The first week at a different rehabilitation center has proven to catch me off guard, by giving me much to think about while I attempt to absorb the complexity of the entire situation. As the first manager of a busy rehabilitation center, I'm attempting to embrace the process of workflow that's in place. This includes trying to keep our patients satisfied and the employees on target for success.

I've learned through the years from my patients that a physician's front office staff can make or break a practice, and I feel this is the same for a rehabilitation department. The initial impression the current front desk staff displays is that they come from different backgrounds. Some are there as a result of being laid off from previous positions in the healthcare system due to staffing optimization, others for their financial representation skills and some for their customer service skills. Together, they work hard to meet the needs of the community, which is quite different from the community I've served for the past 20 years.

The clinical staff has demonstrated their compassion and skilled therapeutic intervention at many levels, including trauma cases and spinal cord injury, as well as significantly involved pediatric and adolescent cases. What an amazing impression this staff has made on their patients, let alone me. The patient population includes many who don't have insurance, are at or below poverty level, as well as dealing with life-altering handicaps and disabilities.

The quality of care and compassion delivered by the support and clinical staff enable not the disabilities of those crossing the threshold of the rehabilitation center, but rather their abilities as they come into contact with my new coworkers. I'm honored to be their full-time manager, supporter and newest team member. Time will prove our evolving teamwork as a world-class model for a rehabilitation institute, the Rehabilitation Institute of South Florida.

My final day at Memorial Hospital West (MHW) outpatient rehabilitation has arrived. After 20 years of practice, the day has arrived when I'll walk out the doors as a senior physical therapist. This is where I practiced, learned, experienced, and enjoyed every patient and family. Most importantly, it's where I learned I had a much larger family than I could ever imagine. Many of my coworkers and I experienced major milestones in our lives together, including the births of our children, illness, marriage, divorce, buying homes and of course, attending graduate school together. We have celebrated the accomplishments of our patients, as well as our own personal accomplishments.

There has clearly been a major emphasis on pursuing a higher education and certification among PT, OT and ST, which has been inspired by ourselves, but most importantly, by an amazing director. She has always encouraged, supported and implemented a transition to meet our professional goals, and this may be one of the most difficult things I encounter on my last day, leaving MHW because of the amazing leadership of Debra Lessard, DPT.

Originally, I started the plan to begin my DPT transition four years ago. Although it was a tumultuous time for myself, personally, at least the plan was started. Instead, with the support of those around me, including my coworkers, director and children, I decided in 2010 that it was time to get the ball rolling again. Life was very busy in 2010, and I found that as I took on more responsibility professionally and personally, I could handle whatever came my way.

Signs were all around me that this was what I needed to do, especially as new graduates with DPTs came to our center for clinical affiliations. Their knowledge was definitely different, and this triggered within me a need to learn more, so I could understand "why we do what we do." Recalling the moments before deciding to take the journey for my DPT, my mentor had light words for me: "You don't know what you don't know." This sounded absurd at first, but as I listened to conversations of DPTs, I had no idea what I was missing. At this point in the program, the DPT is about putting it all together, making sense of it all and explaining the rationale for doing what we do (just to name a few).

Years later, as opportunities present themselves to me, I'm jumping on the bandwagon to accept (within reason) the challenges that face me, to make rehabilitation a success for our patients and practitioners. All of this while I save the world and raise my daughters (shaking my head - I don't know how I do it either).

On Monday, Jan. 28, 2013, I'll be transitioning to a new facility in my healthcare system, under the tremendous leadership of an amazing therapist I've known for years. I'm excited to get to know new therapists, meet up again with those I've known for years as well, and support every staff member as I feel I have done in the past. As Dr. Martin Luther King Jr. said so well, "If we are to go forward, we must go back and rediscover those precious values -- that all reality hinges on moral foundations and that all reality has spiritual control."

Finally, after a hiatus of approximately two months from my studies, school is back in session. This semester is one credit, which doesn't mean there isn't much to do. On the contrary, it has come to my attention that classes giving the least credit for the work require more busy work than two-hour credit classes. As I enter each semester, I look forward to the coursework and expect it will be the most enlightening course I may ever encounter; and again, I'm admitting the same for the Spring semester. This class will teach my classmates and I how to choose a case report, and write in the most professional standards, an abstract that will allow us to proceed with our graduation this summer.

To begin this semester, I've been reading a most fascinating book aimed directly at how to prepare and write a case report. The material is easy to read and actually entertaining. Written by a physical therapist for physical therapists, it seems minimally challenging to actually come up with a case report. However, knowing what I've experienced over the past year-and-a-half studying for the DPT, I know this won't be the case. The next step is to read three articles, followed by another 10 articles that we will be tested on in order to comply with passing this course.

Last year, I painfully made it through a class that taught me, in great detail, the statistics and research that go along with explaining why we do what we do every day. The skills learned from that class will be used functionally for this semester's class; however, I'll be reviewing the literature "out there" in order to support (or reject) the decisions made by me for a patient I've worked with. Finally, I'll develop an abstract for my case report, which I'll be preparing in the final semester in my quest for my doctorate of physical therapy.

All of this excitement is taking place as I complete my final two weeks in the rehabilitation department I've worked in for the past 20 years. One more week to complete performance appraisals for some of the most amazing people I've ever met, as well as encourage others who I feel would grow from promoting themselves to a position that I'm leaving behind. As I prepare for the next chapter of my life and journey, I'm thankful for the opportunity that has presented itself, to promote what I've learned and experienced, and use as support for new staff in my healthcare system.

"A New Beginning" was a topic I covered over the past few weeks. As a firm believer in rapid, positive change with unbridled energy, I decided to apply for a higher position within my healthcare system. As of this week, I was honored with the offering of this position, as manager of outpatient rehabilitation services for Memorial Regional Hospital and Joe DiMaggio Children's Hospital.

I've worked at Memorial Hospital West for the past 20 years, and will miss the staff I've worked with over the years. On the positive side, our healthcare system fosters teamwork across the entire system, and soon we'll all join together to become The Rehabilitation Institute of South Florida. This will provide an even closer relationship of peers, as we share our specialized knowledge with each other and provide comprehensive care to the community we serve.

As I sit in human resources of the main hospital, I'm watching a seven-minute video reviewing our mission and vision, with employees and patient interaction from several of our facilities. Interestingly enough, much of the video contains excerpts from physical, occupational and speech therapy.

I'm having a moment of silence, as I call it, when I recognize therapists from my current position at Memorial West, as well as therapists from my new position at Regional (with plenty more from other facilities as well). I recognize that we are a major part of our healthcare system, and during this video, I realize that we play an even larger role than previously thought. So why haven't I seen this video before? Probably because I haven't changed roles (permanently) in quite some time.

I look forward with great enthusiasm to this new role, listening, supporting and mentoring new staff and growing with them. I've been prepared by an incredible leader and supported by the best clinical manager. Additionally, I've learned invaluable lessons from physical, occupational and speech therapists over the past 20 years; this is what I will bring with me, as well as the knowledge of a DPT in the making.

My schedule remains full, with raising my daughters, my zoo, playing tennis, having somewhat of a personal life and of course, studying for my DPT (for which my classes start tomorrow). Yes, it can (and will) be done. Most importantly, pursuing my DPT has provided me with the opportunity to take on this role in the system. I will end this blog with a quote that sums it up for me, from William Butler Yeats: "Education is not the filling of a pail, but the lighting of a fire." Let it be yours, too!

Day in and day out, more than a few patients have taken a life-threatening event and turned it into a life-changing experience. Many have admitted there is some reason that they're still alive and have taken the opportunity to experience what they were meant to accomplish, whether permanently wounded physically or not.

As physical therapists, we observe our patients going through this transformation. Not only do our patients and their families learn to deal with physical changes, but we also observe the emotional, psychosocial and spiritual changes that accompany these changes. In order to support our patients and families, we've become accomplished "listeners" and providers of available resources to those we treat.

Regardless of recent changes in insurance allowances, successful physical therapists have become quite savvy in providing support for their patients and families. Observing the professionals I'm surrounded by, I notice there's a growing awareness about nutritional support. Not only have therapists gained a greater knowledge in this area, but they've adapted these changes into their own lives. Encouraging others to gain knowledge in this area has become rampant in my workplace.

For example, a "book-club" type atmosphere has become the norm in regard to this subject. Additionally, besides the nutritional education, many therapists are studying ways to adapt what they've learned to other areas of their lives. This has carried over to the way they're treating patients as well as sharing the knowledge with them to break down functional skills in a step-by-step manner. The skill, knowledge and professionalism, not to mention compassion, that surrounds me is astounding.

As a result, patients and families acknowledge that what has been put in front of them to overcome is actually an opportunity to create a new beginning. The knowledge gained and practiced by therapists further demonstrates the need to continue educating ourselves and ultimately provide each one of us with the same opportunity: a new beginning.

What a wild year it has been for those of us enrolled in the DPT program. We acquired the credit hours to partially meet our goal, which is set to be achieved in August 2013. We've learned new techniques, new terminology, diagnostic vocabulary and how to read the literature in our field. Plenty has been absorbed into our practice of physical therapy already, and as a result we're practicing a bit differently than we were before starting the program. As a PT staff leader in our outpatient department, it has opened my eyes to the potential of other therapists; not just those who have been practicing for years, but also those who just missed the graduation deadline to reach their DPT.

Interestingly enough, those who have their master's degree in physical therapy have been the most resistant to returning, but have also become the ones who just started a new DPT program this fall. I'm proud to say that as this year comes to a close, there are eight staff enrolled in a transitional DPT program, and as of last night, another two will be starting in 2013 (Congratulations Christine and Amy!). For those of you with small children, single or married, working full-time or part-time or as staff relief, it's absolutely possible to achieve what you may feel is impossible. What better gift to yourself to advance your degree, knowledge base and open a vast array of opportunities for your future! (Not to mention, share with your children the gift of success).

Besides what we've gotten ourselves into with this project of completing our DPT, we've leveraged ourselves to become more active in other areas such as community-based programs, continuing education and lecturing to our peers, other medical professionals, as well as the community. If you would have asked me in 1990 where I saw myself in 2013, it certainly wouldn't have been standing in front of a large group of professionals sharing information and learning as much as I have (I never really was much of a public speaker).

Throughout the past year and half, I've embraced the idea of doing so, and I partially attribute this to understanding why we do what we do in the field of physical therapy. As we come to a close this year, I want to congratulate those who have achieved the accomplishment of a DPT, as well as those who have decided to become part of Vision 2020. Happy New Year!

As this year comes to a close, I'd like to reflect on a most productive, busy and emotional past 12 months. Final grades have arrived this morning for the fall semester of the DPT program. My capstone project will begin very soon. After narrowing down my choices to two patients, this week I came across two more interesting patients who are potential candidates for this project. Just when I thought I'd made my decision, I realized that perhaps a bit more thought should be put into the decision. Time will tell as my patients attend physical therapy.

This past year has brought changes to our outpatient department, including an overhaul of therapists' schedules in order to accommodate our patients' needs. Starting in January, the changes will take effect in the hope of reducing congestion in our center, which can be quite overwhelming with 40-plus PTs, OTs and STs. We've managed to keep all staff on the schedule, with their (occasional) struggle to accommodate the needs of the population we treat. On top of this, outpatient rehabilitation at our facility will join with our other facilities to become a centralized Rehabilitation Institute of South Florida, providing the most comprehensive care in the region.

The year has been most productive with school and work. Most of us can relate to the busy, emotional lifestyle that comes with working full-time and maintaining a healthy, happy home. As for my daughters and I, we made it through the year by experiencing and understanding that we have each other to count on, unconditionally. One daughter graduating high school and starting college; the other learning to drive; both joining with me to volunteer and support our community, especially the victims of domestic violence.

Although each one of us remains busy with school, work and community, we still manage to communicate effectively to support one another and our daily routine. Especially now, with recent tragedies taking place, it's just as important to remain strong and vigilant in reaching our goals and supporting each other along the way. We cannot do it alone, as my coworkers/ doctoral candidates will agree. The next year will bring even more change, for the positive, for all of us. I wish everyone a happy, healthy and prosperous new year!

Rapid change is necessary to stay afloat in healthcare these days. From staffing optimization to unifying rehab across the South Broward Hospital District and becoming the Rehabilitation Institute of South Florida (RISF), we're experiencing exciting and, at times, nerve-wracking changes. This brings with it major renovations, including possible physical changes to our department and as a result, increasing the staff to accommodate the needs of our patients. What most of our staff members have experienced in changes to their schedule and worries about reduced hours is unfounded, since we'll be providing more specialized care to our community and will more than likely be adding additional staff to support our needs.

As our name changes to the RISF, along with it comes the need for new and much sought-after equipment. As a member of the Technology Task Force, I've taken the lead for searching after products related to gait and balance systems. Every week, there's an in-service or two attended by a few members of this team. There are a few products that we, as a team, are most interested in, and the next step is to research the evidence-based literature on these products. Now that I understand how to interpret these studies from my "Evidence-Based Research" class, this should go relatively smoothly over the next couple of weeks. Filtering out the manufacturers' research is another story.

Most surprising to me is the amazing technology available for use on our patients. We, as a busy outpatient department, have always provided the best care with standard equipment. This new venture will provide us with the shiniest, most attractive equipment that many patients and their families may have heard about and would travel to utilize. Our vision is to be able to offer the most comprehensive care across the region to any patients, regardless of their inability to pay for services, since we are a publicly funded healthcare system. As such, we do not use these funds for this equipment, but rather, as a community-driven healthcare system, financially support our own system with fundraising and use our own personal contributions. Philanthropy at its best, as I see it, and working hard to make the best choice is what's next on the agenda.

This time of year seems a lot slower than usual, being that I'm officially on winter break from my studies. I'm prepared to start the new semester in January, and in the meantime I must admit I'm a little bored. As a result, I've been more aware of those around me, especially those less fortunate. This is the time of year when we have many fundraising events for work, the Memorial Healthcare System in Hollywood, FL.

As a community-based healthcare system, we rely on the government to assist us with helping those in the community who are unable to afford healthcare. These days, however, there seems to be less and less available to help us help the community, so our dedicated employees work tirelessly to do what's best for others. This is being done in the midst of major staffing changes, which makes it all the more special and rewarding, providing a sense of community like never before.

There have been a few days in the past week when all I prayed for was peace and harmony in my department; the stress of changing schedules, the holidays approaching and a fear of the unknown are all things running around our minds. Typically, the department as a whole will contribute monetarily to provide a holiday for a family in need. This year will be no different. As some of the staff struggle with concerns, they'll still pull together to do the right thing for our community. Our next meeting will bring to light the neediest people we may have come across during patient care.

One such family was met during the year, where a 40-plus-year-old widowed mother of two older teenage daughters suffered two devastating strokes within a short period of time. Dad passed away a few years ago due to cancer, and the two daughters were working very hard to finish school. One daughter attends school in the morning, the other in the evening, and this way one is always home with mom. Recently, they were able to find an aide to stay with mom two hours a day in order to allow them to spend time with each other at the mall or with friends. This is the kind of hard work and dedication we hope our children would do for us if need be.

So as I watch and listen to the stories we have to share with each other, I'm reminded how blessed we are to have such a rewarding profession, a job that might be inconveniencing us due to a change in shift only (with no one losing their job) and a compassion that allows us to share anything we can to possibly help a family. As I've said many times before, we're all in this together, and those of us who can, should help. The term "pay it forward" comes to mind. Even if we can't, there's always something to do to help others, not just now, but throughout the year.

Waiting for a new semester to start is much different than 20-plus years ago. I don't remember having any length of time between semesters, let alone looking forward to the next-to-last semester of my preparation for receiving my DPT. The differences between then and now are astounding. Back in the 1980s, my only concern was hoping my used car would get me to the university for my classes from my mom and dad's house, which was more than an hour away.

In Chicago, during the middle of winter, this was quite an adventure. The drive during snowstorms, rain, hail and wind was undertaken on a daily basis, from the south side to North Chicago. Never was a day of school missed, but a few days my professors were more than generous to excuse my tardiness. Back then, our class was small (23 students), personal and we had each other's phone numbers, including our professors. That didn't do much good since we didn't have cell phones. Nor did we have the Internet. Many of my papers and notes that I saved were composed on a typewriter.

Today, almost 23 years later, I'm amazed at the changes as I continue my career, especially after writing it all down. By no means is this post all-inclusive. No longer do I worry about traveling to school, as this is done through an Internet-based program. My research is done at a local university, but most of it is online through respectable resources. Additionally, I'm in constant contact with my school in Virginia through the Internet and on my cell phone.

I don't need to print any papers for school, since my assignments are to be prepared using Microsoft Word and emailed to my professors. Even more astounding is that my classmates and I communicate through a virtual blackboard and through email on a regular basis. A few of us text each other and offer motivation and support when we're questioning ourselves.

With all of this technology to make our lives smoother and easier, I can hold a full-time supervisory job, raise a couple of awesome teenage daughters, take in rescued dogs/cats/birds, keep a roof over our heads and two cars in the driveway. I truly believe that my daily routine would be drastically different if it weren't for an Internet-based, distance education program for the DPT. As a matter of fact, I don't believe I'd have even tried a classroom-style transitional DPT program, if that even exists.

So on this day off from work, I contemplate cleaning the house, washing the dogs and shopping for the holidays, among other things. However, from what I've learned over the past year-and-a-half in my studies, I'm extremely motivated and looking forward to the next semester starting in January. In the meantime, I'll continue reading a manual on how to write a case report, now that I've narrowed down my search to two patients.

A lesson in management comes in many forms. Previously, learning how to let an employee go was observed, especially a long-time employee. This past week has been another lesson. As a result of staffing optimization, there are changes that need to be made in a successful department to further improve the success and support our growth.

A task that was set forth before me was to be completed no later than the week after Thanksgiving. Personally, I felt it was important to complete before we closed for the Thanksgiving holiday, so with the support of my director and clinical manager (and the agreement of everybody involved), it was completed a week in advance.

Keep in mind we're a very close department full of physical therapists and a few physical therapist assistants who have been together for as little as one year, but most of us for 15-plus years. Not only are we coworkers, but also close friends and even family. The changes that must take place were to be discussed with each staff member, one by one, in order to get feedback on their concerns and review the rationale for the changes.

As I made my way through the department between patient care and lunches, I began to see the harmony change in the department, the worried looks, the grave concerns that my peers experienced that day. This carried over to the following day, with, as expected, questions and extremely valid points that these dedicated employees brought to our attention.

Nothing will ever compare to the concern I have for our employees. We've been through many trials and tribulations in the past and have come out ahead. As positive as I've always been, I'm absolutely sure that our success will continue as we pull together as a department and a family. We are who we are as a result of the excellence in service we provide, and we are here for our community and patients.

Today is a new day, and the changes will be initiated very soon. I can only communicate, personally, that change is always good, no matter how difficult it may seem when first presented. Stand tall, my friends, we will get through this as we have gotten through many episodes in the past. We will be stronger for it, and it will support our sense of community and family more than ever before.

Completing the fall semester early led me to believe that my first week would be relaxed and quiet. Unfortunately, this was not the case. As the senior physical therapist in a busy outpatient department, I'm expected to mentor, counsel and discipline employees (although I've been lucky so far in that discipline has never been necessary). This week I experienced a surreal moment when I was asked to be present during the termination of an employee.

As an extra person in the room during the process of termination, I believe my role was to be supportive, or to make sure the employee understood what was being explained. My director carefully outlined the reason and made sure everything was understood; all this while showing empathy and concern for the employee's current state of mind. During the process, I couldn't help but feel for the employee, as well as for my boss. Overall, I have to admit, the process of discharging an employee from work with the tact shown was quite a lesson learned. I certainly hope that if I'm ever in the position to discharge an employee, I can do so with such grace. I'm certainly still learning my position, even after five years of assisting our department in the capacity I've been honored to serve.

Personal growth is a continuous process. Maintaining a supervisory position, studying for my DPT and putting many other tasks on my plate can sometimes be overwhelming. I wouldn't have it any other way, and the lessons I'm learning, both expected and unexpected, will be woven into my theoretical belt.

After much sweat and tears this past semester, I've finally managed to finish my three online classes for my DPT with a month to spare. It was perhaps the most challenging semester so far, with a class titled "Direct Access." Having worked 20-plus years for healthcare systems, I was quite comfortable with seeing patients who were required by policy to bring a prescription from their physician. I didn't have much discussion with my peers as well, as we were all working mothers (when females dominated the field at a much higher rate), raising families and keeping a household.

Having been a single mom for more than four years, raising two teenage girls singlehandedly and looking forward to a fantastic career as a DPT, I've learned this semester that our future is brighter than ever. We are the practitioners of choice when it comes to musculoskeletal dysfunction, and we have the knowledge to screen patients for referral, if necessary, to the appropriate provider.

Perhaps I found this course to be most challenging because I wasn't familiar with it. For now, I'll share the wealth of information learned to empower other therapists to comfortably contact physicians if there is something of concern. Specifically, to discuss movement-impairment diagnoses, as we're able to do, and request a physician of medicine to investigate his area of expertise. Learning how to do this tactfully and not interfere with medical diagnosing will be the challenge, as physicians may be standoffish. I can be optimistic, though, and expect that we can accomplish this goal and enhance our future with the skills we've learned while working so hard on our education.

I may seem a bit "behind" in understanding what direct access is, but at least now I've learned the basic idea. Additionally, with projects such as writing a referral to a physician from a doctor of PT, writing a response to a consumer's question regarding a health concern she has and what physical therapy can do for her, as well as interpreting the lyrics of a song and how they relate to the history of the DPT, I know our future is full of promise and autonomy. Thank you, Dr. DuVall, for all you've shown me and I look forward to contributing to our profession's vision.

One thing is true in the field of rehabilitation: Change is constant. This has never been more true than at the present time. Within the past year, there have been staffing shortages followed by staffing surplus; needed equipment, but not enough room; along with insurance changes that are limiting patients' ability to obtain necessary help. Somehow, we survive and stay profitable.

The balance lies in predicting what may happen in the near future. Anticipate events to be less than ideal, such as the decrease in census and the possibility that hours will be cut. To balance this, a department must come up with ideas that will increase revenue and possibly not involve insurance payment. This would be cash-basis programs to offer the public, taking it to the school field for sports-related issues, offering mother-baby classes with pelvic-floor education, providing yoga to pediatric patients or even offering a Pilates-based class for core stabilization.

These programs, taught by specially trained physical therapists, can continue while the insurance changes fluctuate and affect our individualized patient care. The programs may be considered more maintenance than attending PT on an individual basis; however, they'd be ongoing and preventive in nature for our patients. This would legitimately keep us above water while motivating others in a group environment. We have tested this in the past, with a "Social Sensory Group" for children with special needs, and it works. The ideas have come from the staff, and the team works well together to make sure our future is secure.

Certainly, the most creative and motivated employees have been those who have returned to school to invigorate themselves. Having been out of the "loop" of structured learning for so long, I've come to realize that new ideas come from networking as well as our fresh DPT graduates. Let this be a sign that as we continue to improve our knowledge base, we'll continue to secure our profession and reach out to be the ones who are chosen for care by our patients.

As these past few weeks roll by, I manage to organize the rest of my assignments for my third class this semester. Having finished two out of the three classes already, I've become a bit of a procrastinator with my studies and haven't utilized my "down-time" for school as I planned. This morning I've arranged a new study plan, and will be able to complete my assignments on time (actually, ahead of time) so I can prepare for the semester in which I complete a case report.

Busy times for busy t-DPT students. As a full-time senior physical therapist for the busiest outpatient clinic in Broward County and a mom/dad of two teenage girls, as well as a DPT student, I've learned one very important thing about myself. I thrive on a busy lifestyle. Even in my middle age, I wake up before the sun rises to feed my "zoo," wake up the girls for school, play tennis for an hour, shower and make it to work for a 10-hour shift.

At the end of the day, if exhaustion hasn't taken over, I'll read for school or enjoyment and try to get in at least seven hours of sleep. Mix in a bit of plumbing problems with two floods over the past two weeks, as well as arranging a neutering for one of the latest additions to my house (among other surprise events that pop up in life), and you've got the recipe for chaos. Strategic planning for school is necessary, in light of these numerous challenges that occur on a daily basis. To top it all off, I learned only a day ago that there is a hurricane coming uncomfortably close to home. I'd have learned of this sooner if I was one to watch television, but finally did just yesterday thanks to a pelvic floor patient while we did lower abdominal exercises.

On this day off from work, I sit here quietly in the public library preparing to complete an assignment for my Direct Access class. This project will be quite enjoyable, as it combines music lyrics to be interpreted in relation to direct access. Music and physical therapy. Two of my many favorite things. As my two daughters sit across the table from me studying their work as well, I'm excited to think of the moment they will watch me receive my DPT. For now, I'll savor the moment (and the chaos) and not miss a moment that was intended to be.