The Wide World of Sports/Fitness Nursing
Tony Omlor, RN, BSN, CCRN, knows the 13 years he spent caring for critically ill patients was a good investment of his time. But like many nurses, he grew frustrated watching people suffer and he eventually began to look for ways to use his nursing skills to help people avoid serious illnesses. “Darn it,” he thought, “there’s got to be something I can do to keep people from getting to this point.” Today, as clinical manager for heart and vascular services at Grant Medical Center’s health and fitness center in Columbus, Ohio, Omlor is doing just that.
Helping Americans stay healthy and prevent disease is one of the main thrusts behind an emerging trend that combines nursing with some aspect of fitness or sports. Although the nursing profession has yet to officially develop a specialty in “fitness nursing” or “sports nursing” on either the professional or academic level, a growing number of nurses are becoming involved in these areas.
The connection between physical fitness, wellness and disease prevention is well documented. As a result, hospitals and HMOs around the country have begun opening fitness centers and offering wellness programs with information on nutrition, stress management and exercise. Many corporate employers, meanwhile, have begun offering on-site fitness programs and wellness centers for their employees.
In addition to these practice settings, nurses can also find job opportunities working for professional sports teams, college and university athletic departments, and hospitals, clinics and orthopedic practices that have sports medicine or sports injury programs. Some nurses are involved in sports medicine on a full-time basis while others work on a part-time, contract basis for sports teams.
For example, some nurses work for professional football teams each summer, evaluating the health and fitness of players who are either preparing for another season or trying to make the team for the first time. Other nurses work professional baseball games, either sitting in the dugout to help injured players or treating injured fans at the first-aid stations.
Taking Fitness to Heart
Perhaps the most direct transition from traditional nursing to fitness or sports nursing takes place in cardiac rehab units at hospitals. Patients who have suffered a heart attack or other cardiac event recover by improving their conditioning. Thanks to cardiac rehab nurses, they also learn the proper way to exercise, get encouragement to continue exercising and receive nutritional information designed to improve their diets.
“It’s a refreshing atmosphere with healthy patients coming and going,” Omlor says. “When all you see are people who are very ill, it wears on you after a while.”
Although people who live and work in the neighborhood also use the Grant Fitness Center to work out, the nurses work exclusively with hospital patients recovering from illness. Patients work out in classes that typically number between eight and 10 people, although some classes have as many as 22.
The nurse–or two nurses for large classes–doesn’t work with patients the way a personal trainer would, Omlor explains. Instead, they move from patient to patient as they exercise, watching for signs of exertion such as an elevated heart rate or blood pressure. They also monitor the patient’s EKG to make sure they’re tolerating the exercise. Sometimes a nurse will stop and interview a patient to see how they’re feeling and how they’re progressing in the program, which typically runs about 12 weeks.
Nurses are also responsible for taking action when a patient shows signs that are outside the normal guidelines, such as a patient who comes in with elevated blood pressure. “The nurse is the one who has to intervene, call a physician, find out what to do and implement treatment,” says Omlor.
Along with exercise, most cardiac rehab programs include information on diet and stress management. Nurses work with physical therapists and nutritionists to develop a plan to help each patient recover in the best possible manner.
According to Omlor, the atmosphere in the health and fitness center is so enjoyable that he has no problem filling open positions. Nurses are clamoring to escape the more stressful atmosphere found in other practice settings. It isn’t all fun and games, though. Omlor has had to call on his prior experience as a critical care nurse to help patients who have suffered heart problems while working out.
“The first time I defibrillated a patient here, I had done it so many times that it seemed routine,” he recalls. “You have to know how to do things like that and you have to be comfortable dealing with that situation.” Nurses who work in a cardiac rehab program must have ACLS certification and be able to do the basics, such as starting an IV. Omlor believes a background in critical care nursing is also important, whether it be in an ICU, catheterization lab, open heart step-down unit or on an open heart floor.
Setting an Example
Another important quality nurses working in cardiac rehab programs must have is an appreciation for exercise. And not just in the intellectual sense–they must value it so much that they incorporate it into their own lives.
It’s a matter of walking what you talk, Omlor explains. “Patients respect it when the person who is taking care of them actually does the exercises. They’re much more willing to listen if they see it’s important to you.”
One of the first things a patient will ask a nurse in a cardiac rehab program is what sort of exercise he or she does to stay in shape and stave off illness. Telling the patient to “do as I say, not as I do” won’t cut it, Omlor warns. “To that patient, you’ve lost all credibility if you’re not doing something [to keep yourself fit].”
Some patients get the chance to see nurses and other health care professionals practice what they preach. Omlor says he has never been to a cardiac rehab unit that didn’t encourage the employees to use the exercise equipment. Seeing nurses squeezing a few reps into their schedule on their lunch hour or coffee break goes a long way with patients and adds an element of fun to the job.
Although some patients need to be prodded to exercise, others need to be reined in. “Younger males will come in with an idea of how they used to work out and try to resume that form right after having a heart attack,” says Omlor. “They’ll be huffing and puffing, sweating profusely and straining for that last rep. That’s when a nurse has to step in and remind them: ‘This is a gym but you’re in a cardiac rehab program.’ If they feel like you’re taking something away from them, you have to be careful because that can deteriorate quickly into an ugly situation.”
Although the hours are great for a nurse–7 a.m. to 7 p.m. weekdays–there are other rewards that make working in a cardiac rehab program worthwhile. Some patients enter the program angry and sullen, but somewhere along the way they make the transition into happy, even jovial people. “When you go home from work after experiencing something like that, you’re walking 10 feet off the ground,” Omlor declares. “There’s no paycheck that can compare to that.”
Fitness for the Medically Underserved
Because fitness nursing is still an emerging field, it can offer nurses entrepreneurial opportunities to design their own careers. Lori Radcliffe, RN, BS, CPT/CFC, has turned her interest in fitness, nursing and humor into a business called “Jest” for Fitness & Food. The Eatontown, N.J. resident is an African-American nurse who is also trying to introduce fitness to low-income communities that are underserved or ignored by other health care workers.
Radcliffe teaches classes in Pilates and dance and movement therapy at a nearby nursing school, a hospital and the Rutgers University athletic center. However, she says, fitness nursing as a specialty has not yet progressed to the point where nurses will find job listings under that title.
“You have to be careful not to jump right into the fitness area,” Radcliffe cautions. “It’s something that you have to balance between what you’re currently doing [as a nurse] and the skills you’re trying to develop.”
Radcliffe’s own evolution from RN to fitness nurse came quite naturally. A longtime athlete who received an athletic trainer’s scholarship in college, she first earned a degree in kinesiology before continuing her education by earning a nursing degree. She later became a certified kickboxing instructor and has used her nursing credentials to help her secure work in the fitness field.
“I have contracts with these places [where she works] and I know they hired me because I was a nurse first,” she explains. “I’m not saying someone with [just] a fitness background couldn’t have done it, but the way I got in there was through my contacts in nursing.”
For instance, Radcliffe was recently trained in The Lebed Method of dance and movement therapy for breast cancer survivors. She received the training because the hospital for which she teaches the class wanted a nurse to teach the course to its breast cancer patients.
“They wanted somebody [with medical background] so the doctors would be more comfortable with it,” she says. “Over the years, the connections I’ve made being a nurse have helped me.”
According to Radcliffe, a nurse doesn’t need a degree in kinesiology to become a fitness nurse, but a national certification as a personal trainer would be a big help. She says fitness nurses can’t demand the fees that personal trainers get ($50 to $150 an hour), but it’s not unreasonable for a nurse to charge a rate of $50 to $60 an hour.
Fitness and nursing are a natural combination, she adds. “Nurses generally like to help people anyway, and I think it’s a natural avenue for someone who likes health and wants to help others.”
Healing Injured Athletes
Frederick Brown, RN, MS, ONC, APN, a sports medicine nurse at Midwest Orthopaedics in Chicago, finds rewards in his job as well. He works as a nurse for an orthopedic surgeon who specializes in shoulder and elbow surgeries. Midwest Orthopaedics has 35 to 40 physicians who specialize in various orthopedic injuries, many of which are sports- related. Brown estimates that the physician he works for has performed more than 300 shoulder surgeries in 2004.
The doctors perform surgery on athletes as young as 12 (usually gymnasts) as well as college-age athletes. The physician for whom Brown works has patients who are baseball players, basketball players, swimmers and wrestlers. Midwest Orthopaedics provides orthopedic services for the Chicago White Sox professional baseball team and the Chicago Bulls basketball team. The facility also treats people who have been injured on the job as well as elderly people who have to have an entire joint replaced.
“I think the biggest challenge for me is that not only are you taking care of the patient but there’s usually a parent involved and sometimes a coach, depending on the player’s level of expertise,” Brown says. “If you have enough of those types of people in your practice, that’s a lot of people you’re taking care of.” He often finds himself dealing with parents, coaches and athletes who are anxious about whether the patient will be able to return to his or her sport.
These days, Brown mostly works in the areas of administration and education. The latter role usually involves breaking information down into simple terms so the patient and others can understand their injury and their expectations for recovery. “You have to describe to patients and parents and coaches–and even physical therapists–exactly what the injury means and what the treatment plan is,” he explains. “With most people, you have to tell them a few times before it actually sinks in.”
He goes over the surgical procedure, recovery and the rehabilitation protocol. Sports nurses don’t actually work with the patient on rehabilitative exercises. That’s the domain of physical therapists. But the nurses work with the PTs and physician’s assistants to move patients through the various phases of recovery.
Another challenge Brown has learned to overcome is his lack of sports experience. He has never played many of the sports played by his athlete patients. “It’s important to know some of the mechanisms that go along with the sport,” he says. “For me it was somewhat of a steep learning curve.”
Perhaps the hardest part of a sports nurse’s job is dealing with an injured patient who will never be able to return to his or her sport. Sometimes the athlete has dedicated his or her life to that sport and suddenly is unable to continue. The question for the athlete then becomes: What do I do with my life?
There are, however, many other instances when all goes well and the athlete is able to return to competition. Brown says the physician for whom he works often receives letters from athletes thanking the doctor and nurse for helping them return to competitive sports. One female weightlifter sent them a photo of herself with the trophy she won at a power-lifting tournament.
Take Me Out to the Ball Game
Some opportunities in sports medicine let nurses get even closer to the action. Ruth Allen, RN, an administrative nurse in the psychiatric unit at Alameda County Medical Center in California, turned her love of baseball into a part-time job. This 69-year-old African-American mother of three grown sons is a nurse for the Oakland A’s professional baseball team, working in the first-aid station at home games. She became a team nurse when a colleague spotted Allen at a game and asked her to fill in for her while she was on vacation. The colleague never came back to work.
Allen says she took the job because, as a season ticket holder, she would have been at the games anyway. She and her sons are avid baseball fans and the job provided her with free entry to the game plus tickets for friends and relatives.
She has worked A’s games for 25 years, sharing duties with another nurse. Allen works roughly half the A’s home games, fitting them into her schedule when not working at the hospital.
According to Allen, the most common injuries suffered at baseball games are burns (from the steam or burners in concession stands), ankle injuries (people trip and stumble a lot at games) and injuries incurred when someone gets hit by a foul ball–which, she says, typically happens three times during an average game.
Fans have also suffered heart attacks and strokes at games. Plus, team nurses often provide monitoring and education for ballpark employees, many of whom are retirees with health problems such as diabetes and hypertension.
Nurses won’t get rich working at baseball games, Allen says. The pay rate is between $19 and $21 an hour. She arrives about two-and-a-half hours before the game and leaves about an hour-and-a-half after. But still, the perks are nice. She can get six to eight tickets a game, if needed, and does so whenever her sons visit from out of town. She also has quite a collection of souvenir shirts and jackets and the much-coveted bobble-head dolls.