OT in acute care hospital setting

I'm a new grad and have been working in acute care hospital as an OT for about 1 year. I've become increasingly frustrated with this setting, and OT in general.
There are 2 OTs ( including me) working in acute, while there are probably 8 PTs/PTAs. We have 30-40 patients on our caseload, but most of the time don't see more than 10 patients a day (with only one of us working on a given day). I've noticed that physical therapy sees the patient almost everyday. I'm sick of the way things are going because OTs evaluate the patient, but then they are lucky if they are seen 3 times a week- or they discharge before we can see them again.
I've talked to my supervisors and they say they can't find any OTs- but this has been going on since I started a year ago- so my impression is they don't value OT much.
The other thing about doing OT in acute care is what we do (exercises, ADLs, ROM) most of the time, I wouldn't consider it skilled. And it doesn't require
a masters degree to be able to do it.
So to get to the point of my post... please write about your exeriences as an OT in acute care setting... have you had similar experiences? what do you like about the setting/ what don't you like? and have you found other setting to be more of a challenge/ or require more skills?
I'm thinking about switching my career- that's how frustrated I am! I need to hear from other people in similar situations! Thanks

I keep wondering why people never think of one more year of school to get their masters in healthcare administration. I would think OT would be a great intro to an administrative position. From my research some schools even waive many of their entrance requirements if you have a previous masters degree.

If you would consider another setting to work, please let me know.
Sincerely,
Heidi
jnhs@live.com

I have just started working in the acute setting after 17 years in the community. The hardest thing for me was that I didnt get to know the patients and felt like I had to make a full assessment on a patients ability to manage at home based on a 15 min interview, often not even seeing them perform much in the way of ADL's or relying totally on other staff reports (which can be inaccurate). I am beginning to see the role of the OT but its a very combined role with PT, I think, which offers a challenge in itself especially if you and the PT disagree about the persons status. I do think that the acute setting offers OT's challenges and I think it definately skills you up in rapid assessment so Im happy to be giving it a go. I think OT's are valuable in this area, particularly in regards to assessing cognition. PT's dont like doing this, nor the doctors I find so I am going to try and focus on this area a bit more. Hope all going well

Being an OT in an acute care setting is very challenging b/c you have limited resources when it comes to treatment. Try going to a SNF to build up your treatment repetoire.

In acute care, your job as an OT is not to rehab the patient, but to assess them and their needs at that moment in time, and give feedback via your evaluation note to the MD and case managers about how to start d/c planning: i.e., SNF, home with HHOT, acute rehab, home independently with family, etc. If you want to treat patients and get to know their functional status fully, then either work in a SNF, outpatient OT or a rehab hospital, or even home health. Acute care is not the place for you if you truly want to do 'rehab.' I have been an OT for 10 years, and I have worked in all of the possible settings for OT. I currently do acute care exclusively, and it is my forte.

I don't usually comment on these type of bulletin boards but I felt like I needed to offer up my opinion. I know kathy-marx wrote her comment almost 2 years ago (who has probably switched up careers at this point) but I found the response upsetting. (Besides the recruiter and the OT/teacher) Yes OT is challenging in acute care. You do have 30-40 evals per day, you do have a limited time to see the patient, you do have limited resources, and yes ADLs are typically your main treatment method. 30-40 eval per day? Job security. You're needed. Yes, most likely the rehab director doesn't feel like OT is important. But isn't that an opportunity to educate what OT does? Not only to your department but to the staff and the physicians. In acute care, the OT is the first point on the continuum of care before skilled nursing, long term care, acute rehab or home. If you don't have OT referred at the first point of care, they won't be referred in the other settings! OT's have a knowledge base that isn't covered by physical therapy! We do cognition, activity modifications, and more. Your patient may be able to walk 200 ft but if they can't put their pants on, your patient isn't going anywhere (unless they're a nudist). We do have a limited time to see the patient, but thats where OT's need to be skilled in art of conversation. You need to find out everything about that person in 15 minutes, and you can get it you just have to know what to ask! As an OT, I usually get a better picture of the patient than the social worker, PT, and Care management all together. (Not to be cocky, but to tell you its possible) You do have limited resources. What I'd like to ask is what do you do with people that are homeless who have limited resources? You as an OT should be able to figure out how to make it happen.In acute care, I do everything from ambulation to dancing with the patients. I don't rarely do just exercises and ROM, I focus on functional tasks and what the patient wants to do.

Sorry I keep going but one last thing. In acute care, your job IS to rehab the patient INCLUDING discharge planning. Whether it is 1 day or 30 days, you as an OT need to provide the education that the other disciplines don't provide so that they can continue to get better!

Just my thoughts.

jay in Saint Augustine, Florida said: Sorry I keep going but one last thing. In acute care, your job IS to rehab the patient INCLUDING discharge planning. Whether it is 1 day or 30 days, you as an OT need to provide the education that the other disciplines don't provide so that they can continue to get better!

Just my thoughts.

You don't have time to really "rehab" the patient in acute care, because the typical length of stay is 2-3 days. If you have a more long-term patient, that person is usually very sick and probably can't tolerate much therapy anyway, but if they can tolerate it, your job is to continue discharge planning and continue to get the patient to a point where they are stronger so they CAN tolerate rehab. If you work in an long term acute care hospital, THEN you get to rehab. REHAB is usually done in outpatient or rehab hospitals, LTACH's, SNFs. Even home health OT's do more rehab than in acute care. OT's in acute care usually spend their time doing evals.

I'm a new grad and have working in Acute care for 7 months. It is sooo good to see that somebody feels the same way! Although OTs are respected @ the hospital I am at (we are well staffed and have plenty of referalls) I am frustrated w/ the setting and the career in general. I am often doing ROM, strengthening, and ADLs... not rocket science! At the same time, I feel that at any given moment I may be expected to be a vision, psychiatric, hand, etc. specialist.. I am not skilled in any one of these areas yet. I feel bored and overwhelmed at the same time. I think that our profession is spread too thin. In a way I would love to build my skills, on the other hand I would like to engage in a career that is more clearly defined. As for your other questions, what I like about the setting is that its fast paced and time flys by, I'm interacting w/ several different staff & pts throughout the day(and if I don't particularly like a pt, I just need to wait a few days). Sometimes I have really successful treatment sessions in which I am sure the education I provided them will make their lives easier. But to be honest, more often I feel useless.

DinaOT in Raleigh, North Carolina said: You don't have time to really "rehab" the patient in acute care, because the typical length of stay is 2-3 days. If you have a more long-term patient, that person is usually very sick and probably can't tolerate much therapy anyway, but if they can tolerate it, your job is to continue discharge planning and continue to get the patient to a point where they are stronger so they CAN tolerate rehab. If you work in an long term acute care hospital, THEN you get to rehab. REHAB is usually done in outpatient or rehab hospitals, LTACH's, SNFs. Even home health OT's do more rehab than in acute care. OT's in acute care usually spend their time doing evals.

Sorry if its just me, but from your response it seems like OT in the hospital in not considered rehab and merely there for evaluations for the next facility? I see many patients that can't go to SNF, Acute Rehab, or a LTACH due to insurance or other reasons. If they don't get treated in the hospital, they don't receive any therapy at all. So my question to you is what about those patients? Is the educated, the handouts, the equipment I provide to them not considered part of rehab? Sorry if I feel offended, but basically your saying that I don't really do rehab in the hospital. At many of the hospitals that I've worked at, it's that frame of mind that doesn't advocate for occupational therapy as a whole. That may be what you did in your hospital, all evaluations and no treatments or basic treatments theraband exercises and all (most likely because your hospital was poorly staffed), but this definitely NOT what I do. I believe that belittling acute care occupational therapists by stating that the services they provide is not considered "really" rehab doesn't help advocating for OT at all. It merely reinforces the misconception that OT isn't a valid profession. Just my thoughts.

If you think giving out education and handouts is rehab in a 20 minute visit in acute care, then I guess I stand corrected. My definition of rehab is seeing someone longer than 2 days in acute care. And the reality of it is that OT's really don't see patients longer than that in acute care.

I am an acute care OT, and I am the only one. I have 8-10 evaluations a day with about 20 on my caseload. There are 4 PTs, and 4 PTAs. We also have 4 Techs; however, they are mostly assisting the PTs. I can call them if I absolutely need them, but PTs have dibs. I am totally overwhelmed. It is very hard to prioritize, especially for those who are all high priority. I usually love PTs by the way. Here, though, it is different. The PTs get mad if I ambulate the patient and they also get upset if I disagree with their assessment. Example: One PT discharged a patient because PROM is not skilled; however, I took them on because they can move AAROM in Gravity Eliminated. So anyway, the PT tells her techs and PTAs and it is like the whole department is against me. Meanwhile, I am trying to get the PT back on caseload because he can move his legs too just Gravity Eliminated. But they are resisting, and feel that I am stepping on their toes. It is a mess. So my boss (who is a PT) tells me to look at the smaller picture. But what I really hear is please do not try so hard to help each patient and just do enough to get by (so the PTs do not look bad). Ahhh! I feel like I am stuck between a rock and a hard place. If I help the patient too much, the PT gets upset and if I don't help the patient that much-the patient gets shafted. Please can anyone offer any helpful advice to get the PTs off my back when they differ in opinion.

Why some OT master programs require people to take 3D skills craft as pre-requisite??

DinaOT in Raleigh, North Carolina said: If you think giving out education and handouts is rehab in a 20 minute visit in acute care, then I guess I stand corrected. My definition of rehab is seeing someone longer than 2 days in acute care. And the reality of it is that OT's really don't see patients longer than that in acute care.

If want to provide hours of direct treatment and get to know people thoroughly, Acute Care is not where you need to be. I believe that Acute Care is not a good place for a new grad. You need to be a "Jack of all trades" who is willing to toilet people, Masters Degree or not. That's the reality of Acute Care.

The other big reality is education. Not only for the patients, for the staff. In my small community hospital I am the only OT, with the number of referrals per day varying between 1 and 14. Many of them are inappropriate, and I often don't get referrals for those who are appropriate. So my goal now is to educate the nurses and MDs in what is an appropriate OT referral.

Lastly, OTs are valuable to the Acute Care setting no matter what you consider to be "real" therapy. After 20+ years in the profession I'm not looking for a creative challenge, but I still want to make a difference. I help to determine where people go from here, whether or not they're safe to go, and how much help they need. Sometimes I'm the only person who notices that a patient is not ready to go home.

Educate others and consider yourself valuable. Good Luck.

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Beth Smothers in Orlando, Florida said: I am an acute care OT, and I am the only one. I have 8-10 evaluations a day with about 20 on my caseload. There are 4 PTs, and 4 PTAs. We also have 4 Techs; however, they are mostly assisting the PTs. I can call them if I absolutely need them, but PTs have dibs. I am totally overwhelmed. It is very hard to prioritize, especially for those who are all high priority. I usually love PTs by the way. Here, though, it is different. The PTs get mad if I ambulate the patient and they also get upset if I disagree with their assessment. Example: One PT discharged a patient because PROM is not skilled; however, I took them on because they can move AAROM in Gravity Eliminated. So anyway, the PT tells her techs and PTAs and it is like the whole department is against me. Meanwhile, I am trying to get the PT back on caseload because he can move his legs too just Gravity Eliminated. But they are resisting, and feel that I am stepping on their toes. It is a mess. So my boss (who is a PT) tells me to look at the smaller picture. But what I really hear is please do not try so hard to help each patient and just do enough to get by (so the PTs do not look bad). Ahhh! I feel like I am stuck between a rock and a hard place. If I help the patient too much, the PT gets upset and if I don't help the patient that much-the patient gets shafted. Please can anyone offer any helpful advice to get the PTs off my back when they differ in opinion.

You need to be respected by your boss. If you don't have his respect, you'll get nowhere. Try to educate him on what you can do, and should be doing. Try to get support from others in your hospital. I hate to say it, but this might not be the right place for you to be working. If you can't educate them in the value you have to offer, if they are so close-minded to think you are there just to help the PTs, you may need to move on. There is a course called "Management of the Complex Acute Care Patien

There is a course "Management of the Complex Acute Care Patient", given by Daniel Malone, coming to Jacksonville in May (sponsored by Education Resources Inc). You should go if you can. Build your reputation, gain respect, if you can't, look elsewhere or they'll beat you down emotionally and professionally. OT is not watered down PT! Good Luck!

I am doing a graduate project on acute care setting. I was wondering if anyone working in the acute care setting would like to give me their email address so we can discuss a few issues they notice in the setting. After reading this thread i see there are a few! Thanks!!

Does anyone have good reference for orders in acute care?... When tx should be held &/or if after surgery or decline in medical status does OT need new orders to resume therapy?

Hi, I am also doing a research paper on OT acute care setting for a cota program and was wondering if anyone happened to know anyone who would be willing to share information on this type of setting.

You dont expect to come out of Grad school feeling blindsighted by the OT profession, they cant teach you real "life", for example my perspective and opinion of OT has shifted ever since I started working in a rehab hospital setting and it is not because OT is not a wonderful profession, it is in the perfect circumstances,or in specialized fields, in the hospital setting however, it is frusturating and stressful, not to mention our country's healthcare system is a joke, where productivity superseeds pt's well being, it's absolutely discouraging when you get an eval and the pt is medically unstable or compromised and you have to see if they can put on their socks and transfer to the toilet?! There is just something wrong with that..and I just feel ridiculous saying to a patient, well i need to see if you can dress yourelf. Sometimes they are not even aware they will be required to do 90 min of therapy a day, nobody told them or even got their consent, and by the way I dont feel what I am doing is skilled either, not Master's level skilled! in theory OT is a wonderful profession, in reality it is lost cause, i feel like a glorified CNA more than anything else, if there isnt a shift in the direction the profession is going I feel its days are numbered. I may anger a lot of OT's out there, but just to be frank, I dont see it's value in the hospital setting, nursing can do OT, PT can do OT, anyone can, so what makes us special?

You dont expect to come out of Grad school feeling blind sighted by the OT profession, they cant teach you real "life", for example my perspective and opinion of OT has shifted ever since I started working in a rehab hospital setting and it is not because OT is not a wonderful profession, it is in the perfect circumstances,or in specialized fields, in the hospital setting however, it is frusturating and stressful, not to mention our country's healthcare system is a joke, where productivity superseeds pt's well being, it's absolutely discouraging when you get an eval and the pt is medically unstable or compromised and you have to see if they can put on their socks and transfer to the toilet?! There is just something wrong with that..and I just feel ridiculous saying to a patient, well i need to see if you can dress yourself. Sometimes they are not even aware they will be required to do 90 min of therapy a day, nobody told them or even got their consent, and by the way I dont feel what I am doing is skilled either, not Master's level skilled! in theory OT is a wonderful profession, in reality it is lost cause, i feel like a glorified CNA more than anything else, if there isnt a shift in the direction the profession is going I feel its days are numbered. I may anger a lot of OT's out there, but just to be frank, I dont see it's value in the hospital setting, nursing can do OT, PT can do OT, anyone can, so what makes us special?

FB in Buffalo, New York said: Hi, I am also doing a research paper on OT acute care setting for a cota program and was wondering if anyone happened to know anyone who would be willing to share information on this type of setting.

Hi, I have just started, 1 day, in the acute care hospital setting and would be interested in what your research found. Would you mind sharing your findings with me? I am sure it would be helpful to me going forward to know the pitfalls and benefits as shared by others with you for your paper. I am the only COTA at this hospital, so I can't pick a co-workers brain:)
Thank you (my email is rldl@earthlink.net) if you would rather email me.

O.T. in acute can get frustrating at times, especially since P.T. is so dominant. you really have to set egos aside. But O.T. does have its value if you build the respect from your collegues. A.E. training for back surgeries, hip surgeries is one big niche we OTs have at our hospital, training patients in modifications to their daily adls to function at home. we also have the ortho UE issues. But. try to emphasis our value in adls and function to return home. at the specific hospital i work at, i see patients who only stay a couple days but also rehab pts who are with us for weeks. it does get to doing evals everyday because of how busy we get, but its not consistent enough to warrant more staff. productivity plays a big part in limiting our staff too. again,its frustrating, but rewarding when a patient thanks you for the helpful education.

I have been doing OT in Acute Care in a large university hospital (one the largest in the state). We have minimal staff (11) for the number of our caseload (upwards of 100), whereas PT has a full staff of 30 for not much more of a caseload than OT. Of course there is PT vs OT battles/turf wars and which is recognized most in the hospital. But that cannot be what you focus on. Acute care is and will be fast-paced with short stays that is how our medical system works and is a good thing (facts show prolonged hospital stays place patients at higher risks for hospital-acquired weakness, infection, etc). Your job as a OT is huge in that short period of time. Ortho patients are a great example of OT, as someone else said, does it really matter if you can walk 200 feet, but to be able to dress yourself, feed yourself, etc is so much more meaningful if you think about it. I see patients who stay a few days (ortho) up to months (oncology) and I rarely do exercises or ROM. OT has the opportunity to teach adaptations (think how is someone going to function at home after an abdominal surgery, not just ADLs but cooking, cleaning, driving, etc), assist with vision, cognitive concerns, delirium, etc. Yes we make discharge recommendations. And as I tell all my students, the long term goal is to assist a patient to discharge to the least restrictive environment. Your job is to help with that. If you feel like a glorified CNA then you need to refocus what you are doing...why are you not teaching during that time? Every patient I take to the bathroom has to try to do there own hygiene because that is what rehab is. The thing to remember is you therapy is what you make it. If you aren't doing "therapy" then you need to take a look at how you can change your ways. That is what OT school taught you.

Jane - This is not an argument about which discipline is better for the patient. It was in response to the original message as to how to help yourself as an OT come to realize the nature of acute care is and what you yourself as an OT can do to adjust/alter your thoughts/practice.

9 times out of 10, patients need both disciplines. And yes I do know what the protocol for THA's are for the PT as I work very very closely with the PTs in our department. It is a collaborative environment. And I'm not saying that under any circumstance is walking not important, because if you think about it, how is a patient able to do their ADLs without the mobility/endurance aspect of it.
In order to benefit the patient the most there needs to be collaboration between disciplines. The thinking of believing OT's are brain dead and that OT schools teach ideas that are immature is negative and harmful to the collaboration and promotion of rehabilitation in general. How are we going to work together under the newest legislation and future legislation under our healthcare system. CMS caps are not just an OT thing, they are going to affect all areas of rehab, thus it would be better to prevent the bickering and negative thoughts and rather collaborate to push for our services. Just a thought about that.

As an OT, do you see many OTAs out there? Is it worth it to be one with the economy and the new things that are happening with the healthcare system>? Any useful advice would be appreciated.

OT and PT are to complement each other for the patient's benefit. When mobility and endurance alone do not allow a patient to return home safely, OT then is needed to allow for a safe discharge. The latter is something case managers in the hospital often overlook. They and and insurance company are looking mostly at how far they walk and assume that family or facility can address the rest. If we don't want re-admissions, then OT and PT have to advocate for the patient who needs more than to be mobile alone. Medicare will penalize hospitals for re-admissions. Private insurers will follow suit. OT and PT can help avoid re-admissions of the complex patients by better preparing them for d/c home to HHC or making sure they are admitted to rehab when efforts otherwise fail. This should be accomplished in a timely fashion to keep your hospital from going under financially. Your CFO will remind you of that! More often the cognitively intact acute care patient has need for PT alone, and return to adequate mobility will allow return to independent and safe ADLs, and that is why PT is staffed higher. The complex cases obviously need OT more than elective ortho patients. Neuro patients are a prime example. I would however say that THA patients are an exception, as OT training definitely complements PT in preventing dislocations by early education in THA precautions for self care/homemaking (before they feel good enough to get in trouble), especially those going home 4th day post-op. OTs do need to focus on the complex patients, not compete for all patients. OTs do have real skill and knowledge in aiding recovery from serious injury and illness and work well with PT to make for a safe transition to an appropriate d/c setting. When OTs focus on the complex patient population, we will be recognized for our place in health care and will continue to receive a pay check well into the future. Trying to justify ourselves by having the same size caseload as PT will not help!

Additionally, most complex patients are very fortunate to have OT in addition to PT, as we know that PT typically has a very high caseload and cannot address all deficits in the acute care setting. Most PTs that advocate for the patient work closely with OTs.

And yet, we have heard the talk as well about PTs and other disciplines. If you are not into OT, then do not comment on an OT related forum. And when you go to OT and work as an OT, then you can come and talk.

Working as an OT in any setting is what you make of it. If you have a negative attitude or feel like what your doing is not actually "rehab" then your treatment will show it. Like I tell my fieldwork students, acute care is the hardest place for an OT to work mentally, physically and emotionally. You have to know a lot of things. You will go from a knee replacement then to a stroke, then to the NICU, then to a COPD patient, then to a medically complex patient, then mental impairment, etc. You have to know everything. The problem with that is because you have know everything it is very hard to specialize and excel in one area (orthopedics, neuro, etc) which I believe is a reason why many people look down on acute care OT. What I tell people is that if you really want to help a patient at their absolute worst and greatest time of need you work in acute care. If you want a flashy job with recognition then acute care is not for you. Acute care is very much “rehab” and those who say that it isn’t have a very poor understanding of what the OT profession is. Take a look at the history of OT and where it started. OT’s roots are in acute care. If you are a person that is so needy and self absorbed that you have to have constant rewarding and need to see constant positive reinforcement then acute care is not for you. Not to sound morbid but in acute care people's lives are at stake. It's easy to work with a patient that is medically stable but try working with someone who had a heart attack, stroke, got hit by a car, shot or has had some other type of trauma less than 24 hours before you see them. Try dealing with IV lines, foley catheters, surgical drains, chest tubes, telemetry, surgical wounds and other medical lines & equipment while mobilizing a patient to the bathroom. A wrong move and you could cause a real problem. I have seen many “seasoned” OTs come into acute care as a career change & fail because they can do not have the skills to make it as an acute care OT.

Thanks so much for this discussion, I've been an ot in a snf for 10+ years but will be transitioning to a new setting in the near future. My long term plan is to go to a rehab hosp but a shorter term plan is to spend a year or two in an acute hosp and gain skills.

I found this article that discusses the role of OT in acute care.

Any suggestions from those who are in acute care on how to best prepare is appreciated. I do feel fear but am hopeful I can do it. I do better w/longer term folks but do feel I can make a difference in the hoped for new setting.

oops here is the article I meant to link:

www.aota.org/Practitioners/PracticeAreas/Rehab/Tools/43243.aspx?FT=.pdf

Hey ADAM IN LARGO I was thinking about taking an acute care OT position at the hospital in Largo but I am a new grad. Do you know a lot about the hospital in Largo? I am a little nervous about the mentorship there. I did really well during my FW in a large acute care hospital in DC but it was a teaching hospital. I don't need my hand held... I also don't want to go to an environment where I have no support. What do you think?

Why dont you try Acute Rehab? (Inpatient Rehab)

ANNie in San Diego, California said: I'm a new grad and have working in Acute care for 7 months. It is sooo good to see that somebody feels the same way! Although OTs are respected @ the hospital I am at (we are well staffed and have plenty of referalls) I am frustrated w/ the setting and the career in general . I am often doing ROM, strengthening, and ADLs... not rocket science! At the same time, I feel that at any given moment I may be expected to be a vision, psychiatric, hand, etc. specialist.. I am not skilled in any one of these areas yet. I feel bored and overwhelmed at the same time. I think that our profession is spread too thin. In a way I would love to build my skills, on the other hand I would like to engage in a career that is more clearly defined. As for your other questions, what I like about the setting is that its fast paced and time flys by, I'm interacting w/ several different staff & pts throughout the day(and if I don't particularly like a pt, I just need to wait a few days). Sometimes I have really successful treatment sessions in which I am sure the education I provided them will make their lives easier. But to be honest, more often I feel useless.

I am a student and I am doing my clinicals at an LTACH Setting and I am having a difficult time coming up with "creative" treatments ideas with these patients. My last clinical site was a SNF and I had no problems coming up with treatments. Why is this so hard for me to do? Seeing you have the knowledge and experience what could you suggest that I do?