New Place, New Challenges

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I'm in a new place!

Good bye, California, I have loved exploring you. Hello, Washington, show me your finest!

I'm staying in a metro area with lovely friends I met in the Midwest and am commuting about 50 minutes west toward the coast. The town to which I am assigned reminds me of the small Midwestern communities in which I have spent a chunk of my career. Many of the older folks grew up there and spent most of their lives within a several hour range of there. They are good, hard working people living simple lives, beacons of light making their communities a better place.

The assignment...is a challenge. Let's just say the state is involved and there are many problems to correct. The building is beautiful and has one of the largest and most well stocked rehab departments in which I have worked in quite a while. Despite the nice paint job and the manicured gardens, I walk through the front door into a dimly lit deserted corridor. Room after room is empty. The remaining residents have been moved to the back of the building following a mass exodus of residents from the facility.

I feel an undercurrent of unease. There is no therapy staff in the building to orient me or the new travel PT who has arrived at the appointed time. I spend my first hour in the building answering call lights because the office is locked.

The Director is a no-show that day (and the next). The tech (her son) shows up a couple hours later but is of little assistance. He goes to morning meeting then spends the rest of his time in the office on his cell phone. There is another travel OT who has been there for three or four days, and a permanent PT with very limited long term care experience who has been in the US for about 8 months.

This is the kind of assignment in which I am so very glad that I am not a new grad!!

It has trouble written all over it.

It's a new place, and I will give it a chance.

Having been around the block, though, I am already concerned...

Lesson of the Day: Change...Embrace It!

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I have been in the throes of hard-drive preparation for another assignment. There’s no easy way to describe the period of time in which the window opens for another assignment. It requires patience, perseverance, and trust that you’ll end up

• in the right place
• with the right people
• doing work you enjoy.

In the back of my mind, I replay the thought that I am really going to miss this assignment. I have made such good friends and enjoyed many new experiences. I have spent one of the best years of my life here. But I’m just not ready to settle down and go "perm."

Here’s how it works.

My recruiter sends me a list of the openings in the locations in which I am interested. I want to see if there were openings near my parents in Missouri/Kansas and also in northern California. The list reveals no current openings close to Mom and Pops in the Midwest. One option down, I concentrate on California.

My recruiter submits my information to several skilled nursing facilities (SNFs). It takes time.

This is when patience is a virtue. Some managers are on vacation; some SNFs are interviewing other travelers who have submitted their backgrounds before me. There are days in which you think you will be interviewed, and then days in which you think you will have an answer.

Then you don’t!

After 10 days of cat and mouse, I've made a decision.

Where Am I Headed?

I will travel three hours north and west of my current location and settle in a small fishing town right on the Pacific Ocean!!

The harbor, minutes from my new place...

I am thrilled! I have always wanted to live near the Ocean…

The beautiful Pacific close to dusk

and they want an OT who can start a new program.

I am their girl.

This appears to be a SNF that hasn’t had an OT for a long time, if ever. The thought of that generates all kinds of questions in my mind. Will they be open to what it takes for me to build a program?

I ponder these questions while sitting at the Fish House overlooking the Bay eating a hot cup of clam chowder and watching the fog set in.

Surreal. Sitting on the bay under the bridge at the fish house...

....and, then, instead of worrying about the "what-if's," I take a deep breath of the cool, salty air and simply sink into the moment.

Change...embrace it!

What to Consider: IF YOU'RE A WANNABE TRAVELING THERAPIST

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No life lessons today.  Just some recommendations in case some of you are considering a medical, nursing or rehabilitation travel assignment.

Experience

I'm not yelling, but I need to put this part in caps:  YOU SHOULDN'T EVEN THINK OF BEING A TRAVELER IF YOU ARE FRESH OUT OF SCHOOL.

You could be put in ethical dilemmas you never dreamed of due to your lack of experience. Get some experience in the field, then travel in the setting in which you've become experienced. 2 years is good. You're a baby therapist until then.

These buildings benefit from experienced therapists who have the experience to make a positive impact.

This is to OT's, since we have a crazy shortage: It is likely in many locations that you will be the only OT.

Newbies need mentorship! The buildings need a confident expert!

Skilled nursing facilities (SNFs) need you to have knowledge of contracture management and wheelchair positioning. You shouldn't consider skilled nursing unless you can take a wheelchair apart and put it back together, eye a resident and tell your co-workers what size wheelchair width (s)he needs without pulling out a measuring tape.

I've heard of OT's who say,  "I don't do wheelchairs!"

I say, "Shame on you."

Research

Do your homework!

Go onto the state website for any state in which you wish to travel. If you want to go to a state that takes months to get a license (like California), start the process on your own before you contact the recruiter. You can negotiate their reimbursement of the license.

In my case, I took a fun trip to California in December 2009 to get the required Live Scan fingerprints completed. I pulled everything together by March 2010 (not in a hurry, since I was not at that point mentally ready for the change), and I received the license in early July 2010. By the end of July, I was feeling an itch  that had to be scratched (though I loved the therapy team at the building in which I was working). I was certain of my assignment in California by mid August 2010.

For me, it was all about the recruiter. I was working for a different travel company two years ago when I received a call from Med Travelers. The recruiter presented me with an opportunity to work with them in Fall 2009, but I chose another option and ended up in Kansas City.

It was while working in Kansas City in Spring 2010 that he called me again, and this time, I knew I wanted to work with him. He had been so professional, so patient. I want to highlight this recruiter sometime, so I won't say any more, but to keep it simple, working with Med Travelers has been a very positive experience!

Gut Feeling

Test your gut feeling when you talk to each recruiter. Trust your intuition! The one with whom you feel most comfortable and trust the most is your future recruiter.

It doesn't matter if they aren't paying quite as much as the other guys, believe me!!

My first recruiter from another company was a guy who always seemed to be on the beach or rescuing puppies. He didn't return calls. He didn't do squat to provide options for my next assignment, even though the pay was stellar. In the end, it wasn't worth it.

Most travel companies, in fact, offer very similar packages. So, beware the ones who offer you the moon, the sun and the stars!

Details

Ask recruiters for names of therapists on current assignments so you can interview them. Make a list of things you need explicitly written into your contract. For instance, make sure you write any planned vacation time, reimbursed travel or guaranteed hours per week into your contract.

Make sure you clear all tax questions about living and working in different states with the company with whom you wish to work before you start, especially if you own a house and will not occupy it.

...and FYI, your assignment needs to be greater than 50 miles from your home of record, or your per diem benefits (lodging/food) are taxable.

If you stay in the same assignment for over a year, your per diem benefits become taxable, which is why I am leaving my current beloved assignment after September 7.

If you wish to get relocation reimbursement, keep in mind that it will come out of the same pot of funds from which your weekly salary is paid.

For example, if you want full reimbursement for driving cross country and staying in hotels for 3 days, you'll end up with a slightly smaller salary on a weekly basis over the course of a 13-week contract than if you took a smaller sum. It depends on what you want, just be aware.

The Interview

When you interview with your particular assignment, ask:

• Why they have an opening
• How long it has been since they had a permanent OT
• How long their current traveler has been in place
• The size of the building For example, if you are asked to be the only OT in a 150-bed building, you should know you are going to be absolutely swamped, doing documentation after hours and probably crying when you drive home on Friday nights. Just ask!
• Don't be afraid to ask about the building's issues (every SNF has some issues)...

I can tell you that if you have solid experience promoting joint integrity and postural stability through contracture management and positioning programs, they will want to snatch you up.

Granted, that is not all that you will be doing. It's likely you'll have a variable caseload of Medicare A, HMO and Medicare B patients. If you have questions about this, send me a comment, and I will outline it for you.

Due Diligence

If you want to be a real star, go onto the Medicare website and check out the skilled nursing facility for which you are interviewing.

From this tab, type in the name of the building and check out the number and type of deficiencies (aka "tags") the building had from the last posted state survey.

This will fulfill your due diligence, as you may be able to discuss clinical issues and determine what programs you may be able to initiate or assist with to improve quality of care.

Again, trust your gut.

When I interviewed for my current post, I was rock solid after an hour talk with the regional director of ops that I would love this building. In addition, I found she was the only other OT in 15 years of practice that clinically problem-solved the same way I did with long-term care patients.

Wow! She has turned out to be an incredible ally and peer.

If you're hesitant to be alone, travel to a location where you have friends or family. Don't be afraid to explore! That is the great advantage of going various places...it's a big, wide, wonderful world.

Tre

P.S. If you're thinking of traveling and have questions, write me!  I'd be glad to help you through the process.