The SNF Misconception
Way back in one of the first few quarters of the PTA program, I and many of my fellow classmates would project about what field of physical therapy we could most see ourselves working in. Most of us were on the fence. The general sentiment was work for the experience and then be choosy. Outpatient orthopedic was tempting - performing myofascial release, joint mobilizations and hydro therapy (if you are one of the lucky therapists out there with access to a pool or underwater treadmill). Inpatient/SNF had some benefits as well; reliable diagnoses and hours, rewarding work and let's face it - better pay.
Now that I am finished schooling and find myself as a working therapist in a skilled nursing environment, I marvel at the misconceptions we had as students. The biggest of them all was that SNF patients have a slow recovery and therapy can progress at a snail's pace. There is some validity to this observation; after all an 85-year-old doesn't bounce back from a hip fracture as well as say, a 25-year old who was in a car accident. I have seen, however, amazing rebounds in functional ability from a patient who had been on palliative/hospice care to ambulating 400 feet with SBA two days later.
The truth is I'm finding most days are genuinely unpredictable. My most active, goal-accomplishing patient can be sent to the hospital unexpectedly one day, while the least-participating patient rolls down to the PT office requesting therapy.
Would it be more exciting to kinesiology tape the 14-year-old soccer player with patellofemoral syndrome or celebrate the normal ROM of the patient with adhesive capsulitis? I guess that would just depend on your point of view. I'm finding the small victories in watching patients reach functional STGs, such as sit-to-standing independently, can be fairly epic and rewarding. Boring, slow and depressing? Skilled nursing is not. Most days I'm finding myself busy, challenged and gratified.