Simple Concepts. Dynamic Results. 

Making the Transition

Posted on March 19, 2015 by AUTHOR (edit in theme settings) | 1 comment

I worked as an out patient ortho therapist for 18 years. I went to all kinds of continuing ed classes, watched countless surgeries and never turned an ear to any therapist that was to teaching me something useful. I always said that I would never leave out patient and work in any other setting as I thought that out patient ortho is the only therapy I would do throughout my career. I always thought I would never work in skilled nursing as this is way below my skill level. Until after my second child was born and the 30 mile drive each way plus working those 10 hour days (couldn't turn down the OT)  was just too much. The town I live in is very small, it has one out pt ortho clinic run by a husband and wife, both PT's that will not and have not hired any therapist since they opened and a skilled nursing facility that had a horrible reputation in town for bad care but was only a half mile away. Well, I really only had one option and as you can imagine and it was difficult to even think in that direction. I spoke to my wife about it and told her my concerns about treating strictly the geriatric population and how I dreaded the thought truthfully. Her reply was so painfully true it instantly made me reconsider. She said "someone has to treat them, they need good help as much if not more than anyone else". For some reason that really hit home! I went and inquired about open positions and of course they weren't hiring but I got on their per diem list. I worked there a total of maybe 4 times in 6 months before the RVP called and offered me a full time position. It was a big decision but after considering all factors I took the plunge as a full time therapist in a "SKILLED NURSING FACILITY!! Devastating! All those years of training in my mind where going to be wasted! I was taking the path to PT hell!!  Well, after 2 plus years I have to tell you I couldn't have been more wrong! I was there only 6 months before the opportunity to be the director was offered, I excepted the position and from that point on I really started to have fun! I had the privilege of working with a great Administrator who gave me the green light on every piece of equipment I wanted. I filled the place up with all out patient equipment like a leg press you can use from your wheelchair, BAPS boards, a rebounder, a Nu step and all kinds of good balance toys. I was like a kid in a candy store! My department was not going to function like a normal nursing home rehab where people sit in their chairs for and hour and do the can can! My peeps are gunna move, they are gunna balance like when they were 20 and they are gunna have the stamina to walk down the grocery isle instead of taking the 3 wheeled scoot around scooter! I was not going to waste all my years of learning and knowledge to watch people sit in a W/C and exercise! I have taken all that I know and just diluted it to fit the older populations ability. It's all about function no matter what the age right?

The point I am trying to get at is that I had this image in my head of this awful place to work! A place where all my skills will not being utilized and the case load does not fit my skill level. But I gave it a chance and It was the best move for me in many ways. Instead of feeling good about making an impinged shoulder better in a few visits I have possibly given a person a few more years of freedom to live at home instead of a LTC facility. I still see the occasional total joint which used to be one of my favorite diagnosis to treat and now I think it's boring. I love taking a 95 year old and putting them on some foam or the functional grid and making their balance better. Watching them go through the progressions and getting away from the wheelchair. Or taking a patient that has Lewy body dementia with severe burns to both feet with contractures in all toes that is W/C bound to walking with hand held assist over 300 feet within 2 months time. These are the things that give me gratification now. I love out patient and always will but I have to say it would be boring to me at this point to be honest. I love the challenge of figuring out a problem and making it better. I am always getting challenging patients in my building which keeps my mind stimulated and engaged in the profession. I have enjoyed the transition so much I wish I had done it sooner. We as therapist all want to make people better and be a hero to our patients. This can be done in any setting if you continue to be creative and skillful in your approach with every patient you treat. Don't make the mistake I made in letting your out patient arrogance stop you from making positive changes just because you feel it's below you to work in any other setting.  Put your skills to the test and help those that need it most!

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  • Josh

    Great article :) I’m a PT and can definitely appreciate your apprehension about the switch to SNF. Luckily, you worked with a great director, it sounds like. I think it’s more difficult if you provide great care only to send them back to their room where they get lousy care.


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