From Pediatrics to Acute Care

It might come as a shock to you, but I recently got a new job in acute care at the regional hospital in my area!

It’s kind of crazy to think, especially since I was so focused on pediatrics for so long! But acute care has always been an interest of mine, and I even had a rotation in acute care during fieldwork. Rather than letting you all wonder why or ask questions here and there on a random Instagram post, I thought I would dedicate a little space on the blog to share more.

So I’m answering questions submitted through Instagram!

Has it been difficult to adjust to the pace of acute care?

I don’t think so. I feel like I have more freedom in acute care because I don’t have to follow a minute by minute schedule. In pediatrics I was usually booked 8am-6pm, and most of my sessions were 30 minutes. It could be difficult to stay on top of things so that I wouldn’t be late to bringing a child into the treatment room.

In acute care you get a list of patients and you’re off to see them in whatever order you want for the amount of time you want, or the patient will allow. Another thing is that where I work, the productivity standard is 75%, meaning in an 8 hour day, I’m expected to actually be working productively for 6 hours (this includes documentation, chart review and patient encounters). Of course we want to see more patients, but once I hit that 75% I feel comfortable and less pressured to see patients as quickly.

Why did you leave your last job?

Honestly, I was burnt out. I loved where I worked, I’m proud of the clinic I helped build, I loved my coworkers, boss and my patients. But I was getting tired of doing the same thing day in and day out. Naturally, pediatrics is a slow moving beast. Rarely do you get a case with a clear cut plan of care and an expected discharge date. In almost 2 years, I had discharged maybe 10% of my patients. And of course that’s not a bad thing, that truly is the nature of pediatrics, I just got tired of it!

I also knew it was burn out when even taking vacations and reducing my clinical week from 4 days to 3 days didn’t change the anxiety I had around work. I wasn’t just tired or needing rest. Sleep was difficult to come by and my anxiety was high because I felt like I wasn’t doing a good job even though I was (because it can be really hard to have kids reach goals for many reasons!).

Did you have FW there?

Luckily, I did have a fieldwork rotation in acute care (not this same hospital). This definitely helped prepare me and I didn’t feel like I was stepping into a completely new world.

Do you have mentorship at your new job?

Yes! I’m lucky to have plenty of clinicians to mentor me. For the first 2 weeks I was shadowing different OTs and gradually transitioning to independence. It felt like fieldwork but condensed into 2 weeks. This is my third week and I still reach out, ask questions and seek mentorship even though I’m technically on my own with my own list of patients. Everyone is very encouraging as well and are constantly checking in on me.

Has it been hard to transition from peds to adults?

Not necessarily! It’s nice to have patients that can converse with you and understand why you’re there with them. There can be challenges for sure, but I feel that even my job in outpatient prepared me well for the type of expectations I have in acute care.

The transition has been okay for me since I have some prior experience in acute care, but mostly because I have great mentorship from all of the therapists. Safety is a bigger concern for my adult patients… an adult falling vs a child falling is a very big difference, and truly can mean the difference between life or death. I’m also managing a lot of precautions, lines, IVs, and different abilities, so that’s a big difference with outpatient peds.

Will you ever go back to peds?

I don’t know! I am still interested in lactation consulting. So that kind of involves pediatrics. I don’t like making plans for the future though, so I won’t say with 100% certainty that I know I will go back to pediatrics.

What’s your schedule like now vs before?

In outpatient peds, I started with a 4 day work week, working 7am-6pm Monday thru Thursday. I dropped my clinical hours to 3 days after a year, and worked 8am-6pm Monday thru Wednesday.

At the hospital I work a 40-hour week, Monday thru Friday. We have flexible start times, so I can start anywhere between 7:30a and 9a, and then work my 8 hours.

Even though I’m work more days per week, I feel much more rested and like I have time during the week for things other than work and thinking about work! i.e. I feel like my work-life balance is better now than before.

What is the role of OT in acute care?

So in general, the role of rehab is to determine the patient’s current level of function, their safety awareness, and make a judgment call on what their discharge needs are. We are part of the clinical team, we assess the patient and along with other disciplines, determine whether the patient is okay to return home, or may need further rehab after their discharge from the hospital.

Acute care, in its nature is short term. Most of our patients aren’t staying for more than a few days, so we aren’t providing intensive therapy. We evaluate the patient and figure out where the patient would be safest to discharge to, so that they aren’t coming back to the hospital.

As an OT, I’m looking at the patient’s physical functioning, their coordination, vision, sensation, etc. how they complete their ADLs, ask about their home environment and if they have people to support them at home. I ask about how they were doing prior to their admission, and if they have declined significantly from their prior level of function, then I’m most likely going to recommend they go to a rehab facility or receive outpatient services. If they are at their baseline level of functioning and they have support at home to help as needed, then I’ll most likely recommend they go home.

I also determine whether they need durable medical equipment or if they need to make environmental modifications at home to ensure they are safe.

How did you make yourself a competitive applicant for acute care coming from peds?

I’m not totally sure what made my resume stand out… Granted I applied to 2 hospital systems and one didn’t call me back, while the other called me the day after I submitted my application. From my experience with both of these hospital systems, one is super picky and they won’t even entertain some applications, while the other follows up with everyone and sees potential everywhere.

I had a quick phone interview with the recruiter to answer some basic questions, and then had a peer interview at the hospital with some therapists, the supervisors and the director of rehab. Here I got to really show them what I’m made of – what experience I had, my flexibility, my passions, etc.

What feedback did you get in interviews since acute care is so different?

During the interviews, I think the biggest thing was that they wanted to make sure I was flexible in nature – because it’s super necessary in acute care to be able to jump from one thing to another and react appropriately. A lot of acute care positions are open to new grads/no experience necessary – so it’s not really about your experience, it’s about your eagerness and willingness to learn, grow and adapt. Are you able to be independent, make quick decisions on your feet? Can you take constructive criticism?

So there you have it! My transition from outpatient pediatrics to acute care in a large hospital! If you have further questions, please feel free to comment or message me!


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