Friday, April 17, 2015

A Day in the Life | Skilled Nursing Facility

Today I am so excited to have Bill Wong here to share a day in his life as an occupational therapist. You might already be familiar with Bill from his strong social media presence. Today, Bill is sharing what a typical day in his life as a per diem occupational therapist working in a skilled nursing facility looks like. Oh, and he shares his experience of being an occupational therapist with autism. Please read on to learn more!

I had many of my current co-workers ask me, “Bill, you are a young person. You are capable in working full time hours now. But, why are you choosing to work per diem?” My professional reply has been, “I just want some time to do the extracurricular stuff that I want to do.” While this is 50% true, the other 50% is that I want to avoid burning out, like I had in my first job in OT in pediatrics.

Start of the Day

I wake up at about 7:00 a.m. every day that I am working. My goal is to leave my house between 8:00 a.m. to 8:30 a.m. to get to my work place for the day between 9:00 a.m. and 9:30 a.m. Depending on the day, I will spend 35-75 minutes on the road to get to my work. To keep my times relatively consistent, I often don’t go on freeways unless there is a stretch where I can go with little traffic.

Usually I will know where I go for the day from the Friday (or sometimes earlier) of the previous week. However, I will keep my cell phone to my side in the event that I have a call from my staffer at my SNF company. After all, it is possible that I may need to go to another building for the day instead, or have a schedule change due to something emergency come up.

Once I come to work, I clock in and receive my schedule for the day. I looked over my patient’s list to see if there are patients that I am unfamiliar with. I will also check on assignment board to see if these patients also have physical therapy for the day. This is important because there maybe some patients where co-treating is the only option. After that, I will prioritize who I should see for the day. For me, I will do evaluations first, and then complete them right after. I choose this option to work around my working memory deficits. After that, I will try to look at the rehab gym to see if there are patients already there. If so, I will try to work with these patients also. If not, I will go with whoever I can find that are available.

Throughout the Day

How much time I spend with the patient will be the suggested intervention time minus 15 minutes. If the building is bigger, I will subtract another 5 minutes. The reason are because- a) I spend an average of 8-10 minutes per daily note. b) since I am an OTR, I might be expected to write some recertifications, progress reports, and discharge summaries, which can take anywhere from 8-12 minutes per report. c) the patient might want to be seen for a later time than I planned. d) the elevators at these buildings are slow. After all, as a per diem SNF occupational therapist, I am expected to get the daily notes done at the very minimum. If I can get any other reports done, that is a bonus.

If I were to have at least one evaluation, I will go through the patient’s medical chart in about 10 minutes so that I can know important details about the patient- for determining possible appropriate goals, appropriate billing codes for physician orders, and any other vital details for the rest of the occupational therapy team to know. After all,

As for my documentations, to compensate for my short term memory issues, I will do my documentation once for the patients I have seen before lunch, and once after lunch. This compensation strategy has worked well because I know I am minimizing my chances of messing up patients’ daily progress documentations.

Meanwhile, I have to be on my toes until after 2 pm, especially on days where I anticipate there will be many hours of needs in facilities that I can reasonably drive to. After all, I will not be surprised to receive calls regarding working overtime on these days.

If it were a Friday, I will be proactive in calling my staffer to know the buildings I will work at for the following week. By being reliable (yet knowing my limits at the same time), I am able to build a great relationship with my staffer. In turn, I get more preferable places to go for work, especially due to me being proactive. This is important because per diem practitioners are lower down on the packing order for available hours, though they are higher than the practitioners on registry. I am thankful that I don’t work on registry because I would have gotten working hours at facilities that I might not desire as much.

End of the Day

On a good day, I get to start going home by 6 p.m. However, on a long day, I might not start going home until 8:30 or 9 p.m. This will depend on whether I work overtime or not, as well as the number of reports I am expected to finish. In some facilities, it can be a lonely feeling when I am the last person to leave on the rehab team. In other facilities, I might be accompanied by some other rehab team members who stay late. After my work is done, I will drive anywhere from 30 minutes to 2 hours home, depending on the distance and traffic.

Back to Home

I will go home for a home cooked meal. After that, I might either crash straight to bed, or spend an hour or two on social media. The latter is important because I know it is important to continue to grow my social media presence in occupational therapy globally.

What I Have Learned

As an occupational therapist who is autistic, I have learned early on in my career that I might need more mental breaks than my neurotypical counterparts. Yes, I am to a point where I am more than capable to work full time hours. In fact, there are days I am capable to work overtime, which I did not have this ability previously. However, having known what burnout feels like, that is why I choose per diem instead of full time or part time for my career.

I also have gotten past the point of worrying how people might perceive me- as someone with strong knowledge in autism, but choosing to work at SNF. After all, I realize that I need to work with my strengths and weaknesses, as there is no such thing as a perfect occupational therapy job. The fact that I can work in occupational therapy successfully and competently after some initial struggles is a testament of my work ethic and desire to succeed.

About Bill:

Bill Wong was born in Hong Kong and came to the United States with his family as an 11 year old in 1996. Bill received his bachelor’s degree in statistics from University of California, Riverside in 2007, master’s degree in occupational therapy from University of Southern California in 2011, and clinical doctorate degree in occupational therapy from University of Southern California in 2013.

Bill was diagnosed with Asperger’s Syndrome in August 2010. After a year in trying to find his identity in occupational therapy, he decided to establish his specialty in autism. Since receiving his diagnosis, Bill has presented at occupational therapy conferences at state, national, and international levels. Bill has also guest lectured at 8 different occupational therapy masters programs on autism.

Bill’s passion for his occupational therapy career is to be able to deliver occupational therapy presentations to Chinese speaking countries in Chinese and to continue to establish himself as a leader in occupational therapy and autism communities.

Connect with Bill:

Twitter: @BillWongOT
TEDx Grand Forks:

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