Abstract
This phenomenological study explored the perceptions and experiences of newly graduated OTs working in skilled-nursing facilities. Four themes emerged: evolution of entry-level competence, negotiation of relationships with colleagues, navigation of systems, and transition from idealism to realism. Findings implicate the need for change on multiple professional levels to enable new graduates to successfully transition into practice.
Primary Author and Speaker: Nicole Fidanza
Additional Authors and Speakers: Salvador Bondoc
The skilled nursing facility (SNF) is the third most populated employment setting for occupational therapist (OTs) and it is the top choice for newly-graduated OTs entering the field (American Occupational Therapy Association, 2015). In the SNF, clinicians are challenged with maximizing client care with decreasing lengths of stay while also being accountable for managing healthcare costs and preventing re-hospitalizations. This challenge often weighs heaviest on new clinicians. To date, there is a paucity of literature that addresses the lived experiences of newly graduated OTs. International scholarship has focused on their perceptions and attitudes (Gray et al., 2012), but none has focused on the SNF. If newly graduated OTs are entering the SNF setting, and if little is known about their lived experience, then the profession needs to better understand what can be done to promote their clinical competence and to enhance their professional development.
This qualitative, phenomenological study utilized in-depth, semi-structured interviews to explore the perceptions and experiences of new graduates. Recruitment took place via postings on social media and direct emails sent to recent graduates from an alumni database. Purpose and snowball sampling was used to increase the likelihood of response saturation. To qualify, participants must be in their first year of OT licensure and be working at least 20 hours a week in a SNF.
Participants took part in interviews conducted in-person or via online video conferencing. Interviews were based off a guide organized into four categories: demographics, transition to the workplace, continuing professional development, and parting words. Probing, summarizing, amplification, redirection, and reflection were used during the interviews. Each interview was audio recorded and transcribed. Using the Colaizzi process, open and in-vivo coding was used to extract significant statements. From these statements, meanings were formulated and then sorted into categories, subthemes, and overarching themes.
Ten newly-graduated OTs, with experience ranging from two to eight months, participated in this study. Four themes emerged that captured their experience: evolution of entry-level competence, negotiation of relationships with colleagues, navigation of systems, and transition from idealism to realism. Participants reported a lack of employer-provided supports which resulted in feelings of abandonment and forced autonomy. They identified several SNF-specific stressors that limited their delivery of client-centered, occupation-based, and evidence-based care. Participants were dismayed to discover a disconnect between academic expectation and clinical reality, but took little or no action in response to it. In recognizing this dissonance as the reality of healthcare, participants slowly abandoned their idealistic expectations of others, their departments, and the SNF. Despite the challenges in the SNF setting, new clinicians developed their own adaptation strategies and initiated their own learning to develop their clinical competence.
The experience of being a newly-graduated is OT is captured by the overarching theme of expectation versus reality. The findings of this study indicate the need for change on multiple professional levels to enable new graduates to successfully enter the field. Increased workplace supports, including orientation, mentoring, and structured learning activities, are needed for new clinicians. Similarly, academic programs should provide increased opportunities for supervision of OT assistants and interprofessional collaboration. New clinicians must enter the field with a better understanding of the complexities of the SNF setting, and be prepared to manage them effectively.
American Occupational Therapy Association. (2015, September 16). 2015 salary and workforce survey- Executive summary. Retrieved from http://www.aota.org/-/media/Corporate/Files/Secure/Educations-Careers/Salary-Survey/2015-AOTA-Workforce-Salary-Survey-LOW-RES.pdf.
Gray, M., Clark, M., Penman, M., Smith, J., Bell, J., Thomas, Y., & Trevan-Hawke, J. (2012). New graduate occupational therapists feelings of preparedness for practice in Australia and Aotearoa/ New Zealand. Australian Occupational Therapy Journal, 59, 445- 455. doi:10.1111/j.1440-1630.2012.01029.x