Written by: Yaffa Liebermann, PT,GCS,CEO
1986 – 1989 Point Pleasant Hospital, NJ
As an immigrant, I came back to the Unites States on an H1B visa which was sponsored by Point Pleasant Hospital. I worked there for three years without leaving the states and, after three years, I obtained my Green Card and became a permanent resident. The Green Card allowed me to work wherever I wished, pay my taxes but I could not vote. Five years later we became citizens of the USA.
Working in An Acute Care Hospital:
My employment with Point Pleasant Hospital was a great learning experience. Due to this experience, I recommend new graduates to get their first job in an acute care hospital. As a new therapist, you will learn how crucial it is to provide skilled care during the early stages of the patient’s healing process. The patient would then be discharged from the hospital with information to continue exercising and progressing at home.
Hospital stays, due to sudden injury or exacerbation of chronic disease, are always the most traumatic part in the recovery process. As a therapist, your skilled care combined with emotional support is of the utmost importance. Your professional advice helps to lay the foundation for the entirety of the patient’s healing process.
As for your own career, working in an Acute Care hospital will offer you insight into the broad spectrum of tests, procedures, surgeries, latest pharmacological information, uses of research, and access to medical libraries. Most of all, the experience will acquaint you to a variety of experiences with all age‑group patients and their diagnoses in the different departments.
This information will serve you well in your future as you will be able to refer your patients to the appropriate discipline in order to address their individual problems. You will gain knowledge in specialty physicians who provide a variety of surgical procedures, the preferred surgery performed for the patient’s injury, and the progress that each doctor expects from his/her patients.
Have Your Own Patients:
An existing system in the Physical Therapy department prioritized the timeliness of treatment over that of continuity of care. The rehab aid would put the new arrival chart on the bottom of the pile and each therapist would take the top chart.
I heard a patient saying: “I do not like it, sometimes I get a good therapist and sometimes not so good. If I am lucky, I will get a good therapist this time”. I also felt that there is no continuity of care with this system which is important as it allows us to develop a trustful, working relationship with the patient.
When I went to interview for my next job the first question that I asked was: “Does each therapist get her/his own patient”? The reply was yes so this was the next job I accepted.
Arguments in The Rehab Department:
Two therapists used to enjoy arguing and fighting on various subjects which caused a division in the entire team. During lunch one day, I heard our secretary say that they should take their argument to another table, not to disturb her lunch. I realized that it does not matter who started the fight or who is to blame as both people were considered instigators. Any issue can be solved between two people quietly with the goal being a pleasant atmosphere that makes the team member enjoy coming to work.
Independent, Minimal, Moderate, Maximal:
These were our terms to describe how much support the patient needs from the therapists. Our supervisor read our notes and saw that there is discrepancy among the therapists. The therapists documented different scales to the same patient for one week. It was not gradual improvement but varied day by day dependent on which therapist was treating. The supervisor gathered all of us and we clarified the levels of support in our documentation for use by all the therapists. Later, that day she had turned it into a new guideline. I was impressed by the way our supervisor handled the subject. She saw a discrepancy, discussed the issue with us and provided a solution based on the staff decision. The solution came from the therapists, was utilized by all the therapists and was not a mandate dictated by the corporate team.
30 Years later:
In my experience, an injury at a young age which was not treated correctly by physical therapy will surface again after 30 years. This statement is not backed by research but rather my own observation. An example: A 45-year-old patient suffered from a right hip fracture. My goal was to teach him how to use crutches correctly.
During the evaluation I saw that his right leg was thinner due to reduced muscle bulk. I asked him if he had an injury when he was young, and his reply was: “yes I broke my Tibia when I was 9 years old and since then I pampered my right leg”.
This was the leg that he broke the second time at age 45. As a way to verify my assumption I checked with everyone I could and have always found the same situation. It appears if the body was broken or damaged in a particular place, the healing and the repair are not as strong as the original.
One can live without physical therapy after injury but the body will not return to its prior level of function without guidance. The skilled PT teaches the patient full weight shifting to both legs, equal distribution of weight and full movement on both.
During vacations, I found myself watching other people. I was able to detect which person underwent a knee and/or hip replacement, because they did not sit on both buttocks equally and put most of their body weight on the unoperated side. I suspected that the treating PT did not train for equal weight bearing on both buttocks when sitting. The patient also pampered the affected leg and put most of their weight on the stronger buttocks.
A Guideline for Interviews:
1) Be yourself. You are a wonderful person (otherwise you would not have chosen a profession that provides care for people). If you like to talk with your hands – don’t change your persona and sit frozen during the interview. Let them see the way you are as, if they do not like it, it is better to know during the interview.
2) Be at ease. Let them know you are the right one for the job. Do not talk about money at the first interview. Ask for information about the patients, what the administrators expect of you and what kind of professional performance they prefer. Ask what responsibilities you will share with others.
3) Talk to the staff: During the interview, if you can speak only to the supervisor, ask if you may walk around a bit after the interview. Talk with the staff members to form an impression of the facility. Ask yourself if you would like to spend the next few years of your life, eight hours a day, with that group of people.
4) Express your expectation and your wishes.
5) The atmosphere in the department: Try to understand and gage the atmosphere. You can see how the therapist approaches the patients, how much time they devote to each treatment, if they use a variety of techniques or equipment. Do they provide quality care and challenge the patients? Always ask whether one therapist follows the patient from the evaluation process to the completion of treatment or whether a single patient has many different therapists. Although you need the experience, if you will not be comfortable and happy in that particular situation, interview at another workplace.
There is a huge difference between being a student learning to be a therapist and actually working as a therapist. The usual approach the graduate takes in a new job is to meet the patient and begin treatment. My own experience in new jobs has taught me that there are several stages of job adjustment before a therapist can feel comfortable in her job:
1st week‑ You complete your evaluations and treatments as assigned, but you do not yet know who the key players are in the department.
2nd week‑ You begin to understand the structure of the day and what is needed from you as a therapist which can be quite difficult. If you are a pessimist or if you are the crying type, this is typically your week to weep.
3rd week‑ You now realize the full complexity of your job but you are now mentally prepared to face the challenge head on to do your best and make a living.
3rd month‑ You start to become comfortable with the treatments and the procedures at the facility.
6th month‑ You know the population of patients, the people involved in the department, and you understand the daily routine and the expectations of the supervisors.
1 1/2 years ‑ You are comfortable with all the activities of the department and are thinking about promotion or change; you crave a more active roll or think about moving to another facility.
2 years ‑ You really know the hierarchy and the politics of the organization. You begin to analyze your personal progress within the company and possible progress outside the company. If you stay, work to develop programs and make your place of work worthwhile for yourself and the patients.
Job Responsibility and Development:
The job is yours; do with it as you please. You can fly high and be successful, or you can stay on the ground and just make a living. I always say, “I work for one compliment a day.” By this I don’t mean a compliment on my clothing but a complement from the patient regarding the therapy I provide for him. “I had less pain after therapy,” or “I could walk better, and I felt that I could go up the stairs with less difficulty.”
Your first responsibility of the job is to help people get better and to heal faster; you comfort them and teach them the correct way to use their own strength to become stronger more quickly.
If, within your facility, there is a need for a program, develop it, create it, write it and implement it. This may sound too simple to be true. Your department will appreciate it and will have another program; you will also be able to add it to your resume.
Before you develop a program, you must carefully research your ideas, write them up and share them with your supervisor. Your supervisor may also feel the program is very important and may help you develop and implement it in your facility. Make the supervisor part of the idea; you will gain her support. Creating a program may take hours of preparation on your own time at home, but a successful program is worth every minute. You will be repaid for your time one way or another.