Sooooo, now what?

Classes are done.  There are only two and a half weeks left of my final externship.  The national exam has been passed.  So, now what?

PAAAARRRRRTY!!!!

Yes, I am sure there will be some celebrating, and one of my biggest desires is to sit at home for two days in my pajamas with nothing to do.  Given that we have just moved into a new home, and we have two teenage kids, it is unlikely that I will have the freedom to do nothing, but a girl can dream!  I am also excited that I can actually read for pleasure again! I love to read, and I have not had the time to read anything other than textbooks and research articles for almost 6 years.  I have a stack of books that I have been looking at wistfully and thinking “someday”.  Well, someday has finally come!

Graduating also means that I can get out there and do what I have been trained to do, and be compensated for it.  Money is not the main motivator for me, though.  I want to work where I can actually make a difference and feel valued.   Exactly where I want to go with this profession is not clear to me yet.  So many facets of the field are attractive to me, and I am thrilled that I have chosen a profession that allows me to change, and grow, and continue to learn. 

Because I cannot relocate at this time, I may need to take employment where I can get it, but I am going to hold out for the right position for as long as possible.  I am a new graduate, and let’s face it, I still have a LOT to learn.  I want to complete my clinical fellowship year in a supportive environment and don’t want to be thrown to the wolves to figure it out.  Rest assured that I will be interviewing prospective employers as much as they will be interviewing me.

As for the future? Who knows.  I still need some time and more experience to figure it out.  My clinical externships have shown me much about what I like, and more importantly, what I don’t like, but there is still so much out there to explore.  One thing is certain, I have found a profession that warms my heart, challenges my intellect, and feeds my soul.  My bag is packed, and I am so ready to begin this new adventure.

Stick a fork in me. I'm done!!!

"Stick a fork in me. I'm done." Those are words I hope to never use about my chosen profession.  Having been in school for the last six years while attempting to maintain a healthy marriage, happy kids, and my sanity, I know a little something about burn out.  I think we have all been in situations that we are just so sick and tired, it becomes a huge effort to even meet the standards of mediocrity.  How does this happen? Why does this happen? What can we do to prevent it?

One reason I think burn out happens is because we are no longer intellectually challenged.  The work we do becomes tedious and repetitious.  We have seen and done it all, and nothing new has been presented in a very long time.  I think another reason it happens is because we are working in an environment where we are not valued or our work is not respected.  It becomes a grueling task going to work every day when, even though your clientele are interesting, your work is not recognized or deemed important by the other professionals with whom you work.  What can we do when this happens? Fortunately, our field offers many options.

First, recognize the warning signs of burn out before you run out of fuel.  These signs can vary from person to person.  For me, it is excessive changing of hairstyles or hair color.  Women often want to change their hairstyle or opt for a new color to compliment a season or just update their look, but feeling the desire to do this on a weekly basis is a little much! I have come to recognize this as a sign that I need to explore other aspects of my life to find what it is that really needs some changing.  I have a friend who says that her warning sign is obsessive rearranging of furniture. What are your signs? Knowing what they are is the first step in preventing total burn out from occurring.

Now you know it's coming, what can be done? The field of speech-language pathology provides so many opportunities to learn and grow.  There is no way a person will learn everything there is to learn in the field in their lifetime.  Our professional license does not limit us to work in one setting our entire careers.  If we tire of working in a school setting, we can find employment in a medical, home health, early intervention, or a myriad of other settings.  We have the opportunity, through continuing education, to learn new skills that will allow us some of the greatest career flexibility.  Can you imagine being a pastry chef and told the only thing you can make are apple turnovers? You may begin by being challenged to make the BEST apple turnovers the world has ever known. You can research where and how the best apples are grown, the best spices are processed, what chemical processes occur when these ingredients combine and how they affect human physiology, but eventually you are going to tire of making apple turnovers.  Maybe you decide you want to design a new way of processing a certain spice, or a new technique for growing apples, or decide you want to learn how to cook steak.  Well, you can! The only thing holding you back is YOU!  Okay, that may be more than a little oversimplified, because some of us do have other things to consider such as family and finances.  I, for one, do not have the luxury of just picking up and moving because I have my family to consider.  The children are almost done with school, and I wouldn't want to uproot them now.  My husband has a good job and has worked for the same company for almost 20 years.  You can't give up the benefits that go with that!  Many people also need to stay in certain jobs because they cannot afford to take a  job that may be more interesting but pays significantly less, or maybe they need the health benefits their current job provides.

In my experience, there are always options. There is always something that can be done to effectively change your situation.  Perhaps finding a volunteer opportunity. One of my SLP friends that works in the schools also does pro bono work for people with ALS.  There are some SLPs who work in one setting but do PRN work once a month in a completely different setting.  There is always the option of taking private clients on the side, as long as this does not conflict with your current employer.  Another school-based SLP I know designs therapy tools and has set up a side business for that.  If you are in a setting that is not particularly respectful of the work an SLP does, you can design some inservice training to educate them.  After all, the lack of respect probably originates from a lack of knowledge.  If there are policies in place that prevent you from serving your clients best, perhaps there is a committee you can chair or other avenues you can pursue to effect positive change rather than stewing in an unhappy broth that always turns out bitter.

Given the realms of possibility in this profession, the limitless knowledge there is to be gained, and the boundless opportunities to enrich the lives of others, I don't see how I could possibly become burned out on this profession.  I will keep track of how often I run to the beauty supply store, however, to ensure that I never say, "That's it. Stick a fork in me. I'm done!"

How does that make you feel?

During our educational path in becoming SLPs, we were often told that counseling becomes a large part of what we do.  This makes sense given that we are taught to be active listeners, how to pick up on body language and tone, and we encourage others to express themselves and communicate.  Most of us in this field are innate empathizers as well, and we are usually the ones who take the time to listen.  People respond to that by feeling comfortable enough to share with us more than they would with other professionals.  I often find myself asking clients how they feel about their disorder or what they think about the progress of therapy or to consider what goals they wish to set.  Sometimes clients reveal too much, and the lines between personal and professional become a little blurred.  We definitely have to be careful about not overstepping our boundaries and learn to recognize when to refer to another professional that is better suited to deal with emotional issues.

I did not realize how much counseling plays a role in our scope of practice until I began my clinical externships.  Parents of children with disabilities share their grief and frustration, students provide intimate details about their personal lives, and patients in fragile medical condition bare their emotions of fear and confusion.  Just today, I met with a new patient who broke down several times while I was attempting to assess her.  All I could do was give her a tissue, hold her hand, and tell her that she was in good hands now, that I was glad to know her, and I would help her in any way I could.  She thanked me profusely for listening and showing that I cared, so even though I did not complete my formal assessment, I learned much about who this person is and how I may be able to help her through our informal interaction.  Of course, I also let the staff psychiatrist know he might want to pay her a visit as well! 

I cannot say that I am uncomfortable with providing some level of counseling to the people I serve; however, I am not completely comfortable with my ability to provide adequate and effective counseling.  This, I think, is more an issue of experience, but I certainly do not have professional training in this area either.  My undergraduate degree did require me to complete an introductory course on counseling, but it was general and not specific to my profession.  Perhaps it is because I am at the end of my academic career and completely burnt out, but I do not think that adding another class to our already demanding course load is the answer to filling in this gap.  We are given enough information to get us through and get us started on all aspects of our field, and none of us graduate as an expert in apraxia, dysphagia, aphasia, and the myriad of other speech-language disorders.  I am sure we have all done independent research on certain topics as they became applicable to our clients at hand.  This led me to wonder what resources there are for those who wish to delve deeper into the topic of counseling, and here is what I found:

Books

• Counseling Skills for Speech-language Pathologists and Audiologists by Lydia Flasher and Paul Fogle.  Available from Amazon.com http://www.amazon.com/Counseling-Skills-Speech-Language-Pathologists-Audiologists/dp/1435499360/ref=pd_sim_b_2

• The Source for Counseling for SLPs by Hope Reed.  Available from LinguaSystems http://www.linguisystems.com/products/product/display?itemid=10690

• Counseling the Communicatively Disabled and Their Families Ebook by George Shames. Available from onlinebookplace.com http://onlinebookplace.com/counseling-the-communicatively-disabled-and-their-families-a-manual-for-clinicians?region=us&engine=google_pl&gclid=CIio5Ouq6bcCFWFxQgodjEwAmg

Continuing Education

• Practical Counseling Skills for Speech-Language Pathologists (.5 CEUS). Presented by J. Scott Yaruss, PhD, CCC-SLP. http://www.yaruss.com/Yaruss-courses.htm

• SpeechPathology.com offers several articles on the topic of counseling that can apply toward CEUs. This requires signing up for access and currently costs $99/yr for professionals and $49/yr for students. http://www.speechpathology.com/articles/search/all/term:counseling/

A Google search will also reveal blog sites from other professionals who have written about this topic and their personal experiences.  Counseling and educating clients and their families is a small but vital part of what we do as speech-language pathologists.  I don't feel we can really help the person until we really know the person and take their personality and experiences into consideration.  It is comforting knowing that other professionals are also aware of this and are willing to share their knowledge on how to develop the skills necessary to provide services in a holistic way.  Hopefully, these resources will help others seeking to further develop their own counseling skills.

Work and Religion

This is one of the topics we were asked to explore for Professional Issues class this week:
 
Early on in the history of time, health care and religion interacted.  Think of the health care systems in your community.  Saint Somebody hospital or the Jewish Medical Center are all over our country. Still, we’re not always comfortable with that topic in our profession. Why do you think that is?  What is the role is spirituality in our profession, especially in the context of difficult situations? How can an SLP practice his or her own faith during the delivery of services? How do you think you will respond (or did respond)  when your client brings up his or her faith?

Religion is not a topic I am typically comfortable talking about with many, and I have always followed a personal rule to not discuss religion or politics in the workplace.  The reason for this is not because I am ashamed of my beliefs, but I am fearful of being judged based on a religious label and not for the person I strive to be.  Let's face it, stereotypes and prejudices exist, and we are all guilty of making assumptions or having preconceived notions about someone based on a label that is assigned to them.  Faith is a very personal experience, and people can have very strong opinions about their beliefs or the beliefs of others.

Faith is often given more consideration when people are facing serious and difficult situations.  Finding a connection with something bigger than us often becomes more critical when medical issues are present that cause one to question their own or a loved one's mortality.  I am currently completing an externship at an inpatient rehabilitation hospital, and several patients have asked me to pray for them or shared their stories of faith with me.  This has not been a problem or an uncomfortable experience for me, so far.  I just listen to their stories with an empathetic ear and without judgment.  I tell them I will pray for them.....and I do. 

 The ASHA Code of Ethics does not conflict with how I choose to live and how I am expected to conduct myself professionally.  The way I live my life is guided by my spiritual beliefs, and I apply those same principles to the work I do.  These principles of honesty, integrity, compassion, open-mindedness, and thankfulness can be quietly integrated into the work I do, and my faith is quietly present with me always.  My beliefs don't need to be discussed, announced, or worn.  They just are, and I hope that is enough.

My niche

This blog addresses workplace environment.  We were asked to consider, not the perfect job or duties assigned to it, but to consider the ideal workplace environment.  All creatures have their own special niche. An environment in which they thrive best.  A polar bear would not do well in the desert, nor would a lizard do well in the Arctic.  Human beings have proven that we can live and adapt to many different environments, but where do we thrive best?  The answer to this question is unique to each individual.  Happiness in one's surroundings goes beyond the physical.  It is mental as well as emotional.  It is spiritual.  This applies to the workplace as well.  We can love what we do, but if we don't do it in a satisfying environment, it can lead to much stress and dissatisfaction.  So, what is my workplace niche? In what environment can I best thrive?

For me, I suppose relationships are one of the most important elements.  Nothing is more stressful to me than working (and living) in tense situations.  I don't like gossip.  I don't like drama.  I don't like walking on eggshells just because someone is in a bad mood.  I don't have to really like my co-workers on a personal level, nor they me, but I want an environment of mutual respect for the work we do and a display of professional courtesy.  I like to work within a team framework where everyone has a valued role and opinion.  I want to be part of a workplace that is nurturing and supportive where colleagues bolster one another and communicate positively and effectively. 

I like variety and would not want to complete the same tasks day in and day out.  That's one of the many reasons I chose this profession.  I thrive on challenge and new opportunities to learn and grow.  There has to be balance, though.  I'm not sure that I would thrive in an environment, such as a medical setting, where you never know what patients you will have from day to day.  Thinking about why this is, I have to refer back to the importance of relationships.  I enjoy building relationships with people, including my clients/patients.  In an acute care setting, you often do not have the opportunity to build relationships.  You do what you need to do to assess the patient and/or get them swallowing, and then it's on to the next one.  There certainly is satisfaction in helping people in those situations, but I know I would be  happier having the opportunity to spend more time with them and forming a relationship with them.

Although I appreciate structure, I would like to have professional autonomy and the freedom to develop my own system of organization.  Creativity is a strength of mine, and it would be stressful for me to not be able to use it.  I would not thrive in an environment that did my scheduling for me or limited me to specific assessment tools or interventions.  Being micromanaged makes me quite cranky! 

Time is also a critical factor in finding the ideal workplace niche.  I put great value on my personal time.  I have many outside interests, and I need time with family and friends.  Although I do not mind putting in occasional overtime or filling in on a weekend here or there, these would have to be rare occasions.  I also know that I would not like having to be on call to come in at a moment's notice.  What I do may be a big part of who I am, but it is not the only part of me!  Besides, some of my best therapy ideas have come while out walking the dogs, digging in the garden, or talking with my kids!

Every workplace has is shortcomings, and I do not expect to find one that meets all of my expectations all of the time.  I do not know exactly what I want, but I know more about what I don't want.  That alone is a big step in the right direction to finding my own workplace niche that feeds my intellect and nourishes my soul.

It's a small world after all!

For this post we were asked to consider social media such as Facebook, Twitter, Linked-In, etc., and explore the role it has played in our education, whether or not we will use it professionally, and what cautions should be observed.  I would consider myself a moderate user of social media.  I have a Facebook account and have been known to get lost for hours in Pinterest.  I do have a YouTube account that I occasionally (once or twice a year) load videos to share with family that live on the other side of the country.  Now, of course, I have this blog, and I follow a few others on various topics of interest. 

What I love about social media is how easy it is to connect and share with others in real time, and what I dislike about social media is how easy it is to connect and share with others in real time!  Let me explain.  It's wonderful to be able to connect with friends from high school that I have not seen in years, and let's be honest, probably never will see again.  I have moved around a LOT and worked in many different places, and social media is a quick, easy way to keep in touch.  Sit and write a letter? Ain't nobody got time for that!  Well, wait.  With the time spent on social media, many of us probably could write a bunch of letters!  Sending a tweet or updating your Facebook status is so easy, right?! Hmmm......a little too easy.  I think people can become reliant on social media to validate their feelings, self-worth, and get too involved in the drama of others.  It is a delicate see-saw act to try to find the perfect balance with social media. I certainly don't want to share too much, but I don't want to be deceptive or disingenuous either.

Social media has actually played a large role in my education also.  My graduate studies have been through a distance education program at Western Kentucky University while I currently live in New Mexico.  Students in my cohort live all over the country.  One was even residing in Morocco when she started the program!  One wonderful student started a Facebook group just for our cohort, and this has proved to be invaluable.  It is a place where we can share ideas, clarify assignments, get support and encouragement, and vent our frustrations.  We all had to meet in Kentucky last summer for an intense 6 week clinical internship, and we all felt like we somewhat knew one another already.  It made the experience so much richer, warmer, and more comfortable.  Our department has a Facebook page, too, and members share a lot of good information on the program and the profession.  YouTube was also a valuable instrument during my education.  Not only did I find oodles of videos that demonstrated various techniques or instruments that aided in my understanding, but it also served as an easy way to share my own clinical video assignments with instructors.  Pinterest has also played a big part in my education since I can quickly and easily organize therapy ideas and information in one electronic source.  I really really despise paper clutter, so I think Pinterest is the greatest idea EVER!  If you have a great board on therapy ideas, crafts, or recipes, comment below with a link! I would love to follow you!!

Will I incorporate social media into my life as a professional? I can answer with a confident "yes".  I am looking forward to keeping in touch with my cohorts and keeping up with their successes and accomplishments.  I also feel that we have created a great support network with one another and will be available to bounce ideas back and forth and provide helpful information.  I like several Facebook pages that other SLPs, vendors, and manufacturers have created, and these pages keep me up to date on new merchandise, sales, and great new therapy ideas.  Pinterest is a no-brainer with its seemingly infinite number of ideas.  As long as it is around, I will be pinning.  YouTube will continue to be a resource for me as well.  A lot of product manufacturers and vendors post video demonstrations, which makes it easy and convenient to see how an item can be used and if it will be beneficial to your practice.  This beats having to wait to attend a conference or wait on snail mail for a packet of information.  It is also a great resource for finding examples of therapy techniques.  Just last night I was searching for examples of melodic intonation therapy, so I could try it with a current patient of mine.  Really, the world is a much smaller place thanks to social media.  Humans are more connected to one another now than ever, even if it is in a superficial manner.  We have created a vast and intricate maze of connectivity.

All of that said, we still have to tread carefully through the maze.  As my mama always said, "Don't believe everything you read and only half of what you see."  What a wise woman!  That proverb couldn't be more true in today's world.  Deception exists, and we must remain vigilant about not falling prey to misinformation.  We still must apply evidence-based practice when reading or seeing something on social media.  Just because it's on Facebook or Twitter does not mean that it is necessarily true.  We must always consider the source, and check, double check, and triple check what are presented as facts.  Thanks to free and sophisticated editing software, pictures and videos are easily manipulated in very convincing and deceptive ways, and people can post anything they want with any credentials they chose.  No only do we, as professionals, need to take care and use precautions, but we need to educate our clients on the potential dangers of accepting information on social media as gospel. 

I look forward to staying connected and expanding my network and will continue to use social media personally and professionally.  I can get ideas and connect with other professionals from Kenya to Kentucky and everywhere in between.  When  used responsibly, social media is a valuable resource that can keep us informed, inspired, and involved.  It really is a small world after all!

Empathy

I am currently in my third and final clinical externship, and it is proving to be the most difficult of my placements.  I am at an inpatient rehab facility that is beautifully kept, and I have a wonderful supervisor.  The work is very interesting, and I am finding ways to apply my classroom knowledge more than ever.  I have grown fond of my patients and really enjoy the opportunities to educate them and help rehabilitate them to their prior levels of function.  The hours are long, and I am always in motion.  Lunch usually consists of grabbing a few bites of a granola bar or other portable, snack size food between patients or while writing reports.  I honestly don't mind being this busy.  It feels very productive and makes the day go by fast.  Despite all of the positives, I have found myself very emotional and often on the verge of tears.  I have been struggling with insomnia and an elevated level of stress.  Why?  I think I have finally put my finger on it.  As wonderful as the facility is, and as competent as the staff are, there is still something missing that I think is commonly lacking in medical facilities.  Empathy.

Empathy, according to Dictionary.com, is a noun meaning "the intellectual identification with or vicarious experiencing of the feelings, thoughts, or attitudes of another".  It is often incorrectly confused as sympathy, which is broadly defined as understanding the feelings of another.  Empathy  goes beyond understanding.  It requires one to imagine themselves in another's predicament, to feel what they feel.  I believe that showing empathy requires less talking and more listening, more doing.  Empathy does not judge.  I don't know if empathy can be taught or if it just is innate in some individuals.  Either way, it exists within me.  Some might think this is burdensome, but I believe it is a blessing.  It will hopefully allow me to connect with my clients in a way that will aid in becoming a competent and effective clinician.  What a wonderful characteristic to possess in a medical setting where people are sick and scared and hurting!  Well........not exactly.

I am learning that there is little time, in my facility at least, to provide that empathetic touch.  Inpatient rehabilitation is a lot of work for the patient as well as the clinician.  There is physical therapy, occupational therapy, speech therapy, diagnostic tests, nurses, and doctors all vying for time inbetween meals, showers, and family visits.  There are barely enough hours in the day to provide the required services, attend meetings and trainings, and complete the required paperwork for all of the assigned patients.  I understand that a patient's time in the rehab facility is limited, so medical staff try to get the most out of the time they have to help a patient return as close as possible to their prior level of function. It is wonderful that the staff work so hard to help clients reach their rehabilitation goals, and I have seen some amazing results.  I have also seen patients confused about why they are being asked to complete certain tasks, rushed around without explanation of where they are going, and disregarded or brushed off when they expressed pain or fatigue.  Yesterday, I had a patient tell me he would rather be dead than be in his current condition.  Harsh.  I have had to walk out of rooms knowing a patient is confused, upset, or in pain because I have to move on to the next patient or because another clinician is waiting to take them to their next therapy.  I certainly don't believe that staff don't care about their patients, but rather they are busy doing their jobs and have been doing this long enough to become desensitized. 

The fact remains that the patients are human beings.  Most of the patients at my facility are older.  Many have lost the ability to walk, swallow safely, and/or communicate effectively as a result of stroke, surgery, TBI, or some other ailment.  Many of them have always been healthy and are having difficulty accepting their infirmities.  There is not only physical pain but confusion, helplessness, and depression.  Can you imagine being an active, healthy individual that suddenly finds yourself unable to walk, bathe yourself, or speak intelligibly enough to express your basic needs?  You have to ring for a nurse just to go to the bathroom or get a drink of water.  Perhaps, all of your food is pureed, and your liquids (coffee, juice, and even water) is thickened to a nectar or honey consistency.  I tried drinking thickened water for a day.  Major yuck!  You hurt, possibly more than you ever have, and every activity you must perform wears you out.  Ugh, depressing.  It is something most medical staff and clinicians have never experienced, and it is hard to place oneself in that situation.  Don't we owe it to our patients to at least try? I absolutely think we do.

I refuse to get to the point that I am desensitized to the feelings of another, especially when that other is suffering and scared.  I will find a way to balance fullfilling the needs of my job and fullfilling the needs of my patients.  I will listen and respond with patience and compassion.  I will take the time to explain why, and how, and what happens next.  I will always remember that this person with whom I am interacting is a living, breathing, feeling human being.  If I cannot do these things, I cannot be.  Simple as that.