flying solo

i am quickly approaching the two month mark as an official working therapist! crazy! it has been a very challenging two months, in a lot of ways.  it has also been very rewarding, and i have grown a LOT in my skills, and have made a difference in LOTS of people's lives. that's what it's all about. :)  my stress and joy fluctuates by the hour of the day... yes, a new job is hard for anyone in any field, but i can say i didn't realize what i was getting myself into when i agreed to this setting and this site to be my first entry into the field!  a lot of times i have wondered if a different setting with more therapists and mentors available would have been better to develop my core skills... or if i was just not cut out or had the initial background i need to be an independent OT at all.  it has been ROUGH and i have questioned a LOT...  but ultimately, i know i made the right choice. and two months after that horrible first week, i am thriving, making new victories each day, and discovering new challenges after each one... i have failures and let downs, and then i have wins and praises.   i am sure this is the right place for me at this time in my career and that the therapist i will be in a year or in two years will be thankful for the intense experience.  meanwhile, here are some of the tough points of my first job (promise i will write an entry with all GOOD things one of these days!):

1. this is my first real job (outside of all the random summertime/part-time gigs i've held the last 7 or so years), and adjusting to being on my own (on clinicals there is ALWAYS at least 1 OTR or COTA  nearby to ask a question to, vent to, watch what they are doing.. copy what they are doing, and get great advice from.  at my job, i am the only OT.  the only one-- after being "off" for an entire three months!  i was basically thrown in the water to sink or swim!

2. this is a very CHALLENGING setting.  i am working as an "outpatient" therapist (by medicare terms) in an retirement community serving residents of assisted living, independent living, and memory support = approximately 350 residents.  It is truly a spectrum of needs and abilities (exception: I do not see official "skilled nursing" residents (long-term nursing residents or short term rehab patients). There is a SNF on-site, in a different building with their own therapy staff- I very rarely interact with them or work in the SNF.).  The patients I see represent every level of independence, every type of disability or illness (physical, cognitive, or psychosocial, and most often a combination), and requiring nearly every [reimbursable] OT modality available.  I am an entry-level  therapist in a job that requires advanced skills from just about every area of practice.  We can see this as a good thing: I get a lot of exposure to different things and don't get bored with the same diagnoses over and over.  But more often I see it as AHHHHHHH.

3. There is definitely a nationwide trend in long-term care that "assisted living facilities" are accepting residents with greater needs than what used to be considered appropriate for ALF.  This deserves a long discussion.  I started to write a TON then decided maybe the topic needed it's own post for my little soapbox. :)  Anyway, the point is, ALF residents are either very dependent, or they are very at risk for becoming dependent down the road.  Many ALFs are under-staffed for the high needs of residents, and as a result, many needs aren't being met, and many caregivers are feeling burnt out and frustrated that their position in ALF isn't "what it used to be".  Much of my role currently involves caregiver training, teaching techniques and strategies that make it easier for the caregivers, and coming up with exercise programs or maintenance programs that will keep patients at their current level the longest-- as opposed to traditional "rehab" or "restorative" therapy.  I still do see those typical "outpatient" folks, but for everyone else I have to be VERY creative to determine what exactly they need the most (lots of times it might be environmental mods, equipment, teaching a new routine or structure to follow, among other things), and how to ensure that everyone (i.e. caregivers and family) are on board and will carry it out without me.  It's tough!

4. Did I mention I am ON MY OWN?  WAAAAAAAAAH.

5. My company pays employees hourly, and we are expected to work no more than 40 hours per week, and must maintain an 81% productivity.  This means I am expected to see patients for a total 6.48 hours per day (on average) bill EXACTLY for reimbursable minutes, and still manage things like paperwork (in other words, justifying the 6.48 hours I spent), emails, calling families, speaking with caregivers and nursing staff, walking to and from patient's rooms on floors and to and from the memory support unit (about 1/4 mile each time I walk down there), provide occasional in-services, attend 1-2 hour long conference calls, staff meetings, watch required training modules, order equipment for patients--  and do all of it WELL so that I don't get a denial from medicare.  All the "extras" are almost more important than the patient time.  (Sad- right?)  So on top of all the pressure and challenges of being a new grad, being on my own, working in a difficult setting, trying to learn new modalities and make the most of each treatment session, motivate patients to even participate (many are VERY quick to refuse a scheduled session), I have added pressure to be FAST and EFFICIENT about all of it.  *Phew*

(Note: A couple weeks ago, I attempted to do some paperwork off the clock so I could get it done on a Friday and not have it hanging over my head until Monday-- I got reprimanded for doing this.  I would MUCH rather be salaried for this reason, but I suppose it is good that they cap me at 40 hrs.  I could easily spend 60 hours per week at this job and be way more burnt out than I already am.)

6. I am still getting my feet on the ground in a new town and don't have a lot of immediate social support.  I have a roommate who is actually great, but I'm pretty sure he thinks all I do is complain. :)  A college friend is here too and she has been wonderful-- we just aren't joined-at-the-hip close.  I know a couple other people casually, but again, not close friends who I really have a lot in common with.  My coworkers are all older, and most are married and/or have kids.  All of this probably wouldn't be such a huge deal-- since I've only lived here a few months and it takes time-- but approaching Christmas, it's been getting me extra down, and it's discouraging.  It's hard to not have go-to plans for fun when Friday comes after a really difficult week!  Relaxing, reading, cleaning, and shopping only go so far -- laughing and socializing and talking are my true stress relief!

7. Having not started my job until late October, I had very few options about how to manage my holidays and be able to travel.  My parents live in Ohio, and my three older brothers live around the country (none in driving distance).  Closest family is my aunt- 1.5 hour away, and my grandma, 2.5 hours away.  The youngest brother got married in October in California; his wife also grew up in Ohio and her family is there too.  They were both able to get a full two weeks off from their job to travel for the holidays... and my parents wanted to host an open-house reception for them since many of our hometown family friends weren't able to travel.  This will be the 29th (next Saturday).  My company gives employees two paid holidays per year: Thanksgiving and Christmas day.  Coming on so late, I was told I could choose one additional "personal" day between Nov 12 and Jan 2, and it had to be approved; it could not be the week of Christmas day.

Well what good is having a day off on a TUESDAY?!

Therefore, I volunteered to work Christmas day in exchange to have the 28th off, in addition to the 31st, so I could actually spend substantial time with family.  Working on Thanksgiving wasn't so bad, but then two days ago, I found out I'll be working Christmas Day at the SNF (where I don't usually work) -- by myself.  I get to wake up in the morning-- by myself.  Then I get to come home to an empty house and open two presents (one is to: me, from: me) --  by myself.  And eat breakfast, lunch, and dinner -- by myself.  All of this hit me about two days ago, and I am having a bit of a meltdown.

I think the anticipation of spending my favorite day, my most important time of year, my most looked-forward-to season- alone, is probably worse than the actual day will be.  I can say this is one year I just want Christmas to be over with.

I AM looking forward to our family gift exchange on the 28th in Ohio.  It will just be one of my brothers and his wife and I, and my parents.  Small, and delayed, and not quite the same... but it will be amazing and I will forget ALL about this week and block it out of my head.

Merry grown up Christmas!  Flying solo isn't all it's cracked up to be-- but I know I'll be stronger and a better therapist because of it, and I will appreciate all future holidays and time with family that much more.