring the patient’s quality of life, according to Karima. “You start by setting standards. These are the standards that guide the practice of nurses when they touch our patients. This is the specialized knowledge and skills nurses need. At Toronto Rehab, we pay attention to how nurses acquire knowledge and skills, and we help them to develop their expertise.”

As Canada’s largest adult rehabilitation teaching hospital, Toronto Rehab nurses serve as teachers and mentors for nursing and other health care students. Nurses also participate in research endeavours and implement new knowledge in nursing practice.

With increasing demand for rehabilitation services and the average age of nurses in Canada now 44 years and rising, the need for rehabilitation and complex continuing care nurses will continue to grow.

As Angella predicts, “rehabilitation nursing is the way of the future.”