So you want to be an acute care Physical Therapist?

What’s the first thing you think of when you hear the words, “Physical Therapy?” I’m going to assume it has something to do with athletics, sports injuries, a torn ACL or rotator cuff. That’s what I used to think, at least. When I first learned about the field of physical therapy, I actually had no idea there were even physical therapists that work in hospitals. Then to say I would eventually be one of those physical therapists who worked in a hospital- ew, gross! Dealing with foleys, IV lines, patients in gowns that aren’t exactly totally covered, and the occasional (or more often than not) assisting a patient to clean themselves up, if you know what I mean. But guess what setting I chose right out of school to pursue? Acute care. What happened to that girl who was afraid of needles, the girl who nearly passed out when completing her observation hours, the girl who cringed at the smell of urine? Well to be honest, I’m still afraid of needles if they’re going in me (eek!) and I can’t exactly say I like the smell of urine.. but regardless, here I am, an acute care physical therapist.

This magical acute care dream did not come to me overnight. I, alike to most of my classmates, wanted to be an outpatient physical therapist. That is, up until my last clinical rotation just two months before I graduated. I had actually gotten into physical therapy because of multiple patellar subluxations during soccer in high school. My first trip to outpatient therapy, I looked around the room and was like, hey, I think I like this. So, my journey began! I completed a 3+3 program, which required me to get observation hours prior to applying as well as during my first 3 years. As I mentioned above, I actually had to sit down, drink orange juice and eat crackers during my observation hours in the hospital. It was always a place that made me feel kind of queasy.

So that brings me to physical therapy school, oh how I miss it (sorry, not really). My first clinical was in acute care. I had an amazing CI, which I definitely think (for better or for worse) can have an effect on how you feel towards a certain setting. He told me, “Acute care is 1/3 what you know and 2/3 how you say it.” Or something along those lines. I remember initially stumbling through my evals, not talking loud enough, not remembering the patient’s name when I walked in the room just after I chart reviewed, lots of little things that I needed to work on. All in all, I learned a lot this clinical, but I was obviously just getting my feet wet and trying to feel comfortable in my skin as a student physical therapist. You know, like remembering all my questions and trying to keep a straight face when a disoriented patient made a strange comment. Truly, I was trying to figure out those 2/3 of how to say things and present myself to my patients.

My second to last clinical was an outpatient clinical. At this point in time I had completed all my coursework and was ready to graduate. One thing I continued to struggle with was my confidence level. As my CI and others told me, “you know this, you just have to be confident in yourself.” Which is so unbelievably true, but difficult to do. For some reason though, this confidence didn’t totally click until my last clinical, which, surprise, was another acute care affiliation. At the time when I was selecting it, I was between picking two outpatients versus one acute care and one outpatient. I was like, well, what the heck, I liked acute care, I might as well try it again and learn some more! So I did.

My final clinical was in the acute care setting in a Level 1 trauma hospital. My CI was a burn specialist. GROSS. When I got the email, I was like, oh my gosh, I am totally going to lose weight from not eating this clinical. I was nervous, to say the least. Needless to say, it was my favorite clinical and my greatest learning experience. I saw all types of trauma including gunshot wounds, traumatic brain injuries, motor vehicle accidents, burns, you name it! I spent all of my time on the trauma floor in between step down and the ICU, it was amazing. This is also where I had my first few experiences with ventilators, including ambulating a patient while mechanically intubated 200 feet! So awesome! THIS is where I started to really fall in love with acute care. The ability to help someone who is critically ill be able to walk again is amazing and such a rewarding feeling. The happiness started showing through me and I know I started radiating more confidence. It’s a wonderful feeling to begin to feel like you (kind of sometimes) know what you’re doing. I’ll never forget one of the PTs there said to me, “You can’t help what you love.” Which is so true. And that’s where I began to really love acute care.

When I was deciding which jobs to apply for, I still applied to both outpatient and acute care. I mean, at this point I just needed a job to pay my loans (ugh). But let me tell you a few reasons I ultimately chose acute care:

1. Working in the hospital requires you to constantly communicate with EVERYONE. You are communicating with nursing, physicians, surgeons, other health disciplines, not to mention your patient. Sometimes you are communicating with more than one at the same time, and sometimes this is not exactly by choice. Working in acute care forced me to overcome fears I had about confronting surgeons about the weightbearing status, asking a physician to order imaging, talking to a nurse about something I saw during my session. I used to be shy, I’m definitely not now. I’ve learned to use simple commands for certain patients, talk in layman’s terms so that family members can understand better, speak louder and more clearly, and re-direct patients who go on a tangent. Communication is so vital to every aspect of acute care whether it is treating the patient or coordinating the care. There’s no way around it, and that’s awesome for someone who is looking to build confidence in those areas.
2. Time management. Those who have worked with me know that I always have my watch on and I freak out mildly when I forget it. One of my professors made it mandatory for us to wear a watch during our clinical affiliations, and it has stuck with me since, for good reason. In acute care, it is in and out from one patient’s room to the next. Although I hate to talk about productivity, it is a thing that must be acknowledged in order to keep a business going. I utilize the stopwatch feature on my watch so that I start it right when I walk in. When I notice my session is coming to an end and I’m at about 20ish minutes, I say to myself – is there something else that is beneficial to this patient that I can do? Educate more? Complete one more exercise (functional, of course)? Obviously I’m not going to stand and talk mindlessly to unethically bill someone, but the watch helps me to manage my time so that I can maximize my efficiency with a patient. If I’m only in there for 9 minutes and I can’t justify a need for anything else, so be it! But you better believe I am respectfully getting my behind out of the room and moving on to benefit another patient elsewhere. I have people to see in my 8ish hour day. Not to mention meetings to attend, maybe something to present, etc. It’s so vital to be able to manage your time appropriately to maintain efficiency in your work.
3. SO MANY PATIENTS. On average I would see 8-10 patients a day. Sometimes I would be able to see these patients for a few sessions, while other times they are gone the next day. This means new patients and new diagnoses ALL THE TIME! AKA more learning and more practice! In acute care, every day is a new adventure, generally with a new diagnosis or comorbidity that you’ve never heard of. Big thanks to google for helping me figure out what some of those rare diseases are. Thanks to my brain and the memory of the patients, now I will never forget it!
4. A full medical record. This means I can check a patient’s MRI of the brain after a stroke or check a CT of the pelvis of a man who just fell. I can read over the full list of medications in a chart, and read up on his last visit to the hospital. Not saying you can’t do this in another setting, it just seems to be a little easier in the hospital. This allows for a more thorough review as well as more practice reading imaging. Sure, radiology probably already wrote up a report about it, but the more practice you get, the better right? Soon enough, PTs will be ordering imaging for all states 😉
5. SO MANY PEOPLE. Nurses, physicians, family members that knew your long lost relative, patients that survived wars, there’s just SO MANY. Not only do we learn and gain clinical knowledge, we also gain a broader knowledge when interacting with others. I learned all about Myanmar from one patient and then heard all about a patient’s elite pole dancing granddaughter. The rapid turnover in a hospital means encountering so many different people all the time. Whether it is learning about a new tool the cardiologists are using or learning about what it was like to grow up in the 40s, there is so much to learn.
6. Vitals! This probably should be higher up on this list, but regardless, you get SO much experience with vitals in the hospital setting, not to mention just reading heart rhythms in general. Besides the fact that the ICU always has them up and on a screen in front of your face, it is also very vital to keep an eye on a person’s vitals before, during, and after a PT session. I swear I whip out my personal pulse oximeter a bajillion times throughout a session. Maybe too many, but I would rather be overly cautious, ya know? And sorry for all of the patients that haven’t been out of bed in days that I take BP of a million times, but your orthostatic hypotension needs to be documented appropriately, just saying 😉
7. Good body mechanics. Because let’s be real, you aren’t lasting long in acute care if you are trying to use your brute strength to stand someone 15x a day. Your body will not like you at all. Body mechanics are vital everywhere, but especially in the hospital, so you don’t end up in the hospital..
8. **Added bonus** – It keeps you a little more fit!? I mean seriously.. constant laps around the hospital (for me, speedwalking or sometimes a slight jog – okay, not really the jog), assisting patients into sitting and standing or into a chair (without a hoyer), or heck even just helping a patient sit on the side of the bed. I’m telling you there are days when I sweat bullets. It’s gross, but then I feel a little better when I don’t go to the gym that day (oops). This setting isn’t for those who may be timid to get a little dirty, that’s for sure.

Now to say I will stay working in the acute care setting forever is silly. Do I love it? Yes. But this profession offers so many opportunities and ways to expand and diversify our knowledge base, it’s amazing! I’m not sure where I may end up, but I know that I love learning and I want to be able to pursue whatever adventure is out there that will offer me the best opportunity to be the best physical therapist I can to my patients. I’m still a “Fresh PT” but I think the options are just about endless 😉

No matter what path you’re on, I’m excited for you! Physical therapy rocks in general (duh), and there’s certainly no “correct” path. But if you’re wondering more about acute care, feel free to get in touch!! Thanks for having me as a guest, Mark!!

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Jennifer Palmer PT, DPT is a “Fresh PT” currently working in VA in both the acute care and SNF settings. She attended Lebanon Valley College in Annville, PA where she earned a BS in Health Science with a minor in Business in 2013 and a Doctorate in Physical Therapy in 2015. In her free time, Jennifer enjoys traveling, hiking, yoga, and trying new things. She also enjoys sipping coffee with her cat and husband. Check out some of her other blogs ranging from Travel to Money-Saving, to more PT inspired blogs such as The Generalist PT and The Struggles of being a Small Physical Therapist.