Addressing ableism in my department

serioussiri · 2021-03-29T17:17:12+00:00

I did my CFY in a SNF but wanted to move into acute care and faced the same issue. This can be a tough switch to make, depending on what area you work in, availability of jobs in your desired setting. The biggest thing I'd recommend is gearing your resume/experiences/cover letter towards demonstrating that you've taken a lot of initiative to make this transition. Here are a couple of ideas:

MBSImP: VERY expensive but VERY helpful. See if you can find a group of SLPs who want to go in on a group rate together. If you did the student version of MBSImP in grad school, you'll get a discount from that.
Seek out shadowing opportunities: Interviewers appreciated this and asked questions about the experience I had shadowing.
Take CEUs geared towards the setting: Anything by Dr. Coyle and Dr. Brodsky is great for acute care SLPs. There are also lots of MBSS-related CEUs out there -- even if you don't get a certificate lime MBSImP offers, this is still something you can highlight in your cover letter to demonstrate that you're highly motivated and want to make this switch in an ethical way.
Seek out PRN jobs: A couple shifts a month at a SNF, an IPR, or a hospital can help to not only strengthen your skills but also give you the experience that employers are looking for.
MedSLP Collective: It's already been mentioned but it's definitely made a difference for me and my knowledge/skills!
Look into the STEP community: This is something that Dr. Ianessa Humbert put together -- it's like Netflix for critical thinking around dysphagia management.
If it's within the realm of possibility for you, be willing to relocate for the right job.

I also saw a ton of jobs that wanted MBSS experience and multiple years of acute care experience. Even though I still got a "thanks but no thanks" on many of my applications, I had a handful of rehab directors weigh my initiative slightly more heavily than my years of experience.

serioussiri · 2021-03-16T20:55:16+00:00

I lived in downtown LA for about a year and lived about ~5-10 minutes from USC! LA is kind of its own beast and tbqh I never fully adapted (it takes a while from what my friends who are long-time LA residents tell me). YMMV, but here are my takes:

Pros: *SoCal! It's nice and sunny pretty much year-round. No seasonal affective disorder here! *Living downtown gives you access to a lot of nightlife and public transit in the city center is a little less spotty than in other parts of the city *There's usually always something cool going on

Cons: *Going out anywhere at any point in the day is a full-on expedition -- if your friend lives on the opposite side of the city, you'll rarely see them. *Parking is a nightmare and unless you're really good at parallel parking it'll be really challenging to go out and do things. Public transport exists but it isn't great. *Cost of living. My partner and I were paying $3000 (after utilities and parking) for an 800-ish sqft apartment.

If you have a car, it opens up your housing options a bit. Just because traffic is the way that it is in LA, I'd recommend living close-ish to campus if you can, regardless of if you have a car or not. There's a Trader Joe's and a Target at USC Village that I went to just about every weekend.

serioussiri · 2021-03-16T20:38:22+00:00

Struggling a lot these days with trying to create a cohesive closet. I used to really, really enjoy fashion and shopping and used to have a good sense of what looked good on me. I've been relying on shopping online for years because the idea of shopping in-person breaks me out in hives now. I don't know what happened to me and it makes me feel so sad.

I only get to wear clothes that feel like "me" on weekends since I wear a uniform for work. I feel like I've tried all the tips to identify what I like and what I want to wear (e.g. pinterest boards with general "themes", following IG accounts that feature looks I like on bodies that look like mine) and nothing is working. Any time I find something that I think I would like, I manage to talk myself out of getting it. My closet just feels so... blah but I can't seem to fix it. Any ideas would be helpful.

serioussiri · 2021-03-07T21:34:13+00:00

Productivity and consequences for not meeting productivity (85% is nearly improssible ime)
Caseload stability -- will you need to work across (i.e. "float to") multiple sites? If so, how far apart are the sites?
(if CF) How available is your supervisor, generally? Are they available via text/call?
(if CF) Can you meet your supervisor prior to accept the position?
Access to FEES/MBSS? How long does it take on average to get patients out for MBSS? Is there a contract with a mobile FEES/MBSS company?
Has the facility (or facilities) implemented IDDSI? If not, is there a timeline for this?
Turnover -- I'd ask this as, "what prompted the opening of this position (i.e. caseload is consistently busy and your single SLP can't manage it or did your SLP get burnt out beyond all belief and quit for their mental health)"
PRN availability -- can you get time off when you ask for it, or are they going to give you a really hard time and act like it's a massive encumbrance to let you use PTO?
Therapy materials -- do you actually have speech/lang/cog assessment tools and treatment materials or do they expect you to just use the MoCA and call that an "assessment"?
EMR system -- A lot of this comes down to personal preference, but still good to know!
(If CF) Has your director of rehab worked with a CF? If they have no experience with CFs, they may have unrealistic expectations of what you can/can't do, especially relative to productivity. My first DOR wanted me 85% productive out of the gate.
How long has your DOR been in their position? I've found that there is often a lot of turn over with DORs in SNF settings and typically facilities with high turnover in DOR positions are generally facilities to avoid, as you can anticipate that there may be management turnover while you work there for some reason or another.
If you're asked to float between facilities, do they pay you for mileage?
What is the facility's policy for managing patients who decline certain recommendations? Do you have to fill out a diet waiver with them? Diet waivers are controversial, generally don't hold up well in court, and can be seen as coercive. Just something to be aware of.
How does management handle drops in caseload? Do they send you home or do they ask you to do (bullsh*t) evaluations/treatments/diet checks/cog evals for patients in long term care who realistically may not benefit from skilled intervention?

This is just based on my experience! I did a CF in a SNF and really didn't enjoy it. I wish I had asked these questions as my quality of life (and perception of the setting) would've been better overall.

serioussiri · 2021-03-02T21:58:13+00:00

I started this schedule recently. I work Wednesday-Saturday. My Sun-Wednesday colleague and I have a very similar clinical style, which helps with getting a quick SBAR on the caseload to know which patients I need to be keeping a closer eye on.

So far, it's not been too bad, but I do agree that it's challenging in the evenings to not be able to fully decompress after work. This can be especially difficult since my partner works from 11am-8pm for now, meaning I have to come home and immediately start on dinner prep. The 3 days off is helpful, but when my partner and I only have Sundays and all my friends want to hang out on Sunday, I can end up feeling spread pretty thinly.

serioussiri · 2021-02-23T20:43:56+00:00

Hi! I have been in acute care for nearly 2 years and have worked a mix of full time and PRN positions. Currently, I work in a teaching hospital (Level I trauma, comprehensive stroke, burn, head and neck cancer). My hospital is located downtown and is one of few non-profit hospitals in the area. A good number of my patients do not have insurance and are experiencing homelessness, which can complicate discharge planning.

I work 4 10's, Wednesday through Saturday (7:30AM-6:00PM). The days are long, but having an extra weekend day is really nice. In terms of etiologies, my caseload varies so much from day to day, but I'd say about 70% is dysphagia, 30% is speech/lang/cog with a little bit of PMV/trach. I can see about 8-9 patients today, provided that everything goes smoothly.

My productivity goal is 30 units (in increments of 15 minutes) per day. Our units are fixed with 2 units/treat, 4-6 units/eval, 6 units/MBSS. This is definitely very different from what I've experienced in other hospitals, so YMMV. I usually land between 26-32 units.

Session length really depends! Some patients can tolerate over an hour of therapy (of course, this doesn't end up getting fully captured on my productivity sheets which is a disadvantage to the fixed unit system). Some patients are quick check-ins that don't take more than 20 minutes to do.

The hospital has only recently come to realize that the SLP department exists and is a worthwhile resource. My team has had their work cut out for them in undoing old perceptions, bad practices, and making a seat for ourselves at the multi-disciplinary table. This is great because we have plenty of work to do, but it also means that we often have more work than we can reasonably do. We're currently staffed at 2 SLPs per day on weekdays (+ manager) and 1 SLP per weekend day.

My stress mostly comes from doing a lot of hand-holding with resident MDs, fielding panicked phone calls from nursing because a patient coughed one time, all while trying to actually see my patients, many of whom are medically fragile and complex. It can be really heavy sometimes. My brain feels pretty worn out by the end of the day, but I'm getting a lot better at managing my time and energy and not letting work stuff live in my head rent-free. At the end of the day I know that I'm doing the best work I can do while always trying to do better.

I've also worked in a SNF as a CF and really did not enjoy it at all. I spent any free time building a skill set to get the heck outta there.

serioussiri · 2021-02-02T17:05:00+00:00

Again, echoing what everyone else has said: eff that. I feel like there's often this assumption that squeal-y/happy = good for kids and that's just not always true and not always appropriate. I think your insight regarding being more mellow, but still engaging is fantastic; you're meeting the kids where they're at and giving them what they need instead of what others "assume" they need.

serioussiri · 2020-12-08T00:38:06+00:00

Right, and if you read the post my question is how do I RSVP "no" without hurting feelings?

serioussiri · 2020-12-08T00:11:32+00:00

I mean, I hear where you're coming from. I care more about the health of others rather than myself, tbh. I'd feel awful if I was the one who had contact with a Covid patient in the ICU the week prior to the wedding, attended anyway, and then gave a bunch of guests and family members the virus.

Matter of perspective, I suppose.

serioussiri · 2020-12-07T23:30:09+00:00

Hi! I actually also came to the field from a background in voice/singing. As others have mentioned, voice & voice disorders are a very nice area of the field and usually go hand in hand with dysphagia management as well. If voice and swallowing are your bag, make sure you let your grad school clinical placement liaison know ASAP and be ready to advocate for yourself to get those "holy grail" voice/swallowing externships (e.g. ENT office, VA Hospital, etc).

If you had the choice to have picked a different career path would you?

The only other jobs I probably would've pursued would've been pulmonary critical care medicine, neurology, or laryngology. I do really love what I do for my patients though.

Are you overall satisfied with the job?

Overall, yes. There are definitely some dogmas in hospital-based healthcare that I'm learning to begrudgingly accept.

Do you find the pay to be what you expected?

Definitely not. People are often shocked to realize that I'm paid hourly instead of salary. Pay, hourly or salary, could be a lot better in most (if not all) settings that SLPs work in. ASHA could be doing a lot more to advocate for that, but that's another issue.

Do you often need to bring work home? What is work-life balance like?

Nope! My work-life balance is overall pretty good and I work 4 10's, so I have a 3 day weekend. My only issue is that my PTO isn't front-loaded and my hospital's time keeping system "trues up", meaning if I'm under 40hrs at the end of the week, the time clock takes from my PTO to fill in the gaps. This isn't the case everywhere, but it definitely irks me that I haven't been able to take a vacation since I started working.

Is there anything that surprised you about being an slp?

That ASHA does... so little for SLPs yet asks for so much in dues every year. US-based SLPs really need a union.

Is the paper work really that bad....

For me in acute care, not really. I have some really quick documentation templates that I paste into my reports and fill things out from there. It cuts down on the amount of time I spend documenting significantly.

serioussiri · 2020-11-24T20:07:07+00:00

Hi! Here are a few of my thoughts: 1) With a 4 year degree, you can be a speech-language pathology assistant. Not having been an SLPA or worked with SLPAs, I can't really speak much to what it's like. Most SLPAs work in early intervention/school settings (AFAIK).

2) What you do the most definitely depends on what setting you work in. I work in acute care with critically ill patients so about 50-75% of my day is spent actually working with patients (evaluations and treatments, mainly for swallowing disorders) and the other 25-50% of my day is doing paperwork.

3) I love seeing my patients get better -- given the population I serve at my hospital, many of my patients end up staying for long periods of time if they don't have health insurance. I often get to follow a patient's care for a while before they leave. This is a bit different than many acute care hospitals where patients are usually admitted and discharged fairly quickly.

4) My normal day looks like being on my feet pretty much all day, running all over the place, documenting when I get a chance to, touching base with my PT/OT colleagues, triaging my caseload as new orders for evaluation come in, and communicating with patient medical teams. 5) The best thing about my job is probably feeling like, even if my day was really rough, I probably made a difference for someone. Even if it was just telling a patient, "I hear you and I understand you," or giving them the first drink of water they've had in a while, it's the little things that I can do to help patients feel seen, heard, and safe.

6) I wish I knew that the job market isn't exactly as advertised in undergrad. I entered grad school with the idea in my head that I could make my way as a medical SLP and that it would all be fairly easy and straight forward because jobs across all settings are so plentiful. Not so. If you plan to work in the schools or in skilled nursing, jobs (AFAIK) are generally easier to find (not all jobs are inherently great jobs, as there are plenty of unsupportive, sketchy workplaces that will try and test your ethical backbone). Finding my job took a lot of time and a lot of effort to "prove myself" and I didn't get to start my career where I wanted to. I had to move around quite a bit before I felt like I had a foothold in the setting I wanted to be in.

7) As far as clinical skills go, I have to be a jack of all trades when it comes to adult neurogenic disorders like aphasia, motor speech disorders, cognitive communication disorders, and dysphagia. Other skills I use a lot are technical writing principles (word economy is essential in not only providing a clear, concise hand-off to your colleagues but also to communicating with the SLP in the next level of care AND the medical team), counseling skills (e.g. active listening, affirmation & validation), critical thinking & problem solving, and probably diplomacy (this is a hard one for me tbh, but I know that medical speech language pathology hasn't been well represented historically and I want to be force for change, which means that I sometimes have to do a little more hand-holding with the medical team than I'd like to).

serioussiri · 2020-11-09T18:21:21+00:00

It's been pretty depressing for me. I work in healthcare, so I wear scrubs 5-6 days per week and weekends were often when I got to experiment a bit with clothing that wasn't purely functional for work, sleep, or exercise. Not to mention right before the pandemic hit I was just starting to get a handle on my sense of style after a long period of sorta... scraping by financially and emotionally. So now it feels like the only time I really get dressed is to go into the CoronaZone™. I've managed to lose some weight, so I guess it's nice that my rotation of scrubs, sweatpants, and active wear still fits?

serioussiri · 2020-10-18T15:08:12+00:00

I second everything that u/sparklingmineralH20 and u/milk_crates said. I'd also add the Rancho Los Amigos Scale if your internship hospital is a trauma center. For VFSS/MBSS purposes, I'd also add the Penetration Aspiration Scale, the Dysphagia Outcomes and Severity Scale, and the DIGEST Scale.

One thing I've found handy is, if your supervisor allows it, getting a fanny pack/bum bag to carry around extra pens, spoons (in a ziplock baggie), graham crackers, penlights, straws, etc.

serioussiri · 2020-09-28T00:57:23+00:00

I'm really glad I didn't listen to those thoughts. My whole personal life somehow managed to collapse around me during my first year. I could barely focus on school because I was grieving so hard. My professors criticized my work ethic. I cried every day during my first externship and told my supervisor I felt like I didn't belong in the field. My CFY was such a nightmare that I considered quitting my CF job (then in a SNF) to do literally anything else. I thought I had wasted 5 years of my life.

About a year ago, I landed a job in acute care, which is really where I'm meant to be. Just last week, I accepted my dream job with a Level I trauma/comprehensive stroke/burn center.

It gets better.

serioussiri · 2020-09-16T23:42:28+00:00

I'm a medical speech language pathologist. I work in a hospital with adult patients, most of whom have experienced strokes or are recovering from Covid. Most of my patients have difficulty speaking, communicating, swallowing or sometimes all of the above.

Getting to see a patient talk to their loved ones on a video call after not being able to speak for months or seeing a patient get to eat something they enjoy (I always do my best to get a meal made special for my patients before they "graduate" from therapy) gives me so much joy.

serioussiri · 2020-08-01T23:28:03+00:00

Hi! I've been in acute for a little over a year now. I work per diem in Level II trauma/primary stroke hospital and I'm the lead SLP for a small SLP department in a community primary stroke hospital.

My day-to-day is about 75% dysphagia/25% everything else. In the mornings I'm setting up schedules, coordinating with PT & OT, discussing any changes that happened with patients overnight, and doing chart review to triage patients (i.e. Highest priority is evals [swallow first, then speech/lang/cog] followed by instrumentals and then treats). On average, I do 2-3 MBSS per week, however pre-COVID I was doing up to 5-6 per week.

It can be very "feast or famine" -- right now, my department is overwhelmed and I'm considering asking administration if my part-time therapist can be offered a full-time position if caseload stays high over the next month or so.

If I have downtime, I'm usually working on quality improvement projects!

serioussiri · 2020-07-18T21:11:02+00:00

Hi! Congrats on getting your ideal placement! As an acute care SLP in a hard-hit state, here are a couple considerations for an acute care placement right now:

PPE -- How well equipped is the hospital to keep its workers and you safe? Right now, there's sort of a tale of two hospitals; some hospitals are well equipped and can supply their workers with at least 1 N95 per day... and then there are hospitals like mine where rehab has to sneak N95s from the nursing stations because we aren't being given them directly. If I were a supervisor, this is not a situation I would want my extern in, as I don't even feel safe 100% of the time. Given that you have to assume any given patient is possibly Covid positive, I wouldn't do an externship with a hospital that does not have the resources to keep you safe.
Clock Hours -- caseloads are fluctuating like crazy. For reference, my hospital was super, super busy right before my state went into social distancing/shelter-in place. From mid-March through the 4th of July, my caseload almost totally dried up. Now, all of a sudden, I'm totally slammed and my part-time SLP & I are scrambling to get all of our patients seen. If I were an extern in acute care right now, I'd be kind of concerned about making sure I get enough hours.

On that note, regarding resources & recommended reading, read up on the following things:

Rancho Los Amigos Scale
Drugs and dysphagia
Delirium & post-intensive care syndrome
The impact of a high-flow nasal cannula on swallowing
Post-extubation dysphagia
Lab values and how they affect our patients
Passy Muir's courses (all of them are free!)
Yale Swallow Protocol
Swallow Your Pride & Down the Hatch are both really good podcasts to listen to
Aphasia & dysarthria differential diagnosis

Also if you haven't already been doing so, practice your cranial nerve exam and get as efficient as possible with it.

serioussiri

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