OT Settings

OT Settings Series: PRN Occupational Therapy Across Multiple Adult-Based Settings with Sydney Moore


Did you think that OT Practitioners can only work at hospitals? Think again!

Next up on our #OTSettingsSeries is Sydney Moore, OTD, OTR/L, CEAS I, CHES. Sydney is an occupational therapist living in Des Moines, Iowa. Over the past year, she has had the opportunity to immerse herself in a multitude of OT settings. Outside of OT, Sydney adores spending time with her friends and family, and snuggling her four dogs. 

Here is a graphic I put together to list out the magical settings that OT practitioners can work in. I know I have missed a few…This graphic has been numerously updated! I am sure it will have to be updated again soon!

MEET SYDNEY

Name and credentials: Sydney Moore, OTD, OTR/L, CEAS I, CHES

Number of years in practice: 2+ years

OT Setting/s: PRN – SNF, Acute, Outpatient Workmans Comp, Private Practice Owner

Shannen: Hi there Sydney, I think a lot of people will enjoy reading your perspectives here especially since you are a newish grad demonstrating the possibilities and opportunities that can occur in rising up to the challenge of working in multiple settings. Can you please give a synopsis on your settings and share how working PRN has challenged or strengthened your career trajectory?

Sydney: A majority of the facilities I work in are in the Des Moines Metro. Settings range from urban and rural acute care, continuing care retirement community (ILF, ALF, SNF)  and an outpatient hand therapy primarily with worker’s comp. Additionally, I am currently working to grow my own private practice providing mobile outpatient services to aging adults within the home. 

One of the greatest benefits I’ve experienced of working PRN is the exposure to the many resources Iowa has to offer. In each setting there are seemingly staple resources and services patients receive following discharge. I’ve used this experience to make myself a mental “master list” of resources because I truly feel as an OT, it is my obligation to connect patients to resources and services which provide ongoing support during the rehabilitative process. While many of my facilities are “urban,” they frequently are accessed by clients residing in more rural parts of Iowa. While there are many resources available in Des Moines, rural clients who were sent to Des Moines due to complex needs may or may not have access to a plethora of resources. I work to use my “master list” to connect clients to resources whenever possible at time of discharge and throughout the rehabilitation process. One of the ways I’ve gained these resources is by connecting with each healthcare team whenever possible.

As a PRN therapist, there are some facilities I work in regularly and have built relationships within the therapy team, nursing and social services. However, there are some places I work during nights or weekends and there it becomes more challenging to get to know the full-time staff.  

Shannen: Who benefits from OT services in your setting? What are common patient diagnoses? How does or how can a person get referred to your setting? Who qualifies?)

Sydney: I remember listening to a Mind Your OT Business podcast and Laura Park Figueroa described OT as “the original life coach.” OTs have such a beautiful, holistic scope which works to amplify the current skills and abilities to best meet long term goals. I’m a firm believer that nearly every human may benefit from OT services, but logistics may dictate who receives services and in what setting they receive these services. 

Clients recovering from more involved diagnoses, such as falls, fractures, CVA, acute infections and chronic disease exacerbations may be more prevalent in acute and SNF settings.  Residents in Independent Living and Assisted Living facilities are most often receiving services following acute hospitalization, skilled nursing stays or for frequent falls, functional declines and emotional wellbeing. The COVID-19 pandemic has significantly impacted the mental health of aging adults due to social distancing measures, visitor restrictions and cancelled group activities. My experience in outpatient hand therapy has primarily been treating patients with injuries sustained at work. Injuries including wrist and finger fractures, carpal tunnel and repetitive use injuries. 

Shannen: Aw, definitely love Laura; she is brilliant! I will link her podcast to your previous answer. Okay, so thank you sharing the above. I appreciate you highlighting the shifts that have had to occur since the pandemic. Let’s move forward now. What value does OT bring to your settings in your opinion? And perhaps, share a recent salient occupation you incorporated into a treatment session?…

Sydney: Working PRN has allowed me to experience the value that OT provides across settings. OT plays an intricate role in the rehabilitative process, because we address so many factors that otherwise may be overlooked. I’ve found that the care team does a great job of determining a “solution,” for safe discharge planning, but it’s the OT that finds if the proposed solution is feasible for the client and family. For example, assisted living can be a fantastic discharge plan, but it’s not affordable for many. As OTs, we can find ways to meet the needs of both our patients while also addressing underlying medical concerns, etc. 

I really enjoy the creative aspect of being an OT and incorporating meaningful occupational into interventions with small additions, like creating a cat matching game to facilitate grasping patterns or more involved activities like baking mug cakes. Occupations are truly what drive our human nature, so I do the best I can to use them in each session.   

Shannen: Cannot agree with you more there. I think oftentimes we want to propose assisted living as an option, but in reality for some patients the financial aspects of that setting are unmeetable. Also, love love love the occupational task of baking mug cakes. Alright so one of my favorite questions to ask: How do you describe occupational therapy to a new patient in your setting who asks “what is OT for me?”….

Sydney: I most often describe OT as “working on what you need to do, have to do. and want to do. Need to do items are toileting, dressing and showering; have to do things may be tasks like cleaning, cooking and laundry; and things you may want to do are hobbies, social events and more.

A majority of the settings I’ve worked in have a culture with a greater focus on completing ADLs and meaningful occupations. COVID-19 has modified the way I’ve delivered services, as many patients are proactively quarantined and require in-room treatments only. Despite restrictions, it seems patients truly enjoy the additional time OT spends in allowing patients to complete ADL routines as independently as possible. 

Since the COVID-19 pandemic, it seems more patients are choosing to discharge home with home health services rather than SNF. Caregivers are requiring more education, resources and support as complex patients are discharge home, and as an OT I assist with providing this to ensure a safe discharge. 

In the multiple SNFs I’ve worked in, frequency, duration and length of stay varies. It seems each company has adjusted to PDPM slightly differently in how they provide therapy services. Most often, patients receive OT services 5-6x/week for 30-45 mins with plan of care written for 4 weeks and updated as needed. Patients may transition to long term care, home with home health or ILF/ALF with home health or outpatient therapy. 

In outpatient services for ILF/ALF, residents receive OT services 2-3x/week for 25-60 minutes. Depending on the goals and progress, clients may receive only 3-4 weeks of therapy or several months. The nursing staff and care team receive significant education in that setting throughout the plan of care to ensure carryover following discharge.

Individuals receiving therapy following a work injury have varying plans of care. While I can recommend a frequency and duration for patients, ultimately it is the decision of the referring physician. 

I continue to be on the hunt for an IADL assessment that I love, but measures I frequently use are the Modified Barthel, SLUMs, BIMS, PHQ-9 and GAD-7. I’ve found in SNF that MDS coordinators often utilize the BIMS and PHQ-9. Facilities vary on who completes these, but I try to do them with all of my SNF evals. There have been a handful of experiences where patients have scored differently in my assessment indicating either a cognitive or mental health concern that was not noted previously. One of my greatest “success stories” as an OT was when I had completed the PHQ-9 at eval and then again at UPOC which indicated a 7 point increase in depressive symptoms. I was able to communicate this to the physician, who was able to address this which led to an improvement in overall affect and participation in therapy.

Shannen: I really appreciate you touching on your assessments that you incorporate especially in regard to the person’s mental health via the PHQ-9. I personally use that or the GDS – Short form (I will link this!). Can you share about the certifications you have? To be honest, I do not know what some of those letters are behind your name:)!!

Sydney: I have two certifications – Certified Ergonomic Assessment Specialist I (CEAS I) and Certified Health Education Specialist (CHES). My undergrad is in Kinesiology with an emphasis on community and public health. Several professors indicated that this degree was a great stepping stone to the certification. I had no idea at that time that public health and occupational therapy were so intricately connected. It’s definitely served me well as an occupational therapist! 

My “back up plan,” if I didn’t get into OT school was doing something with workplace wellness. So, it didn’t surprise me that I found myself interested in workplace ergonomics in OT school. I was ecstatic when presented with the opportunity to work toward the CEAS I certification in school. 

Shannen: Well that is fabulous!! What a way to combine your interests! Can you share what you like about PRN work? Can you share a HIPAA compliant patient story win (with changed details, no use of the client’s name…)?

Sydney: I LOVE variety. The multiple settings OTs work in was one of the many things that attracted me to the profession. Being a PRN OT has provided me the opportunity to experience multiple settings and network within the profession. I’ve found that while it’s more difficult to find a mentor working PRN, it’s been rewarding having multiple seasoned OTs who can provide insight. I’ve really enjoyed working in settings throughout the continuum of care for older adults. Working across the continuum has helped me to grow as a therapist and improve the quality of treatment sessions.

Near the beginning of COVID, I was working PRN in an ALF as the regular OT staff was no longer able to travel between the buildings on campus. I evaluated this patient, we’ll call her “Joy” for HIPAA purposes…

Joy experienced a significant functional decline due to visitor restrictions, cancelled group activities and in-room dining only. Her family reported her cognition rapidly declined during this time period. Initially, my OT plan of care focused primarily on improving participation in ADL routines including simple housekeeping and toileting. As I got to know Joy, I learned she adored talking to her adult children on the phone. She had a hard time hearing with her current landline, but I learned she had an iPhone. We were able to build in “iPhone training” into her OT POC. She progressed from not being able to identify the iPhone to independently answering FaceTime phone calls from her family. She became connected with not only her adult children, but her grandchildren and great grandchildren. Near discharge from OT services, I helped her daughter unload Joy’s new recliner from her car. I introduced myself and tears started to fill her eyes. She was so thankful for her mom’s progress and new abilities to connect with family during these dark, uncertain COVID times. 

Shannen: BE STILL MY HEART. OH LITERALLY THAT STORY IS JOYFUL!! Okay, so I like to be a glass half full kind of gal, but let’s talk about what things you do not like or wish you could change…

Sydney: Solely working PRN has several challenges ranging from personal, practitioner and logistical challenges. PRN work occasionally is lonely. It means sometimes working the off hours of nights and holidays, and being the sole OT practitioner on site. I frequently miss out on interacting with the therapy team and building work relationships. Not knowing the clinical staff means sometimes it’s awkward figuring out who to ask certain questions to. There’s also the never ending challenge of learning where supplies are and the different EMR platforms used. As I’ve transitioned into working solely PRN, I’ve had to become more comfortable with feeling awkward. Not being afraid to ask questions and not know the answer 100%.

Likewise, being an evaluating therapist working PRN hours means I may evaluate a patient and never see them again. If I’m not consistently working at a building, sometimes I miss being part of the plan of care and helping the patient meet their goals. I truly love the relationships we build as OT practitioners, so this was a difficult transition for me

The logistical challenge of PRN work is insurance and benefits. Fortunately, I’ve been able to stay on my parent’s insurance until I can transition to my significant other’s insurance, but a majority of my PRN positions do not provide PTO or 401k benefits. I’ve needed to organize these pieces on my own, setting up my own 401k and planning for unpaid days off.

Shannen: I appreciate your honest perspective there. I found in my personal experience in previously working PRN, I oftentimes felt out of sorts, on my own, and also frequented with sadness from not knowing how a patient continued on… And then the pandemic hit and where I work, we are not allowed to work in multiple jobs anymore.

So, how did you “get your foot in the door” to work in this setting?

Sydney: PRN work is readily available, but I’ve found consistency is the key. When I agree to do PRN, I do my best to be available as often as possible. This is challenging at times, particularly during COVID times. If I’m not available for the specific day they ask, I try to offer alternatives for the same week. During COVID, I’ve branched into Telehealth and offer that as an option too. If I haven’t worked in a facility for a bit, I try and reach out periodically to touch base. 

Shannen: Where do you see yourself in 5 years? 10 years? How does working in this setting help you reach your personal professional goals?

At this time, I’m hoping to grow my practice into my main role and continue to work PRN to maintain my skills and knowledge. I enjoy the variety as a professional, but also feel the schedule would work well when we grow our family in the future. The variety of settings helps me progress toward my professional goals as being a life long learner and continuing to improve access to OT. 

Shannen: I also look to the future sometimes and try to imagine what my work life will look like with the addition of children hmmm.

In your opinion are there specific “special skills” (like things you aren’t prepared from entry level OTA/OT skills) you would recommend to be successful in your setting?

Sydney: I wouldn’t say you need “special skills” to be a PRN therapist, but there is definitely a lot to juggle to be successful. I’ve found that the skills that make an excellent employee need to be amplified while working PRN. Communication, organization and willingness to ask questions are crucial skills for success in. There’s a lot of personal planning that goes into “full time PRN work,” like budgeting, scheduling, etc. Organization is key when tracking the different EMR systems, policies and other variations for each setting. Typically when hired as PRN, there is limited on-boarding and orientation processes. I found myself feeling like I was “in training” much longer at a PRN job in comparison to a full time job. Initially, I really struggled with this feeling. This feeling that I wasn’t competent, that I was asking too many questions. I wasn’t quite prepared to develop this skill of being okay feeling awkward and asking questions to staff members I didn’t know. With time and practice, this process has become more comfortable for me allowing me to enjoy the work that I do. 

Shannen: How do you deal with grief, illness, sadness, loss, caregiver burden… in your setting?

Sydney: As a new grad, I’m not sure I was truly prepared for the amount of sadness and loss there is during the rehab process. I was surprised how often I found older adults experiencing grief in the SNF setting, grieving their independence and transition into late adulthood.  I’ve learned to have open and honest conversations about how sad, frustrating and stressful the rehabilitative process is. I strive to validate patients’ feelings and be their shoulder to lean on in rough times. I think back to when I knew I was successful in addressing mental health my patient said “I need a Sydney talk,” prefacing her need to express her feelings.

As for my own mental health, it’s tough sometimes. I find the most difficult part is making time for the fun things, especially during a pandemic. Life can feel soooo overwhelming during these weird times. Quarantine and social distancing has truly put a wrench in my typical routines of spending time with friends, seeing family, traveling, etc. Sometimes quarantine feels like this constant circle of work – adulting tasks – sleep.  So, I’ve had to be very adamant (like scheduling time in my calendar) about making time to do something creative, accomplish a project or connect with friends and family. 

Shannen: Oh, girl I feel you here. Overwhelming is a theme of “these times”. YOU are not alone in that. Okay so we will start wrapping this up. Can you share advice you would give to someone thinking about / wanting to work in your setting? Perhaps, what you wish someone would have shared with you before your started?

Sydney: When I was in grad school, I dreamt of working PRN across multiple settings. That was my professional goal, to experience all of OT simultaneously. Somehow, my self-talk and the advice of others convinced me to take a full-time job that left me with never ending ethical predicaments and feeling unfulfilled. My advice is to follow your gut. Regardless of your self-talk, the advice from others and the “norm,” do what you feel is your path. You know your path.

Shannen: WOW, Okay I think actually I know I need to hear that advice. Multidimensionality at its finest. Thank you so, so much!!

Want to connect with Sydney?

IG: @happyathomeconsulting

Website: https://happyathomeconsulting.com

Questions? Comments? Feedback!! Please consider posting below!! Follow the hashtag #OTSettingsSeries on Instagram to never miss a post :)!!

Finally, a lovely thank you to Sydney for sharing a glimpse of her multidimensional and dynamic OT life through her unique lens as a therapist working in a multitude of settings.

With Kindness,

SHANNEN MARIE OT

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