When I was at the AOTA Conference in Baltimore, I had the great pleasure of meeting up with a number of my former students who are practicing OT all across the country. It was, as always, delightful to see them and to know that they are out there helping so many people whose lives have been limited by illness or disability. I felt very proud to have them as my colleagues and satisfied because I had participated in the effort to prepare them for this great career. This year, though, I also came away with a nagging worry, based on two former students’ comments about their work.
Upon walking into the Baltimore Convention Center, I ran into the two students in quick succession. The first had graduated two years ago; the other had been practicing for about 15 years. They worked in two distinct regions of the country in adult rehabilitation settings. Each of them spontaneously shared with me that they were frustrated in their work because they had been significantly limited in their scope of practice. Both were prevented from assisting patients with transferring and were told to ask physical therapists to perform this function. They were actively limited by their supervisors and administrators to training patients in basic ADLs or upper-limb strength and endurance and discouraged from working on more complex goals. Their OT peers were acquiescent to these restrictions and seemed complacent. My former students described a reduced level of satisfaction with their work and decreased self-confidence.
I was dismayed. I recalled how idealistic and capable both women were upon graduation, and it was sad to see them feeling dissatisfied and unsure. This was not the kind of OT that we taught in their educational programs. It was not the scope and process that is outlined in the OT Practice Framework or that was being celebrated at the conference. It was a restricted, watered-down kind of practice that cheated the clients of a full set of services and reduced the effectiveness of the entire care team.
I asked these young colleagues what they were doing to deal with the problems. One was making efforts to change the culture and ways of her work place; the other was looking to move on from hers. Both seemed doubtful that they could effect enough improvement in their settings to achieve full practice. Their fatigue and discouragement has been reflected in a number of the comments that our readers have shared on our Today in OT Facebook page when topics veer into therapeutic use of self, client-centered practice or occupationally-based intervention. Many OTs describe being under such pressure to keep a rapid pace of practice, to the point that they cannot really provide services beyond the very basic minimum as defined by their employers.
In fact, sometimes I wonder if we can even call this kind of service OT. Just because a licensed occupational therapist does something, is it automatically OT? In no way do I offer this question with disrespect, but I offer it as a challenge to the business-as-usual, obedient, don’t make trouble, fear-based mentality that allows us to slip into habits that are counter to everything we value and that ultimately lead to boredom and burnout.
Here’s the thing: Who decides whether what you do with your patient/client/student is authentic, high definition occupational therapy? If you are a credentialed OT, you, your licensing board and your professional association do. It is up to all of us to advocate for our clients to have solid, bona fide OT services. If OT has been ordered and written into an IEP or a service plan, then it should be delivered. Real occupational therapy, as defined and delivered by a real OT. Any administrator or supervisor who does not expect you to use your clinical reasoning and judgment to plan and deliver the needed intervention is shortchanging his or her facility and consumers, and restricting your practice.
I am advocating what some in the world of business call disruption. Change your workplace and your practice. You can start by educating your colleagues and superiors about the true scope and practice of OT and slowly adding in changes to your own practice. Brush up on your skills and stop calling in someone else to do transfers. Take a patient down to the recreation area, kitchen or outdoors for a session. Throw away the hand bikes and come up with motivating activities. Take a course or get some coaching in assertiveness and get ready to respond when your boss asks what is going on. Rock the boat and save your own life. If you just can’t effect enough movement in your place of work, start looking to go where you can practice your profession fully and tell them why you are leaving when you exit.
OT educators and continuing educators, maybe we need to do more to prepare our students and colleagues to be assertive, courageous practitioners and clinical managers. These problems are neither new nor unusual. What can we do to teach and sustain the skills and will to advocate for patients’ rights to excellent, full OT?
I hope that my words and attitude do not cause you too much distress, but if you are practicing reduced OT, I hope they will challenge you enough to get you moving. Practicing OT can and should be the creative, exciting, important professional experience that inspired you back when you chose it. It is up to each of us to make it so.
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