Occupational Therapy

OT Practice Setting Pros and Cons—Inpatient Rehab and Skilled Nursing Facilities

It is typically seen as an advantage of a profession when there are many avenues for your career to take. Depending on the type of facility they work at, an occupational therapist can enter new roles, gain diverse work experience, and hone a range of skills. However, as a new therapist, the same element that makes occupational therapy so advantageous is something I found particularly trying. Graduating as generalists automatically prepares an occupational therapist for work in nearly any setting. This adaptability can be quite overwhelming, as it entails deciding which practice setting is the best fit, before having any paid work experience.

By speaking with mentors and professors and seeking out opportunities to shadow a working therapist, an OT student can achieve a more complete picture of what a work day in each setting will look like. This article highlights various OT practice settings and emphasizes the importance of identifying aspects of your personality that can assist in succeeding in certain practice areas, which can help in finding the right fit.

I have compiled information from colleagues who currently work in a number of setting, detailing their day-to-day and big-picture struggles as well as the positive aspects of their practices. In this post, I will discuss inpatient physical rehabilitation and skilled nursing facilities, with other practice settings covered in later articles.

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Inpatient Physical Rehabilitation

Some struggles in this setting involve the size of the hospital. The amount of beds per facility will vary from place to place, but typically inpatient care takes place in larger-than-average acute hospital with several hundred beds. Occupational therapists are often assigned to certain wings or floors, allowing for some direction. However, it can be overwhelming and you may get the feeling you are never doing enough. A large setting such as this can provide experience with patients who have a wide variety of diagnoses, which will give any therapist significant clinical experience in a short time.

While working in the small quarters of a patient’s room, a therapist’s adaptability and creativity can go a long way toward beneficial treatments for their patients. This close contact also allows occupational therapists to answer questions about a patient’s safety and cognition that other professionals may not be familiar with. This means the therapist is in a position to put each patient’s support system, including family members and caregivers, at ease regarding their loved one’s transition to the next level of care.

In the absence of assigned minutes or units per treatment, therapists have the ability to vary the length of treatment they provide. Flexibility like this can be a positive attribute, allowing therapists to spend more time with patients who are motivated and progressing towards their goals. It can also provide some therapists with ethical dilemmas, where they may be tempted to shorten treatments with difficult patients.

It can be taxing to explain occupational therapy’s role constantly, as it remains a lesser-known field in most settings. This is a result of the newness of the profession and confusion with other disciplines, such as physical therapy. Doctors who are unfamiliar with occupational therapy may refer patients who are not good candidates for our services. It is important for each profession to communicate in order to ensure services are appropriately distributed. On the positive side, large therapy departments can foster a sense of community and collaboration amongst therapists of all disciplines. Assertive communication can assist in building confidence quickly, which is especially useful for a recent graduate.

Skilled Nursing Facility

A skilled nursing facility consists of short-term rehab for patients who recently had surgeries or injuries. This includes many joint replacements and neurological diagnoses such as cerebrovascular accidents, more commonly known as strokes. Some skilled nursing facilities also have long-term care units for residents who demonstrate continuous self-care needs with minimal acute medical conditions.

In this setting, there is often consistent collaboration between disciplines to help a patient progress. Soon after admission, staff begin planning for a patient’s discharge location, which means long-term goals are focused on the patient’s natural setting and their social support. Due to the significant weight long-term goals hold, occupational therapy is a large part of the discharge process. Discharges are primarily determined by therapists, in coordination with social workers, which gives each therapist a great feeling of importance and responsibility.

There is high satisfaction derived from helping patients meet their goals, which are usually achieved quickly due to the nature of patients who cycle through short-term rehab. In working closely with patients’ social supports and completing home evaluations, there is a large opportunity to build a rapport with people involved in patients’ care.

Assignments such as home evaluations can serve to break up your day and allow for more well-rounded experience. Frequently-changing work schedules allow for flexibility, which can be beneficial to therapists who have other roles to balance, such as being a parent or holding a second job. However, this flexibility can also be seen as a negative, causing some difficulty making consistent personal plans outside of work.

Insurance regulations control how billing units are distributed to each patient, based on their view of the patient’s needs. This, unfortunately, can limit the plan of care a therapist has in mind and can prevent a patient from receiving continued therapy if they are not progressing towards their goals. Additionally, insurance controls factors such as the amount of paperwork required and productivity standards that force accountability for therapists’ treatments and time spent with each patient.

There are challenges and rewards that some settings may share. What skilled nursing facilities and inpatient physical rehabilitation have in common is the fast-paced nature of their work days. Someone who is quick to think on their feet and enjoys constantly being busy would thrive in settings such as these.

Check back soon for part 2, where we will cover what struggles and rewards are seen in home health and outpatient settings!

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Brittany Ferri is an occupational therapy consultant, certified clinical trauma practitioner, and certified light therapist. Her specialties are mental illness, health writing, and complementary modalities. She is passionate about disease prevention and meeting the emotional and physical needs of al... Brittany Ferri is an occupational therapy consultant, certified clinical trauma practitioner, and certified light therapist. Her specialties are menta...