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Skilled Nursing vs Hospital – Challenge the Stigmas

by Jennifer Flanagan


By SNF Operations Manager Jennifer Flanagan, SLP

If you didn’t have a skilled nursing facility (SNF) clinical experience, it may be hard to believe the SNF setting could offer you as much diversity, clinical challenges, and patient relationships as you’d find in a hospital or an outpatient clinic. As an SNF Operations Manager, who has worked in both the hospital and SNF settings, and is familiar with the experiences of all my SNF physical therapists—I can confidently say that it is both challenging and enjoyable to work in an SNF! Often this surprises our clinical students and fresh PT graduates.

Put SNF on the List

I can recall a story where an interviewing clinical student admitted to me that of her ten clinical rotation requests; the top nine were hospitals and her last choice was an SNF - and she cried when she found out her clinical would be in the SNF setting. The student started her clinical with apprehension, but at the end of her rotation, she had found an unexpected passion for geriatrics and chose to work in the SNF setting after graduation. That revelation is not a unique experience.

Stigma #1: Hospital diagnoses are more diverse than in SNFs

Many new PT graduates initially are focused on working in acute care or outpatient. The skilled setting can be looked at as a kind of transition between these two popular settings. Some SNF buildings may have larger long-term care (LTC) caseloads to work with residents who’ve had a functional decline, but a significant percentage of your SNF caseload is more likely to be short-term rehab.

Many SNF therapists feel they get the best of both worlds because their patients aren’t so acutely ill, and they work with them daily and are very hands-on to get them to return home. Because skilled nursing can involve rehabbing patients in-between hospital and home, those PTs tend to see everything from total knee and hip surgeries, neuro cases, and complex medical conditions. The variety of diagnoses is what makes skilled nursing fun, challenging and unique!

Stigma #2: SNFs don’t require the same level of clinical expertise

Drop the viewpoint that you’re just taking care of elderly people that can’t be at home, and you won’t use all the skills in your arsenal. There is a lot more to skilled care than meets the eye.

The SNF setting may center on geriatrics, but all patients will not have the same condition or problem. You have to look at your patients as individuals and assess more than you would in hospital or outpatient. Your goal is to return them to their previous level of function, or living arrangement, and often this involves the need for innovation and creative problem-solving.

Stigma #3: SNFs have unrealistic productivity standards compared to Hospitals

Productivity standards are individual expectations set by the particular SNF or therapy company. The most important thing to realize is that no matter what setting you choose, there will always be an expectation regarding the amount of work you need to complete—whether shown in units billed, the number of patients seen, or productivity. That said, SNF is an area where you’d want to do your due diligence and see if the SNF you are interviewing with has realistic expectations before accepting a position.

Stigma #4: SNFs don’t have the bells and whistles that hospitals have

This is not necessarily the case. SNFs are very different now from when I first started in that setting, as is the patient population. Seniors and geriatric patients no longer want to sit and watch TV in a chair all day. SNF residents are incredibly open to using new equipment and exercising. They’ve embraced a culture around working out and maintaining strength—it’s not just gait training. Most SNFs have state-of-the-art equipment, therapy gyms, and even pools for aquatic therapy.

We can talk about setting, but it’s the people who matter most

As therapists and caregivers it’s the people we treat that impact our job satisfaction. The SNF population not only has a wealth of knowledge to share, but they are typically hard-working and appreciative of our efforts. I find that the connection with geriatric patients is often more significant and the depth of relationships more meaningful.

Your challenge, should you accept it

Challenge yourself to seek a well-rounded clinical experience that includes a variety of settings so you don’t fall into one after graduation without first gaining experience in the others. Challenge yourself to recognize that stigmas do not equal truths. You may find that you feel passionate about something you were not expecting. Many of our clinical students and therapists realize this after experiencing the differences between hospitals and SNFs.

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