Rehabilitation Nurse

Many people who grow up watching the careers of their parents are naturally drawn to the idea of following in their parents’ footsteps. So when Elizabeth Bennett watched her mother change from stay-at-home mom to rehabilitation nurse while Bennett was in the Air Force, her fate was sealed. Fast-forward some years and Bennett is now a professional rehabilitation nurse with a wealth of experience treating patients whose illnesses ranged from strokes to diabetes. She readily admits she has no regrets about choosing the career path she did and also admits she has been fortunate enough as a rehabilitation nurse to see “miracles everyday”. Bennett’s combination of differing experiences and background made her the perfect interview for students aspiring to follow a similar career trajectory. In these questions she tackles every subject from what a normal day for a rehabilitation nurse is like to why she chose to specifically choose a position treating patients with diabetes. She even offers some advice for aspiring rehabilitation nurses so you don’t want to miss it.

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What inspired you to want to be an RN?

When my parents got divorced, my mother had always been a stay-at-home mom to four kids, and she did not have a high school diploma. Being left at age 45 was a huge wake-up call for her, and a time of deep decision-making. She decided to take her GED (general education diploma), and enrolled in a technical school to become an LPN (licensed practical nurse), and completed that training in a little over a year, and set immediately out to earn her RN through a 2 year degree program at a local community college. I was already in the Air Force by this time, and had always had the dream of being a nurse, but never really saw the way to do this, and yet, I watched my Mom create her own circumstances – and if that wasn’t an inspiration, I couldn’t imagine what would be! So, I had to set my mind to a way to get this done – I had many friends who were nurses back then (in 1988) who encouraged me, so I planned it! I took one class at a time for nutrition, chemistry, biology, psychology, pharmacology, anatomy & physiology – just to get ready for the day when my military duties were done and I could apply to nursing school! I applied to two different programs, one for an ADN (associate degree nursing) and one for a BSN (bachelor degree nursing), and was accepted for both of them. My mother advised me to take the BSN program, even though it was an hour and 40 minute drive each way for classes (before the internet!) and off I went. Two years later, I graduated with a BSN from Georgia College & State University, and passed the national boards that summer. I do not think I have ever had a more emotional experience. It was difficult, it was not convenient, it was challenging. I almost quit a few times, but you know what got me through? I would write my name with those treasured letters “R.N.” after it several times a day. So that inspiration became reality.

You started out as a general medical nurse and then quickly moved to working with rehabilitating patients. Specializing in rehabilitation, what was a normal day like for you?

While I was a general staff nurse, I met many different patients, and many of them were coming to the floor just out of surgery. The people who had suffered strokes, or cerebral vascular accidents (CVAs) were those that required the most physical care, and had the highest needs and demands for the RN’s time. I knew that there was much more to understand about why the brain didn’t work the way it used to, and I wondered what it was like to be in a body that didn’t make sense any more. See, many patients who have a stroke cannot feel or control parts of their bodies, depending on what part of the brain had been injured. And that injury could be from an accident, too. Fascinated, I talked with one of the instructors from Georgia College, who was a CRRN (certified rehabilitation registered nurse), and she told me about the specialty. I had to study a lot of neuro-anatomy, understand the spinal cord and what different physical problems happened at each level of spinal cord damage, and also damage to the brain. It was quite an undertaking! But I studied and passed the national certification exam – by one 5 points, I might add! But I passed and was a nurse and certified in rehab. I found a job in a rehab hospital in Macon, Georgia and became a staff nurse there. I worked on the floor with people who had just had a stroke, and were discharged from the acute-care hospital to a rehabilitation hospital for a long-term care plan, they usually stayed about a month. A typical day was receiving my assignments and report from the off-going nurse, then making assessments. I would do nerve testing and chart progress, teach people to move to their limits, and provide passive range-of-motion to keep numb limbs from becoming stiff from disuse. Sometimes I would read to patients, and sometimes I could help teach them the physical skills they needed like learning to drive with one hand in a simulated workstation. I could teach them to point to a picture and converse with them if they had lost their ability to speak. A typical day was filled with so many different kinds of activities besides dressing changes and medication delivery, which is what most people think nurses do. I absolutely felt good to see people able to walk again or speak again or leave back to their lives. It changed my life every day. Also, I would coordinate with their insurance companies and provide updates to their outside doctors, and arrange transportation to appointments for them.

What were some of the most unique challenges you faced as a rehab nurse?

The most challenging part of my job was carrying hope for people who had none. When you’ve had a stroke or cannot talk or move your arms or walk – you have had a totally life changing even! A lot of patients would come to the rehab hospital, feeling like they were depressed, despondent, or that they just didn’t care anymore. Like their lives were over. Of course, over time, and with some counseling and improvement in their abilities, they feel better about themselves and their abilities to move on in life, but that was always the hardest thing to deal with. In the end, the best thing I found was to keep a positive regard for each person, right where they are, without judging their feelings in any aspect.

What did you love the most about the job?

Being a rehab nurse was so unique in that I could see miracles every day – big and small. The first smile on the face of young man who was paralyzed after a neck injury – the success of a middle aged professor who wrote his name in a scrawl after a stroke – a hesitating step after a paralyzed leg got some control back – each of these add up every day to the successes of being there to help. Probably the most memorable was while I was on an assignment as a travel rehab nurse at an Army Hospital. “Broken Soldiers” came back from Afghanistan away from home, suddenly back in the U.S. from a war zone, suffering greatly from both war time physical injuries and post-traumatic stress disorder, too. One soldier was a woman who had been injured with an explosive device while driving, survived the explosion but lost two arms. Watching her stand proud and salute at the end of her extensive rehabilitation and community re-introduction made me feel like it’s all worth it to do. Even more so because I’m one lucky veteran that did not suffer such an injury during my time.

You eventually steered into a new specialization, aiding individuals with diabetes. What made you decide that there was a gap in care for these types of patients?

Wow, yes. Over the years I started to see more and more people actually with heart disease, foot amputations, pain, and kidney disease. It took me some while to figure out the commonality in all this: these are all predictable events of undiagnosed or uncontrolled diabetes. And, I found out that diabetes is one thing that is a chronic condition in that: it in never expected to go away. It’s treated with medicines and monitored with testing, but never gets any better. And, like most things that we deal with day-to-day, they get to be less and less in importance. In other words, it’s an insidious decline that is easy to not worry about. I think the watershed moment happened after I started to find out more about integrative health (as opposed to sick care) and had enrolled in my master of nursing degree (MSN) and had a higher exposure to prevention rather than treatment. I can’t express my shock to find out that most diabetes type 2 is (1) preventable, and (2) can be cured if caught early enough. Cured instead of treated! That really surprised me. The more I studied and found out the more dedicated I became to this calling. Our food choices affect our health in the long term and in the short term in ways that I never would have expected. I read good solid research that isn’t highly publicized, and started to talk to some physicians who actually knew this. So, as an advanced practice nurse (that is with an MSN) I slowly came into my own practice! I explored the Washington State Nurse Practice Act, and found that I can use every one of the international Nursing Diagnoses to identify, plan, and help with lifestyle choices – or as the doctors call it – lifestyle medicine. Off I went!

After asking myself the question – why don’t people change when they know they “should,” I examined the way we (the health system) treat people. Well, in short, we throw a little knowledge that way, give the people some instructions and pills and little more in the way of supporting lifestyle change. So through a many-years long learning process, I have arrived at being a Registered Health Coach, and I use a special skill set to have conversations with groups of people or with individuals to assist them to move past blocks and into better health. It’s a slow process, but when I see people lose weight, get off of diabetes medications (with their physician approval!) or avert diabetes altogether, it makes me happy to be able to help – one person at a time.

Can you explain what a normal day is like for you now? What kinds of challenges are you faced with on a daily basis?

The biggest challenge is that people do not want to pay for their diabetes education and decision support processes. And only about 35% of people with the diagnosis of diabetes have coverage for diabetes education anyway. I have not formed a corporation, and I have not “become” a non-profit business for grant and funding purposes. I’m thinking about it. The fact is, I’ve settled in my thoughts that people are way more important than about any health policy, so I am investigating how to outreach to people. Normally, I coach people either in person or on the telephone or Skype regarding their health choices, and I have restricted my private practice to people with or at risk for diabetes, and their families if families are involved in their care and then only with the client’s permission. I make referrals when needed for medical care. Some problems I work with are smoking cessation, feeling unworthy to make better choices, teaching about diabetes problems, and I facilitate group diabetes education, which I call “Diabetes Success Groups,” in a physician practice and I am looking soon to expand to a senior center and maybe an association with a county hospital. It’s a growing practice, full of surprises and opportunities every day.

What do you love most about being an RN health coach?

Oh, the best thing ever is that “ah-HA” moment. Through coaching, I use the motivational interviewing technique primarily, where no advice is given, no pressure is given, and the entire conversation is 100% about what the clients wants to discuss. Almost every time – the person names a goal (big or small, it doesn’t matter – it’s their goal), and we come up with a plan on how to start to actualize that goal! We look at barriers, plan around those, and agree on this plan. It’s where we start off on the next conversation. It’s so exciting to me and so empowering for clients!

What education and experience is needed for someone who might eventually decide to become an rehab nurse? What about an RN health coach?

To be a rehab nurse, one has to be an RN, and have a bachelor degree, but it doesn’t have to be in nursing. Also, there is a lot of studying, which can be done individually, or you can take a 5 day course to prepare you for the national exam. It’s a hard test, too! To learn to be a coach, one can enroll in a learning experience from places like Wellcoaches, or Vera Health University in Seattle, for example. I chose a combination of Health Sciences Institute HIS) where I studied a year to become credentialed as a Chronic Condition Professional Health Coach and then as a Registered Health Coach. I also enrolled in the Institute for Integrative Nutrition (IIN) of NYC for a more expansive and enriching education in food choices, leading a balanced life, and having successful relationships, spirituality, work and exercise for our bodies. All in all, I chose one very clinically based program (HIS) and one very holistic program (IIN). Graduates of IIN need not be medical professionals, but will be very well equipped to meet with and support others in their journeys!

Do you have any advice for individuals who are about to enter (or who have just entered) the nursing field?

You know, I have never regretted becoming an RN once. You can do so many things – work at the bedside or in a hospital, be a consultant or a case manager, teach, become a medical-legal expert or find your own private practice. You can be a yoga therapy nurse or use energy healing. If you become a nurse practitioner you can prescribe and see patients like a doctor can. It’s a lovely way to live a life of service, and to always be able to earn enough money to support yourself and maybe a family, too. I highly recommend registered nursing as a career choice for anyone looking to be of service to others. It’s demanding and that heart is needed. If you are only looking at the money, well, that is there, too – it’s a career you can make your own decisions about and very flexible.