The Wide World of Sports/Fitness Nursing

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.

Playing Games

When Reggie Brown of the Detroit Lions was tackled in a game against the New York Jets on December 21, 1997, it appeared to be just another good hit. That is until he didn’t get up. Immediately, Kent Falb, the team’s head athletic trainer, ran out onto the field to determine what was wrong. Unfortunately, the impact displaced Brown’s first and second vertebrae, but it was impossible diagnose that on the field. All Falb knew at the time was that Brown was struggling for every breath. But it was Falb’s quick-thinking reaction along with the help of team doctors that helped to stabilize Brown and prepare him for transport to the nearest trauma center.

While the public may automatically associate athletic trainers, also referred to as sports therapists, with professional athletic teams, their expertise reaches far beyond the playing fields of the NFL, NBA, NHL or MLB. It’s an allied health specialty that’s gaining respect among school districts, sporting clubs, hospitals, physicians, and even in the field of industrial manufacturing.

In fact, the profession has been experiencing significant growth for nearly 30 years. Membership in the National Athletic Trainer Association (NATA), the profession’s leading organization, has grown more than 520% since 1974. Its most recent statistics reveal that membership topped the 28,000 mark in 2001.

And it’s a specialty that continues to create new jobs for sports medicine graduates. In fact, NATA forecasts continued job growth of at least 2,600 more jobs by 2005, and another 7,000 jobs by 2010.

The Fundamentals

In some ways, athletic trainers assume many of the same responsibilities as triage nurses—they’re usually the first ones on the scene and in charge of making split-second assessments. “The trainer is the first-line soldier, working in the trenches with the athletes,” comments Dale Baker, the Smith and Nephew chair for director of education at the American Sports Medicine Institute, based in Birmingham, Ala.

As in Brown’s case, Falb was able to gauge the urgency of the situation and prioritize the initial treatment steps. In less traumatic cases, trainers determine whether or not an athlete’s injury is severe enough to warrant transportation to the hospital. If not, they treat the injury on site and follow up with a rehabilitation plan.

“We’re trained to splint a fracture, perform cardiopulmonary resuscitation (CPR), assess injuries and illnesses, and rehab an injury,” states Laura Harris, PhD, ATC, assistant professor of athletic training at Ohio State University, School of Allied Medical

Professionals in Columbus.

But trainers also work in preventative capacities, such as strength training, conditioning, exercise instruction and overall health maintenance. “Athletes are expected to do a job and the trainer is trying to get them back to work as soon as possible,” notes Michael Mandich, ATC, an independent consultant based in Lewisville, Texas.

Because their responsibilities cover such a wide spectrum of health care tasks, athletic trainers and sports therapists are typically required to have a four-year degree that includes classes in anatomy, physiology, psychology, nutrition and conditioning. Employers also require a variety of certifications, namely athletic trainer certified (ATC), CPR and first aid. Additional certifications focus on specific areas within the profession, and requirements vary depending on the needs of the job.

Of course, to practice at the professional sports level, trainers must have several years of experience and usually an advanced degree. Even at the collegiate level, the competition for positions is extremely stiff, and a master’s degree can be a deciding factor.

“Most trainers recognize the need for advanced education in order to be competitive. It’s difficult to make it to Division I, II or even III without a graduate degree, and it’s especially difficult to get into the professional level,” asserts Harris. “It doesn’t necessarily matter what your degree is in, but it proves you’re someone who has challenged your critical thinking skills.”

Unlike physical or occupational therapists (PTs and OTs, respectively), not all states mandate athletic trainers be licensed. However, 43 states currently demand some form of regulation, from licensure to registration, and the average starting salary hovers around $28,000.

Game Plan

Almost without fail, an individual’s introduction to sports medicine comes from sustaining an injury while playing a sport. “I would say about 98% of us in the profession were injured as an athlete and had to be treated by a trainer. We didn’t know about [the field] until a trainer took care of us,” says Harris, a former gymnast.

Of course, there is that small percentage that simply saw sports medicine as a way to stay directly connected to sports without becoming a professional athlete or coach. Mandich is one example: “Growing up in Green Bay, Wis., I always wanted to work for the Packers. I knew I was never going to play for the team, so I thought the closest I could get would be to become a trainer,” he says.

While Mandich hasn’t landed that dream job with an NFL team yet, he has been able to expand his skills through various positions. Since graduating from the University of Wisconsin at La Crosse in 1997, he has worked at PT clinics, hospitals, and with a number of school districts. “I especially like working with kids because it’s challenging work and always changing. You never do the same thing two days in a row,” he comments.

Little League

Many athletic trainers start off their careers treating high schools athletes, getting them in shape, and prepping them to compete at the more advanced collegiate level. Unfortunately, there are very few individual schools that can afford to hire a trainer to solely attend to students’ needs. Rather, school districts usually contract with local clinics or hospitals to have staff trainers work with the schools on a part-time basis. These specialists split their time between patients and students. “I like being part of the fast-paced environment during the day and working at a high school in the evenings,” Mandich says.

“In more rural environments, some of the education budgets are not as lucrative, and schools may have to hire a trainer to service the entire district instead of one trainer per school,” notes Harris. “At the high school level, trainers are more often used in the game settings for emergency medical situation rather than for their rehab or prevention skills.”

Yet another sport medicine career path is teaching. In this scenario, individuals are in the classroom during the day and on the field or court after school. “However, that’s a job with a high amount of burnout because they are there from early in the morning to late at night,” states Harris. “Typically after five to seven years, many trainers find a spouse or start a family and want better hours.”

Neither the health care nor the educational communities overlook the importance of having certified trainers to support young athletes. Recent studies have shown that too many children are insufficiently trained and, therefore, sustain unnecessary injuries. According to U.S. News & World Report, there is an alarming rise in the number of overuse injuries among children, such as persistent heel problems among young soccer players.

Complicating matters is the fact that many youth teams are coached by parents or sports enthusiasts who may know about the sport’s fundamentals but aren’t necessarily trained in the finer aspects of conditioning. Without a balanced approach to practices, weight training, and overall conditioning, children are at risk for injuring themselves or, at the extreme, causing permanent damage. Additionally, the medical community has expressed concerns about undiagnosed concussions, particularly among football and soccer players.

With more than 30 million children playing on school or recreation-league teams, it’s no wonder that there’s a growing call for change. More organizations and schools are recognizing the importance of appropriate training and, where budgets allow, are seeking the expertise of professional athletic trainers. Even the American Academy of Pediatricians has publicly advocated the use of ATCs for high school sports. Therefore, industry analysts believe this is a work setting that will continue to grow for entry-level sports medicine grads.

The Practice Arena

For those who prefer treating a broader range of people, doctors’ offices, PT clinics and hospitals also offer interesting career options. In these settings, the ATC works along side PTs, OTs, doctors and nurses as part of the health care team. Additionally, patients vary in age, race and socioeconomic backgrounds. Specialists may see professional and collegiate athletes, weekend enthusiasts, children, and even the elderly—all of whom may have suffered an injury or require additional training in order to avoid further complications. Says Mandich, “Athletic training is a very interdisciplinary approach. You’re still treating an active population, they’re just not all athletes.”

Regardless of the environment, sports therapists are required to function under the supervision of a physician and are often the link between patients and the rest of their health care team.

“We work with the primary health care team that consists of the patient, parents if a minor, coaches and physician. Then there is the secondary team, which consists of a rolodex of consultants, such as PTs, exercise physiologists, nutritionists, psychologists, social workers, school nurses and chiropractors,” explains Harris. “Our co-workers run the gamut of the health care professions.”

Additionally, trainers in the clinical setting assume more of a rehab perspective, including exercise prescriptions and patient education. In a time of heightened cost-consciousness, ATCs have proven to be a valuable asset. The NATA reports that physicians have indicated a higher rate of reimbursement when employing trainers. Additionally, ATCs free up doctors’ time to see more patients while continuing to cater to an individual’s needs.

As the population ages, industry analysts anticipate a significant increase in the need for sports therapists in the clinical arena. As people grow older, they become more susceptible to activity-related injuries. Therefore, there will be a greater demand for specialists who can help individuals return to their daily life, which includes instruction on how to prevent further injuries.

Another promising development for ATCs is the recent changes in insurance policies that now agree to reimburse providers for sports medicine treatments. “The list of companies that will reimburse trainers is growing, whereas PTs have been billing for their services forever. In terms of reimbursement, trainers have been undervalued and underutilized,” says Mandich.

“As we gain more progress toward reimbursement—and the number of potential services that are covered by reimbursements—we will also see salaries increase,” adds Harris.

The Professional Team

Perhaps the most promising employment environment for ATCs is nowhere near a football stadium, ice rink or hospital. Rather, it’s within the walls of high-rise office buildings and manufacturing plants. Corporate America has taken notice of the benefits of being physically fit, including the financial results. At its most basic, active employees are less likely to use up sick days and make fewer medical claims against insurance policies—they even add to high company morale.

Although most evidence is anecdotal, more and more companies are encouraging employees to exercise and maintain healthy lifestyles by providing workout facilities, discounts to private gyms, and even perks like free movie tickets to those who prove to be physically active. But back in 1985, Honda of America Manufacturing (HAM) simply wanted to give its employees and their families a place to exercise, get in shape and enjoy recreational activities. That’s when the automotive manufacturer opened its first Wellness Center in Marysville, Ohio.

Now, nearly 20 years later, HAM boasts three Wellness Centers, each with degreed professionals on staff to assist employees with their physical needs.

“Each center promotes wellness with education. There is nutrition information from a registered dietician, and associates can discuss their wellness concerns and have one-on-one consultations for issues like stress management. The centers’ program departments plan recreational activities, such as intramural leagues and holiday parties. The aquatics departments run the pools, swimming lessons and aqua aerobics. The fitness departments’ staff have the capabilities to help individuals with any from training—from a marathon to body building,” explains Dave Litzke, the coordinator for the Marysville center.

While the centers are designed to accommodate individual needs, their staffs also help HAM employees recuperate from injuries, whether suffered on the job or during their off time. “Injured athletes need to return to playing at the same level of competence in the shortest period of time—that is what the athletic trainer does. A lot of those same treatments also work on other workers and athletes, including the weekend warrior,” notes Baker.

“Nowadays, larger organizations are recognizing athletic trainers as entities that are viable options to help offset or deter health care costs,” adds Casey Kirk, coordinator at one of HAM’s Wellness Centers.

Athletic trainers are particularly valuable in the industrial environment where assembly workers are expected to do heavy, monotonous functions that can lead to workplace injuries, if the workers are not properly conditioned.

“When you look at the volume and repetition of movement an associate does in a fast-paced manufacturing environment, the amount of trauma on the body equates or supercedes that of an athlete. Upon their gaining employment at Honda, some people may not have the baseline physical condition that’s required,” explains Kirk. “Associates who work in these facilities need a high level of conditioning.”

Both Litzke and Kirk agree that it’s satisfying to help people not only obtain better performance on the job, but to also enhance their lives as a whole by becoming physically fit. “We work with a diverse group of people in very different ways. In the morning we could be working with a senior citizen, in the evening we could be working with mom who just had a child, and at night it could be helping a high school athlete,” explains Kirk.

Keeping Score

In order for athletic trainers to be effective with their clients, regardless of the setting, a holistic approach is required. Lifestyle, motivations and health care goals are all taken into consideration. “Most of the time, you’re not dealing with sick people but people with health care problems nonetheless. You have address the whole person in treatment,” advises Baker.

And it’s this complete approach that places sports therapists in a unique position within the allied health field. Their broad knowledge, multiple applications, and adaptability to numerous environments make them an asset.

Indeed, it was Kent Falb’s expertise that helped Detroit Lion Reggie Brown not only survive that tumultuous tackle, but allowed him to make a remarkable recovery. Less than a month later, Brown was jogging and doing other prescribed exercises on his way back to a fully functional life and a winning athletic career.