8 MARCH 11, 2013 • WWW.AOTA.ORG
I
mmediately after CatherineHoyt, OTD, OTR/L, finished her doctorate about 5 years ago, she hit a wall.
“I got my final papers signed and I was all done and was just so excited to officially be a doctor of occupational therapy that I spun around and ran into a wall,” Hoyt recalls with a chuckle.
But as a new therapist, Hoyt faced other barriers.
“I was anxious,” she says. “When I had my first patient to see, I was just hoping that it would go okay. Would
they like me? Would I know what I was doing?”
Hoyt says even though her fieldwork was worthwhile, there was something different about finally being a therapist.
“In fieldwork you always have that safety net. If you mess up, your supervisor can say, ‘That’s not a good idea.’ And you might feel bad about it, but at least you know that what you end up doing will be right,” says Hoyt, who specializes in helping children with sickle-cell disease at Washington Uni-versity School of Medicine in St. Louis.1
Hoyt remembers one of her first clients for a reason she would rather forget. The client’s family was comfort-able inviting Hoyt into their home, and Hoyt thought she was really making a difference.
But then the client was “hotlined”–– referred to child services.
“If I had this client now, I would be more assertive from the get-go,” Hoyt says. “There were things that were of concern to me then that I didn’t voice
Joining the Workplace
ANDREW WAITE
ILLUSTRA
TION © B
ULLSEYE / IMA
GEZOO / JUPITER IMA
Joining the Workplace
because I was trying really hard to develop that relationship with the fam-ily. Looking back, I could have initiated by discussing some of my concerns with the family and helped the family address those concerns.”
Fast forward 5 years and Hoyt’s growth is obvious. On the morning she was interviewed for this article, Hoyt had dealt with a foster mother who initially had not seen the value of occu-pational therapy for her child.
“With my increased confidence, I was able to tell her why there is a need for my services. She needed to know that her child has really bene-fited from occupational therapy,” Hoyt says. Hoyt’s assertiveness enabled her to retain the client and help the child become independent in activities of daily living as a result of occupational therapy.
So what was different about the past and present?
“There is a change in your role from being a student where you are always quick to do what your professors say to being the professional that is expected to have the answers,” Hoyt says. “You have to develop confidence in your knowledge and skillset and find that just-right balance between being pro-fessional, but also being able to meet people at their level.”
Hoyt is an AOTA Emerging Leader, meaning she has participated in the development program that recognizes
dedicated practitioners with 5 or fewer years of experience and offers leader-ship training and ongoing mentorleader-ship. Entry into the program is competitive. So when Hoyt admits that “finding that professional balance is still hard for me,” it should be plain that the adjust-ment between student and practitioner is an intensive process.
After interviewing several of the Emerging Leaders on their own transi-tions, it also became clear that achiev-ing professional equilibrium can be accomplished by becoming comfortable in the workplace, with clinical skills, and with communicating those skills to others.
FITTING IN
So much about confidence in any set-ting is about fitset-ting in. It’s no different in the workplace, Emerging Leaders say.
In school, fitting in came more natu-rally, they explain.
“When you are in school, pretty much everyone wants to socialize, and you are not as pressed for time,” says Emily Vaught, MS, OTR/L.
But in the workplace, the dynamic is different, says Benjamin Gross, OTR/L.
“It’s harder working with profes-sional peers than it was working with other students,” says Gross, who works in a private outpatient clinic that specializes in neurological conditions. “When I was working with students, most of them were my friends. Working
with other professionals, you are not necessarily their friends, and that’s not necessarily the role that you are supposed to be playing.”
Pair this social dynamic with the fact that starting a new job can often be information overload, and it can be overwhelming trying to feel comfort-able in a new workplace.
“I remember a lot of files, some nice people, and just being scared and ner-vous,” says Lindsay Ferguson, OTR/L, of her first days on the job as a school-based practitioner. “It was so new, and, sure, I had my fieldwork experience, but this was my life and my responsi-bility. Am I doing the right things? Am I evidence based? Will people like me here? What is my workload going to look like? What are the working condi-tions going to be like?”
Carrie Beals, OTR/L, says “It proba-bly took a year for me not to feel like I was always the new guy.”
But if new practitioners can view their co-workers as resources, the tran-sition into the workplace can be much easier, say Emerging Leaders.
“It took some time for me to develop those relationships with my co-work-ers,” says Beals, who works at Maine Medical Center. “I think that just asking questions and admitting that I was new and willing to learn broke down that barrier. My co-workers were like, ‘Okay, great. We will take you under our wing and teach you.’ Being frank and
Participants in AOTA’s Emerging leaders program share lessons learned
in successfully making the transition from student to practitioner.
Successfully Navigating From
Student to Practitioner
10 MARCH 11, 2013 • WWW.AOTA.ORG
honest [about knowledge gaps and any uncertainty] and being able to say, ‘I need a little bit of help,’ can make a big difference.”
Maureen Peterson, MS, OT/L, FAOTA, AOTA’s chief professional affairs officer and one of the developers of the Emerging Leaders program, says establishing a support network early on can ease the adjustment period for any new practitioner.
“If you are lucky enough to be in a setting that has other seasoned therapists, you can take a look at them and take a look at the atmosphere in the facility. Are the OTs really engaging with their clients and with each other?
Because if you see that people are open to sharing their expertise, experiences, curiosities, and questions with each other, that’s a very big clue and cue that you should be just as open to do that,” Peterson says.
As new practitioners become accli-mated to the culture in their new work-place, they can start to fit themselves into it, Emerging Leaders say.
“What would definitely help ease the transition is to figure out the culture and to model yourself around that while also being true to yourself,” says Ferguson.
Paul Arthur, MOT, OTR, knows a bit about bending his own personality to fit with his clinic’s culture.
“When I walk into a facility, I have a very light touch. I’m pretty quiet and I just try to let them feel me out,” Arthur explains.
But in his current job, Arthur has realized that he needs to push his comfort zone in order to not feel like an outsider.
“My co-workers want to be a part of one another’s lives. People want to have you over to their house. They want to have potlucks all the time. They want to celebrate people’s birth-days and things like that,” Arthur says. He participates because he wants to share in what his co-workers value.
“It’s still hard for me to get excited about three birthdays a month. So it’s an adjustment for me, but I think it’s something I have to do.”
Peterson says that successful pro-fessionals understand how to appropri-ately fit into the workplace.
“You certainly don’t want to hide who you are,” she explains. “You want
to have your own personality shine through because as an occupational therapy practitioner you want to be able to use the therapeutic use of self with your clients. You have to be your-self and be comfortable with that your-self in order to do that. But all of that needs to happen within the context of being a professional in a new environment and while beginning to create your profes-sional persona.”
Vaught says her own self-reflection has served her well.
“I have this big personality,” she says. “When I was in school, I was bent on working in a private practice. But it turns out that I actually thrive in a big hospital setting because it allows me many interactions throughout the day.”
Vaught says new practitioners should think about how their col-leagues are going to respond to them, not just about how they are responding to new colleagues.
“One of the best things I did was understand that I could be a little obnox-ious if I had to be with the same five
peo-ple in one small place all the time. I have learned that it’s important to respect other people’s space when they need it and make sure they are respecting your space when you need it.”
SKIll SET
More than just feeling comfortable in the workplace, new practitioners also face the sometimes daunting challenge of being confident in their clinical skills. Thinking back to her early days on the job, Beals recalls being oversensi-tive to clients’ conditions.
“I can remember on several different occasions looking at a client’s medical history and thinking, “Oh, my
good-ness, the patient has hypertension! I need to be careful with mobilizing them.’ And now I realize that a lot of people have hypertension. You don’t always need to have your radar up, so I chuckle at times at stuff I used to auto-matically get worried about. Now it’s a little bit more comfortable and easy for me to navigate.”
Beals’ more relaxed approach is a sign of her growing professionalism. Many new practitioners are worried that they won’t have the skills to treat clients. But Emerging Leaders say that’s not what new practitioners should be thinking about. They should be confident enough in their abilities to ask questions and admit when they don’t know something.
Gross remembers missing chances to help clients because he was too afraid to ask co-workers a question for fear they might doubt his skill.
“I was working with a very elderly community and there were a lot of resources within the community to obtain things like adaptive equipment or
If new practitioners are able to feel confident in the workplace,
with their clinical skills, and in communicating those skills,
they will be well on their way to a successful career.
other things that would help. It’s some-thing that I wasn’t really aware of at the beginning, and I could have addressed those issues and led the families to those resources, but I didn’t know about them yet,” Gross says. “I always felt like that in the beginning. It was constantly a catch-up game. I would learn about things after the fact when I should have been more willing to ask a co-worker up front and figure out what I was missing so that I could provide the best service.”
For new practitioners, it’s important to remember that theory prioritized in school does not always have a linear practical use, Emerging Leaders say.
“Keep an open mind. Not everything you learn in school will always apply, but you can always take those lessons that you learn about theory and different frames of reference and apply them in a different way,” Beals says. “It’s never just one theory that you go in and see with this patient in mind. You always have to have all these things running as you see a patient. So learning how to bring all these different pieces together in the real-life setting was important for me, and it’s just something that I learned on the job.”
Peterson says the fresh theoretical knowledge students bring can be useful and can spark excitement and innova-tion into the workplace. But…
“There needs to be a nice balance between being confident about what you do already know and being willing to let people know what you don’t know in order to complement and fill those gaps as you build your own professional portfolio.”
TAlK IT OUT
It’s fitting that Peterson uses the term
portfolio, which is something that is
meant to be shared, because in addition to finding the right level of confidence, new practitioners must also be skilled at communicating their expertise.
“They need to be able to articulate to family members as well as other profes-sionals what they are seeing, why they are choosing a particular intervention, what goals they hope to achieve, what is the hope for a particular intervention,” Peterson says. “And they need to be
able to articulate that in a professional, succinct manner. They should be colle-gial with all the people around the table, yet maintain their individual, unique identity as an occupational therapist or occupational therapy assistant providing a unique service with a unique perspec-tive for any particular client.”
Emerging Leaders say the key to communicating is being able to translate for the clients and their families. That comes back to the idea of thinking about occupational therapy services in a more real-world manner.
“In school you are thinking in this theoretical framework and ‘Oh, this is evidence based, so this is clearly the best.’ But sometimes when you are out in the field, you may still have that thought of ‘This is evidence based, this isn’t evidence based. What am I even doing? I’m not even sure why I am doing it,’” says Hoyt. “But finding a way to con-vey the information you have learned, what you hope to achieve, and how you will measure progress in a way that is understandable to the families and par-ents of children while continuing to earn their respect actually makes someone a better practitioner.”
Vaught works in a facility that has observation rooms with a blind mirror, meaning parents are able to watch their child’s therapy session.
“That was very intimidating. It made it harder to explain what I had just done, and I was taught that if you can’t explain what you are doing, then you don’t really know what you are doing.”
Vaught says not being afraid of saying “I don’t know,” and being confident enough to speak more conversationally greatly improved how she was able to communicate her skilled services.
“In the beginning I was kind of robotic. ‘I did this, I did this, and I did this, and this is how it went,’” Vaught says. “But when I allowed [kids and par-ents] opportunities to tell me about the fact that they went to a birthday party last week and all these wonderful things that they have going on outside of the clinic and then relate that back to what we had just done, I felt like my profes-sional relationship with clients and their families went to another level.”
For Ferguson, communicating with teachers produced the most anxiety. It didn’t help that she had a few difficult interactions early on.
Ferguson saw a client with attention deficit hyperactivity disorder. The cli-ent’s teacher had a policy that students who didn’t pay attention missed recess. Ferguson tried explaining that such a negative reinforcement wouldn’t work with this particular student and the teacher should consider a different strategy. But the teacher wouldn’t listen.
Ferguson also worked with a client who was legally blind in one eye. The teacher refused to change the student’s seat position in the room, even though he had to pivot completely to follow the lesson.
Ferguson found herself in arguments with these teachers to no avail.
A professional...
is open to feedback
is not afraid to let
some-body know when they
need help
is willing to share a little
bit of their own personal
story if it is helpful in
their sessions with their
clients
knows their own strengths
and weaknesses relative
to the professional skills
that they need to have
is balancing the
men-toring and professional
development that they
need to hone those skills
is confident about the
skills they already have
learned from school and
fieldwork
12 MARCH 11, 2013 • WWW.AOTA.ORG
“Sometimes I would work with a teacher and they would ask for help and not implement the strategies, and it was just frustrating,” Ferguson recalls.
But in her 5 years on the job, Fergu-son has learned to adjust her strategy by communicating her skills in a more productive way.
“I have learned how to approach teachers so that I am using a lot of positive words and letting them know they are in charge and that I am there to support them. I am changing my use of self so that I can best serve the client,” Ferguson says. “Because, ultimately, as an occupational therapist you want to see a child do his or her best. And the teacher wants the child to be able to do his or her best, too. So I try to feel the teachers out and see how I can support them in a way that also lets them under-stand my value.”
A PROFESSIONAl lOOKS lIKE… As Peterson and Emerging Leaders discuss, if new practitioners are able to feel confident in the workplace, with their clinical skills, and in communicat-ing those skills, they will be well on their way to a successful career. Gaining that confidence comes by not being afraid to ask questions, appropriately fitting per-sonalities into the workplace, blending
learned theory into real-life scenarios, and learning to talk about the services provided in a meaningful way. New prac-titioners who focus on these elements will resemble the professionals Peterson describes as ideal.
“A professional looks like someone who is open to feedback. Someone who is not afraid to let somebody know when they need help. Somebody who is willing to share a little bit of their own personal story if it is helpful in their sessions with their clients. Somebody who knows their own strengths and weaknesses relative to the professional skills that they need to have and is balancing the mentoring and professional development that they need to hone those skills with being confident about the skills they already have learned from school and field-work,” Peterson says. “They are life-long learners.” n
References
1. Hoyt, C. (2011). Branching out: Occupational therapy and children with sickle cell disease.
OT Practice, 16(14), 24–25.
2. Yamkovenko, S. (2011). 2011 emerging leaders
attend leadership training. Retrieved from
http://www.aota.org/Practitioners/Resources/ ELDP/2011Training.aspx
This article: http://dx.doi.org/10.7138/otp.2013.184f1
Andrew Waite is the associate editor of OT Practice.
He can be reached at [email protected].
educators “jumping in” when they needed help to gain an objective perspective on the therapy session, but students and educators alike identified the value of students finding solutions on their own later on in the placement. A second strat-egy, debriefing and performance-specific feedback, included the use of guided dis-covery and prompting questions to elicit student problem solving and analysis, with the ultimate goal of helping students develop skills in evaluating their own performance. A third important factor in student learning was the students’ ability and willingness to be flexible and adaptable during the evaluation/interven-tion and comfortably share their thoughts and ideas about the sessions; this helped educators adapt their teaching to respond to students’ needs. A fourth strategy, providing specific prompts and structures to support occupation-centered observa-tion and documentaobserva-tion, was very helpful in facilitating student analysis. Prompt sheets and templates helped students see how theoretical concepts translated to practice. Finally, students articulated the value of practice experience over time in an actual practice environment as helpful to their learning.
Conscious use of the above strategies by fieldwork educators can help students effectively translate the ideals of occupa-tion into practice. n
References
1. Copley, J. A., Rodger, S. A., Graham, F. P., & Han-nay, V. A. (2010). Occupational therapy students’ experiences in learning occupation-centred approaches to working with children. Canadian
Journal of Occupational Therapy, 77, 48–56.
http://dx.doi.org/10.2182/cjot.2010.77.1.7 2. Copley, J. A., Rodger, S. A., Graham, F. P., &
Han-nay, V. A. (2011). Facilitating student occupa-tional therapists’ mastery of occupation-centred approaches for working with children.
Canadi-an Journal of Occupational Therapy, 78, 37–44.
http://dx.doi.org/10.2182/cjot.2011.78.1.5
Debra Hanson, PhD, OTR/L, is an associate
profes-sor and the academic fieldwork coordinator for the Department of Occupational Therapy at the University of North Dakota in Grand Forks. Hanson has more than 20 years of experience working with fieldwork educators and students. She is the academic fieldwork coordinator representative for AOTA’s Commission on Education.
FIElDWORK ISSUES
learning to Use Occupation as Treatment During level II Fieldwork
continued from page 7
f O r
M O r e i N f O r M A T i O N
Emerging leaders Development Program
www.aota.org/practitioners/resources/eldp
leadership Forum on OT Connections
http://otconnections.aota.org/public_forums/ f/7894.aspx
New Practitioners/Recent Graduates— AOTA Resources
www.aota.org/practitioners/ new-practitionersrecent-graduates
Clinical Supervision in Occupational Therapy: A Guide for Fieldwork and Practice
By D. M. Costa, 2007. Bethesda, MD: AOTA Press. ($49 for members, $69 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http://store.aota.org/view/?SKU=1238. Order #1238. Promo code MI) AOTA CEonCD™:
Everyday Ethics: Core Knowledge for Occupational Therapy Practitioners and Educators, 2nd Edition
By D. Y. Slater, S. M. Reitz, L. C. Brandt, & L. Gabriel, 2011. Bethesda, MD: American Occupa-tional Therapy Association. (Earn .3 AOTA CEU
[3.75 NBCOT PDUs, 3 contact hours]. $105 for members, $150 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http://store. aota.org/view/?SKU=4846. Order #4846. Promo code MI)
AOTA Online Course
Occupational Therapy in Action: Using the lens of the Occupational Therapy Practice Framework:
Domain and Process, 2nd Edition
By S. S. Roley & J. DeLany, 2009. Bethesda, MD: American Occupational Therapy Association. (Earn .6 AOTA CEU [7.5 NBCOT PDUs, 6 contact hours]. $180 for members, $255 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http://store.aota.org/view/?SKU=OL32. Order #OL32. Promo code MI)
Occupational Therapy Fieldwork Survival Guide: A Student Planner, 2nd Edition
By B. Napier, 2010. Bethesda, MD: AOTA Press. ($34 for members, $49 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http:// store.aota.org/view/?SKU=1253. Order #1253. Promo code MI)
