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I have been pondering on and off this past week what to write in my final post on what makes me a ‘better’ clinician. Initially, I was annoyed that I was even thinking about it. I had taken a long weekend off, away from work, and so I was trying not to think about work.

And then it all became very obvious. Breaks make me a better clinician!

For three days straight, I did not think of work. Or if I did, I quickly banished it from my mind. (I admit, on the first of the four days I took off, I did do some thinking related to work, but it was very relaxed, on a subject I have a passionate interest in, and I stopped when I started to get tired.) It. Was. Glorious.

The magic of Taking a Break did not happen right away. My first day back at work was exactly like a first day back at work after a break. What am I doing here? Why is it so hard to focus on researching patient histories? Professionalism? Where did I put that…I’ve been acting goofy all weekend. Whyyyy am I soooo busyyyyy?

But then, suddenly, the second day back, my mind was filled with 10 million (exaggeration) new activity ideas for my clients! Now the only problem is to find the time to put some of them together. But it made me feel like I was an SLP again; not some robot-SLP going through the motions and drilling cards with children for eight hours a day.

Happy Better Speech and Hearing Month!  …and take a break!

(Full title of this post redacted for brevity and pithy-ness: “This post might be cheating as a real post with substance, but it’s true.”)

While reading a book by Steven Pinker, I came across this fantastic quote.

This should pretty much be every grad student’s mantra when making lesson plans and remind us all on bad days that our patients are, above all, human.

“…the Harvard Law of Animal Behavior: ‘Under controlled experimental conditions of temperature, time, lighting, feeding, and training, the organism will behave as it damn well pleases.'”

Word.

A commenter (<3) wondered if I had any tips/advice/warnings for anyone beginning their CFY. Crickets. What was I doing this past year? Do I know what I’m doing now?

Okay, well maybe.  A little.  So I thought about it for a while. Quite awhile. But this is what I came up with.

  • If you’ve had a break between the end of grad school and the beginning of your CFY, brush up on your knowledge of whatever area of SLPing you’ll be doing. I brushed up on my childhood language knowledge, but ended up neglecting my dysphagia knowledge because I felt more confident about it.  I really should have done both.
  • You just graduated.  You learned a lot in the last two years.  But you just graduated. I find this field highly experience-based. Try to accept your failures and lack of experience with as much grace and self-love as you can. You may notice this is on my Goals list. I put a lot of pressure on myself (I’m sure I’m not the only SLP who does this!), but in reality, you’ve still got a lot to learn.  And that’s okay.
  • Try not to panic.  Okay, really, that’s useless advice because we’re all going to panic. But try to manage your panic as best you can. I think the majority of times I made myself look like an ass in my CFY was because I was in a blind panic.
  • Other people don’t expect you to know everything either. (If they do, they have incredibly unfair expectations and you should ignore them as much as possible.)
  • Ask a lot of questions.  If you are working with other SLPs, ask! If you don’t have a nearby SLP to ask, either email past supervisors or get on one of the ASHA boards for the special interest groups. These are excellent places for people to share and ask ideas. There are probably other online boards for you to visit as well.
  • Research the questions you have. It’s always handy to have someone to ask, or who can point you to a particular resource or resources to look at. But don’t forget the importance of finding research-based answers to your questions.
  • Continue adding to and expanding your own materials and resources. Unfortunately, you will still encounter situations/patients where you will think “If I had X….” These will usually occur at inopportune times where you will scramble and sweat to get the resource/information/activity done for a particular situation/patient. If you do have the time, consider spending a morning/afternoon/day/whatever trying to anticipate what types of information/materials you might need for your particular job setting and spending the time making them.  If it is handouts with information about something for patients or parents that you complied and ordered by yourself, make sure you put your name with your ASHA CF and maybe the year at the bottom corner. You worked hard to put that information together, and the credit shouldn’t end up with someone else. Alternately, if you borrow something specific or very closely from a particular source, make sure you credit that source, or note that it is adapted from a particular source.
  • Advocate for your patients. It can be intimidating to confront people who you think (or are) in a position of power, but when it comes to patient care, it’s very important. The department in which I work has already established itself, so there is not much work for me to do in this area, but I realize not every one is that lucky.
  • Advocate for yourself. I suck at this.  Really suck. (This is because it goes under the broader category of “assertive,” which I also suck at.) If you need something to aid/improve your work performance, ask for it.   Keep cards that patients give you telling you how awesome you are. Keep copies or evidence of presentations you have given. Keep copies or evidence of anything that you think shows all the work you do and/or how well you do it. When you do something awesome, write it down so you don’t forget and can bring it up later at your yearly performance review.

Anyone else have advice?  Comment!

I think about this a lot.  A LOT. In fact, I probably spend waaay too much time thinking about this. But I think people’s jobs/lives/general awesomeness could be improved if the immediate environment was designed to actually help us out.

I started thinking about this back in undergrad when I worked for a daycare.  One of my fellow “student teachers” (our Official Job Title) was studying early childhood education and had a real interest in how the daycare was laid out to benefit both the teachers and the children.  She pointed out a few things to me.  And then it was like a revolution: EVERYTHING EVER could be made simpler if the environment was altered to a purpose.

So that’s obviously an exaggeration. But that’s what it felt like.

I think about my out-patient surroundings a lot.  Probably because I have the most control. (Sadly, a brand-new hospital is not going to be built just because I think there are some improvements to be made. Ha!) I also think about it a lot because it plays a large role in how I manage my kids in therapy.

1. To make a room seem smaller, put an object, like a table, in the middle of the room. (Yes, even a small table. I have one of those [wretched] tiny, square activity tables for children. I placed it in the center of my [hunormous] room to prevent one of my [rambunctious] children and it [magically] mentally cut off half the room in that child’s mind, making my job much easier.  And much less exhausting.)

2. Lock them in that damn chair. (No, not a Rifton chair.  Yet.) Seriously.  Push that table and chair up against a wall if that’s what it takes.  Don’t get me wrong, most of my caseload is three years old and younger and getting them to focus for a full session while sitting in a chair is unlikely (but not impossible), there can still be a time for sitting.  And if that child must be corralled and cornered into a chair to accomplish that, then so be it.

3. Remove all visual distractions from behind you.  Or, whatever the child is facing while strapped into sitting in a chair. Unfortunately, this is not something I can really control in my current therapy room. Even when I have a kid strapped into sitting in her/his chair working on an activity, on the far opposite of my hunormous room, carefully guarded by my desk, a trashcan and two chairs (don’t ask) lies an open shelf with a few toys on it. This inevitably leads to pointing, requests, whining, and at times my herding them back into their chair.  I mostly keep it clear or keep dysphagia materials on the top-most, easily seen shelf…but sometimes I slip up.

4. Get rid of that mirror hanging from your door.  Who invented that? Someone who hated speech-language pathologists? Someone who has never encountered a small child? Some people may disagree, but I loathe them. I know mirrors have their place for articulation treatment, but why why why would you want one hanging on your wall when you can just as easily have a small one that you could pull out when you need it.  I can’t tell you how many children will distract themselves by making faces and putting their mouth on it.  Yuck!

5. Invest in some stop signs.  Well, not real stop signs. (Disclaimer: I am not inciting anyone to go out and steal government property, i.e., your local stop signs.) Just make some.  You can even be lazy and make them circle or square-shaped instead of the classic hexagon. I always try to put one on my door so that my kids have to request (at their language-appropriate level) to open the door before we leave. Put it at their eye level. (Fun fact: I cannot draw straight lines when using white-out to make the edges of my stop signs!)

6. Keep things out of sight. Or not. This ties in with number three.  Most of my toys are actually in our shared toy/game room, but I also have some in a closed metal cabinet. They are out of sight and my kids can’t be, well, kids and try to distract themselves and me.  Somethings I have laid out where they can see, either because I’m showing them what we are going to be doing, or so that they can see and not touch and practice requesting items.

7. Keep things out of reach. Or not. This also ties in with number six. Sometimes I want my kids to see things but have to make a request in order to get what they want. Other times I want them to pick one of the games I selected, and feel they have a measure of control in the session, so we can jump right into a good ol’ drill-play routine.

8. Be careful of your room size.  Again, this depends on the age and temperament of your patient. With really small children where you might be doing more play based therapy, you obviously want room enough to play. On the other hand, you don’t want to spend half your time chasing them around and not actually doing any therapy. Obviously, we can’t all control our room size.  I sure can’t.  But I moved things around a lot in my room to try to make it do as much work for me as possible.

9. Clean hands! There should be hand-sanitizer containers either right outside or right inside the room.  Keep everyone germ-free!!! Or close to germ-free!  My problem?  I’ve got to be more consistent having both myself and my kids use it first thing. Guess I need a STOP: HAMMERTIME WASH YOUR HANDS sign for myself.

Those are ones I have worked through in the past year. There are probably more. I always wonder: are there studies for things like this?  For therapy rooms/clinics and/or hospitals that show the proof of environmental modifications in aiding better outcomes for patients?

I’ve been meaning to come back to this.  At first I was just to busy. (I got a job at a hospital!) And then I didn’t know what to write about. (People who blog about their jobs get fired from their jobs!)  I’m not sure I know exactly what I will write about, but there are a few ideas bouncing around in my head.

But for now, some thoughts on (greater than) one year past graduation and just past CFY.

1. It was (un)surprisingly a lot like grad school:  I felt very, very focused, but I also felt like a very, very hot mess.

2.  I asked a LOT of questions.  All the time.

3. I am never going to stop learning!  (Happy face!)

4.  I am never going to stop learning.  (Sad face.)

5. I love what I’m doing.

6. What in the world am I doing???

7. Fall down six times, get up seven.

8.  Ow.

Now, a year out, I am feeling unfocused.  I’ve lost the momentum of panic.  Now I have some measure of control; some understanding of the pattern of work; a very little bit of experience to look back on.  That’s a strange feeling.  The past three years have been a headlong plunge into the unknown with a tiny penlight that kept shorting out. And now I have the surprising luxury of taking some control of the direction of my life.

That is an incredibly empowering feeling.  And an incredibly terrifying one. What do I want to do this year?  What can I realistically accomplish over the next year?  I’m not sure, but I aim to find out.

Salary negotiations part deux!  Just to recap what we covered last time:

  • My level of experience
  • Demand for SLP services
  • Geographic location/cost of living

And what we will be covering this time:

  • Employment setting (i.e. nursing home vs. school vs. hospital vs. skilled nursing facility [SNF] vs. for-profit vs. not-for-profit [NPO])
  • Size of the organization
  • What is the compensation package?

Same Disclaimer as Before, 2nd Verse:  What follows below are some tools I was provided to make this…educated (more or less) guess about salary.  I am a first-time professional job searcher and am certainly not an expert on these matters.  I’m learning this as I go along too.  Nevertheless, I hope these tools are useful for people trying to determine a fair salary for themselves given their experience and geographic location.  At best, I think these tools gave me enough information to not over-price myself, but I still worry that I may be under-pricing myself.

Setting

As you will have observed from reading the Annual Salary Report (hinthint), pay varies across job setting.  Generally speaking, you will likely make less money in a school than a hospital, and make less money in a hospital than a SNF or nursing home. Likewise, if the hospital job you applied for is a NPO, then you will probably have a lower salary than an SLP working in a for-profit hospital. This is important to take into account when preparing an answer to the question “What kind of salary do you expect to make?”

Size

Size of an organization matters, too.  If you are working for a small, not-for-profit hospital in a small town in the midwest, you should expect a lower salary than a not-for-profit organization that runs multiple medical centers or perhaps has some funding/connections with a university.  It’s all down to the resources the organization has: a for-profit organization has more, as does a larger not-for-profit organization when compared to a local hospital that is not part of a larger healthcare system.

Compensation

What benefits is the company offering you?  A health insurance package?  Does it include medical, dental, and optical?  Other types of insurance, like life insurance or disability.  How do vacation and sick-leave work?  Is it paid?  Unpaid?  Are there retirement benefits like a pension? 401(k) plans?  Do they match contributions to your 401(k)?  Are there annual salary reviews (related to performance reviews)? Do they offer tuition reimbursement, health club membership, child care options, elder care options? Do they pay for or have a certain amount of money set aside for continuing education?  Do they pay your professional dues?

Yeah, it’s a lot to think about. It’s important to take into account, however, particularly if you are considering multiple offers.  If one place is offering you a higher salary, but no health insurance benefits, and the other offers a lower salary but provides full health insurance coverage, you need to really compare which is the better deal.  Will you still come out with higher salary if you are using part of that salary to pay for health insurance out-of-pocket?  Research and find out.  Benefits are an important part of the compensation package.  You may notice on the Salary Calculator that you can look at the total benefits package for that particular area as well.  I would highly recommending looking at that to see the actual monetary value of these benefits and what it makes your total salary when looked at in actual dollar amounts.

Whew. That’s a lot to consider, isn’t it?  Feel like banging your head against the wall?  Me too.  And this is all the information that you need to consider when going into the job ready to name a salary range and if you feel the offer is not acceptable and you plan to negotiate. You should also check out what the ASHA website has to say about salary.

Speaking of negotiating…here are some things to think about when the salary discussion comes up in the interview.

State whether the offer is acceptable, not acceptable, or if the figures in the higher end of the range (if they give you a range) are acceptable.  Always base your responses about the salary on research you’ve done on the areas I’ve mentioned in these posts, and phrase your response in those terms, i.e., “Based on my research….”  Make it as objective as possible.

You can always always always say “I’d like to think it over.”  You do have time to think it over.  This will give you the opportunity, for example, to consider if the benefits they offer you make up for the somewhat lower salary number they offered you. It will also give you time to discuss the offer with people who have more experience than you and who may explain aspects of the offer or contract that you aren’t sure about.  Plus, you may just need to the time to gather yourself together so you don’t appear gobsmacked that someone is finally offering to pay you before you accept.  (Haha!)

What’s negotiable?  There are both monetary and non-monetary aspects of the salary you can negotiate.  Monetary includes (the obvious) salary adjustment, extra compensation for working overtime, a yearly bonus, signing options, or stock options if it’s a for-profit business.  Non-monetary options include many of the benefits listed above, including health benefits or paying member fees or for continuing education. Again, the ASHA website has some excellent insight into the process as well.

If you still get a “no,” but are still interested in working for that particular organization, ask to have a review at the end of your CFY (and get it in writing!) and note all the instances you were awesome during your CF to brining up as extra evidence of why you deserve a raise/extra benefits, along with all the objective data you’ve collected, at the end of the CF year.

Bonus Material

Here are some links provided to me and my fellow classmates by one of our wise and wonderful supervisors about salary negotiation:

Comments?  Questions?  Time to share your wisdom, folks!


Having just got off the phone speaking to a human resources representative, I feel I should take a moment to nail home an important point about phone calls. (Which actually one of the SLPs at my hospital internship tried to drill into me weeks ago.  You can lead a horse to water, I guess….)

Sell yourself.

I completely just failed at that.  Reflecting on the conversation I just had, the rep was giving me plenty of opportunities for me to extol my virtues and I did not take the opportunity.

The plan? I’m going to write down what I consider the highlights of my resume; what I think makes me a unique candidate.  I am going to have this list handy so I can throw in as many as possible during my conversation with an HR rep, or leave as many as I think I can in a message.  The one near the top of my list?  That I am looking for a CFY.  If it turns out the job I just applied for is not open for CFYs, there may be a CFY position available that they haven’t posted yet and that they can tell me about.

Lesson learned.

At work today, I was sitting working on a progress note, and I realized I hadn’t addressed all I should have about resumes.  I mean I was totally focused on my work and thought of this idea at lunch or some other break in a day.

Let’s talk about online application forms.  The bane of my existence. The bane of my existence.

So, you will create a resume.  Have a million people edit it and comment on it and you will have a beautiful resume that you will then make into a .pdf so that you can email it to all the wonderful job opportunities you find on the internet.

And then you will actually GO to a website on the internet and hit the Apply For Job button and you will find yourself taken to an online application form.  Most will give you the option of uploading your own resume…and then mercilessly butcher it by trying to slot the bits from your resume into the empty text boxes online which you will only have to fix and did not save you any time at all.

Okay, I’m being a bit unfair.  I know this is a way for companies to get the information they want from you.  But it does make one start to feel the beautifully crafted resume you created is moot.

And so, some tips:

  1. Find some place on that damn thing to put your experiences at your university clinic.  On my regular resume, this is under the regular “experiences” slot after my externship experiences.  However, when the online application specifies “Jobs” I feel that I can’t bend my technically-a-graduate-course-I-took experience into a “job.”  (Although it was.  A job with long hours and no pay.)  I usually stick it under some part of the resume that says “job-related experience” or something similar.  However, if I don’t run across that, I go ahead and stick it under a “job.”  I will be recognized for all the hard work I put into clinic at grad school.
  2. Make sure to include your CPR/AED/first aid certification on there somewhere.
  3. In fact, you should put it in there (and your beautiful .pdf resume) like this: “(American Heart Association/Red Cross) Basic Life Support (BLS) Healthcare Provider certified.”  I recently realized that the world of healthcare calls it BLS Healthcare Provider certification (not CPR certification) and if they’re using their search engines for that, I want them to find it.
  4. Find a place for your membership to NSSLHA (because I know you’re all members of NSSLHA, right?  Right?  It’s a good way to show early dedication to the field…plus, when you make it to the end they give you a discount on your first year’s member ship in ASHA!)
  5. Do not bang your head against the wall.

Questions?  Also, I realized, if other folks out there have advice themselves for resumes, please leave it in the comments!  The more minds with more experience sharing advice, the better!  Your wisdom:  share it!

So I have been hitting the job market for the past 10 weeks or so and it has been filled with (mis)adventures.  While I feel my program actually prepared me pretty well in looking for a job (i.e. we had a couple of classes about writing a resume, what to do at the interview, negotiating job offers, etc.), I definitely have a lot to learn when it comes to putting it into practice.  I am passing on my advice so 1) I can look back five or ten years down the road and laugh about how much I still didn’t know and 2) perhaps save a fellow speech-language pathologist graduate looking for a job some head-against-wall banging.

This first installment focuses on resumes.

  1. Get as many people as possible to read over your resume.  This includes your friends, your family, your professors, and hell, anyone you may happen to know who works in human resources.  Get as much feedback as you can.
  2. Include contact information, objective, educational history, employment history, honors, professional organizations, and honors.
  3. Use an objective specific to the job you are applying for.
  4. Use action words.
  5. In fact, go check out the ASHA website.
  6. When describing responsibilities under your experience section, try to highlight things that make you unique.
  7. Don’t make the resume crowded.  Be as succinct as possible.
  8. Include the titles of the people you are using for professional references.

Questions?

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.

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