The in-service wasn't bad. My supervisor helped a lot by making what I said more functional and understandable for the CNAs and LPNs, because I got kind of carried away explaining the process and anatomy of the normal swallow. It was really really great to have her there, and she kept reminding the group that it's a team effort to help keep these residents safe and relatively healthy.

A lot fat good this inservice did though, I think, b/c not all the CNAs came, mainly b/c they are needed out on the floors. And I'm not sure I've seen any improvement in the way these patients are fed or treated at mealtimes. :( Oh well, my supervisor reminded me it'll take time and lots of re-education to make changes.

Well, I had my bi-monthly feeling-overwhelmed-breakdown this week where I left almost a half hour's worth of messages on my supervisor's voicemail after hours (she said she had her phone off after work and didn't realize I'd been calling), which cumulated into a rather lenghty email about how I felt like I haven't had enough training or education to prepare me for this job, and that I am always feeling overwhelmed and needing more support more often now as the school's caseload is ramping up (more screenings, more IEP meetings and updates due, more evals, etc.). Last week I worked over 50 hours. Today I woke up with such a headache and when I got to the nursing home to start work, I started to feel nausea and just had to go home. Today's my first sick day. I think I've been battling a mild cold for a couple weeks and the stress finally got to me.

I'm OK now after I've slept a lot more. My supervisor responded immediately to that email, saying she's sorry i'm overwhelmed and that the "caseload is becoming unmanageable--even for an experienced SLP" (hello, there are 135 kids in the whole district in the load). She said she'll discuss it with the boss of LifeCare Centers of America to help me get additional help. She added, "The CFY year is the most difficult and most stressful, but I think the responsibilties you are being given are too much. ... Please don't feel pressured to be perfect in every decision that you make. You are learning. Strive toward efficiency."

And by the next day they've decided to come here on Monday to discuss it with everyone involved - nursing home, school, etc. Man, Life Care Centers of America is awesome. They have good people who really care and can get things done fast. I wish I said something earlier. I responded to her email by saying I didn't know whether this was too much for me b/c I'm new, or b/c it's too much. Which is true. I also have this thing about feeling the need to prove myself (call it pride), which made me hold out for as long as I had. But I was coming to a breaking point. And the people at this bed & breakfast have seen me going through this, and were concerned too that I was coming home later and later. Hehe there's a pharmacist here who keeps offering his meds (not prescription, but he has a store of OTC drugs he carries with him) for headaches and to fight the symptoms of my cold.

Anyway, I'm just very glad that something's goin to change. I haven't told Vinny yet, but I suppose I should keep him involved. I'm a little hesitant to say something though, b/c he gets riled up easily for my sake and gets things done so fast - like on Monday afternoon I said I'd like to have a bit more info about Sunbelt before my talk at U of Iowa early December, and by Tuesday morning Vinny had a large info pack put together and mailed out to me, saying I should get it by Thursday or Friday. He's crazy I tell you.

But I'd rather have the LifeCare people settle things first. If this is confusing, here's the breakdown: I officially work for Sunbelt becuase they ultimately pay me. LifeCare Centers of America pays Sunbelt for providing me to them. Heritage HealthCare Center is a nursing home run by LifeCare, which is a national company. The Miami School District pays LifeCare to have me part time. Does that make sense?

I'll update again after things are settled. My supervisor also said that what I do is equivalent to 3 full time jobs. !!!!!!!!!!!!! I had no idea; I just knew I was losing my mind and thought it was typical for a new grad. She said I was doing a good job though, so that's happy. Oh yeah, my 3-month eval was not bad either. I got one grade of "5" (on a scale from 1-5, 5=best) in the area of organization and scheduling hahhaha She said I run around so much and keep it together that there's nothign more I can do to improve.

My supervisor's coming again on Monday, Oct 23!!! It's the first eval day (CFYs have to be evaluated every 3 months) and my first official in-service!!! The one I did with my Children's Memorial Hospital supervisor was her project and everything, but this one on Monday the head nurse asked me to do it. It's about feeding individuals with swallowing problems. It'll be about an hour long, I think, and I'm making a handout with portions from a dysphagia brochure project I did for "Oral Structural Disorders" class with Alice Smith last year! Yeah so if you're still a student I suggest you keep all your projects and stuff b/c I never ever expected to actually use the brochure I made! I've also got an ASHA binder with a cheesy DVD video clip of a CNA feeding two patients, with some discussion questions. We'll see how this all goes!

A "Typical" Wednesday
6:45 Arrive Heritage Health Care (nursing home). Go to my office, put on white lab coat which has pockets full of: 1 stethoscope, 2 laryngeal mirrors (1 plastic, 1 metallic), 1 black marker for pts who have poor vision, 1 pen, 1 flashlight, 2 saltine cracker packets, 1+ applesauce cup (depending on # of evaluations ordered that day), 1 graham cracker packet, 1 goldfish cracker packet, 2+ straws, 2+ tongue depressors, 2+ toothettes (small sponge on a stick for oral hygiene). Pick up clipboard with 2 copies of: dysphagia eval form, speech/language eval form, plan of care form, weekly treatment log, progress notes pages, and blank paper. Sign in to Sunbelt time card and Heritage time card.

6:46 Pick up a dish of mechanical soft food from kitchen, take to restorative dining. Treat patient N during breakfast meal to ensure safe swallowing, sometimes co-treat another pt L as "group thearpy" at same time. Train/educate restorative nurse on duty about methods.

7:30 Pop over to small/fine dining room. Treat patient H at his breakfast and train CNAs (certifed nursing assistants) on duty. Meanwhile, screen (observe to find others who may need swallowing evaluation) for other dysphagic patients.

8:15 Run over to "the unit" to see if patient D has completed her meal. If not, treat. If yes, ask nurses how she did, how much she ate, etc. Oral motor therapy. Chart on pt N from the morning ("chart" is used as a verb to mean document-treatment-in-the-chart). If pt N has returned from breakfast, oral motor therapy with him too.

9:15 Evaluate whoever's on the list. Talk to nurse(s) about patient, review patient's chart, make sure all material needed are in pockets and clipboard. Go to patient's room. If in the first 15 minutes of evaluation decide that pt will not need treatment, wrap up and move on. If pt will need treatment, treat for 45 minutes after 15 minute eval. This is all to do with insurance billing stuff that i will NOT go into.

Continue treating/evaluating 30 minutes-1 hour of different patients and charting. Although, getting faster at charting is my main goal. Productivity is calculated by minutes billed (that is, however many minutes spent in direct contact with patient doing treatment) divided by minutes worked (amount of time spent in facility). Ideally, it should be above 70%. Let's just say that the best i've done so far is 69%. Hmph.

I try to have lunch before 11-11:30, so that I can be back in time to eval/treat when patients are having their meals at 11:30+

12:00 Speed drive over to C.A.B. Elementary School in Miami (~10 minute drive). Take from car 3 messenger bags. Bag 1: important paperwork and notes. Bag 2 [heaviest]: formal tests and probing material for articulation and langauge for different age-ranges. Bag 3: toys for therapy, stickers & stamps for rewards, my water bottle, other miscellaneous items. Altogether on my passenger seat, my car's passenger-seatbelt-not-on alarm goes off. I think that means they weigh more than 20 lbs, or however sensitive it is.

12:10-12:30 Therapy with 2 kids who are in different grades and have to be pulled out of 2 classrooms. Write percentage accuracy on goals in notebook.

12:30-1:45 Spent doing 2 or more of the following: giving a formal speech and/or language evaluation on a child (takes 20-45 minutes depending on the child and type of test), screening children (having a short conversation w/child and asking questions to decide whether child needs a more in-depth speech/language evaluation; takes about 10 minutes), re-assessing children who are already on the caseload to update their speech/language therapy goals (takes 10-30 minutes), observing and/or assisting one of my speech aides and giving feedback about their treatment sessions. These could be across 4 different schools (1 high school, 1 junior high, 2 elementary schools).

1:45-2:20 Back to my office/desk in the junior high to meet with my speech aides (SLPAs) and answer their questions, discuss progress of kids, and teach them therapy methods or things to look for (although there hasn't been enough time for that lately, just mostly answering their questions)

2:25-2:45 Go down the hall of the junior high to do therapy with one kid.

2:45-whenever Meeeeeettttinnnnggggssss..... IEP (Individualized Education Plan) meetings where everyone (student, parent/s, regular teacher/s, special ed teacher/s, school counselor, school psychologist, occupational therapist, me, and then some!) has to discuss the kid's overall progress, agree on this and that and the other... AHhhh!!! BORING!

whenever-whenever ... maybe another meeting for another kid for another reason... *roll eyes*

whenever (usually 3:30 or 4pm) If my mind is not mush already, I might write up an eval I did that afternoon, and/or a screening or two, or update some goals, or etc.

Today after all that I actually went back to the nursing home and worked another 2.5 hours there and didn't get home till 7pm. That's the end of another 12 hour day. Typical.
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Maybe I'll type up a "typical" Thursday or Friday another time. I realized today why I always feel so tired when I get home. It's not just the stress and thinking on my feet all the time, it's that i'm ON my feet all the time! I only get to sit when I eat lunch, SOMETIMES when I'm feeding a patient, when I'm driving between buildings, and when I'm doing therapy with kids (although I can't say that's restful!). Oh wait, I'm forgetting those meetings where I'm ready to fall asleep right there. Or when I'm falling asleep at the school office while writing up those evals /screenings /goal updates.

Excuses
Sorry it's been so long since I claimed to update soon. I'm so busy at work that by the time I get home I'm too tired to sit in front of the computer and type like I used to. It might also be that I'm starting to observe/eval/treat during some patients' breakfasts at 6:30AM. Yeah, can you believe it?!?! Me?!

Returning to WJSHC for Foundations Class
If you didn't already know, Linda Louko invited me to come back to WJSHC on Friday, Dec 1, to talk to graduate students (and maybe even senior undergrads) about being a travel SLP. I already bought tickets to fly into DSM and Michelle Bullock says I can stay with her. :-) I'm pretty excited. I like sharing about experiences and learning from each other. And if you've already read my first post, don't worry that I'll repeat all the same info. There will of course be overlap but there's much more to say, plus I don't think I was very clear on that first post. Anyway, I hope you can make it!

Heritage HealthCare Center (HHCC)
The rehab services director mentioned to me last week that I needed to increase my productivity. Nursing homes require employees to make note of how many minutes you worked were "billable" (i.e., basically anytime you do direct therapy [not even eval, has to be tx]) and divide that by how many minutes you worked in that day. So I had to screen a lot of patients and write orders for evaluations. Boy this is already gonna get too detailed. I didn't even mention yet about finally meeting my supervisor (Amy) two weeks ago. She followed me around all day on a Wednesday, which is the day that I spend half at the nursing home and half at the school. More on HHCC another time.

Cobre Valley Hospital (CVH)
The day Amy came was my first time doing a modified barium swallow study (MBS) at the hospital. I'm glad she was there, because it helped break the ice between the radiology doctor and me. I was warned several times by several people that this radiology doctor is not the friendliest... so having an experienced SLP there to be authorative was helpful. I did another MBS there on my own once after her visit and it went well. I've also been there for a couple bedside swallow evals. More on CVH later.

Miami Unified School District
My secretary (Cheryl) is hilarious and my speech aides are wonderful people. One of my SLPAs, Jeana, invited me to a 'girls night' at her place hehe. We watched a movie and had snacks. It was great to hang out with them so casually like that. Caseload-wise, the new count is around 135 students. It's actually manageable because Cheryl is so good at what she does. She gives me a list on Tuesdays of 4 things I need to do before Friday: 1) do formal evals on these kids, 2) update present levels of performances and tx goals for these kids [usually the longest list], 3) screen these kids, 4) IEP meetings this week. I have to do all these in between my scheduled tx sessions and any time that I can I try to observe one of my aides with their kids to give advice or answer questions. ::sigh:: it's 10pm and I'm actually quite tired. So I guess I'll try to tell more about working for the schools later, too.

It just seems like so much to say, it would overwhelm anyone reading through this casually. And I wouldn't know what to cut out. I guess I could still do my narrate-a-"typical-day" idea, but there is no typical day. Oh well, no obligations, right? :-) This is for fun, for your information, for my personal journal. Who reads this anyway? No comments = no readers, right?

WEEK 2

Update coming.... LOTS to say....

I'll probably narrate a "typical" day... But i'll try to keep the excessive details and internal dialogue to a minimum haha

For now, here's my schedule:

Each day has a 30 minute lunch, and some gaps in time for travel between places
Monday: 7:30-4:00 Skilled Nursing Facility (SNF)
Tuesday: 6:30AM (for a meeting!!!) - 9:00 SNF, 9:30 -4:00 Schools
Wednesday: 7:30 - 11:00 SNF, 11:30-4:00 Schools
Thursday: 7:30-9:00 SNF, 9:30-4:00 Schools
Friday: 7:30-11:00 Schools, 11:30-3:00 SNF

Week 1

INTRO
Hello again everybody! Even if less people read this blog, I still enjoyed documenting my outplacement experiences last Spring just for my future reminiscing. This blog will contain info about my CFY experience as well as what it's like working for a travel company. Skip down to "Day 1: Heritage Health Care Center" if you don't care to read about how I got here.

TRAVEL COMPANIES
By the way, if you do want to travel, I highly highly recommend Sunbelt Staffing, specifically Vincent DeMauro. I've sent my resume to and made contact with almost all the travel companies that come up when you google "travel SLP". None of them compare to the quality of service provided by Sunbelt. I won't even go into detail about the trouble I went through with the others before I contacted Sunbelt. I'm specifically suggesting Vinny because he's my recruiter and go-to guy. Not only has he been sincere about getting the best for me as efficiently as possible, but also ... I get a referral bonus hehe.

One more thing, Foundation Medical Staffing (FMS) was sketchy as ever, and Reflectx Staffing was a huge disappointment. Staffing Options and Solutions (SOS) doesn't provide a lot of location options and has poor benefits. Educational Based Services (EBS) healthcare is mainly school systems even though they advertise hospitals on their website. Core Medical Group are slow to respond. Others I can't even remember what their service was like. Please please trust me. Sunbelt is honest, efficient, and sincere. I can't emphasize this enough. They are also the ONLY one that is JACHO certified, and that says something significant re: quality. ::whew:: [rant over]

The process
Ok, so after I sent my resume to Sunbelt, they called back immediately and asked for my preferences re: location, settings, preferred pay range, and start date, asked about what sets me apart from the other applicants so they can mention it to potential jobs, and had me fill out a skills checklist.
Staffing company secret: Vinny says there is a list of facilities who request travel SLPs that all staffing companies get. He said the difference between Sunbelt and others is that Sunbelt won't just wait for something to pop up - If they don't already have an opening for the area you want to work in on that list, then they will call up their existing contacts (and they are over a decade old, so they have a ton of contacts not even listed) and ask if they need an SLP. If that doesn't work, then they go through the phonebook and call every facility asking. Vinny said they usually take a week to find something for someone. Reflectx said it takes 2 months to get things set up. Argh i wont' even go into that.

Well anyway, exactly one week after that first phone call from Vinny, he called me back saying they had people searching for me all over Texas (my requested state) for every medical setting, and couldn't find one that would accept a CFY for less than a year or more. I said I didn't want anything more than 9 months, by the way. It seems they all wanted me to stay on for at least another year b/c they think taking the time to supervise a CFY they need longer committments. Vinny keeps assuring me (and I trust him wholeheartedly by now) that after I get my C's I can go anywhere I want. Man, he got back to me so fast on everything - like the day he called to tell me Texas was a no-go, he said there's a meeting coming up in the afternoon and he'd bring up my situation to the group. He actually called me back right after his meeting, and gave me more info and options! And this continued until I got to where I am now! Honestly, I'd completely lost faith in all travel companies by the end of the summer until I contacted Sunbelt!

Long story short, this job in Globe, AZ, came up on that list next day and I was called immediately, literally right after they got the email that morning. My interview was set up and I got all sorts of info about the job, and much much later that day, Reflectx Staffing called me after 1.5 months of waiting for something to happen with them saying there's an opening in Globe, AZ, and that's when I truly believed that Vinny was telling the truth about that list, and learned that Sunbelt has the best service. Hehe ok starting to sound like an advertisement or infomercial, but i just can't get over how much trouble it was for me with those other companies. No more infomercialling, I'll just state the facts and let you assume I'd be singing more praises for Sunbelt if I could.

So the phone interview was set up for a mutual time on a Friday, and I was super nervous. Vinny calmed me down saying my references checked out great, and sent me a thing about doing phone interviews. It turned out a PT called me b/c the SLP couldn't make it, and she barely asked about my experiences and spent most of the 20 minutes telling me about the position. Next week I was told I got the job and then the paperwork started hehe. Well no, first they said they were negotiating my hourly pay and my schedule for school and SNF. Vinny, as my recruiter, handles all those negotiations, for which I am super grateful b/c I probably would've settled for much less pay and longer school hours. Vinny said he told them straight out that I didn't even want to work in the school setting, and that asking me to work more in school than at the SNF would be a deal-breaker, so he got it down to 20 hrs in both settings. He also negotiated a later start date. He made sure there was gonna be someone to supervise, and make sure I got my full 9 months. *insert praises*

Hehe naive me, I thought after I signed and sent 2 forms (one was employment agreement, other was housing agreement), I'd be all set to go. Well, within a days, I got this huge packet in the mail. Let's just say I filled out and faxed at least 50 pages of: JACHO quizzes, medical documents, employment forms, insurance and tax forms, personal credential forms, voided check copy, etc etc etc. It was quite intense! Included getting my immunizations updated and a drug test. I had to get it all done within a week because I planned on a week to drive to AZ. Fortunately I started the application for temporary AZ licensure the day I was hired, versus the day I got that packet.

Vinny, the credentialing department, and the housing department of Sunbelt were all crucial to this process. I started my drive from Chicago to Globe on Monday afternoon, July 31. Details and road pix at www.xanga.com/autosmiler. One more mention: Vinny wanted me to call him when I started my drive, when I got to Globe, and after my first day of work to see what I thought and how I was doing.

Another mention: Lori (housing dept) called soon after I was hired, too, to talk about my housign prefs. I said I had no pets, it doesn't matter which floor I got, but I preferred laundry on site and secured apartment. She said they typically find a 1 bedroom furnished apartment, though I spend my own on utilities and bring my own linens & kitchenware. Hehe a week later she calls and says she'd been searchign hard all week but there just aren't a lot of options in Globe. I said I expected that cuz there's a population of 7k. Anyway, she said the ones she did find were requiring a year contract and won't accept 9 months. Besides that, none had pix on the internet and she refuses to sign me up for anything she or I can't visually approve. *insert praise* She did find a 3-bedroom house that I could rent starting September b/c someone's still living there, but I'd have to stay in Motel 6 until then (which they pay for). She also found this www.dreammanorinn.com where I am living in utopia. Seriously. She didn't have the website before, she just gave me the info and I scheduled a site visit for the day after I got to AZ. I honestly cannot believe they are paying for all of this. It's a bed & breakfast / boarding house, so literally everything is taken care of, and the owners are the nicest people I know. And I still get my monthly utilities stipend, I think. Oh yeah, I got paid for the travel to Globe. Saved hundreds on gas by driving a Prius hehehe.... *smug alert*

DAY 1 & 5: Heritage Health Care Center

This is a skilled nursing facility with 70+ beds which also includes acute, subacute, and outpatients. The outpatients are usually kids, and sometimes I will go over to the Cobre Valley Hospital to do Modified Barrium Swallow studies. There are 2 wings and a unit for those with dementia. Everyone's been sooo helpful and friendly, I've only ran into one person who was iffy but she ... no longer works here I think. The rehab team works very well together, and they are hilarious. When we went out to lunch one day for the director's bday, one guy at the table was saying to a PT next him, "Hey stop stepping on my foot... Oh wait that's my other foot". LOL!

I was told there's usually 4-6 or more on my caseload, but there were only 2 on my first day. Hehe fine with me! Good to start slowly. Fortunately I don't think I have to deal with insurance that much, but maybe that's gonna come up later. Lots of running around informing the dietician what kind of food to give to which patient, educating the nurses about how to feed the patients, and finding a time when the patient's medical chart is available to write in.

Day 2-4: Miami School District

I've got 2 speech-language pathologist aides (SLPA's) who need training and a secretary. There are over 120 children on my caseload, covering 4 schools, 1 'headstart' center for really young kids, and 1 live-in facility for 21+ y.o. with mental retardation. Finding out all this on day 1 was like jumping into the deep end of a pool with a belly flop, but slowly floating back to the surface with each passing day. Pre-school hasn't started yet, and I don't have to see anyone until after next week, so I am very grateful. I can't explain much else b/c it gets complicated, but I'll update as I undersatnd more of it myself. Deb, who is everyone's boss, will be coming down next Monday to orient me more and help me thru the processes.

Oh, did I not mention that I'm the only SLP in the SNF AND in the Miami school district? Yes, I went through this entire week on my own. !!!!!!!!!!!!!!! My official CFY supervisor, Amy, works out in Phoenix and she's got a CEU course to go to, while Deb went on vacation this week. =P

But that's ok, I'm oriented now, and can ask better questions. This is enough of an update for now, I think... I'll talk about some patients on my caseload later, b/c they're quite interesting. I'd also like to give props to my outplacement supervisors at UIC Hospital for allowing me so much independence. If I didn't have that one experience, I might've broken down in anxiety already.

Oh, and my future schedule will not be only M/F at SNF, b/c that means i'd have more time at the school which was not part of my contract. THey are workign to give me 4 hrs at the SNF and 4 at school on Wednesdays. I brought up this situation w/Vinny mid-week via email and asked if it had to be exactly 40 hrs each week (and other questions). Due to the time difference (he works out of Tampa, FL), we couldn't get a hold of each other via phone. So he called after his work at 7:15pm Eastern time from his own cell so that he'd catch me at 4:15 AZ time right after my work so he could answer my questions! *insert praises* He encouraged me about feeling overwhelmed saying it usually takes 2-3 weeks tops to get comfortable, and reminded me that I can always leave messages in his direct phone line and there's a 24 hour phone service as well if I have urgent things.

Please comment. I like your opinions, and I want to know what you want to know from me and my experiences.