Many SLPs aspire to work in the acute care setting. However, with limited job opportunities available, it can be a difficult setting to break into. Generally, with limited experience, newer graduates take jobs in skilled nursing facilities. After years in the SNF, it can feel like you may have aged out of opportunities to work in acute.
However, this is not true! I’m here to prove to you that anybody who is motivated and passionate about acute work can work in the hospital setting. I worked in the SNFs only for the first four years of my career. Then, I broke into acute care in the greater Boston area, of all places. In a city that is completely saturated with SLPs, I managed to get my first acute care position by working weekends in a smaller suburban hospital. This experience snowballed with others, and now I work full-time in acute care. On my personal journey, I took travel contracts in inpatient rehab and then the acute setting. However, I wrote this piece to apply to any clinician, whether you are looking for permanent or travel work. Here is my advice to the SLPs who want to work in acute care.
To learn more about the responsibilities of the acute care SLP, check out this piece from ASHA about getting started in the acute care setting.
Seek Externship Experience in Grad School
This is something I didn’t do, but wish I would have. In grad school, try to get an externship that is an acute experience. This can be a great learning experience, and also a great networking experience. If you make a great impression on your supervisor, he or she could be a great person to give you a job recommendation to another hospital, or even hook you up with a job at your placement location.
Learning about the acute setting in school is such a bonus for your clinical skills experience and for your resume. But don’t worry, if you didn’t get an acute externship in grad school, the doors have not closed for you.
Look For Jobs In Rural and Small Hospitals
Hospitals vary in size, demographics, and location. Generally speaking, a lot of SLPs who work in acute like to work in acute because they like the challenge of a complex medical setting. It is exciting to work with trauma patients and complex patients, and have interesting caseloads. Therefore, larger and more urban hospitals tend to be better staffed than more rural or smaller hospitals.
As a traveler, I worked in smaller hospitals who were DESPERATE for SLPs. Some of them went months without a full-time SLP on staff. They were so happy to get a traveler who could work for a couple of months and I felt so appreciated. If you cannot find a hospital looking for an SLP in your immediate area, then consider relocating, even if for a small amount of time, to gain experience. I would recommend at least 1-2 years in a setting to gain experience.
Everybody has to start somewhere, and it’s not necessarily going to be in a top-ranked facility. Look and apply for SLP positions that are outside of major urban areas or those in completely rural areas. While you may not have the most complex caseload, it is a foot in the door to acute. Smaller and more rural hospitals are a great place to learn hospital dynamics, how to communicate with doctors, protocols, electronic medical records, and scheduling. As I mentioned earlier, I started working in acute care in a suburban Boston hospital. While people were chomping at the bit to work in Boston proper, the locations just a little outside of the city were struggling to find job candidates.
Apply For Weekend PRN Positions
A great way to get your foot in the door with a hospital is to work PRN, especially on the weekends. Hospitals run services 365 days a year and don’t discriminate between weekday and weekend. Most speech departments will run services seven days a week. That means consistent staff is needed to cover evaluations that come in over the weekends. Working weekends is a great way to get your foot in the door with a hospital, especially if they have any openings that may happen at a later time.
Weekends are also a great start for clinicians without instrumental experience because often, modified barium swallow studies do not happen on the weekends. Radiology runs on a skeleton shift as well and will save modifieds until Monday.
Just be prepared that you may have to come in for one to two weeks for hospital orientation during the week. Hospitals will want you to orient to the hospital itself, and then the speech department may have their own protocol to follow to train you on policies and have you marked as competent to work on the floors. This could be difficult to coordinate with a full-time job, and sometimes is best if you could coordinate a hospital orientation period with a change in buildings, or with time off.
In the acute care setting, most of your day will be spent doing bedside swallowing evaluations and/or instrumentals. Then, you will be educating patients, family members, and staff on your results. This goes without saying, but you NEED TO KNOW DYSPHAGIA! I don’t mean, “Oh, the patient coughed so I’m putting them on nectar.” I mean know dysphagia! Not only dysphagia, but you need to know normal swallowing anatomy and physiology as well. Know the current research and current practices. Personally, I stay very current on dysphagia EBP and am constantly taking swallowing courses. MedBridge is a good source for swallowing courses if you need a place to start with CEUs. Swallow Your Pride, a podcast by Theresa Richards Ma CCC-SLP BCS-S, is another great source of current dysphagia information. As well as Dysphagia Cafe, a website by Jonathan Waller, SLP, who has concise, well-written articles about dysphagia.
Be prepared upon interview to answer questions relating to dysphagia. Questions could include hypothetical patient situations, as well as information about your previous dysphagia experience and continuing education courses that you have taken.
Be Honest With Your Skills
In the acute care setting, your decisions and treatment can be life or death for some patients. Be honest with your skills in the interview and let the interviewers know that you are willing to learn and also willing to hold or pass off any evaluations that you are not competent to complete. From there, they can decide if your skills fit the needs of the hospital and if you can handle the caseload. To be honest, some small hospitals are like glorified SNFs, and the patient caseload is almost the same as in an SNF. In other settings, such as a larger trauma center, you would be working with complex trauma on a daily basis.
When I started working in acute care, I was not 100% competent in trachs, videos, etc. I let my coworkers know that and was honest with my skills. I passed off evaluations that I didn’t feel competent completing, for patient safety reasons. Slowly, as I worked longer, I got trained in skills I was lacking and developed a stronger clinical skill set. However, to this day, there are still things that I will not complete (e.g. a NICU evaluation). I don’t know the first thing about babies and would hold that evaluation for a skilled clinician.
Money Isn’t Everything
Pay compensation in hospitals varies, to say the least. Some hospitals pay very well, and others not so much. A lot of hospital pay scales are based on years of experience, so as a new grad, pay can be significantly lower than what you might be offered in an SNF. As somebody with 10 years of experience in the field, my hospital rates are actually higher than what most SNFs would pay me. That being said, if you really want to work in acute care, sometimes you need to put the money aside. I always advocate negotiating for a higher rate, however, sometimes I know it’s not possible. Especially when hospitals run on a union pay scale and it’s based on years of experience. In this case, newer clinicians can definitely be locked into a lower rate.
Have a Unique Skill
In the hospital setting, dysphagia might be 90%, if not more, of what you do on a daily basis. Acute care SLPs tend to be very skilled in dysphagia. Across a team of acute care SLPs, each SLP may bring his or her own special skill to the table. For example, one SLP may be very interested in head and neck cancer, maybe voice therapy, or cognitive-linguistic treatment.
Whatever it is, for your interview and for your work, find something outside of dysphagia that you are passionate about and hone that skill. You will be viewed as more valuable during your interview if you have a special skill to bring to the team. Actually, this is quite a common interview question I have run into across acute care interviews. Usually, something along the lines of, “What is a skill or passion you have outside of doing bedsides?” Even if you love every and all treatment, have an answer prepared for this one. Have a skill you are passionate about that you want to share with the interview team. Don’t say, “I like all treatment, I’ll do anything.” Be memorable, have a skill, and have a passion.
Have Good Communication Skills
This may seem like a no-brainer for a speech-language pathologist, but it is not a given for everybody. You need to have good, if not EXCELLENT, communication skills to work in a hospital. Half of your job is communicating recommendations and results to the people around you. You will need to communicate to patients, their families, the nurses, the doctors, the other clinicians you work with, etc., etc. Being a good communicator is a must! Communication is something that is picked up quite easily in interviews. The way you make eye contact, your body language, and the ability to communicate effectively with your interviewers is a must.
In grad school, I interviewed for an outpatient hospital externship and did not get the position. The feedback that I got from the interviewer was that I didn’t get the position because I didn’t pick up on the non-verbal signals that the interviewer wanted me to elaborate and explain topics more than I did. If I couldn’t pick up on non-verbal cues for communication in an interview, they felt that wouldn’t be a good fit clinically.
Practice communication and mock interviews with your friends and family. Ask a family member who knows nothing about dysphagia to have a conversation with you about it. Ask them if they understand, and problem solve what could make your delivery more clear. Also, you can practice mock interview questions with friends and family and get feedback from them on your interviewing skills. After I lost that grad school interview because of missed non-verbal communication, I worked to improve my interview and communication skills. That has helped me tremendously in the long run!
Be Willing To Learn
Ultimately, an ability to learn is a quality that people want to see. You may go into an interview and not know all of the answers, but that’s okay. My friends who apply for jobs in acute ask me “what do I say when if I don’t know an answer”. Honestly, my best advice is to say “I don’t know, but I’m willing to learn”. Demonstrate an ability to learn and willingness to collaborate and work with your colleagues to find answers.
Can I Get A Travel SLP Job Without Acute Experience?
As a traveling SLP, people ask me if clinicians can get a travel SLP contract in the acute setting without prior experience. It truly comes down to the situation, need, mentorship on staff, and competition for the job. I have seen smaller, more rural hospitals who have accepted SLP’s without prior acute experience, but strong SNF experience. That is rarer of a situation and in most cases travel jobs will require acute care experience. Overwhelmingly, if you want to travel in acute care, I would recommend getting experience prior to travel.
To close, if you are reading this, working as an acute care SLP is completely within your reach. The jobs may be hard to find, but they are there. Please feel free to comment below with any questions or email me here: Contact page
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