OT Across America: Springfield, IL with Tiffany, Kylie, and Ashley

I’m so excited to share my first “OT Across America” interview spotlighting three OT practitioners from Springfield, Illinois! I loved getting to talk with the three of them and getting to know their unique perspectives about OT in their city.

The three of them were really gracious with their time and met with us at D’Arcy’s Pint where we all enjoyed the delicious and world-famous horse-shoe! If you’re ever in Springfield, you don’t want to miss it.

We spoke with Tiffany McDannald, COTA/L, Kylie Reynolds, OTR/L, and Ashley Reed, COTA/L.

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What drew you to occupational therapy plus a little bit about your background?

Tiffany: I was a early childhood special ed teacher and I got really interested in occupational therapy in my classroom. They came in and worked with my kids in the classroom and I have a special draw two kids with autism and sensory disorders so that was mainly what led me to it, but I’m not doing any of that now. I’m in acute care and I like that too.

Kylie: I became interested in OT because my younger sister has cerebral palsy, so I’ve kind of been around therapy my whole life. We’re only two years apart. And so I just decided on OT because it was the most interesting to me of all the different therapies. I’ve been an OT for four and a half years and I started out doing acute care and outpatient peds. Then did a short time of traveling and now I’m back doing acute care.

Ashley: I was a certified nursing assistant before I became a COTA, I worked in a nursing home and a hospital. And in the hospital I got to work with a lot of OTs and PTs because I had a lot of quads and paraplegics on my floor so I got really interested in OT because it was pretty similar to what I was already doing with self-care tasks. So I looked into it for that. I wanted to go for nursing at first and then I decided maybe OT is more my thing. So I have worked in a SNF and I loved it. And now I work at a transitional care unit at our hospital and in acute care.

How long have you all been practicing?

Kylie: Four and a half years.

Ashley: Four and a half years, almost five.

Tiffany: I’ve been in acute care for two years.

What does your typical day look like?

Tiffany: I usually get to the hospital about 7:00 o’clock and I spend about an hour to an hour and a half chart reviewing all my patients. So I usually have a list of like 10 to 12 patients. So I chart review them and then I hit the floor and check with my nurses to see it’s okay to see my patients. I’ll see a couple of patients, then we have board rounds with our case managers where we talk about discharge or anything that’s holding up discharge. Then I see some more patients. That’s pretty much it. Write a bunch of notes.

Kylie: So mine’s pretty much the same. I get there at 7:00 and do to chart reviews for an hour to an hour and a half. Then usually we do most of our evals as co-evals with PT. So I coordinate with the PT or multiple PTs and see where we’re going to start. And then kind of similar to Tiffany’s – see patients and then we have rounding mid-morning. And then just see more patients, and then typically I do most of my documentation in the afternoon.

Ashley: I begin my day at 8:30 because I don’t like mornings. And I also begin my day chart reviewing for about an hour hour and a half. I try to get my patients in order on which ones I need to see first and I work on the stroke floor mostly. So normally those are the ones that we’re trying to see more often because that’s our accreditation and those are the ones we’re trying to get into inpatient rehab. But I also try to see the people that haven’t been seen the day before or a couple of days or people that need updated notes.

I’m supposed to do my documentation after two or three patients. It does not always happen because once you get into the flow of your day you just want to kind of keep going. So normally after lunch is when I do the bulk of my documentation and then I try to fit in three to four more people before the end of the day. This depends how it goes. Occasionally I have to go to our department, rounding with all the nurses and doctors and put our input for discharge recommendations.

What is your productivity like? And how many patients do you see a day?

Tiffany: Well we’re always in trouble for our productivity because it’s so subjective. You never know when you’re going to get a med cancel or people are going to be too sick. You just never know when you’re going to get stuck in a room for an hour and a half. But, our expectations are to see I think right now it’s like 1 to 1.2 patients per hour. Individually it’s like 60%, but when you combine the therapists with the assistants we’re averaging 90% overall for our department.

Kylie: It’s been kind of changing. It was based off of how many minutes a day we were seeing. And then it was how many patients we were seeing per hour.

Tiffany: Yeah, it flip flops back and forth what they’re going to focus on.

Kylie: It’s just patients per hour now. They want to see 8 patients per day. I feel like I was running around all day today and I got 7 in just because with ADLs, they take longer. So that’s all I can get in.

Ashley: When I get past like seven, I’m like “Hey I rocked it today!” It just doesn’t always happen. It all depends on what kind of treats you were seeing that day. Some treats are only 15 minutes so you get a lot in. Some are 70 minutes and you only get a few in. So it all depends on the day. For inpatient rehab, if we want to get them in there, they really focus on ADLs with them because of the FIM score. So we have to do ADLs before they accept them. And so those take a long time, especially if they’re not totally there yet.

What are the most common diagnoses that you all see in acute care?

Tiffany: We don’t have necessarily assigned floors in our hospitals so we really can see all kinds of patients. But we do kind of have some that we tend to see the most of. So my floors are usually the gen-med or intermediate care floors. Sometimes I’ll float down to some of the cardiac floors so really I see just about anything on gen-med. But generally a lot of older people with pneumonia and generalized weaknesses.

Kylie: I’m typically supposed to be on the neuro floor, but it depends I go from general medical/neuro and usually one day a week I’m in the ICU. In our hospital, it’s a level one trauma center so we get a lot of motor vehicle accidents and trauma. Also strokes, generalized pneumonia patients, respiratory failure, fractures, heart surgery, kind of everything really.

Ashley: I’m spoiled and I get to stay on the neuro floor a lot. So I see a lot. We’re actually a neuro, oncology and surgical floor. So I see strokes, TBIs, and we have a lot of psych on our floor right now because they closed our psych unit. So our psych patients are on our floor a lot; they’re throughout the hospital too. And then oncology patients and I have a lot of abdominal surgeries on my floor. Like Tiffany said we have a pretty big variety of what we see every day. Keeps it interesting.

Tiffany: Our hospital has a huge cardiac department attached to it. And then like she said we’re a level one trauma so a lot of the outlying hospitals feed into our hospital.

What do you like most about your job?

Tiffany: I think what I like most is that every single day is different. When I leave at the end of the day I’m excited about what’s gonna be there tomorrow. What kind of new patients am I going to meet? What kind of new problems are they going to have? And I like that that it’s just always changing. Most of the time you’re not seeing the same person over and over. Occasionally it happens, but generally it’s changing a lot.

Kylie: I like that it’s busy and that I’m not sitting all day. I’m always moving – I like that. And then I like just seeing a bunch of different things and just getting to meet a lot of different people.

Ashley: Pretty similar. I like the variety and everyday is not the same. I get to work with lots of different disciplines: speech therapy, physical therapy, doctors, nurses, respiratory therapy…I work with lots of different people so it keeps things interesting.

What are your biggest challenges?

Tiffany: Really for me the biggest challenge is the whole productivity thing because I want to provide the care that is appropriate for my patient and do what’s best for them. And you know if I have a patient that I need to see for an hour I want to see them for an hour and not worry that I’m going to get in trouble because I didn’t get all the patients in that they want me to see. I just like to do what’s best for my patients. And sometimes that’s challenging.

Kylie: So probably the same thing. Productivity is a big thing. It’s frustrating when you feel like you’re running around all day but you’re still told that you need to see more people when you’re already staying late a lot of the time and trying to do what you can. I think documentation is a big part of it because with Epic you have more access to a lot more patient information but it also feels like it takes longer to look people up and it takes longer to type the notes. So that takes a big chunk of the time.

And then sometimes there are nurses that are not very friendly so it makes it hard to ask them for help or just get them to be on the same page or follow through with what you write on the board for mobility and stuff like that.

Ashley: My biggest challenge is probably productivity. It’s difficult to be productive in acute care because people are sick. They’re going down for tests and they don’t feel good that day. So it’s hard to see enough people. Chart reviewing is a challenge because people are changing every single day so you have to do your whole chart review all over again every single day. It’s not like you can just pick up where you left yesterday because something might have totally changed overnight.

I would say some nursing staff it’s hard to get them to be part of the team. We therapists can’t be throughout the hospital every day so they need to do their part on getting the patient up. Doing other things with them besides keeping them in bed. So it can be hard to get them on board.

What is the job market like in Springfield?

Tiffany: The job market in our area is highly saturated for occupational therapy assistants. We have a school right here in town, and it makes it really difficult to find a job locally and that has an effect on your pay rate. When it’s saturated you’re not going to make as much as you would someplace else with more demand.

Kylie: It’s probably the opposite for OTRs. It’s harder to find them in this area. The main OT schools are in St. Louis or Chicago, so in this middle area there’s not a whole lot. And then on the other hand, I went to college in St. Louis and we looked for jobs there. That market is super saturated so it’s really hard to find jobs for OT or PT in St. Louis. There’s just not a lot of jobs and the pay is a lot less than it is up here.

But then I’ve also noticed in this area that there’s not a lot of job postings for OTRs; they might need one. They had a job posted forever and nobody applied and they took it down. So sometimes you have to do some calling like, “Hey do you know anybody that needs an OTR?” And they will say, “Yes we do. We just don’t have the job posted.” So that’s part of the problem too I think.

Ashley: Like Tiffany said for COTAs it’s oversaturated, but it’s also a very small OT world around here so it’s a lot about who you know. So if you know someone in the field already that’s how a lot of your jobs come. I have a PRN job that I keep because I’m worried that I’m not going to get enough hours at my other one. So I think that’s pretty common for people to have PRN jobs around here because you want to keep in the loop of having a job.

Is there anything unique about OT in this region?

Kylie: Discharge planning is kind of tricky around here. We’re in the larger city in the area and so you have a lot of people from outlying rural communities that are feeding in here and sometimes finding placement for them can be difficult. A lot of them want to go home and there’s not a big home support network in the smaller rural communities.

Is OT appropriately represented in your setting? Do you need to advocate, or is it well known?

Ashley: I think in our acute care around here OT mostly gets ordered as a tag along with PT. I don’t think we get ordered a lot by ourselves. I think PT gets ordered a lot by themselves and most of time we have to speak up – if you want the patient appropriately seen every day then you need to add OT too.

I feel like a lot of times when it’s time to make placement recommendations OT is the one that’s saying, “Well they can walk 300 feet but they still can’t get themselves dressed.” And I feel like we’re kind of brushed aside a lot if we’re the only ones that are saying that they can’t go home. They’re like, “Well PT said they can go home, so they send them home.” So it’s a lot of advocating.

I have many conversations every day about why I’m saying that they can’t go home. I can’t force you to go somewhere, but I’m not going to recommend it because you can’t do these things or you don’t have any help at home. So I think sometimes when the doctors have a push to get them out, as long as PT has said that they’re good, then they’re good. But OT kind of gets pushed aside a little bit. So it’s hard to advocate.

Kylie: I’ve noticed the same thing. I think I feel like it’s better where we work than where I worked before at another hospital close to here. For them, they only had one full time OT for the whole hospital and they had two full time PTs plus two PTAs. And PTs caseload was like 60 plus patients and OT had like 15 to 20. So that was really frustrating. And then here I feel like it’s a little bit more balanced. I feel like at least order-wise they’ll try and put in both PT and OT. That is frustrating when they only order PT – there’s more than just walking. Same things that you said too – that sometimes OT gets brushed aside as far as discharge; it’s not as important as what PT has to say.

How would you rate the compensation in this area?

Tiffany: I don’t know about compensation necessarily compared to other areas but compared to other settings I feel like in acute care our compensation is really lacking. But then you know I have people say, “Well you get excellent benefits where you are.” But when I was looking at being a COTA I wanted to work in the school systems and that was working nine months and still having the same kind of good benefits and at least double what I’m making now in acute care. It’s frustrating too when you hear the nurses are getting a $250 incentive because, “I need somebody to work tonight.” I think we could be better compensated.

Kylie: I feel it’s similar to what I was making at the other hospital in this area. I feel like you make less in acute care than you would like in skilled nursing. I know at the other hospital I worked at they have a harder time finding therapists than they do here so they offered sign-on bonuses there where they don’t do that here. And then in St. Louis that pay was a lot less than what it is here. I mean it’s OK I think for OTRs.

Tiffany: I’m a single parent and with the position that I’m in, when I first started before I got my first raise, I still qualified for state benefits. So you know, I kind of feel like that’s low pay if you’re qualifying for state benefits.

Ashley: It’s pretty low level for assistants vs working in a SNF. I know when I looked at working on a SNF around here, it was ten or eleven dollars more an hour that I would have gotten. It’s quite a bit of a difference. They probably get a little bit more criticism about their productivity but so do we. So which would you rather deal with? Sometimes they say our benefits are better, but I don’t really see that anymore. We just got word a week ago that we’re going to start getting free CEUs, so that’s a bonus. It’s not a lot when you think about it, but once you’re having to do the CEUs they’re expensive, so it’s something.

What are your future plans for your career in OT?

Tiffany: My intention has always been to go back to the school system. I’m thinking I might want to try that. I’d like to have my summers off. And I really miss the kids but I really love acute care too. But you know I think if I go back to the schools then I can still do PRN acute care in the summers. I was a teacher before and I took out all my teacher retirement to go back to school. So I don’t have any retirement other than what I’m currently accruing. So I was kind of planning a working retirement where I would take some travel positions until I find some quaint little beach town I want to settle down in. So I have two teenagers so I was planning in a couple of years when they get out of high school that I would take up some travel positions and just see where it takes me.

Kylie: When I started OT, I thought I wanted to do peds definitely and I was terrified of acute care. Then I had a clinical in acute care and I loved it. So then I didn’t know what I wanted to do. And my first job was acute care and outpatient peds so I got to do both. And now I’m doing only acute care. I think eventually long term I want to do peds full time and then like Tiffany said do like PRN acute care. I think I prefer outpatient peds to school.

Ashley: I plan on being a COTA for five or ten more years, but right now I’m taking classes for a bachelors in health care administration because I don’t have a bachelor’s degree. So if I ever decided I did not want to do acute care or SNFs, there’s not many opportunities here. So that’s just kind of my fallback. But right now I’m happy doing what I’m doing, but in 10 15 years do I still want to be doing all this heavy lifting? Probably not. But for now I’m I’m happy, but I need a backup plan. That’s my plan right now. I thought about going back for OT school but the things I’ve looked up just didn’t seem like it would be worth it. It’s more paperwork, more student loans. Not that I want to be a manager or anything I just needed something else just in case. So that’s my plan right now. I’m kind of a fly by the seat of my pants kind of girl. No plans really.

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Thanks again to Tiffany, Ashley, and Kylie for spending time with us talking about their work as OTs and COTAs in Springfield! We really enjoyed getting to know them and their perspectives in their careers, and we look forward to keeping up with their future plans.

Are you an OT or COTA in Springfield, IL and have some additional perspectives to share? Please feel free to share in the comments below!