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The Good and Bad of Skilled Nursing

by Natasha Freutel

So you are barely done with school and you are already being approached by recruiters.

Their email starts off something like this, "We have an amazing opportunity for you at a skilled nursing facility! You will love it! We will give you a bonus and relocation money as well!"

Sounds enticing. Maybe you already have your heart set on working with elderly patients, or maybe you just can't turn down the pay. Regardless of your reasons for considering work in skilled nursing, there are always pros and cons to every job.

Pros of Working in Skilled Nursing

The pay is excellent

According to the average wage at a skilled nursing facility (SNF) is $86,750, which is second highest of all sectors, next to home health. Depending on where you live, SNFs will often offer higher wages and bonus incentives for new grads due to the increasing demand for licensed Occupational Therapists (OTs).

Limitless learning opportunities

Nobody knows everything right out of school. But don't worry, at most skilled nursing facilities there are plenty of staff members around to help. Take the opportunity to get creative treatment ideas from the veteran OT Assistant (COTA) or ask a friendly CNA to show you how to use a Hoyer lift. Don’t be shy about asking for help, you are only holding yourself back if you don’t!

You will learn about a broad range of diagnoses and conditions

Unlike some other settings, SNF patients often have a wide range of diagnoses. In the same day, you may treat an elderly lady with a new hip replacement, a lovely man with dementia, a 40-year-old who was in a car accident, and a 98-year-old with hand contractures.

Older adults are awesome

Not everyone is destined for work with elderly patients, but their stories, sense of humor and appreciation for your work makes most days worthwhile.

Lots of continuing education

Most companies offer an abundance of opportunities to get continuing education for free, and often you even get paid to attend. Take advantage of this and start getting your CEU’s early.

Use of modalities and opportunity to become Physical Agent Modality (PAM) certified

Many SNFs have modalities such as ultrasound, electrical stimulation, and diathermy available for your use. As an OT, you are not legally allowed to use these unless supervised by a PT or you are PAM certified. Once again, take advantage of the CEUs and opportunity to rack up supervised hours.

You will stay in great shape running around the halls all day!

Wear your Fitbit and watch the steps pile up. Depending on where you work you could be running around a large facility all day getting patients, bringing them back to their rooms or helping them with their afternoon stroll. All that walking means you can treat yourself to a donut at the nurse's station.

Cons of Working in Skilled Nursing

The work expectation is HIGH

Most companies require a productivity of 85 to 92 percent on average. What does this mean? You are expected to spend approximately 90 percent of your day face to face with patients. That means out of an 8-hour workday you only have 48 minutes for breaks and documentation time. Also, treatments are billed by the minute, so you are often expected to spend 45 to 75 minutes with each patient, and it's crucial that you complete these minutes if possible.

The paperwork can be a drag

As in every other setting, paperwork is no fun. Once you get used to the new documentation system it gets easier but, your first couple weeks to be a giant learning curve and lots of hours spent at the computer.

You will spend a lot of time in the bathroom

Bottom line, elderly people go to the bathroom often and sometimes take an excessive amount of time. If there isn’t a CNA around be prepared to put on some gloves and help clean up before you head to the therapy room.

Not everyone wants to get better

It is the patient’s right to refuse treatment, and some people downright do not want to get out of bed.  Your smile can make the day of someone who otherwise feels like they have no reason to keep going.

Be creative and be kind.

It's easy to get burnt out

The high workload, difficult patients, physical nature of the job and fast paced environment can cause early burnout and emotional stress.

Contract companies get fired

In many areas most SNFs will outsource their therapy to a contract company. Since it is a competitive industry contracted companies change all the time, which means you may be out of a job or have to move to a new facility if the incoming company doesn’t hire you.

In Summary...

Skilled nursing facilities offer a valuable experience for any new grad occupational therapist. You will have the opportunity to enhance your skills, learn from the best, and work with a variety of different patients. Whether it be a long term plan or a short-term solution, take advantage of the positive aspects of the job and enjoy every minute of it.

Still not sure about skilled nursing? Take our short quiz to find out with OT setting is best for you:

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