6 Lessons for #OT practitioners working in skilled nursing facilities | SeniorsFlourish.com #OT #SNFOT #occupationaltherapy

SNF OT Practitioner: 6 Lessons Learned Within My First 6 Months

by Mary Kate Carroll OTR

I’ve been working at my facility for a little over half a year now, and let me tell you, it’s a wild world out there. Even though I had some level II fieldwork experience at a SNF, it’s an entirely different ball game compared to being a student and working as a licensed entry level practitioner. So, I thought I’d help out my fellow recent grads who are thinking of working in a SNF someday.

Here are the six lessons I learned within my first six months working as a SNF OT!
1. You’re not going to know everything and that’s okay6 Lessons for #OT practitioners working in skilled nursing facilities | SeniorsFlourish.com #OT #SNFOT #occupationaltherapy

The biggest obstacle I had to overcome during my first few months working at a SNF (and I still struggle with this sometimes) was my feeling of inadequacy compared to my co-workers. I was comparing my skill sets and knowledge to those that had 5-10+ years of experience and education over me. I was expecting myself to plan these super involved treatment sessions, stay on top of my documentation, incorporate all kinds of occupation-based assessments in my evaluations, and have excellent rapport with all my patients - just like I had seen my co-workers perform with their caseloads.

In reality, that’s near impossible to achieve. Even the best therapists with years and years of experience simply cannot do it all. At the end of the day, the most important thing is to remember that you graduated, you passed your boards, and your employer hired you, so you must be doing something right! Don’t doubt yourself - you made it this far!

2. Never stop learning

Another way to combat that feeling of inadequacy is to do your research. Just because you’re done with school doesn’t mean you’re done learning! The most obvious way to boost your brain power is to simply look things up on good ol’ reputable and evidence-based websites (lookin’ at you, AOTA) or in some of your old textbooks.

A book I highly recommend for the new practitioner is the Occupational Therapy Toolkit by Cheryl Hall, OT/L. It outlines treatment ideas for certain diagnoses, provides educational handouts and HEPs for patients and families, and is just generally a great occupation-based OT “starter kit.”

Beyond books and the internet, another great resource is simply brainstorming with your peers. It’s okay to ask your coworkers questions if you’re unsure about something—they’re the ones that know best! I can’t tell you the amount of times I’ve collaborated with my fellow OTs, COTAs, PTs and PTAs asking, “What the heck do I do with this patient?”

Additionally, my graduating class from OT school keep in touch via a group message. We bounce ideas off of each other, ask questions, and discuss fun treatment ideas.  If you’re a hands-on learner, the best way I found to gather information is to attend continuing education classes.

Identify your “problem areas” and find as many CEUs as you can addressing that topic. For me, that problem area was creating skilled and medically necessary documentation. Even though I’ve only been out of school for a few months, I’ve attended two CEUs addressing documentation tips for the skilled therapist. You’re going to need the credits to maintain your licensure anyway, might as well be in areas that need some improvement.

3. The documentation can be overwhelming…

But with some practice, it can become manageable. Now, every facility is different, but at my SNF, we have documentation for daily treatment notes, evaluations, discharges, and weekly progress notes. Plus, as an OTR, you also need to review your COTAs’ daily notes.

That’s a lot of writing and staring at a computer screen, especially when your caseload starts expanding. My first couple of weeks adjusting to my first caseload, I spent many a late night, reviewing my evaluations and treatment notes to make sure they were “perfect.”  To combat this, I started utilizing point of service documentation. This means, maybe after you run through the HEP with your patient, jot down some information about how they did while they’re taking a rest break.

This way, you won’t be staring at your laptop at the end of the day, struggling to remember all your treatment sessions. It’s a slippery slope with POS documenting; it’s easy to get into “the writing zone” and ignore what’s going on around you. So, practice is necessary to find that balance between documenting and hands-on treating!

Check out WHY these are important! 6 Lessons for #OT practitioners working in skilled nursing facilities | SeniorsFlourish.com #OT #SNFOT #occupationaltherapy 4. You’re going to have bad days….

Really, really truly horrible awful days. Your ADLs will go over, your patients will refuse you and be grumpy, you will be behind on all your notes, you’ll stay late. Sometimes your patients won’t be making as much progress as you had hoped and you’ll have to have some tough discussions with family. Sometimes your patients will get sick and pass away.

You’re going to have days where you feel like a bad therapist, where nothing you do feels like enough. On these days, it’s imperative to remember why you went into this career.

I have a text saved from my dad while I was completing my undergrad that reads, “You’re a healer, you’re meant to do this.”

You went into this amazing profession because you wanted to help people get back to their daily lives. In this field, it’s necessary to make your own sunshine. If everything is going wrong, try to be the one good thing that happened today.

Keep an upbeat attitude, your patients and your co-workers take notice!

5. Take care of yourself

The burnout is real, especially as a new practitioner. It’s really, REALLY hard to maintain a good work-life balance if you’re not used to working full time at a demanding job.

Try, as often as you can, to leave work at work (yes, this means paperwork and venting about your day). Do one thing that isn’t work related that you enjoy, whether it’s exercising, cooking a good meal, or watching a favorite show (mine is Jeopardy!). Reach out to your friends and family, schedule fun things to do on weekends or whenever you’re not working. This gives you something to look forward to, especially on those tough days.

Taking care of yourself also means saying “no” to working extra shifts or working late sometimes, even if you need the money to pay off loans (ugh). If you neglect yourself and become a workaholic, you’ll begin to lose meaning and joy in YOUR life. It will negatively affect how you interact with your patients—and that’s not good!

6. Remember client-centeredness

It’s easy to get sucked up in the world of minutes and documentation and productivity and timeliness working in a SNF. However, it is essential to remember you are working with a human being, not “the COPD lady.” These are people who are scared or anxious or confused. You’re interacting with them just after a life-altering injury or illness. They are looking to you to help them regain their independence and dignity. Look at the whole person when treating them, and formulate a plan addressing their specific goals.

What do they need to do to get home? With difficult patients, it’s so much simpler to just slap on some wrist weights and have them play a card game while you struggle to complete your daily note from the last session. You need to remember what you learned in school--the emphasis is on client-centeredness and occupation-based treatment sessions.

Creating meaningful, occupation-based sessions involve some creative thinking out of the box, but it is so much more worthwhile and beneficial to your patients, and in turn will make you feel like a superstar therapist.

Being a new OT practitioner is TOUGH, but so incredibly rewarding. It’s okay to feel a little unsure of yourself. Everyone remembers what it’s like at their first job and everyone was once in your shoes.

At the end of the day what really matters as a new practitioner is:

1) Are you helping your patients to the best of your ability?

2) Are you treating them kindly and with respect?

3) Are you actively seeking to better yourself as a clinician?

With this information in the back of your mind, you’ll survive your first six months and beyond in the world of skilled nursing facilities.  I hope my six life lessons help guide you on the beginnings of your OT journey, and best of luck!

About our Guest Blogger:

Mary Kate Carroll OTR obtained her Master’s degree from Gannon University in May 2017 and landed her first full time OT job shortly after passing the NBCOT exam. She currently works at a skilled nursing facility near Cleveland, Ohio.


If you are looking for more options to "Never Stop Learning," check out the Learning Lab - helping OT practitioners be confident and competent by being the best they can be when working with older adults.


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Comments 18

  1. I am a new OTR in a subacute rehab/SNF and have been working for a little bit over 2 months now. This was posted when I first started and it spoke volumes to me then, reassuring me that like Mary Kate, I would come out on the other side. I too was spending hours behind the computer screen, running through the halls of my facility, and simply trying to figure out how to be an OT. Now, just about 2 months in, I reread this and it new things hit home. Yes, things have gotten better and I don’t have a pit in my stomach every night before work and my heart doesn’t race everytime I walk into work, but there are still challenges as a new OT practitioner. This post did and continues to remind me that I can do it, and as a new OT, we all have been/will be there. Mandy, I thank you for posting Mary Kate’s experience because it has helped me tremendously, it has helped me overcome nights where I come home from work emotionally and physically drained. And Mary Kate, thank you for so beautifully articulating your feelings, it has truly helped others, like me! Thanks!

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      So happy Mary Kate’s article was able to put you (a little more at least!) at ease, Marilou! You are definitely not alone – I remember feeling the exact same way when I started. You have the skills and it is hard that it takes time to fine tune things clinically!

  2. Oh my, I have just been offered my first job as a Cota at a small snf and feeling a bit overwhelmed!! This article helped me so much to put things in perspective and gain some confidence to jump in. Thank you so much for this article.

  3. hi truly well articulated and yes the first few weeks, months are daunting, but remembering to stay grounded and using all your caring skills is super important.
    Thanks for sharing .

  4. I’m in my 9th month as an OT and my 9th month working at a SNF. This was all so relevant and I second everything that you said! Thank you for reminding me that I’m not the only one struggling with it all!

  5. This blog post spoke volumes to me. I am on day 4 of my first job as an OTR at a subacute facility, which is not a SNF but similar demands and obstacles. I was finding myself dreading the drive and getting discouraged and overwhelmed questioning whether or not I’d succeed. There are so many things so daunting for the inexperienced therapsit and this post was so beautifully written, perfectly articulating the struggle of how a new practitioner feels. Thank you for sharing and helping me feel excited for tomorrow, regardless of what ot may bring.

  6. As a fellow Gannon grad, hello! Thank you for these helpful tips! I’ll be sure to refer back to this post often as I consider and possibly accept a job in a SNF in the near future!

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  7. Thank you Mary Kate! I am a new graduated COTA recently hired and working in SNF and this information has been so helpful and I feel much better after reading this information and inspired to do a better job. thank very much again for taking the time to share these six steps .

  8. Mary Kate, You are doing fine. Just always remember to ask your patient, “what is important to you?” They may not care if they ever get underwear on-just may not wear them at home, but need to do laundry, and are having a hard time reaching things in the washing machine.. Sometimes with the pressures of productivity, it is hard to think about each patient individually, and what is truly important to them. That is always my leading question-best of luck!


  9. Today was my third day at my first job working as an OT at a SNF. I read this article smoking a stress cigar on my mom’s back porch and was almost moved to tears. Thank you Mary Kate for sharing your insight. This first week has been overwhelming but just sharing your story gives me hope and reminds me why I got wanted to be an OT…. to aid an observe the the indomitable human spirit. Thank you very much. -Tyler M

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      oh my gosh Tyler, those first few days, weeks (months!!) can be super stressful! You’ve got this! You made it though school and that transition can be hard, but your patients can always tell when they are working with someone that truly cares. 🙂

  10. I’m about 2 months into my first OT job in a SNF. Its definitely been overwhelming and I’ve experienced a lot of the same feelings/situations as Mary Kate. This article was really reassuring and its good to know I’m not alone. Thanks!

  11. As a rehab tech in the skilled nursing setting and future geriatric OT – I appreciate and empathize with your viewpoints. It is good to know that all of these experiences are normal and I feel inspired to keep pushing myself to service such a valuable community.

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