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So, I was doing some continuing education in FEES this past weekend. (Finding fun in sticking a small camera up your colleagues’ noses for two days.  Not sure what that says about me as a person.) It was a mix of speech-language pathologists working across of variety of (mostly) medical settings.

Nerd that I am, I liked to hear what it was like for each of them working across different settings. (Especially those working in long-term care facilities with trachs and vents! I mean, PEOPLE EATING AND SPEAKING ON VENTS???  I had an entire class on trachs and vents and my mind still  boggles.)

Anyway, in reflecting on the interesting information I had gathered about various clinicians’ job settings, I suddenly had a questions.

Q: Did I just miss an opportunity to network?

A: Yes.

Not necessarily in the job crawling sense (although if I were looking for a job, it would have been a good place to do it), but rather in a, Let Me Make Contact With People Who Know More About Certain Stuff Than I Do. Maybe the opportunity for me to do that was not particularly obvious to me because I already work with a good group of clinicians with whom I can ask questions. But that’s not true for everyone! And it’s also not true that everyone I work with happens to be an expert/have a lot of knowledge in a particular area that I have questions in. Not to mention if there comes a time in my life where I am looking for a new job. Wouldn’t it be nice to have some contacts in my back pocket?

The question is, how do I make that leap from chatting about my/their job/s to, “So can I call you sometime.” “Can I have your email address in case I ever have questions about X?”

Of course, not all of these SLPs were doing work that related to my current interests and activities in my own job (see also: people talking on vents.) But it got me thinking about future workshops or conferences I attend. Guess networking falls under one of my Top Goals of All Time: Being Assertive.

Does anyone else have thoughts on networking? Do you use it? How do you make (and keep) contacts? What do you use it for or have you used it for? How do you work exchanging contact information into the conversation?  Or is that last question an obvious sign that I am insecure and un-assertive? Guess I have a lot of work to do.

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TodayIwill

TheListofKickingAssandTakingNames

A List:

  1. Clinical ladder!
  2. Increasing my knowledge of dysphagia
  3. Keeping up with cognitive and aphasia therapy evaluation and treatment techniques
  4. Organizing both my work places and myself so that I am not running around like a chicken with its head cut off
  5. Continue to push for therapy reimbursement guideline changes
  6. Research therapy for children with autism
  7. Do something related to education that relations to my profession (this goal needs to be more specific)
  8. Accept my failures with more grace
  9. Do not panic in stressful situations.  Stop.  Think.  Taking a moment is better than panicking.

I thought there was more than this. But this isn’t a permanent list. I give myself permission to change it as circumstances change, opportunities change, and I change.

The Facts:

  • Today was the case presentation that is the culmination of all my experiences at my hospital internship.  (It’s also an indicator I only have three days left at my internship.)
  • My case presentation was not actually a case study singular, it was a case study comparison of two patients. (Something quite new, at least over the past few months.)
  • I was nervous about the length since the times I had clocked over the weekend were less than awesome.
  • I had finally gotten the Powerpoint presentation to present  my comparison columns in the correct order (i.e. left to right–it had previously been bringing up the right column prior to the left.  Go figure.)
  • The presentation was first thing in the morning 8 o’clock in the morning.
  • I was to come early to get everything in order with CI.
  • I was presenting to the entire rehab department.
  • The presentation is not over until two particular rehab department members ask questions (that are either stupid easy or completely over your head depending on the mood).

What Actually Went Down

  • CI made the presentation Just in Time due to a hectic, crazy morning.
  • I was later than I meant to be to get things set up.
  • I was very nervous at the beginning.  More than I thought I would be.
  • My Powerpoint perversely decided to present my columns backwards even though I had it completely fixed. (Curse you Windows!)  And let me tell you, when you’ve rehearsed your presentation (i.e. comparison) order from left to right, going right to left is a bit of a challenge.  Especially when it’s unexpected.  Especially when it’s in front of a large group of people you really want to impress.
  • I said ‘um’ too much.
  • I used too much jargon. (This is another personal goal:  FAIL this time, but hopefully will continue to make progress on this in the future.)
  • I kept clicking the right click button instead of the left click button to move to the next slide.
  • I made some errors in distinguishing certain types of things from other things.
  • I only got a question from one particular rehab member rather than two before the presentation was officially over.

You win some, you lose some, right?  I’m so glad it’s over.  Another thing off the list!

(P.S. The next job crawling post  [The Interview] is about half written, so look for it in a day or two.)

NOTICE TO THE PUBLIC

It is perfectly ACCEPTABLE and NORMAL to politely interrupt certain hospital staff (i.e. nurses) to impart information about a particular patient.

This can be done in the following situations:

  1. When the nurse is in the room of another patient
  2. When the nurse is in the room of another patient and in the middle of doing something
  3. When the nurse is in the middle of going from point A to point B to accomplish something

The only time you CANNOT under ANY NON-LIFE THREATENING circumstances interrupt the nurse is while s/he is handling medications.

Standing around waiting for the nurse to complete tasks is UNACCEPTABLE and ABNORMAL behavior because it slows you down.

Any overwhelming anxiety you feel about being perceived as rude for interrupting someone in the middle of completing a task because you were raised by a Southern mama (or any mama capable of instilling the Fear of God as regards Rudeness) should be IGNORED and DISPOSED OF.  This paralyzing desire to be Polite will instead make you appear as though you are a completely unassertive failure.

Interrupting nurses is ACCEPTABLE and ENCOURAGED under circumstances outlined above.  NO ATTEMPT to be Polite should be made.

You may now return to your regularly scheduled blog surfing.

  1. Recognize I get nervous/anxious in places with a lot of people and neutralize panic by realizing I only have to actually talk to maybe 3 or 4 people in the room/area (my client, the client’s nurse, and client’s physician).
  2. BE ASSERTIVE.  (I’m going to get this tattooed somewhere and maybe I will always, consistently be assertive.)
  3. Just say my plan for the client with confidence.  I might be wrong (been there before!), but I look stupid when I was right but said it without confidence.
  4. Fake the confidence! Maybe a few years from now (hahaha) I’ll actually feel it.
  5. STOP looking at CI. JUST STOP.  Give myself a moment to think about it.  The answer might actually come.
  6. Think about what I am going to say to the doctors and then say it.  (Think ‘A’ section!)  Organize my thoughts.

This weekend, I need to:

  1. Edit my thesis.
  2. Re-write and edit the Discussion section of thesis so it’s ready to turn in on Monday.
  3. Edit my write-up of my externship experiences so I can email it on Monday.
  4. Fill out the stupid paperwork for the stupid review board.
  5. Figure out the number for and plan what I’m going to say when I call RIC.
  6. Identify new approach for contacting / impressing the places I have applied for jobs and will apply for jobs.
  7. Game plan for the final 30 days of my internship to ensure I am AWESOME and ASSERTIVE (the later probably leading to the success of the former.)
  8. Take a hike on the south trail.
  9. Soak up the sun.

And…go!

Thesis returned today with a much better response overall than the last draft.  (How fast is my advisor at turn around?  Unfreakingbelievably fast!)  Now to tackle the final portion of the thesis and then hopefully….

I have also been job trawling again.  I’m a little frustrated with my search right now, but I’m recently realized I should cut myself a little slack.  As I continually refine my cover letter with each submission, I remind myself, this is my first time ever applying for a real, true professional job.  As I screw up my follow-up timeline for each job, I am trying to forgive myself since I have never made follow-up calls and the etiquette and not-actually-weird-ness of doing so is new to me. I’m learning this as I go along (perhaps in a less graceful and adaptive manner than others, but there’s still a learning curve to getting into the job market).

The internship continues apace.  My ‘A’ sections on SOAP notes are getting better, but are still not consistently perfect.  (I’ll have two perfect ‘A’ sections in a row and then a set of FAILs.  Grrrr.)  I took forever on a bedside swallow evaluation while CI lurked outside and let me.  (And I don’t mean that in a negative way; that’s how you learn things.)  I have reduced but not eliminated my word vomit while speaking to doctors and still suffer from a somewhat disorganized presentation of information.  I continue to lack adequate assertiveness.

So, it’s almost midterm here (!!!!), so what have I been doing?

Well, I’m writing all the notes now (and still getting comments/changes on 50% of them.  ‘A’ section!  I will conquer you!  *shakes fist*  Not to mention my diagnoses are sometimes a little off.) and I’m getting much faster at it.  This conversation has been frequent this past week and a half:

CI:  Okay, you finish writing the note here.  I’m going to run down and do X and then meet you up on Y for our next patient, okay?

Me:  Okay.

[15 to 20 minutes later]

Me [see CI talking to some of his colleagues on the same floor we were on]:  Um, hi there.

CI:  You’re done already??

I am doing pretty much all the language and cognitive evaluations on my own.  (Yay!)  I’m still assisting/sharing 50-75% of the bedside swallow evaluations and modified barium swallows.  I’m much slower with working out next steps to take while evaluating a client who potentially has dysphagia.  And, in fact, sometimes I’m like, “I don’t know what the hell to do next.”  (On reflection, I should tell CI to give me a few extra seconds before jumping in to see if I can work it out.  I should probably also mention to him that the confused look on my face is actually my ‘I’m Thinking’ face and does not require immediate assistance…just delayed assistance if the confused look doesn’t go away.)

I am now doing most of the DCP with nursing, doctors, and family.  DCP is…an acronym for something I can’t remember.  But basically it’s coordinating care verbally with all those people I listed.  Yes, you will write a note and document the same thing, but let me assure you that nursing and doctors do not have the time and/or just won’t read your note about Patient A.  They will remember if you walk up and tell them that Patient A needs dysphagia soft diet and nectar thickened liquids, and if they need a bit of a refresher or clarification, they can read your note.  Plus, doctors have to write the order for the diet change, so you definitely want to let them know ASAP so your patient can have lunch instead of remain NPO (nothing per oral) since the person who is in charge still thinks Patient A is an aspiration risk.

Anyway, I pretty much suck at this, especially when it’s doctors.  I don’t consider myself particularly awed and/or intimidated by doctors (dealt with my fair share of them growing up), but clearly I am.  I consistently word vomit all over them when I’m trying to give them the results of the study.  Doctors don’t have time for this and they could care less about the details, all they want to know is:  What diet does the patient need to be on?  Unfortunately, despite knowing this, I still word vomit all over them every time.  (As my CI succinctly told me after he watched me awkwardly word vomit all over the phone to a doctor:  The target was here and you were circling all around it.)

GOALS

  • Be succinct when coordinating care with doctors/nurses.
  • Be more on my game/be faster a figuring the next step out in swallow evals
  • Write consistently perfect notes. ‘A’ section I’m looking at you!

(Re:  the title.  While I whining about my first day and how nervous I still was about the second, to a good friend of mine, she kindly pointed out to me that, hey, no one died; I didn’t kill anyone.  So, in her honor and to enshrine her infinite wisdom, I would like to state:  I also didn’t kill anyone on my second day.)

The day started with the exciting additional orientation to the computer system the hospital uses for documentation.  It wasn’t so bad since I was learning practical stuff I would actually use as an intern, plus there was the promise I would be out of there before lunch.  The only FAIL aspect of this part of the day (which rather unfortunately became a minor theme for Day 2 Hospital, Day 1 Actual Clinical Stuff) was that I was not assertive enough.  (This has been a goal of mine since the beginning.  I’ve come a long way, but I’ve got a long way to go.)  It went like this:  there were multiple modules that different employees (and interns) had to stay for.  Progressively, the class got smaller.  When they called the names of the people to leave after a certain model, my fellow starting intern for PT (physical therapy) was called to leave, but I was not.  Confusion!  Wasn’t I supposed to leave when she did?  We’re both students after all?  I debated on asking the woman to read the list again and see if she didn’t leave anyone off, but I didn’t.  So of course, approximately 5 minutes later when I couldn’t do what they asked me to on the program, they realized I wasn’t supposed to be there.  If I had asked I would’ve left 5 minutes early!  It was stupidly unassertive of me.

Anyway, off I went, getting slightly lost, back to the in-patient rehab wing so meet up with my CI (who will be known as…CI).  Despite moments of FAIL, it was awesome to actually be back to actual SLPing.  We move around a lot since CI sees both in patient and out-patient.  It wasn’t quite as fast paced as I was expecting, which I am not complaining about, I was just a little surprised.  Of course, I’ve gotten the impression from my classmates that it can vary:  some days are pretty evenly spaced out, and other days your are slammed.  And now that I think about it, CI probably built in some time today to orient me to different clinical things, since it was my first day.  Anyway, we would usually review the patient’s chart, go see the patient, and then write-up the SOAP note before moving on to the next patient.  I think I will mostly be seeing swallowing and trachs here and not a lot of language or cognition.  I love language and cognition, but I’m excited to try out some swallowing and trach stuff since that is the kind of thing you don’t see in a university clinic.  Anyway, I kinda sorta lamely helped eval a client (see FAIL list below), but I also wrote my first SOAP note!  Not too shabby for a first day SLPing.

FAIL

  • was not assertive in electronic documentation class
  • was not assertive enough in the eval (in fact, I kind of missed the, “Now you try” looks CI was giving me before it was finally said, “Now you try”) so I was caught off guard a kind of word vomited my way through it in the most awkward and embarrassing way
  • I am no longer spatially oriented to the hospital.  It will be a long time learning my way around now!

WIN

  • I wrote my first SOAP note with minimal corrections!
  • I have made a HUGE effort to learn people’s names and it seems to be paying off…!  (Knock on wood.)
  • No more orientation!

GOALS

  • BE MORE ASSERTIVE
  • Pay more attention to my CI’s non-verbal cues, especially at the end of the day, so I’m not caught off-guard when he wants me to jump in.  (This falls in the same category of problem I had yesterday afternoon when I failed to recognize my CI until he greeted me.)

I will try to explain how patients are distributed among the SLPs in the coming weeks.  I’m not quite clear on it myself, so I’m hoping it will be a little more fully explained in the next few days.

Yep, it’s midterm time! …By which I mean it’s halfway through my school externship, which means it’s time for an embarrassing story, some soul-soothing, and goal setting.

FAIL

My supervisor and I were going over the midterm paperwork that has to be filled out and returned after school.  We get around to the sheet I have to fill out, only to discover that I have filled it out completely wrong and have to re-do the entire thing.  This was particularly embarrassing after my supervisor had been overall very complimentary of my work thus far in the externship.  So, R kindly made an extra copy of my midterm sheet and I filled it out again and went over it with her.  That done, it was time for use to leave, so I put all the paperwork into an envelope (also kindly provided by R) to drop off at the University on my way home.  We carpool, so I rode in her car until we got to the parking lot where we meet up.  I transferred all my stuff into my own car.

Or so I thought.  It turns out, upon arrival at the University, that I had left the envelope in her car.  Or at School 2.  I’m still not entirely sure where that damn envelope is, but I am quite angry with myself for making such a stupid mistake.  (It’s always the stupid, small things!)  Well, I left a message on R’s voicemail, just to let her know that I thought I might have left it in her car and that I would collect it when we saw each other next.

A tip for all of you interested in becoming an SLP:  Don’t make small, stupid mistakes during and immediately after your midterm review!

WIN

As I mentioned above, my supervisor was complimentary overall with my performance thus far.  I am happy to hear it, and also happy that I am enjoying working in a school, which I wasn’t certain of.  I’m also excited about starting the writing portion with some of my older language groups and a lot of things coming up, including:

  • District SLP meeting
  • Evaluations!
  • Picking up a voice client
  • Writing progress reports
  • Leading classroom language groups
  • Observing the middle school
  • Observing in the classroom
  • The possibility of a home visit

GOALS

  • Really modifying my language so it is less “adult;”  I have a big vocabulary and I use it, regardless of who I’m working with.  Tailor my speech to fit my audience; so use kid-friendly language (This is something R really suggested I work on)
  • Related to the above, showing and/or doing what I want the kids to do instead of trying to explain it all in words.  As one of my past supervisor’s said, “If they could learn things that way, they probably wouldn’t be coming to see us.”
  • Find more than one way to explain things and not use the same explanation over and over, especially when it’s clear it’s not working
  • Keep learning peoples’ names!  I think I have about 7 names in my repertoire now; not good for being at the halfway point.

Hopefully things will continue to look up from here.  I have a lot looming in my future, so I know freaking out over a couple embarrassing mistakes won’t help me much.  I need to focus on what is next.  It’s far more interesting anyway.

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