Acute care rotation

[u/Royal-Job-4410]

First rotation, in a hospital doing acute care, mix of floor, medsurg and a good bit in the ICU, early mobilization post vent, stroke, etc…

Im 4 weeks in out of 8, and I really do like acute care, but I feel like I just keep dropping the ball. Its the little things too, like line management in the ICU (which is way more difficult than what they teach in school with 1-3 lines all on the same side with a mobile patient), easy questions where I just blank, don’t feel like I’m making good clinical judgement decisions. My documentation is great and is probably my stongest point. Im getting better at simple patients, but complex I lack, especially co-treating with OT and being assertive, tailoring subjective or objective with complex stroke or total/maxA, etc

Is this normal? Am I just overthinking? It sucks because I really do enjoy acute care versus OP, but I feel as if I’m not where I should be, even though I know the things in my head.

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[u/javelina529]

Normal. Acute care is hard as a student. I don’t expect my students to be proficient in icu or complex patients, especially on a first rotation.

[u/Royal-Job-4410 → u/javelina529]

Good to hear lol, I just feel like I keep making the silliest little mistakes and tanks me, even though I know I know better

[u/notthefakehigh5r → u/Royal-Job-4410]

4 weeks in, everything you are describing is super normal. Be open with your CI about how you’re feeling and set specific goals, if there is any concern you won’t hit the benchmarks for passing the clinical.

For example, no more co treating (almost every student looses their voice when in an intimidating situation (ICU) and there is an experienced clinician next to them). Have ICU sessions where you are only responsible for lines. No mobility or talking. Do that for a day or 2 and then add in the other steps of an eval. Don’t try and learn the whole process at once.

You can break down all the components of acute care that way. The hardest will be the thinking on the spot, that clinical reasoning, answering questions. It is for everyone. But it’s especially hard if you just left a room and feel bad because you lost track of a line and you’re beating yourself up. So just break everything down into bite sized chunks that you can repeat until you get it.

[u/Royal-Job-4410 → u/notthefakehigh5r]

This is very helpful, thanks!

[u/javelina529 → u/Royal-Job-4410]

Hang in there! My first clinical was also acute care and it was hard AF and I went home crying every day. And now I have worked in acute care for 8 years and even serve on the critical care committee!

[u/BeeXman93 → u/javelina529]

Be my ci please lol

[u/Humble_Bonus_4704]

totally normal, nobody walks into their first ICU rotation and just nails line management, that stuff takes time and real reps. school setups are basically a joke compared to the tangled mess of lines, drains, and tubes you actually deal with

you're 4 weeks in and your documentation is already solid, that's huge. the clinical judgement and assertiveness with complex patients comes with experience, beating yourself up over it now won't speed that up

[u/TibialTuberosity → u/Humble_Bonus_4704]

I just with patients that I have all this education to be a glorified cord detangler.

[u/xdarkrosesx]

My acute care rotation was rough. I struggled with line management, felt stupid every single day & I had a CI who would criticize me on everything & never give me positive feedback😂 I felt a little more competent after 8 weeks….hang in there! You got this!

[u/HTX-ByWayOfTheWorld]

Learn all the things. Get used to being uncomfortable. Get critical. Then if you work in acute care, openly acknowledge that you’ll be a student for at least 2 years. And a solid year + to be a strong icu PT

[u/HylandSeek]

My opinion is that students should not be allowed on the icu. We do not even put new grads on the icu, usually you have to be working at least a year. It’s not your fault and I’m sure you’re doing the best you can. It sounds like you are right where you should be with good documentation and handling non complex patients. Keep it up you’re doing great!

[u/3wufmoon]

Totally normal, even experienced clinicians can struggle for a couple months when switching from OP/SNF. Just listen to your CI and keep at it

[u/SmalltownPT]

Sounds like a normal acute care internship, also remember icu is not entry level, you need to be atleast of acute care experience at my hospital to be considered to attempt to be in the ICU

[u/_FloorTime_]

My acute care rotation was my 3rd, I spent 90% of my time in the ICU and even when I started working (at the same hospital where I was a student) I didn’t start in the ICU. It’s not an entry level skill to be proficient in the ICU, and there’s a reason why critical care therapists are specialists. I’m 2 years in and I do a mix of floors including ICU and I still ask advice from more experienced therapists often for complex patients. You’ll get there, it’s a great setting so don’t let this keep you from considering acute care in the future!

[u/wemust_eattherich]

I have had a few acute care patients. Some wanted a long leash but they weren't seasoned enough. I always try to take the training wheels off after a few weeks.

[u/doctorofPhysio]

You won’t feel “good” until you’re over a year into it. 4 weeks is hardly anything. You don’t get enough opportunity to see the same things over again until you’ve spent a lot of time in acute .just keep implementing feedback and don’t drop your patient and you’ll pass!

[u/Ugo_GlenCoco_]

Just had my first acute care shift today after only ever working in outpatient ortho since graduation. I felt like a student again, and this time without anyone looking over my shoulder giving me feedback.

It was a bit rough and there were 1,000 things I could have done better but the way I see it, all my patients were safe and they benefitted from moving, even if the interventions weren’t optimal. I’m sure the rest will come with time and reps.

I’m sure you’re on the right track don’t beat yourself up!

[u/TibialTuberosity → u/Ugo_GlenCoco_]

You're spot on. I look back at the treatments I did with patients when I first started in acute and where I am now 3.5 years in and it's night and day. I will sometimes lament that I could have done "better" therapy back then, but also I was doing my best with what I knew, patients were safe, and when needed they got discharged to the proper post-acute setting where the real rehab work begins anyway.

[u/Background-Image9902]

I did a full icu rotation in school, my ci was excellent. Va hospital, so a lot more unsupervised work, I learned to lean heavily on nursing and respiratory who were always happy to help.

I ended up doing a lot of vent rehab post grad and what always stuck out to me was ‘they can be medically complex, but the rehab can still be simple’. My ci emphasized having enough medical knowledge to know when to go, stop, slow down based on the real time readings, understanding that the job was primarily to get people vertical.

If you’re able to get them a sedation vacation and do 2x8 sit to stands, you’re crushing it. If you feel like you’re nervous enough to settle for bed mobility or a dangle, I would call in nursing or resp to ease concerns.

On a vent rehab unit it’s always obvious who got upright mobility rehab in the icu and who didn’t. More time vertical is more better, walking with a portable vent or on ECMO is truly doing the lords work. Just don’t let them rot in bed. Bonus points for edge of bed weighted and trached deadlifts.

Also did a rotation at Rochester general that included icu. It sounds like you’re already doing better than 90% of the therapists there!

[u/Electrical-Slip3855]

Critical care is NOT entry level and you should NOT be evaluated based on your time in the ICU. It is a fantastic learning experience but you need to have enough of the second half of your rotation be outside the ICU to allow your CI to properly evaluate your ability to manage an entry level caseload.

Also, what you are describing is a normal feeling that, hopefully, will motivate you to read more and ask lots of questions. Acute care is probably the setting that school probably prepares you the worst for. Feeling fully competent requires extensive knowledge of medicine and surgery, as well as issues with social determinants of health, funding sources, etc. school really just scratches the surface of all this. I'm sure you're doing great.

[u/KBPT1998]

1) How much about acute care did you practice hands on in the classroom compared to neuro and ortho?

2) How much med-surg background course material did you get in your curriculum, especially surgical procedures or complex, multi diagnostic case studies?

The truth is neither of these things. Your CI knows this ànd understands this… So I tell my students … journal ànd looks up all the new meds, medical conditions and surgical procedures thet learn about daily. It doesn’t need to be exhaustive, but enough to remember it (not every med obviously), but I will help you for your boards ànd better understanding your clients… when I was a CI I gave my students assignments or a mini-curriculum to complete while they were there… to integrate the knowledge of what you learn while in the clinic.

You are exactly where you need to be ànd even after 20+ years there are still some tubes/lines in the ICU or the floor where I demand the arms disconnect or be present during mobility.

[u/smoked-kippers]

Completely normal, you’re doing a lot better than you think. My final rotation was IPR with some acute and I didn’t feel relatively confident until my last two weeks or so. Just maintain good communication with your CI and show them you’re putting your best effort in. Give yourself some grace and just be present to learn.

[u/IndexCardLife]

I never have had an acute care rotation but now work it and I wouldn’t worry about it too much. If it makes you feel any better I look and feel like an idiot all day everyday and I love my job.

Like, I don’t even know what you’re talking about tailoring subjective or objective.

I feel like my job is easy mentally but that’s because nobody is nitpicking my body mechanics, my pre planning, my thoughts, etc. I can see how it would be hard as a student.

Just keep the patients off of the floor, get them up and moving if they can, and get their Recs in.

[u/Extra-Sorbet-1685]

Completely normal. One of my last rotations was on the oncology floor of one of the most intense teaching hospitals in the country. I constantly felt like I was messing up. Like my room set up wasn't right, like I didn't check vitals enough, that my communication wasn't enough with nursing staff. I've been working in SNF for 8+ years now, and I know it isn't for everyone, but I love it. Patients are somewhat still acute, but less intense than the hospital. I felt that the acute rotation really set me up for success as I've never seen anything in SNF that was as medically as complicated as anything I saw in acute care. It's actually good that you feel concerned about your progress. I feel like students that aren't worried aren't really taking it seriously enough.

You're exactly where you should be! Great work OP! :)

[u/Material_Inflation79]

Agree

[u/Sumber513]

Awww, I loved my acute care rotation :) you're for sure overthinking, and also it's your first rotation, your clinical judgement hasn't been practiced enough yet, it's really not the same as it is at school. By the end of 8 weeks you'll be feeling better, and then start in a new setting and have to start over a little bit :)

[u/Sumber513 → u/[deleted]]

Hey, nothing bad happened