Another Look at the Clinical Fellowship Year
Last week I posted an interview
with a CFY-SLP, who shared some of her experiences and thoughts about working in
long-term care (LTC). As spring approaches, I know that many graduate students
are anticipating graduation and beginning their search for employment. While
graduate programs offer a variety of clinical experiences, they do not always
include placements in skilled nursing facilities. LTC settings can be uniquely
challenging, but also very rewarding. Students who are interested in working
with adult and geriatric patients in these settings should gather all of the
information and experience possible as they consider where to start their
professional career.
The CFY (Clinical Fellowship
Year) process is unique to our discipline, and while it may seem unfair to new
grads that physical therapists and occupational therapists leave school and
begin treating patients without supervision requirements, the CFY process
should provide support and mentoring that can ease the stress of starting a new
career. It can also provide practical guidance in areas the student's clinical
experiences might not address. In the LTC setting, the CFY clinician may be the
sole SLP at a facility, depending on the number of residents. The CFY
supervisor should provide advice that can assist a new clinician who might not
be used to working without the support of fellow graduate students, teachers
and clinical supervisors.
One challenge, which Christine
also experienced, is developing a professional relationship with staff
including nurses, certified nursing assistants (CNA) and other therapists. In
any setting - education, outpatient, acute care - you are going to have
co-workers who are more receptive to your ideas and input and those that aren't
as receptive. Because students have worked so hard and are often excited to
enter the field and treat patients, they do not expect to have other
professionals doubt their suggestions or ignore guidelines. Interpersonal
relationships in the work environment must be honed and the CFY clinician has
to educate and direct staff regarding a patient's plan of care and while
remembering that not all staff will understand or even appreciate what we do.
This struggle is constant, and it's important for new clinicians to bear in
mind that not all staff have the education or training that graduates in our
field possess. What seems like common knowledge to us might make no sense to a
CNA or a cook. Nurses might expect us to work with dysphagia patients, but not
understand the purpose of developing a functional maintenance plan for
cognitive skills.
Medical settings of any type are going to involve coding,
billing and documentation. Rules concerning billing and documentation are quite
specific, and to complicate matters, most therapy companies have efficiency
goals for therapists. Unlike salaried jobs, the hours a therapist can work
depend upon caseload and productivity.
I highly suggest that students
who are contemplating positions in LTC seek clinical experience in this setting
or find an SLP in their area that they might observe and consult with.
Next week, I will continue with
some practical "do's and don'ts" for beginning a CFY experience in LTC. I
welcome your questions in the comments section or on the ADVANCE Facebook page.