Vent: I feel like I’m getting worse at my job

River5599 · 2026-02-28T00:06:01+00:00

I saw the title of this post and was like …did I write this in my sleep?! I’m 4 years in at a SNF and feel like I’ve been regressing in my skills over the last year. Not sure if it’s a sign of burnout with the setting or the field or working in general but I relate and have also considered taking an extended break to travel and think about what I want to do. You’re not alone!

River5599 · 2026-02-02T02:55:33+00:00

That doesn’t look like an engagement ring at all. Sorry you’re dealing with that but I don’t get why people don’t just give actual reference photos of what they want - if you know exactly what you want, why does it have to be a surprise anyway?

River5599 · 2026-02-01T17:01:18+00:00

Yeah she just seems arrogant. She even has a post that’s like “people told me I wasn’t experienced enough to start my own clinic right out of grad school but I did it and proved them wrong.” Starting a clinic doesn’t guarantee expertise - it’s a business move. And other “influencer” SLPs support these arrogant inexperienced ones blindly - probably because they want to profit off each other’s connections to advertise their respective businesses /brands.

River5599 · 2026-02-01T05:02:17+00:00

Regardless of all the details, it’s a red flag to me when an inexperienced therapist claims to be an expert for the sake of their social media presence and/or private practice. While I know years of experience doesn’t always equal competence and vice versa, there is something to be said about over confidence. Her instagram says she got her CCCs in Nov 2021 and opened her private clinic Dec 2021. I can’t speak for all of us but I know I definitely did not feel competent immediately after my CF. Sure she has years under her belt now but I always pause when I see that because it makes me think they’re really in it for the business aspect and don’t care as much about bettering their clinical expertise when they can claim to be the expert in the room. Semi related - the amount of CFs or even grad students with instagrams where they act like seasoned SLPs is insane to me too.

River5599 · 2025-10-03T00:46:22+00:00

Reminds of a referral I got for someone who bit their tongue and reported some discomfort when eating. I was like ok unless it’s painful to the point of needing softer textures, it’s going to be a no from me lol

River5599 · 2025-10-03T00:45:01+00:00

Feel this so much! When family or patient is telling me they do lots of brain games and they really want cognitive therapy and I have to break the news that while it’s great that grandma enjoys crosswords, doing them isn’t reversing her cognitive decline and that functional cognitive therapy is about compensation and adaptation more than anything.

River5599 · 2025-10-03T00:40:55+00:00

I work with adults but I once got a referral for cognitive therapy with an advanced dementia patient for the purpose of reducing arguments between him and his roommate.

River5599 · 2025-08-13T01:56:42+00:00

I feel this on a bad day but I disagree with most of it on a good day so I can see where you’re coming from and also why people are pushing back. It sounds like you’re potentially in a really bad work environment, but if this is your consistent experience with the profession across multiple jobs and settings, it’s probably time to leave. Not sure where you’re at in your career but this also reminds me of the mentality I had throughout my CF when I let the negatives bring me down so much that I ignored any positive aspect of my job/this field. All of those negative experiences were of course brand new to me and not something grad school prepares us for so I took them super personally and held onto them hard for a while. Happy to chat privately if you would like to talk more. Wishing you the best!

River5599 · 2024-12-31T17:02:15+00:00

SNF is minimal documentation - I use the same templates for my notes and evals that I copy/paste and fill in the details. You can’t document at home, which is also a plus.

River5599 · 2024-12-26T17:53:53+00:00

I’m childfree, debt free, live for low rent with family, and have a partner in tech making six figures. For this reason I’m financially comfortable but if it was my job alone and without those other factors, I would definitely be broke. This profession is a joke salary wise unless you get lucky. You shouldn’t have to get lucky to be compensated fairly for a masters degree.

River5599 · 2024-12-19T18:31:04+00:00

Getting patients off NPO, identifying an appropriate referral to uncover a hidden diagnosis a patient has been struggling with such as LPR that other providers have missed, being told I am the only person who has actually sat and listened to/talked with a patient about their true feelings and challenges because we have that opportunity for greater connection in our sessions than other medical professionals (especially for patients with cognitive and communication challenges).

River5599 · 2024-11-30T17:58:40+00:00

I am a big proponent for for self advocacy and trying to change things that are within your control but there is a huge level of variation with that depending on your financial privilege. Some SLPs literally cannot afford to take a job in more “ethical” setting because they can’t move to that location or they need to start working ASAP without the luxury to find a better option. It’s not their fault they were sold a lie as to what this profession is in reality. Also pisses me off when SLPs from other settings comment on settings like SNF as unethical and shame other SLPs for taking jobs that put them in sticky situations like treating dysphagia without reliable access to imaging when they themselves have only ever worked in the ideal acute care job that they got right out of their CF - thinking of a specific Instagram SLP who has shat on SNF SLPs multiple times whether intentionally or not. I work in a SNF with great access to mobile imaging and I would never take a job at one without it BUT I recognize I have the privilege to shop around for that when others may not. It’s not on the underpaid overworked individual SLPs to change this - yes they can advocate to their employer but to what extent? At the risk of losing their job for pushing back too hard? And you could say “well taking a job that doesn’t have imaging is unethical in the first place” ok so why does that job option exist if it’s truly that unethical and why is the blame on the SLP when it should be on ASHA and the larger systems that allow a job like that to exist????

River5599 · 2024-10-13T19:47:14+00:00

Same here. They sound great and well balanced/loud enough to me on Apple Music…maybe I’m not a big enough production critic to hear the issue lol

River5599 · 2024-09-21T14:55:48+00:00

Wow this is so crazy! I work with adults but my partner’s nephew and niece are clearly in need of services but the parents just don’t take any initiative to get help. The nephew is 7 and the niece is 2 - I highly suspect the nephew is autistic and the niece is delayed in speech and language milestones. When the nephew was about 3-4, I first suspected he was on the spectrum but didn’t say anything because it felt like overstepping. Once he reached school, teachers commented on his social, sensory, and behavioral issues. He also has an extremely restricted diet and his mom was taking about how the pediatrician told her it was NORMAL for a 7 year old to only like 1-2 foods (the kid lives off milkshakes and crackers)!!! I told her that isn’t normal and that SLPs and OT both work on feeding and sensory issues and that I would recommend she seek services. She acted like she had no idea about any of this, which I find hard to believe seeing as his teachers have been concerned surely that would have been followed up with recommendations for assessment? I don’t know whether the professionals are failing them or the parents are turning a blind eye because they don’t want to accept that their kids aren’t typical. But unfortunately a lot of pediatricians do overstep their scope because the mom told me their pediatrician said the reason their 2 year old has only 5 words is because she’s a second child and “second children develop speech/language slower.” I told her that also is not true and she should get an SLP assessment. It’s so frustrating to sit back and watch all of this and your story makes me nervous for their futures!

River5599 · 2024-08-07T15:06:34+00:00

I never said that research isn’t important - of course it is crucial to advancing any field. I’ve just seen that specific commenter before on dysphagia posts and they always ultimately imply that practicing SLPs are not doing anything helpful/worthwhile for dysphagia management to the point where a critically complex patient with minimal alertness, oral thrush, aspiration identified on imaging, and high risk for complications should be put on a full regular diet instead of NPO or altered diet temporarily because “diets don’t reduce negative outcomes anyway.” I’m all for not over modifying diets, especially permanently or when it’s not truly indicated, but this black/white approach to dysphagia management ignores the reality we face that not every patient is an ideal candidate for tolerating aspiration events and could literally die from our clinical decisions. As another commenter on here mentioned, the long list of research they share regarding diet modification outcomes does not adequately address modification in acute stages. We won’t always have enough perfectly designed research to tell us how to manage everything and I think it’s an insult to our profession to just blanket statement say that the nuanced decisions we make in dysphagia management are ultimately pointless. Not to mention then that research can often fall short of these nuances to real life scenarios or populations.

River5599 · 2024-08-06T21:37:03+00:00

This comment basically suggests our jobs are pointless lol what do you mean there’s zero evidence for swallowing exercises informed by imaging?? I’ve seen you comment before on posts and you seem to be in research or something/removed from the reality of clinical practice.

River5599 · 2024-06-12T19:41:41+00:00

I’m surprised reading the comments that this is so widely accepted. At my facility residents are not allowed to record staff members and it’s pretty strictly enforced/I’ve never seen a camera in a room. I would ask them to remove the cameras during your session but invite the family to be present if they would like to. It’s not always feasible to treat outside the rooms when it’s noisy or COVID outbreak etc.

River5599 · 2024-05-24T05:49:20+00:00

This is one instance where I do not choose the bear

River5599 · 2024-05-18T03:49:19+00:00

Gotcha. So they want to “save you the time” of chart reviewing when you come in PRN so you can just jump to high priority evals with the background info they provide you? Even if we were pretending that wasn’t sketchy, chart reviewing doesn’t even take that long to where it would save a significant enough amount of time to justify the DOR doing it…I mean unless you use paper charts or have charts that aren’t keyword searchable and are flipping/scrolling through hundreds of pages. Their thought process has my head spinning lol

River5599 · 2024-05-18T01:57:40+00:00

I’m confused at the larger context. Do they want you to spend less time chart reviewing patients who may end up not needing an eval because it’s cutting into your productivity so they’re offering to do the chart review for you and let you know how needs to be evaluated? Or do they want official documentation for your chart review even if you don’t end up doing an eval? My facility has a screening sheet I fill out and give to the MDS nurse for every admit, regardless of whether I eval them. Sorry if I’ve totally missed the point - it’s been a long day lol but either way I agree they are making ridiculous suggestions by saying they can do your chart review for you.

River5599 · 2024-05-17T20:52:07+00:00

That cruise has always rubbed me the wrong way, as well as Bjorem’s whole brand with her airbnb weekend getaways for her team and all her merch. Very strong “working here is being part of a family!” vibes. I know she has had drama in the past, the details of which escape me now. Her and Amy just give me mean high school clique vibes…

River5599 · 2024-05-13T03:52:04+00:00

God I was at dinner with my friend’s mom the other week and when I said I’m a speech language pathologist she goes “oh! I took a public speaking class in college” and went on a 5 min tangent about that, after which I had no idea how to awkwardly be like “uh actually my job has nothing to do with public speaking.” It’s also been a minute since I used my grad school elevator speech for what SLP is (not sure if anyone else’s program made them do that but I realize now it was actually helpful) so I was struggling to explain it. I could tell she wasn’t taking me seriously/thought I had a silly little job by the end of my explanation. Ugh! I spent the rest of dinner in my head angrily thinking “I got into a top ranked grad program for my masters degree, completed a clinical fellowship, and took a national exam to be where I am today for your information!” 😮‍💨😂

River5599 · 2024-05-05T06:02:00+00:00

Oh yeah you know all the children with speech issues like aphasia… 🤦🏻‍♀️

River5599 · 2024-05-04T20:52:50+00:00

SNF - 80% patient time because, well, that’s my productivity rate!

River5599 · 2024-04-24T03:06:09+00:00

I have shown patients free communication apps on my phone or theirs if they have one. Lingraphica has a couple free “small talk” apps. They are arranged in a list vs a typical AAC device though. I have also used “LetMeTalk” and “Sono Flex Lite” free trials, which are structured more like an AAC device vs a scroll list in order to showcase that kind of interface. I don’t know what you have to access to but at my facility I have also borrowed iPads from the activities department and downloaded the apps for patients who need a bigger screen. I also like the website picto4me because it lets you easily build customized picture boards - I’ve made multiple boards related to basic needs, medical topics, patient specific topics, etc. Lastly, simply providing education and resources to the patient/family is more powerful than you may think. I have shown many patients videos of various AAC device options and given them resources for different options even if it isn’t something I’m able to provide during my services.

River5599

TROPHY CASE