The flowers are blooming, the birds are singing, there’s the smell of grass as people are out mowing their lawns, the days are lasting longer, the sun is beginning to shine and Easter is behind us. It’s May and soon many trainee speech and language therapists will be finishing off clinical placements, submitting last assignments and sitting their final exams. Within the next couple of months they will be qualified, looking for and starting their first jobs. So, with that in mind this month’s blog article is addressed to them.
Studying for a speech and language therapy degree is demanding. It’s academically rigorous; I still quake at the thought of all those linguistics lectures I attended. I found them really hard going and shed many a tear trying to get to grips with information that I just did not understand, despite reading through academic books that were akin to “wading through treacle”.
It is also time consuming with long study hours (approximately twice the normal contact and study hours of a regular degree). Many a night was spent up studying til 2am.
In addition, you’re actually doing two things simultaneously. You are studying for a degree but at the same time you’re training for a profession too. Most of you will be familiar with clinical placements where you had to quickly acquire new skills, adapt to physically and emotionally demanding environments, foster new attributes such as patience and emotional resilience, and all whilst under the pressure of constantly being assessed and trying to prove yourself. I remember at the end of my degree thinking “thank goodness it’s all over and I will never again have to be observed under that level of scrutiny again”. I find it quite funny now that what I thought of as an ending, was in reality just beginning.
So, here is a list of all of the things that I wish I’d known when I was first starting out in the profession, with advice from my colleagues at Integrated Treatment Services thrown in for good measure:
Pressure
Throughout your career you will experience pressure to varying degrees, but in my opinion it will probably never be as great as it is in the beginning. When you are a newly qualified practitioner you’re full of optimism and enthusiasm and keen to make a start. It’s exciting, but you’re also nervous and worried about making mistakes. What if you don’t know something? What if you get it wrong, what if you forget something, what if you make a mistake? It can be nerve-wracking as you don’t want to get something wrong or let anyone down. You often feel totally unprepared. You can put yourself under immense pressure.
These are all perfectly normal thoughts and feelings and there would be something wrong if you did not feel that way, after all you’ve been training and preparing for this moment, for years. Most people come into this profession precisely because they care and a by-product of caring is that it has the potential to put us under pressure. Be kind to yourself though! No-one will expect you to know everything straight away. In reality, none of us are ever fully prepared and no-one knows everything. We all regularly have to research evidence based practice and the best approach to use with our patients. It’s a constant learning process. That’s one of the lovely things about our profession – there’s always something new to learn. Also, our patients are all individuals and are unique. They often present with complex difficulties and life situations that rarely resemble what you’ve read in academic books. In fact, I never met a patient yet who presented exactly the way described in academic books/journals. They’re all different. Even highly experienced therapists come across unusual cases every now and then in their career, where they need to do some extra study to find the answers they need. That’s why we have continuing professional development, case discussions, mentoring, clinical supervision and peer support.
Remember that you are newly qualified. Be confident in your own abilities. I’m placing emphasis on the word QUALIFIED here. QUALIFIED, means that you have had enough clinical experiences to do your job. It also means that you have been judged by a number of professional bodies to be competent to practice. Remind yourself of this often in your early days. THINK QUALIFIED! I promise you that you know and remember far more than you think.
Clinical supervision
You need to look after yourself as a clinician. Cabin crews on aircraft are urged to put on their own oxygen masks first in an emergency, as without it they can only help others for a short period before running out of air. They are not effective in their job without the tools that enable them to do it. This is true of clinical supervision. Clinical supervision is:
“A term used to describe a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations” – Department of Health 1993
It’s a requirement and obligation for our profession to have regular clinical supervision, but it is more than just a requirement. It’s a tool that enables you to do your job effectively. It’s a tool that facilitates constant growth with the clinician. It’s a necessity for many reasons:
- Firstly, clinical supervision facilitates clinical governance by improving the quality of patient care. It also fosters improvements in risk and performance management. It enables you to practice safely and to grow and develop your skills further.
- There will be many times in your career when you want to reiterate your clinical decision making with someone with more clinical experience than you. There will be times when you need to discuss a case to get some more ideas. It always amazes me how clinical supervision can clear your mind about patient care and the best way forward.
- Alternatively, there will be times when you need to discuss how a case, or working with a patient has made you feel. Within the last year, two of the SLTs within Integrated Treatment Services, had patients that they had been working with for a long time, pass away suddenly and unexpectedly. It was deeply upsetting, because we had come to know and care for those people very much. The chance to express these emotions in clinical supervision was really helpful. Inevitably there will always be times when you will want to cry as a therapist, either through frustration or compassion, or a mixture of both. That’s because we’re a caring profession and are invested in the lives of our patients. It’s inevitable and a good thing as long as we remain professional. We share the highs and the lows with our families. Clinical supervision provides a safe space to express this.
- There will also be times when you feel euphoric because someone has made a break through. This is always exciting and it is human nature to want to share the “woohoo” moments. In a profession where confidentiality is an essential, you cannot discuss your work with others in the way that you would if you worked in another job, so clinical supervision is a good opportunity to do this too.
Make sure you’ve got good clinical supervision in place. In a busy workplace this can get forgotten. If this happens don’t be afraid to chase it up. Lack of supervision can really add to feeling under pressure.
Peer support
Peer support is essential. Opportunities for clinical supervision will be limited. Try and arrange some peer support for yourself. This could be with another therapist in your team or practice, or someone you have trained with. You could try and set up networks amongst your friends from uni (as you go your separate ways). Just make sure that you maintain confidentiality in your discussions. Don’t discuss anything that would lead to establishing the identity of your patient. There are groups on social media that are devoted to the sharing of ideas and peer support. These are popular because the opportunity to bounce ideas off one another is invaluable. The sharing of ideas makes such a difference. We constantly learn from each other and it also saves time. Much of the life of an SLT is spent preparing resources, so anything that saves time is such a benefit. Don’t be afraid to share. If you’ve developed or discovered a therapy resource or idea that has been successful, then share it with your colleagues. If you share, they’ll share and “paying it forward” will benefit everyone.
Reflective practice is your friend
Engage regularly in reflective practice. If you do so it will be your best friend. It’s essential and contributes to your clinical supervision sessions. Speech and language therapy is VAST. There are so many clinical areas you can practice in and there is so much to remember. When you are newly qualified this can feel daunting. You cannot possibly remember everything and you don’t need to. It’s alright to say to a patient/carer “can I go away and think about that so I am giving you the best advice possible”. Tell them you want it to be evidence based and holistic. This is the truth and will show them that you are thinking about them. Use reflective practice to facilitate this process. When you’re putting together an assessment or management plan ask yourself “why am I doing this”, or “why do I think this is the best thing for this patient”? If you can provide a good rationale for it, then it probably it the best course of action. Thinking about a rationale, reflecting on what went right/wrong can be so helpful to your professional development to providing the best possible care.
It leads to you constantly adapting and changing to deliver the best care possible. Establish good reflective practice habits right from the beginning.
Competencies
As you develop regular reflective practice not only will it improve patient care, but it will help you start to gather evidence for your NQP clinical competencies.
Get into good habits right from the start– read the Bulletin and journal articles each month to prepare you for when you are certified and have to complete a certain amount of CPD. Some of the competencies that you have to provide evidence for are based around evidence base, so regularly reading these will help you complete them.
When I qualified I was given conflicting advice about completing NQP competencies. Some of my university tutors told me that “this will be the only time in your career when you are not under a lot of pressure, so take your time completing them”, whilst others advised me to start straight away. The general consensus among our team is to not delay starting to gather evidence for your competencies. It’s a massive task. Usually you need about 91 pieces of evidence to complete them. The sooner you start the better. My advice would be to set aside time each week and look at what you have done in your caseload that week. Then take a look at the clinical dimensions and see which one you may have acquired evidence for that week whilst meeting the needs of your caseload. When you do this regularly you not only keep on top of it, but you become familiar with what is required, so it’s easier to tick something off. Sometimes it can be hard to think of ideas of activities to evidence competency. This is where a network of peer support is useful. Ask your peers and colleagues for ideas and suggestions. This is an area where you can copy each other. You have different patients so it isn’t plagiarism to use the same idea for evidence as another therapist.
Be prepared
Once your exams are over and you’ve finished university, you may have a little bit of time off. Although it’s tempting to do nothing but leisure activities, (after all you’ll be shattered from all that studying for years), don’t waste the opportunity. Start to prepare activities, games and resources that you can use for the future. When I asked my colleagues what advice they would give to you, this was a universal answer. We seem to spend a lot of time printing, cutting, sticking, and laminating (often at midnight), so if you have stuff prepared now it will help you further down the line. Think to yourself “what 10 activities could I do with the pack of naming cards”, or “what resource could I put together for a speech activity” and then go and make them.
Also start to think about what toys/games you will need? Even though we have an office full of stuff, many of us have our own materials that we’ve acquired over the years and could not do without. Having it at home, available at your fingertips is useful. Visit £ shops, charity shops and car boot sales, and start to buy things that you like and think will be useful. I was delighted to buy Pop Up Pirate (that SLT essential) for 25 pence at a charity shop. I’m still using it. Get yourself some stickers, bubbles, colouring pens, wind-up toys as well. You’ll use them too.
Training
Go on as many training courses as you can. You literally can’t have too much knowledge. It will also help you establish good CPD habits.
Ask questions
Remember that there is no such thing as a stupid question. Don’t be afraid to ask if you’re not sure of something. Therapists, who ask questions, learn. Everyone will be willing to help you. We all remember what it was like being an NQP. Ours is a caring profession and that starts with our colleagues too.
Enjoy yourself
Amongst the stresses of starting out, remember to enjoy yourself. You’ve worked for years for these moments, enjoy them. Make sure you laugh regularly. We see some challenging situations, so develop a sense of humour early on and it will help you. Obviously, remain professional, but find the humour in situations.
Finally…….
Welcome to the world of speech and language therapy. It’s a wonderful profession and a privilege to work with the people we do and share their journeys. We make a real difference to people’s lives.
Congratulations on becoming an SLT!! Good luck in your future career xx
Written by Alison Mann on behalf of Integrated Treatment Services
