Episode 1526 - 5 things I've changed my mind about in geriatric rehab

Dr. Julie Brauer // #GeriOnICE // www.ptonice.com

In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Julie Brauer discusses the idea that passion alone is not sufficient for thriving in a career. She mentions that while it is possible to sustain a career solely based on passion, it is not sustainable in the long run. Julie shares personal experiences and acknowledges that many colleagues and friends have also encountered this issue. She emphasizes the importance of considering the entire ecosystem, including supportive management, colleagues with similar philosophies, and a network of supportive friends, family, and partners. Without this support system, Julie warns that burnout is likely to occur and that the initial passion will start to diminish. The episode emphasizes the need for a supportive ecosystem, where managers value and understand the contributions individuals bring to their work. Julie also mentions the importance of growth and opportunities for advancement, as well as being surrounded by like-minded individuals who share a fitness-forward approach.

Take a listen to learn how to better serve this population of patients & athletes.

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EPISODE TRANSCRIPTION

00:00 INTRO What's up everybody? Welcome back to the PT on ICE Daily Show. Before we jump into today's episode, let's chat about Jane, our show sponsor. Jane makes the Daily Show possible and is the practice management software that so many folks here at ICE utilize. The team at Jane knows how important it is for your patients to get the care they need. And with this in mind, they've made it really easy and convenient for patients to book online. One tip that has worked well for a lot of practices is to make the booking button on your website prominent so patients can't miss it. Once clicked, they get redirected to a beautifully branded online booking site. And from there, the entire booking process only takes around two minutes. After booking an appointment, patients get access to a secure portal where they can conveniently manage their appointments and payment details, add themselves to a waitlist, opt in to text and email reminders, and fill out their intake form. If you all are curious to learn more about online booking with Jane, head over to jane.app slash physical therapy. Book their one-on-one demo with a member of their team. And if you're ready to get started, make sure to use the code ICEPT1MO. When you sign up, that gives you a one-month grace period that gets applied to your new account. Thanks, everybody. Enjoy today's show.

01:43 JULIE BRAUER Good morning, crew. Welcome to the Geri on ICE segment of the PT on ICE Daily Show. I'm brought to you by the Institute of Clinical Excellence. My name is Julie. I am a member of the older adult division. Excited to talk to you all this morning about five things I've changed my mind about in Jerry PT over the past, I think it's like eight-ish years now of my career. So I actually have a list of like eight or nine. It keeps growing as I keep thinking about things, but I'm going to try and keep it to around five. And so my hope is that over the past eight years of all the mistakes I've made and the paths I went down and the things I've learned, I'm hoping that someone out there listening today, if I can inspire and encourage you to think a little bit differently, to do a little bit differently, if I can save you a little bit of heartache that I've experienced, then I will call this a 100% success. Okay, so these aren't necessarily in order of importance except this first one. So number one of five things that changed my mind about in Jerry rehab, changing settings will fix your burnout. Changing settings will fix your burnout. It will not. If you are in a situation where you feel really unhappy, you feel burnt out with the job that you currently have and the setting that you currently are in, please know that the grass is not always green around the other side. I promise it's not.

03:08 "CHANGING SETTINGS WON'T FIX BURNOUT"

It's not necessarily that changing settings is going to fix your burnout. Identifying why you are burned out and doing something about the root of the problem is going to fix your burnout. So I'm not going to get into this too, too deeply because I've done an entire podcast specifically talking about burnout and those of you who are thinking home health will fix that. So if you are interested in that specific podcast, send me a message and I will send you the link. But as an overview, I just want you all to know that you have to identify why first before you jump ship. So the why could be a multitude of different things. Is it truly that you are not passionate about an athletic population and you actually are passionate about a more acute, medically complex population of older adults? Is it that you really want flexibility in your schedule and you can't stand the back to back, the back to back schedule of inpatient rehab? You have to be able to verbalize and write these things down about why you are so burned out in your job.

04:51 BURNOUT IN DIFFERENT THERAPY SETTINGS

I spent many years starting out in acute care, getting burned out, thinking that I was going to love inpatient rehab. I was convinced I'm going to have more time with my patients. I'm going to be able to follow them. I'm going to be able to do higher level therapy with them. It's going to be so much better. I went into inpatient rehab. I absolutely hated it. And then I was like, all right, home health, total flexibility. I'm going to be able to see less patients a day. That's definitely going to be the setting for me. Nope, that wasn't it either. What I was doing is thinking that changing up setting was just what I needed to do. And in reality, for me, I came to the conclusion that full time clinical care is what was burning me out. It did not matter what the setting was. And I wish that I would have realized that very, very early on in this process. Now, I learned a lot and I'm really happy that I have experience in all of these settings. However, I could have been much further along in really dialing in what I want to spend my time and effort towards. If I would have thought of that earlier. So those of you that are really burned out, you're thinking about jumping ship. Don't do it. Start to really evaluate those things. Okay, next, you can give a really high quality session and a really efficient session without timing yourself. This is simple. No, you can't know. You absolutely cannot give a really high quality session that is also efficient unless you have yourself on a clock. For the entire session and truly throughout your entire day of doing your job. I think it's really hard because we go from PT school where all we have to do in a day is study, right? Like if our eyes are open, we are like, well, I have to learn the brachial plexus today. And that's all I have to do. So all I'm going to do is sit here for hours upon hours upon hours and study and memorize things from a book. And then we get into clinical and then we get into the real world where we have this thing called productivity. We have to meet while we are also trying to maintain our sanity. And all of a sudden, it is very overwhelming to try and bring quality at the same time as being efficient. So my call to action to you all is put a clock on yourself for your entire day. When you are with your patients, when you are not with your patients, it will change your life. I promise you when I started doing this in home health and you start this just like you start anything, like if you are starting to train for a race, for example, and you know you have to hit certain macros, you need to just start by tracking. What do you normally eat? How many calories are you actually bringing in? So you don't change anything at first. You just track. So you time yourself all of your breaks, your bathroom breaks, your snack breaks, your chatting with colleague breaks, the amount of time it takes you if you are in home health to drive to patient to patient, the amount of time that you are sitting in acute care at the desk and documenting. You time everything. In addition to how long you are actually spending with your patient and how long you are actually doing those subtitles of your session like education or neuromuscular read or gate training, whatever it is, you time everything. You will realize all of your inefficiencies. You will realize, wow, my hourly rate is actually crap. So when I timed myself when I was in home health, I timed everything. And I realized that if I was spending 60 minutes with the patient and I was actually hustling to get everything else done, calling doctors, etc, etc. I was making $40 an hour. Not ideal. Once I started timing myself and figuring out where I could cut, I went from $40 an hour to over $60 an hour. I have an entire podcast just on how to improve efficiency in home health. Again, if you were interested in that, message me and I'll send you the link. So again, my call to action for you all is use your phone. Your lap timer on your stopwatch is really helpful. Wear your Apple watch time every single thing. Start there, track it for a week, and then start chipping away at where you can cut places where you're really inefficient. Not only will you be able to give time back to yourself, which is what we want at the end of the day because taking care of humans all day is exhausting, but your patient sessions, you will get them so much more fit in so much less time. That's a win-win. So start timing yourself.

10:53 PT's DON'T NEED TO TAKE PATIENTS TO THE BATHROOM

All right, next. PTs don't need to take patients to the bathroom. PTs don't need to take patients to the bathroom. That is an OT's job. That is a nurse's job. That is a tech's job. Man, this is one thing that I may be like the most sorry about. What I feel so guilty about for years in my career is that I'm with the patients and I'm wrapping things up, right? I know that I want to get out that door so I can get to my next patient. I'm done. I've done my PT thing and they ask me to take them to the bathroom. It's that moment you're like, I really need to get out this door. And what would I say many times? You know what? OT is coming to see you later this afternoon. They will take you to the bathroom and work on toileting. Then for right now, I'm going to press that button and your nurse is going to come and take you to the bathroom. So many of you have been there. I know you are. I know you've done this. But guys, what do we know happens or not happens? We press that button. Nobody comes. Our patient is sitting there uncomfortable. They may not actually get to the bathroom for a very, very long time. What we know from the literature why we have to change our mind about this and start doing this differently is that many falls in acute care. A very high percentage of them happen in the bathroom. This is avoidable because what is happening? Our patients ring the bell. Nobody comes. And then they have the choice of urinating on themselves or continuing to, and sitting there and waiting or breaking the rules and trying to rush to the bathroom where maybe they're on pain meds, their balance is off, they slip, et cetera, et cetera. We need to realize that is our job. We are not above any freaking job when we are with those patients in acute care. They need their butt wiped. We wipe their freaking butt. That is our job. It is patient care. We are all in this together to get that patient out of this DM hospital and back to their life wiping their butt, taking it in the bathroom. That's included. The very basics of giving this dignity back to this human. It is not a particular person's job. And think about it, even from a self-serving perspective, how much information you learn from taking a patient to the bathroom. You are watching them transfer. It gives them motivation to get out of bed versus like, let's get out of bed and go on a walk and lift these weights, right? You get to see how their ambulatory capacity, right? You get to see their balance. You get to see their problem solving, their stand pivot, how they have e-central control getting down to that toilet. Are they able to problem solve how to sequence those steps? Can they grab the toilet paper? Do they know how to use it? You get so much valuable information. And maybe watching someone toilet and saying, I know that looks off. It seems like they don't know how to sequence this, but I don't know the language to put to it. And I don't, this isn't really something that I understand how to treat, right? Yes, your OT partners are going to be able to take that baton that you hand them after you give them an information. And they're going to be able to do a much better job in that specific task, right? It's collaboration. We need to be setting our patients up for success. Never, ever, ever, ever from today forward, please PTAs ever tell your patient, that is someone else's job, someone else's job. I'll go tell the nurse when I leave. It is your job. You should start planning for this in your sessions. Just give some time before you absolutely have to get out that door. Give five, six minutes to a lot for this patient needing to use the bathroom. It is your job. We are part of a team and you can prevent something drastic happening like falls or someone losing their dignity by literally having to urinate on themselves.

18:21 ALTERNATIVE HOME EXERCISE OPTIONS

Next, weights are the best pieces of equipment to initiate loading with older adults. Weights are the best pieces of equipment to initiate loading with older adults. Look, I love being able to get my older adults, especially those who are pretty medically complex and deconditioned, lifting weights, right? All of you all, this ice crew, your fitness forward, you are incredibly enthusiastic about this. However, if we focus too much on that, I think we can be actually increasing the barrier to loading versus decreasing it, which is our job. We need to realize that the best equipment older adults are using to introduce loading are not necessarily weights. The best equipment are the objects, the animals, the people, the boxes, whatever the odd things are that are in someone's life, an older adult's life, that they will lift, push, carry, pull, hinge. Those are the best pieces of equipment to introduce loading for an older adult. That may not be a weight ever, ever. If it is, amazing. I love it. Bonus points. The best equipment is the one that our patient is actually going to use. I love how enthusiastic we are. And if we can get our older adults lifting weights, wonderful. But ask yourself, like, is this sustainable? Is this only going to be something that they do with me? What am I doing to allow sustainability and longevity of loading with this older adult that they will continue to do after I am no longer caring for them? When our plan of care is over, have I decreased the entry point to loading so much that they have a technique that they can use on their own? Are they going to buy those weights off of Amazon that you've told them? Are they going to have a family member go and buy the dumbbells from Walmart? If they're not, then you better have another option. You better have something that they can use around their home that's less intimidating, that's cheaper, whatever it is. And not over here. Try to introduce the weights, but also give them something that's incredibly, incredibly convenient, right? Where you're decreasing the barrier of making the right choice, which is introducing loading, and we need to make it convenient. So I would argue that while I would bring weights in my backpack, walking around the hospital, I will bring weights in my trunk when I go to see my patients in home health. A resistance band, not a TheraBand, a rogue resistance band, many times was the best piece of equipment to introduce loading to an older adult. It's not intimidating. It's versatile. Not only can you use it to introduce loading and resistance, but I love to use those resistance bands for balance reactions. You can do a lot of perturbations with them. You can put them on the floor and use them as like an agility ladder. They are incredibly versatile. They're light. They're easy to carry around with you. Many older adults are not intimidated by them. Many times, a resistance band is the way to go. Many patients, I am not getting weights into their homes for these really sick folks in home health. It's just not going to happen. They're not going to make it there. So you need to make sure that you have something that is going to be practical for them and it's going to be sustainable. For me, it has been a resistance band. Give that some thought. Maybe go onto Amazon today when you're ordering your other stuff and getting your cart ready for Prime. Add a rogue or some other brand. It doesn't have to be rogue, but a actual resistance band to your cart. Okay. Last one here before we go.

23:53 SUPPORTIVE ECOSYSTEMS IN YOUR CAREER

Last one, most unpopular opinion. You can thrive in your career on passion alone. You can thrive in your career on passion alone. I don't think this is true. I have experienced, and I know many of you have experienced this, many of my dear friends and colleagues have experienced this, that you can survive in your career on passion alone, but it's not sustainable. You have to think of your entire ecosystem. If the only thing that is able to get you up and get you out of bed and get you going to your clinic, your hospital, your patient's home is that you love treating older adults. You love the relationships you build. You were so called to better serve this population. If that's it, if you do not have supportive management, if you do not have colleagues that think in the same way that you do and share your same philosophy, if you don't have supportive friends, family, partners, you are going to really start to burn out. That passion is going, that fire is going to start to diminish. It may not go out completely, but damn, it's going to be a lot harder to keep that going. It is absolutely critical that you are in a supportive ecosystem, that your managers value you. They understand the value that you're bringing. They offer you opportunities to grow and advance and to really stretch your skills that you are surrounded by other people who feel the same way, who want to charge forward with a fitness forward approach. You need to have friends and family and people that you're maintaining your relationships with, and they need to be supportive of what you're going after. You need to create that ecosystem. When you don't have that, I think so many, and I believe this for a long time, as much as I care about this mission, this thing, this job, older adults, as much as I care about it, it will be tempered. That fire will not burn as bright if we do not have the support from all those different parts of our ecosystem. It just gets to a point where maybe you're just running on fumes. Start to think about who your ecosystem is within your job, your managers, your colleagues. Do you have growth? Are you challenged? Are you very passionately connected to your team, to the mission, and about your personal relationships? How are they supporting you? How many individuals have you built up around you that are there to support you? Really start thinking about that. Okay, that's it. I think that was five. Just to review, five things I've changed, or maybe six, five things I've changed my mind about in Jerry Rehab. Changing settings will fix your burnout. You can be efficient and give a high quality session without timing yourself. PTs don't need to take patients to the bathroom. Weights are the best pieces of equipment to use to introduce loading to older adults. You can thrive in your career on passion alone. Five things I've had a massive, massive thought switch as I've gone through my career. Hopefully you all found some of those things to be really helpful. It gave you some things to think about. Please, if any of that spoke to you, do one thing today to change how you think or change what you do. To close this out, I will let you guys know what we have coming up in the older adult division. We have tons of courses. We are going to be in Lexington next weekend. That's our MMOA summit. The entire crew is going to be there. We get to check out Stronger Life with Jeff and Dustin. They're spot there. We absolutely can't wait. We are in Texas, Minnesota, and California for the rest of August. Then MMOA Central Foundations starts next Wednesday. One week from today, our online cohort starts. That cohort is filling up rather quickly. We took a little bit of a break in June and July. If you're interested in that course, I would not wait. I would get your ticket ASAP. All right, guys. Have a wonderful rest of your Wednesday.

25:49 OUTRO Hey, thanks for tuning in to the PT on Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review. Be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our hump day hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.