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


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