Guiding Light
Cheerleader, taskmaster and friend, rehab nurses are beacons of support for patients on the road to recovery

By H. Cheever Griffin
March 21, 2003

The elevator door opens onto the second floor of the Marianjoy Rehabilitation Hospital in Wheaton, Ill., and it's quickly apparent what kind of unit this is. A row of wheelchairs lines the wall. At the end of the wide, blue-carpeted hallway is a busy nurses station and shiny, steel walking and exercise devices. The men and women using these devices are moving slowly.

This wing, housed in a facility near Chicago, is where people come to rebuild themselves. Marianjoy is, in essence, the second leg of their long journey back-usually after many days spent recovering somewhere else from a gunshot wound, a motorcycle accident or a hip or knee replacement. They come here to work their bodies in great and small ways, and to regain at least some of the normal movements and activities of the life they used to know.

This is where Merry Dreier works. Dreier, RN, CRRN, ONC, is one of more than 100 rehab nurses at Marianjoy. While she floats occasionally to various parts of the hospital-and thus has tended to nearly all types of cases-she works most days on this second-floor wing. The majority of the patients here are elderly people who either have suffered a serious injury or have just undergone any one of a number of joint replacement operations.

A small woman with straight sandy brown hair and glasses, Dreier exudes a good natured but no-nonsense demeanor. She's been practicing rehab nursing for 14 years and has written numerous articles about various aspects of her work. Observing her on the job for several hours on a recent winter morning, NURSEWEEK captured a picture of the work Dreier and her fellow rehab nurses do.

After all, rehab patients are different than most. They are not just trying to mend, but to once again thrive. Although their bodies have already undergone tremendous healing, it is now up to the patients to finish the work. For the men and women who serve as their nurses, that means playing several roles: cheerleader, taskmaster and friend.

Departure

It's just after 9 a.m. and Dreier is saying goodbye. A silver-haired woman is headed home two weeks after arriving from a hip replacement surgery.

Part of Dreier's daily routine is to see her patients off-and there's a lot more to it than just a hug or a handshake.

After chasing down the doctor on call to clear up the woman's confusion about her medication dosage, Dreier spends several moments reviewing home care instructions as well as specific rehab activities with her patient and the friend who has arrived to drive her home. She then helps the woman into a wheelchair and takes her down to the lobby, offering her both words of encouragement and caution for her long rehab journey ahead.

Wearing nothing over her short-sleeved nursing blouse, Dreier rolls her patient through the automatic glass doors of the lobby into the icy winds of a mid-January day as the woman's friend drives up from the visitor parking lot. Rehab nurses, Dreier said, usually see their patients all the way out the door. Helping them move from their wheelchairs or walkers into a car seat is often a difficult and delicate procedure.

"The worst thing would be for them to injure themselves on the driveway and have to go right back upstairs," she said. "And it's happened."

Everything in between

After a successful effort and a wave goodbye, Dreier heads back upstairs. She walks off the elevator to find another patient waiting for her in a wheelchair outside his room. The man, a former Chicago police officer who recently fell and broke his hip, also is heading home today-but not before one more quick session in the therapy room. She greets the man warmly and grabs his chair and heads back into the elevator-this time traveling to the basement, where she wheels him down a long, brightly lit hallway and into a giant workout room. The room is buzzing with dozens of exercise contraptions, therapists and patients of all ages and disabilities hard at work.

Dreier navigates her way through the crowd to a therapist waiting at a small mock staircase. Here, her patient will spend the next 20 minutes putting his fragile hip through yet another workout and practicing what had been, until recently, the most routine act of going from one floor of his home to the next.

While Marianjoy's therapists handle most of the intensive rehab work, the nurses play a vital role as well. The nurses make sure patients are adequately exercising and practicing their routines-and continuously working toward their specific rehabilitation goals.

It is this hands-on and interactive part of her job that Dreier said she finds the most rewarding. "It's hard work and sometimes you really have to push your patients," she said. "But there's nothing like seeing the joy they feel when they realize they're making progress and reaching their goals."

Of course, not all patients are so enthusiastic. It is shortly after 11 a.m., and Dreier has just returned to the wing after running down to the first floor vending machine for a cup of coffee. She spies two hospital administrators talking in hushed tones outside a patient's room-and she knows immediately what's happening.

The man inside the room has been one of the more difficult patients. He won't exercise, go to therapy or cooperate with Dreier and the other nurses. In short, he won't try to get better. For some patients, Dreier said, the combination of depression, frustration and pain overwhelms them and they simply refuse to participate in their rehab program.

Dreier huddles for a while with the administrators, who determine that they will take up the case and determine possible next steps for dealing with the patient. She hints that he may need to undergo a more intense form of counseling than Marianjoy offers, and it's unclear whether he'll remain at the hospital. "He has no interest in trying to achieve his goals and that's what it's all about here," Dreier said in a tone conveying both sympathy and tough resolve.

There's little time to dwell too much on the issue, and Dreier spends the next hour tending to the needs of several patients, grabbing a quick lunch and preparing her files for the daily staff meeting. During that meeting, nurses, doctors, therapists and case managers gather to discuss the progress of each patient on the wing.

Arrival

The meeting ends about 1 p.m. Dreier, whose shift runs from 7 a.m. to 3:30 p.m., will spend the rest of the workday focused on the new arrivals. Beds at Marianjoy don't stay empty for long, and several patients are scheduled to show up before she leaves. She heads to the nurses lounge, where she'll read up on the case histories of the newcomers and then make sure they get settled in.

Then it's off to some fun in the sun. This is Dreier's last day before vacation-one she will spend visiting a friend in Arizona. Although she said she's definitely ready to leave behind the cold and snow for a while, she doesn't deny that she'll soon be yearning to get back.

"This is whole nursing," she said of her job. "You really work closely with the person and their family and get a chance to establish real relationships." That certainly seemed apparent earlier in the morning while Dreier helped her departing silver-haired patient prepare to leave. As she guided the woman into her wheelchair, the patient reached out and hugged her.

The two then headed down the hallway toward the elevator with Dreier grinning the whole way. "That's why I love this job," she said.

Contact H. Cheever Griffin at cgcommunications@ameritech.net