Are you a new occupational therapy grad or current OT student wondering which adult setting will be the best fit once you graduate?

There are many settings for you to choose from, and it can be tempting to jump into the first place that calls you back for an interview.

But trust me, this is not the best strategy. While there are options galore for new occupational therapists, certain settings may not provide you the same growth and experience as others.

If you’re interested in working with adults, I’m here to tell you why you should consider acute inpatient rehab for your first job.

After working in a variety of adult and geriatric settings, I firmly believe that if you want the most experience and growth as a beginning Occupational Therapist, acute inpatient rehab is the way to go.

Here are 8 reasons to consider inpatient rehab as a new grad.

1. You’ll Treat a Solid Variety of Diagnoses

In acute inpatient rehab, you will see and treat more conditions than you thought existed.

And it’s awesome.

Not only will you get orthopedic patients, but you will also see plenty of neurological diagnoses and a slew of other cases that will guarantee invaluable learning experiences.

When I was a new grad, I started in the geriatric outpatient setting for my first six months and saw the same few diagnoses over and over. It was still rewarding, but I didn’t feel like I was challenging myself. Once I started my job in inpatient rehab, I really felt like the brand-new grad that I was.

I spent another six months constantly reading up on interventions like I was back in fieldwork, but it was of course totally worth it now that I feel like I “get it.”

2. Reasonable Productivity Standards

Of the multiple inpatient rehab settings I’ve worked in either fieldwork or professionally, productivity standards have always been 75%. Compared to the SNF’s and ALF’s productivity standards of 85-90% for OTR’s, this is a big difference.

When you’re a new grad, you will need quite a bit of extra time to get acclimated to documentation, protocols, intervention planning, chart reviews, and the list goes on.

When you’re faced with the high productivity demands of geriatric settings, this can be extremely overwhelming and it’s almost impossible not to have to work off the clock.

3. Great Team Environment

Another downside of some settings like home health and certain geriatric facilities is that you might be the only occupational therapist working in that facility.

This was the case for me quite a bit of the time as a floating OT. Granted, I did have physical therapists to work with at times, but about 60-70% of the time I was on my own.

It’s really tough to learn the ropes when you’re on your own. This is a huge reason why inpatient rehab is GREAT.

You’ll always be surrounded by other OTs, PTs, and SLPs. If I ever have a question now, there’s always someone with more experience to give me tips and advice for anything I’m puzzled or curious about.

4. Consistent Schedule

This one was huge for me. In geriatric settings, you might go into work, be scheduled for five patients, and get refusals for half of them.

With your productivity standards, you might only be able to charge the company for two hours. (I can’t tell you how many times this has happened to me.)

Thank goodness for the wonderful 7:00 AM-3:30 PM schedule of inpatient rehab, where I know I’m almost always going to get paid for a full day.

Sure, some days I may only have a half day since I’m PRN, but at least I know it’s going to be worth my time to go.

If you get hired on for a full time position in an inpatient rehab hospital or unit, you can be sure you’ll get full days five days a week. If you get a full time position in home health or geriatric outpatient, it can be much less consistent than that due to fluctuating caseloads.

5. Seeing Patients’ Progress

This one is huge for me, since it’s what drove me to become an OT in the first place.

I loved working with my inpatient rehab patients as a patient care tech and seeing how well they were doing with therapy. In acute care or geriatric outpatient, I’ve found that you either see a patient only a few times and then discharge or the progress can be very slow.

new-grads-consider-inpatient-rehab

Along with seeing your patients progress quickly, you also really get to know them, since you’re working with them every day for at least an hour over a two week (or more) average length of stay.

6. The Day Always Flies By

In inpatient rehab, your patients are scheduled back to back. It can seem pretty crazy at first, but I do really love how fast the day goes. (For a rundown about my day in particular goes, check out my blog post on my average day as an inpatient rehab OT).

You won’t be driving around for hours from home to home (which is usually unpaid time) like you would do in home health. For more home health as a new grad, check out why I say to steer away from it as a new OT.

You also have so much to work on with patients that are in this setting that you won’t be lost coming up with treatment ideas.

7. Fewer Ethical Dilemmas

In general, non-profit hospital systems are going to present you with less “situations” that may have you concerned about practicing unethically in comparison to many for-profit Skilled Nursing Facility therapy providers. To be clear, it’s usually not the actual SNF’s that have issues, but rather the agencies they contract with.

You might notice seeing articles like this one from APTA citing “Top SNF Therapy Provider Settles DOJ Lawsuit for $125 Million” on a fairly regular basis. This is scary when the license you worked so hard for is on the line.

This is of course not to say that there aren’t any good SNF companies out there, because there are! It’s just become hard to find these companies as many focus increasingly on profits and productivity.

When you’re a new graduate, it can be much harder to say no to doing things that you feel may cross the ethical boundaries. For example, treating patients that are inappropriate for therapy.

This is also not to say that some hospital settings may have some issues as well. As a whole, though, I have felt that hospitals are much less “corrupt-feeling.”

8. The Job Itself is Extremely Rewarding

This might tie in a little bit with the “seeing patients” progress” part. However, I have to say that even with how tired I can sometimes be, I love feeling like I made a difference every day.

I can’t imagine working in another setting at this point and am really glad I got into it when I first started out. Your patients and their families will be so appreciative of you, which is a wonderful feeling.

It might take some time applying to multiple inpatient rehab facilities before you get a “bite,” but keep at it. It will definitely be worth it.

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These are the reasons why I personally recommend acute inpatient rehab for new Occupational Therapists.

Do you agree? Disagree? I’d love to hear in the comments what your recommendations are for new OTs seeking to work with the adult population.

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11 comments

  • Grant Mitchlell October 3, 2016   Reply →

    Wow!!!! Fantastic Article, I wish I had read this a year ago before I graduated. Fortunately through alot of questions and patience amid the pressure I came to realize exactly what you wrote here. I am in fact work less than half time in inpatient rehab as a new grad and it is exactly as stated above. I stayed away from home health and snf’s even though they were the easiest jobs. Acute rehab is harder to get for these reasons. I am acclimating well and look forward to developing a strong skill set and then trying home health and SNF’s/TCUs

  • Erika Arndt October 5, 2016   Reply →

    I absolutely agree. It is nice to see an endorsement of my decision to take a job at the rehab hospital where I did fieldwork, because it is HARD. I feel overwhelmed as a new grad, a COTA in a place full of OTs, and a floater (different patients every day.) But every day is full of learning and the chance to make a difference. I think that the key for me has been to realize there will be good days and bad days, and to let go of perfectionism, and to SLOW DOWN, because a new grad doesn’t know all the precautions/procedures/ etc. Another unexpected difficulty for me has been navigating all the comorbidities, in school we studied one condition at a time!

    • Sarah Stromsdorfer, OTR/L October 5, 2016   Reply →

      Exactly! I was extremely overwhelmed the first six-eight months of inpatient rehab even after doing a Level II in it the year before. You really realize when you get out of school how much you aren’t taught, but now I’m thankful for the knowledge inpatient rehab has given me. Your tips are so useful for anyone considering this area as well. Thanks for your comment!

  • Laura November 22, 2017   Reply →

    My first Level II fieldwork is going to be in an acute inpatient rehab facility. Does anyone have advice on how I can prepare? I’m leaning heavily towards pediatrics and I’m very nervous (but excited for) this placement.

  • Sara November 22, 2017   Reply →

    I did my level 2 in a SNF and Peds. I would really like the experience of inpatient rehab but am not sure how to get started? If it was overwhelming for you, it must be even more so for someone like myself. Any suggestions are appreciated.

    • Sarah Stromsdorfer, OTR/L December 3, 2017   Reply →

      My biggest recommendation is to find an inpatient rehab position that has a seasoned OT that will provide mentorship. With mentorship, you’ll be fine! With any new job, there’s always a bit of a learning curve but with time at the job it will get easier.

    • Katherine March 18, 2018   Reply →

      Hi. I also did my fieldwork in a SNF and peds. Did you go the inpatient rehab route when you starting working? Hopefully, mentorship would help, but I am still apprehensive with this being an overwhelming setting for me with no inpatient rehab experience. Thanks!

  • Jess April 12, 2018   Reply →

    Hi Sarah,
    I just listened to your podcast on Senior’s Flourish and loved it! I am a new grad OT and currently working in the acute care setting and I have been feeling super overwhelmed with trying to learn everything and when it’s safe/not safe to see patients. I would really like to get a job in an inpatient rehab setting, but it’s been difficult to get an interview anywhere. My fieldworks were in acute care and peds, and I have no inpatient rehab experience. My question for you is this: what is the best way for a new grad to get into an inpatient rehab setting? Do you recommend specific continuing ed. or other classes/experience that can boost my resume and help me towards an inpatient rehab job? Like you said in this post, I think that’s the setting I will learn the most and I want to develop that connection with my patients and see their progress!!
    Thank you so much for your time!

    • Sarah Stromsdorfer, OTR/L April 16, 2018   Reply →

      I have heard that the inpatient rehab jobs can be harder to get depending on what city you’re in. If it’s taking you longer than anticipated to get hired in inpatient rehab, you could get another adult-based job in the meantime and keep looking on job boards like Indeed.com and apply when you see an opening. It took me 6 months after passing the boards to get my inpatient rehab position but I learned some basics while working in a geriatric outpatient/ALF setting while I was waiting to get my ideal job setting. It might be much quicker for you, though! Best of luck to you in whatever setting you choose!

  • Renee September 13, 2018   Reply →

    Hi Sarah!
    I am a recent graduate and did my fieldwork in a SNF/subacute Rehab setting and in Outpatient. I recently accepted a position in an acute hospital setting where, fortunately, there are many other OTs to learn from.
    There was one full-time OT that recently left the IRF unit there. It seems that many of the other OTs would prefer to stay in the acute setting, rather than the IRF. So, there is talk of moving me up there in a couple months.
    I would be the only OT on the IRF, but the other acute hospital OTs would be in the same building, just on a different level. Do you think this would be enough support? I know I was really looking for mentorship as a new grad. Or, what are some ways to maybe make this transition easier for me?
    Also….are there any good textbooks you would recommend for an IRF setting?
    Thank you so much for your help and any suggestions you may have to offer! 🙂

    • Sarah Stromsdorfer, OTR/L September 13, 2018   Reply →

      Hi Renee,
      Congrats on graduating and getting your first job! I think it might not be a bad idea to try acute care first to learn the basic medical background since you’re already there and have the support of other OTs. It might be hard being the only OT in the inpatient rehab unit, so I would maybe wait until they hired another OT in the unit before switching. It can be a tough setting without a good mentor. If you do decide to make the switch, your Phys Dys textbooks from OT school (depending on which of the two you have) are both really helpful when you’re starting out along with MedBridge online continuing ed courses focusing on rehab. Feel free to email me at [email protected] if you have any more questions, and good luck!

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