5 WAYS BEING A SKILLED NURSING PT HAS MADE ME A BETTER PERSON

I first drafted this blogpost on June 4, 2020. With this being the last week of work of my first full time PT job, it’s time to reflect


1 | Patient
I definitely feel like I am more patient since working with predominantly the geriatric population. I used to get irritated very quickly trying to help my parents trouble shoot tech issues and now that I do it all the time at work with patients, it doesn’t make my blood boil nearly as much

2 | Protective
When the COVID19 pandemic hit and all nursing homes went into lockdown, restricting visits from loved ones (for good reason), those who work in nursing homes, effectively became stand in family for all of our residents, a task I didn’t take lightly. I’m not exaggerating when I say it tore me apart to know my residents weren’t getting to be with their loved ones, in some cases, even prior to death. I know as healthcare workers it’s not recommended to get attached to your patients, but how could I not? We were the only family they had? Especially as the therapy team, we became such a source of joy and happiness for our residents who were isolated from peers and loved ones

3 | Flexible
There’s really no choice but to be flexible working in the nursing home setting. Thought you only had a 6 hour day so you decided to sleep in an extra hour? Ha, jokes on you! You have 3 surprise evaluations and a 9 hour day. I feel like at this stage in my life e.g. no kids, I am able to manage the variability in work hours day to day, but I can’t see doing this long term once kids arrive. At that point, I’ll be seeking out a job that covers only 1 facility, or maybe 2 small facilities at most to manage the schedule a family with two working parents demands

4 | Intuitive
In the past 2.5 years, I’ve come across a wide variety of patient personalities, from the most highly motivated, to self-limiting, to the most apathetic. While no two patients are the same, I definitely have gotten better at “reading people” aka being able to call people out on their bullshit, both figuratively and literally

5 | Unflappable
No, I did not pull that word from my personal vocabulary. I Googled, word for calm in high stress situations and out popped unflappable, see also composure. I have had a handful of moments in my short career where I have felt fearful and scared for my safety as a result of the actions or exchanges with a patient, most commonly a psych patient. Hell, one of my sites just had a patient elope after breaking 3 windows on the top floor of our building! While there are times I’m apprehensive to approach certain patients or to give undesired instruction, I find that I am more confident in my position of power and authority

Until next time, Meryn


WHAT I’VE LEARNED IN MY FIRST 6 MONTHS, THEN 2 YEARS AS A PHYSICAL THERAPIST

Happy National Physical Therapy Month!

Long before I had the idea of starting this blog, I was working on a thoughtful and well-formatted running list of what I had learned in my first 6 months as a new grad physical therapist. I’ve made some minor tweaks, but the essence of that original writing rings true and can be found below.

I’ve also since added to the list, now that I officially have 2 years of experience under my belt in skilled nursing – oh how the time flies.


What I’ve learned in the first 6 months of being a new grad skilled nursing physical therapist:

1 | This work is not 9-5. I’ve literally had days as short as 2 hours and as long as 10+ hours.

2 | No one outside your immediate department knows your job title, your credentials, or your level of education.

3 | It almost doesn’t matter how good of an evaluator you are as long as the evaluation gets done so that the assistants can start treating the next day, if not later that day.

4 | Companies don’t want to pay a DPT to treat their patients when it is more cost effective to have therapists “do what therapists do best” (i.e. complete evaluations, progress reports, recertifications, and discharges) and have the PTAs treat.

5 | It is rare to find a job where you supervise only one building.

6 | My clinical skills aren’t progressing here and I’m afraid they never will.

7 | There are times when I feel that I am the only clinician who takes the time to truly listen to their patients. When others are quick to dismiss patient’s for being lazy or unmotivated, I’ve tried to uncover a cause for their behavior.

8 | Patients need the permission and safe space to own and feel their emotions. Some people’s entire lives are flipped upside down when they get admitted to our facility. It’s likely they’ve had a decline in their health and medical status, and at times have been uprooted from their routines and even their homes.

9 | Most patients aren’t MORE motivated with constant reminders about their lack of progress, ongoing refusals, and lack of participation. In my experience, this can lead to decline in motivation.

10 | Compassion and a true desire to connect with your patients will go farther than “bad cop intimidation.” Engaging patient’s in meaningful discussion about their hobbies and interests can lend to problem solving and finding motivating factors and ways to successfully hold your patient’s accountable.

11 | Burn out is real and weekends should be treated as sacred time and space to recharge physically, mentally, and emotionally.

12 | Everything you’ve never done before is only scary the first time – at least that’s what I tell myself to ease my fears.

13 | And in the same vain, you only do something for the first time once. Each time you do that task again, you take the knowledge, successes, and failures with you from the first time to make each subsequent interaction better and better i.e. calling family members to discuss patients, discussing patient’s with physicians, calling insurance companies.

14 | Patients rude comments and stabbing words hurt, but they are not a reflection on you as a person, rather the patient’s outward expression of sadness, grief, frustration, etc. – try not to take it personally.

15 | Patients need help recognizing the small wins to keep motivation and morale high.

16 | Salary negotiation is scary (I wonder if it always will be).

17 | The patients you think or appear in the best health are some of the next to die. The patients you think are destined for the grave hold on longer than expected.

And finally, what I believe to be the most important thing I’ve learned in the first 6 months of work as a new grad PT:

18 | You won’t fix everyone. You’ll want to, you’ll feel like a failure when your best intentions don’t work out. Truth is, some people don’t want to be fixed. I remember a clinical instructor telling me this and thinking that was crazy, what do you mean people don’t want to be fixed? But now I know.


What I’ve learned in the first 2 years of being a new grad skilled nursing physical therapist:

1 | You tell yourself you won’t get attached. But you do. And you cry when you see their empty bed and their name removed from the nameplate outside their door. And you’ll think about them when you pass their room or their birthday comes and goes.

2 | Salary negotiation is exhilarating and makes me feel like a strong, determined woman.

3 | Sometimes you have to lie to patients. But not in crazy horrible ways. “Yeah, I’ll look for that book for you” or “I’ll be sure to follow up with maintenance about your tv remote being broken.” Hell no, I say these things and get out, if I happen to run into someone whose job is to handle these issues, I’ll mention it but I don’t go out of my way for non-therapy or health related issues.

4 | I’m not a stern enough clinician. I’m quick to take a patient’s refusal at face value and do a bad job of forcing a patient to participate, especially in an evaluation. I’m not here to force you to do something you don’t want to do. Should I be more direct with people? Probably, but I’m also not about being the bad guy from day one. I educate and provide rationale but if you want to lay in bed all day, that’s your god damn right.

5 | Patients can’t pronounce my name, but that didn’t take 2 years to figure out. So yes, I’ll respond to Mary, Marianne, Marilyn, Meredith, Meryl, Merlin, and Marnie.

Until tomorrow, Meryn


TOP 10 REASONS WHY I LOVE BEING A SKILLED NURSING PHYSICAL THERAPIST

In no particular order, the following are 10 reasons why I love being a skilled nursing physical therapist! For context, I graduated from PT school in 2018 and, at the time I’m writing this, have 1.75 years of experience working in the skilled nursing setting.

1 | Transition to Home
Nine times out of ten when I ask a short-term, rehab patient during the initial evaluation what their goals for therapy are, they respond with “to get back home” – to which I jokingly replay, I think I’ve heard that a time or two before (side note, also a great segue into discussing home set-up and prior level of function). As a therapist, I feel a sense of accomplishment and satisfaction in helping a patient achieve their goal in returning home. Home is where love and life happens and it’s a joy to help patients return safely to their home environments.

2 | Forming Lasting Relationships with Long Term Residents
I love being able to walk up and down the hallways, see the smiling, familiar faces of residents I’ve worked with time and time again. Because I’ve worked for nearly 2 years with the same long term residents, I have a good idea when someone is declining functionally – whether it be in the way that they walk, how they propel their wheelchair, or even how often they are out of their room. This allows me to screen, evaluate, and treat my patients to prevent further functional decline, to optimize functional mobility, and improve quality of life.

3 | Interdisciplinary Collaboration
I’m sure this makes me sound like a nerd, but I love interdisciplinary collaboration (my entire scholarly project in PT school was focused on interdisciplinary education for professional healthcare students). The other disciplines I have worked with include other members of the rehab team like occupational therapy and speech therapy, in house nursing and dietary, physicians, physician assistants, and nurse practitioners, and what I view as ancillary disciplines like orthotists, prosthetists, and wheelchair vendors/assistive technology professionals. Similar to the hospital setting, it is so beneficial having the ability to walk down the hall and get updates from nursing, express concerns, celebrate victories, and advocate for my patients, without leaving the building, usually without even having to pick up the phone.

4 | Chronicity and Acuity
Working in skilled nursing provides the opportunity to work with short term rehab patients with acute concerns and medical instabilities, but also with long term residents with chronic impairments and various comorbidities. When new admits come to us after lengthy hospitalizations with extended period of bed rest, they are often times very deconditioned and weak, and require extensive physical assist for rolling in bed, sitting without support, even repositioning their legs in bed to optimize comfort and to preserve skin integrity. It is often these patients who challenge my goal writing skills and creativity when forming plans of care. This juxtaposition and variability has helped me refine my skills as a relative young physical therapist.

5 | Variety in Age Range
When I was a physical therapy student, I had the misconception that the only patients in skilled nursing facilities were going to be old people, like 65 or older. I quickly learned during my SNF clinical rotation in Nebraska that this was not always the case. Yes, generally I’d say my patient population is 65 years or older, but it’s not uncommon to work with patients younger than 65. The youngest patient I have had was 27 years old (just 1 year older than me at the time), while the oldest has been 101 years old. I like being able to work with such a wide age range, it keeps topics of conversation varied from life during WWII to Taylor Swift.

6 | Custom Wheelchairs
I have a confession: when I was in PT school and we were learning about wheelchairs, I literally thought it was pointless and that I’d never use that information in my career. Jokes on me because I love, and I mean LOVE, collaborating with wheelchair reps to get my patients custom wheelchairs with custom seating. Wheelchair delivery day is such a satisfying day in the therapy world. It feels like such a win after the long process of evaluating the patient, designing the wheelchair, completing the medical justification paperwork, and waiting for approval from the health insurance companies. It has been a learning process with trial and error, successes and failures, but it is so satisfying to see a patient in their new, custom wheelchair. At the time I’m posting this, I’ve successfully had 6 custom wheelchairs approved and delivered.

7 | Autonomy
Never in my career have I had a physician deny my plan of care for a patient (can’t say the same for insurance companies). In my experience thus far, the physician’s I work with will sign off on anything. Want to pursue a custom wheelchair? Signed. Want to start PT to negate a functional decline? Done. Does nursing staff need re-educated on a restorative program i.e. walk to dine or PROM program? Sure thing. To be honest, I can’t even be sure that the physicians do more than skim the top of the eval to see what discipline it is before signing. I don’t know that this can be said for all skilled nursing facilities, but I feel that I have a lot of autonomy, more so than what I experienced in the outpatient orthopedic setting.

8 | It’s Fun!
In what other setting can you dance with patients to ‘Celebration‘ and ‘It’s Raining Men‘ and bill for it? With some creative wording, dancing in during a PT session becomes challenges to static and dynamic standing balance without upper extremity support with focus on lateral and anterior weight shifting in addition to side stepping and forward stepping to challenge balance reactions for reduced fall risk. Every day may not be fun, but there definitely is fun in every day.

9 | Income to Hours Ratio
Let’s be real. I have two college degrees that were not cheap, so pay is important. Now on a personal level, my work set-up is unique in that I work 10-20 hours a week at a full time, hourly rate at one building and 10-20 hours a week at a PRN rate at the other building (because I work for 2 different entities of the same contract company). The down side is that I don’t accrue PTO as quickly as standard full time employees, but I manage just fine, and honestly it doesn’t much matter right now with travel restrictions in place due to the COVID-19 global pandemic. For comparison, in 2019 my gross income was just over 72K working 1,610 hours in a calendar year. Based off of my own research and conversations with my classmates working in the outpatient setting in my same state, annual salaries can range from 70-85K but as salaried employees, they are most likely dedicating 2,080 to 2,600 hours in a calendar year – a possible difference of 1,000 hours! There definitely is good money to be made in skilled nursing, especially with a couple reliable PRN gigs on the side.

10 | Opportunity to Work in Other Buildings
Working for a contract rehab company affords me the opportunity to work in my ‘home buildings’ (where I serve as the supervising physical therapist) but also other SNFs in the area. This gives me the opportunity to pick up extra hours during the week and on weekends – which equates to more money in my pocket. Aside from the obvious benefit of earning additional income, working in other buildings has exposed me to hundreds of other patient cases, which really helped me gain confidence and improve my skills my first year as a clinician. Now, I’m well known in my company for being a reliable, flexible, and professional physical therapist. My willingness to work at other buildings has helped me network with other directors of rehab and has in turned helped me leverage my worth as an employee, resulting in multiple raises.

Until tomorrow, Meryn