Struggling in my Acute Care rotation

[gsnts725]

Hello everyone,

I’m five weeks into my final rotation of PT school (yay) and I’m struggling mightily and I’m afraid of failing. I’ve had three outpatient rotations before this, so Acute Care has been a total culture shock for me. I’ve been struggling a lot with hospital anxiety and fear of hurting/killing a patient. This has really hurt my performance and my CI has noticed. I noticed I tend to either copy what he does and/or I’m very quiet during treatments when I should be giving more verbal cues. I feel like I’m totally lost on what to do with certain patients and I’m not sure if it’s due to the anxiety or I need to review the material more. He has told me I need to step it up or I may be in trouble.

I’m really struggling to get over this anxiety and I really don’t want to fail my last rotation. Anyone have advice for me? I’d really appreciate it.

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[kdubz7w7]

Immediate disclaimer, I did not do an acute care rotation in school as my inpatient rotation was in a neuro hospital, and I am currently working in OP ortho. I am probably not the best person to answer but no one else has and I didn't want you to be left hanging.

I did spend a few days in acute care during an OP rotation located in a hospital and I agree, it's a whole new world. It was my final rotation and I don't remember feeling especially nervous. I do think my neuro rotation helped me as I was used to very low level pts, fragile health status, and used to ambulation, stairs, bed mob etc etc. But I found it to be rather straightforward? Check their latest status, blood work, make yourself a cheat sheet if you aren't familiar with lab values (my CI made me a list of what she looked for, what was abnormal/red flag, etc), go see them, vitals, help them to do whatever they need to do to go home (eg 5 steps to get inside, etc). Don't ever take your hands off them, pay attention to their breathing, color, etc, basically be ready for them to topple at any given split second. As long as you know you are making safety their #1 priority, feel confident in your ability to keep them safe.

Look at it this way. Your CI is there to make sure you don't kill anyone. Trust that they will step in if it seems you are about to make a bad decision. After all, you are there to learn, not work (yes you're supposed to be independent by the END of the rotation but not immediately, or even 5-6 weeks in).

If you feel totally lost, just say to your CI "help". Again, that is their job. And then whatever they say/do, learn from it and internalize it.

If you are struggling with interventions, ask your CI or another therapist, or even your faculty, to go over some drills for the basic facets of care: bed mob, sit to stand, gait, stairs. Then when you go to see a pt and they can't roll over in bed, you'll know a few things you can try to work on with them.

I don't think it's bad to be copying your CI. They're supposed to be your role model & at least you know whatever they are doing is likely safe and efficient. Basics are basic for a reason! I initially copied all of my CIs until I found my own rhythm that worked for me.

You've made it this far. You would not be there if your school did not trust you to be successful at this rotation. Accept that confidence and try to be more confident in your ability to be there. Think about how much more you know now than you did 2+ years ago! The interventions are still rooted in biomechanics, draw on your ortho skills to help coach and cue your patients. If you STILL don't feel confident, fake it til ya make it honestly sometimes faking confidence actually becomes real!

Feel free to PM me, even if you just want to vent. Good luck! I don't know you but if you've made it this far, I fully believe in you!

 

[wiseOldPT]

The best advice I have is to proactively reach out to your school, your CI, and the directer of clin ed at the hospital. Saying you know you have a problem and want to improve will go a long way, and these people are there to help you. Be honest about what you are struggling with and think about suggestions of what they can do to help you. Would brainstorming some treatment ideas before each patient and 3 red flags to look out for help? Maybe practice some verbal cues you can say ahead of time. Set small, clear goals for yourself.
Also, address your mental health. Even just a couple of counseling sessions can be really helpful in getting out of some negative self talk and anxiety. See what is available through your school- they have experience helping people in clinicals, which can be a really tough mental health time.

 

[ya1]

Hello everyone,

I’m five weeks into my final rotation of PT school (yay) and I’m struggling mightily and I’m afraid of failing. I’ve had three outpatient rotations before this, so Acute Care has been a total culture shock for me. I’ve been struggling a lot with hospital anxiety and fear of hurting/killing a patient. This has really hurt my performance and my CI has noticed. I noticed I tend to either copy what he does and/or I’m very quiet during treatments when I should be giving more verbal cues. I feel like I’m totally lost on what to do with certain patients and I’m not sure if it’s due to the anxiety or I need to review the material more. He has told me I need to step it up or I may be in trouble.

I’m really struggling to get over this anxiety and I really don’t want to fail my last rotation. Anyone have advice for me? I’d really appreciate it.

Regarding your anxiety of hurting/killing a patient: Do everything SLOWLY. If you start helping a patient to move in bed/in sitting, start moving at speed 1 in per 5 sec or so. If the patient can move faster, you will see them doing that and then let them move at their speed. If something hurts, just stop and rest, and then try to move again. At this slow speed, you have plenty of time to stop before you hurt the patient. When you are moving around a patient, also move SLOWLY; in this case, if you do start pulling on whatever tube, you will very likely feel it or the patient will let you know. Before starting working with the patient, ask if they have any pain and where. Tell them that whatever we do, should not cause pain or should be tolerable. Ask them to let you know if something is uncomfortable or hurting and reassure them that you will not proceed with anything unless the patient is comfortable.
This kind of communication will let patients feel more comfortable and they will have a better idea what to expect from therapy. At the same time, your CI will see that you are communicating with patients.
Often, It does not really matter what exact diagnoses they have as long as you are aware of contraindications and precautions. Ask them how they are feeling, if they are dizzy at all. Measure BP and O2 if they feel dizzy and then slowly proceed with bed mobility, transfers, standing, and walking.