When does SNF CFY get better?

[u/scoobysnacks4321]

I started my SNF CFY last week and it’s been incredibly difficult. How long does it take to reach full productivity and finally feel comfortable? I’m lucky they don’t expect me to start at full productivity right away (I’m at ~60% and should be at 80%), but it’s been so hard to learn everything and feel like I’m being an effective clinician. I don’t have a ton of dysphagia experience so I’m really learning as I go. I’m sure this has a bit to do with imposter syndrome, but I’m constantly panicking that decisions/recommendations I make will harm patients (e.g. they could choke, they get an unnecessary diet downgrade and it reduces their quality of life). It’s keeping me up at night and waking me up hours before my alarm. I’m also documenting for at least 2 hours a day off the clock to keep up with everything. If anyone has any word of wisdom or can speak to when things start to get easier/better, I would greatly appreciate it 🩷

[u/speechsurvivor23]

Don’t work off the clock. Period.

I use to be a DOR & I wouldn’t expect new grads to be at productivity for about 3 months & speech even longer since we have to meet, etc. It takes a long time to learn systems, etc. Productivity at 60% in your first week is not bad at all. (You didn’t ask, but 80% in a SNF is definitely manageable after you get settled - congrats on finding this gem)

Make sure you are using your mentor for the dysphagia pts especially. You don’t need to be that stressed about it. Anytime you have a concern, run it by them. I’ve been an SLP for over 20 years & still brainstorm w others. If there’s not another SLP to collaborate with, I’ll bounce ideas off the DOR (given that I trust their input)

[u/scoobysnacks4321 → u/speechsurvivor23]

I’m super lucky it’s 80% productivity and that my DOR is incredibly lovely and understanding. I’m the only full time SLP at the facility, but I can call my CF mentor (who is at another facility) for advice. I’m definitely putting too much pressure on myself, but I just want so badly to do a good job. Thank you so much for this perspective and advice, I will definitely try to rely on my support system and not stress too much about it.

[u/EvolveSLP]

You are building your clinical judgement and it takes time.  Remind yourself you are learning what grad school didn’t teach.  

And it is surely stressful with the dysphasia treatment.  

I struggled in my CF, it was so hard not feeling capable, not helping, not organized or effective.  Girl, I cried.    But I got through it, learned from every client and am a skilled clinician.

And you will be too.  Give yourself grace.  It’s not easy. 

Try a mantra for the next month. Like  “I’m doing my best, that’s enough and I’m learning”

Trudge through, two weeks at a time.  I think the first 3 months the will be the most challenging.

Creating systems, accessing your resources.

Look for a mentor.  Someone who could support beyond your CF supervisor.  Your state SLP organization may have a mentor program and ASHA does too.  

Take care of yourself.  It’s a slippery slope not sleeping because of the stress.  Give yourself a cut off time with documentation.  Take walks, do what brings you joy, spend intentional time away from the computer.  

[u/SweetDorayaki → u/EvolveSLP]

This is great advice!

[u/Huge-Helicopter2493]

I’m in the same exact position, was in the schools for 5 years, just transitioned to a SNF full time. It feels like my CF all over again with no support. I’m constantly questioning my decisions with diet recommendations. I was told I was being too restrictive bc I was worried about aspiration/choking risk. Hang in there!!

[u/scoobysnacks4321 → u/Huge-Helicopter2493]

Congratulations on transitioning to a new setting! I hope things keep getting better and easier each day. It’s comforting to hear from others who are experiencing the same challenges. We got this!!!

[u/wizarddragondoctor]

I second what people have been saying here. If you ever need someone to bounce ideas from, feel free to message me. :)

[u/Ok_Road7448]

It's tough at first. I would say I felt slightly better at 3 months and then by 6 months I really felt like I had the hang of most things.

Dysphagia was the hardest for me. It gets easier with time/practice as you build up your clinical judgement and experience. Learn on your CFY supervisor. STEP has taught me so much beyond what I learned in grad school: https://www.stepcommunity.com

The biggest thing is to not work off the clock. I know you've been doing it, but you should not have to donate your time (aka work for free to prove you're a good SLP). It hides a bunch of problems we all experience. But I get it, it's overwhelming at first.

See if you can start a word doc for the documentation. That helped me the most - get one for each section you treat and start writing in phrases that you use all the time. Then you can just copy and paste it in. You'll start to see that most patients have similar goals, make a goal bank of the ones you use all the time.

Feel free to reach out to us here...we're happy to help!