Stressed

I am so glad that tomorrow is my last day at this particular skilled nursing facility. They asked if I wanted to work next Thursday and Friday, 1/2 day each, but I'm 99% certain I will say no. Fortunately, they didn't ask me face-to-face as it would be a very uncomfortable conversation. My point person for the agency e-mailed me and I told her I would have to mull it over.

I just can't wrap my mind around their high productivity expectations, greater or equal to 85%. This would mean 7 hours of direct-patient contact each eight-hour day. At my former job, we were expected to have a productivity of 75% (6 hours of direct-patient contact each eight-hour day). An article I read from the Physical Therapy Journal Productivity Among Physical Therapists said "productivity standards include an ideal goal of six hours of direct-patient contact each eight-hour day, an expected standard of five hours of direct-patient contact each eight-hour day".

Now I understand I'm a contract therapist so I am not expected to do case management and care conferences; and thus, my productivity should be higher than that of staff therapists. But sometimes I do have to confer with a nurse, doctor or another therapist about a particular patients or patients and that can take minutes, non-billable minutes. Also, I have documentation for every patient that I see, not to mention learning the mode of documentation which takes learning time.

So given their greater or equal to 85% productivity expectation, I should spend 408 minutes total for direct-patient care. At this facility, my planned treatment time total was 425 minutes for, I'm assuming (especially if I'm billing for this time) direct-patient care. This means I have 55 minutes left for documentation and conferring with the staff (if applicable). Not I'm including rest breaks, which by California law, requires 2 10-minutes breaks if working an eight hour day. If that is the case, then I'd have 35 minutes to document along with other non-billable tasks. For so-so documentation, it's doable. But for good documentation, it's cutting it tight. But when you have an evaluation to write or a few, it certainly is not enough time! Does that seem fair? I think not. Now I calculated my productivity and I was in the ideal goal of 75% productivity.

Some patient's can't tolerate 75 minutes of one therapy session at one time, but when you have 2 continuous 75 minute therapy sessions; I highly doubt a patient will optimally perform nor tolerate it, especially many with co-morbidities. In this facility, they do most of their treatment in a gym and most of the time, they do one therapy session after another. Anyways!!! I'm could go on and on, but I'll spare you....but not Chuck:) At least, I have only one more day there and now I think I'm 100% sure I won't go back.

My First Job in San Diego

Today was my first day back at work and boy, am I exhausted...and I didn't work a full eight hours of work! Taking a few months off has made me a bit unfit for my physical job as a PT.

My first assignment was at a skilled nursing facility, only a 15 minute drive northeast of our place. It's a typical skilled nursing facility...not that I've been to many of them. It's not the nicest facility, Bethany on Pacific is far more superior in cleanliness and appeal; but I wasn't immediately horrified...a good thing! It took a few adjustments since I am used to working at a subacute care facility, especially ETCS.

ETCS has set a high standard and thus, I'll probably be disappointed in the quality and care, especially when it comes to nurses and nurses' aides (cross my fingers, I find a few excellent ones!). Notable things that are considerably different: the agency orientation. I was given a really quick, like five-ten minute, orientation of the facility which is far bigger than the TCU. I knew the gym (where most of the equipment is stored except for wheelchairs which are stored in a shed outside...if you can find one), general location of the rooms (kept going back to the wall posting after every patient), where the bathroom was located (which I didn't use because I didn't have time), and the computerized documentation (though they failed to mention, until I asked, that I could glean more information in the hard chart for the initial evaluation at the nurses station). I wasn't introduced to the nurses or at least where I could locate them if I had a medical problem with a patient.

I guess I'm use to the thorough orientation the TCU gives agency staff, especially with the initial evaluation! I got a very interrupted introduction to the evaluation paperwork process. Fortunately, the computerized documentation is easy to follow. I guess it would of been nice to be completely oriented to it. They were pretty relaxed about it saying that I could finish the Plan of Care tomorrow....ummm, no! Anyways......it's just different. I guess as a contract therapist, I'll just have to learn to bug people a lot with all my questions. I'll adjust accordingly.

One thing I miss about the TCU is that its focus is not driven by minutes. I guess that's what you get when you work for a non-profit versus for profit. Really, and I mean really, is a 720 minute RUG level appropriate for a patient who has Alzheimer's and only receiving PT/OT....I'm thinking, not so much. And that's one thing I'll have to stick to my guns, the appropriateness of minutes for a patient.

Anyways, I think this will be a good experience for me. Hopefully, I'll be able to find a few facilities I really enjoy (and hope they enjoy me), but it's nice to get exposure to the different kinds of places and people. The good thing about it....if you don't like it, then you can decline to return back there! And I'm still undecided about this place...well, I am there until Friday. Stay tuned!

PT License

So I found out two days after taking the jurisprudence exam that I am now a licensed physical therapist in the state of California!! Of course, they weren't quick enough to mail me the results as it was first processed by the Federation of State Boards of Physical Therapy who then sends the results to the PT Board of California. But the PT Board was able to update their database and I was able to verify my license on their website.

I will be meeting with Career Staff this week to complete my paperwork and should be ready to work by the end of this week or beginning of next week. I'm excited to start working as I'm getting a bit bored. I'll be starting per diem, maybe 3-4 times a week and then transition to full-time as I become familiar with the agency and San Diego...and when I get used to the idea of working again!

I'll be working at different facilities in a 20-30 mile radius north/south of San Diego. I'm excited to work as a contract PT as I don't have to work weekends (finally!) as I can make my own hours and when I become benefitted, it still pays more than working direct for a facility. Also, I get paid weekly! We'll see how I like it. One of the downside is not getting familiar with a facility as you may not be there long term.

Sequoia-Kings Canyon National Park

For the Fourth of July weekend, Chuck and I decided to spend it camping at the Sequoia/Kings Canyon National Park. Since it was a holiday weekend, we were debating whether to leave after work on Thursday or wake up early Friday morning. We were betting that one of the first come-first serve campgrounds would have an available camp site. Not looking forward to driving six hours at night, we decided we had enough discipline to wake up early to be at the park by at least noon. We made good timing, but our hopes of finding a camp site were looking dreary as there was a line into the national park. All the campgrounds in Sequoia National Park were full and had to drive to Kings Canyon, 76 miles where we entered the park, and found plentiful of camp sites at the last campground in Kings Canyon. At the second to last campground they had a couple of sites available, but they were unappealing located either next to the bathroom or on a slope. We decided to risk losing them by driving to the last campground. And boy am I glad we did because they had a lot available and not next to the bathroom!

King's Canyon is known to be similar to Yosemite Valley, both being carved by massive glaciers during the last Ice Age. According to the Guinness Book of World Records, Kings Canyon is the deepest canyon in the US with a maximum depth of 8,200 feet.

The Giant Sequoia trees are amazing! The park has one of the largest trees on Earth, the General Sherman tree which grows in the Giant Forest. The Giant Forest contains five out of the ten largest trees on Earth, in terms of wood volume. You don't realize their immensity until you get real close to them and you become disappointed that your camera can't take a picture of the whole tree unless you're far far away from them.

We went on a guided tour of Boyden Cave, a mile-long cavern in Kings Canyon.

Of course, on our way home, we had to make a pit stop! Chuck found Lengthwise Brewery in Bakersfield.

We had a sampler of all the beers brewed there and we couldn't leave without a growler of their beer. We're going to have a pretty big growler collection when we head back home to Seattle! We already have two from Stone (thanks to Chuck's parents who bought us another one), one from San Diego Brewing Co. and one from Lengthwise Brewery. And I think from our first visit to San Diego, we brought one back to Seattle from Coronado Brewery. No more, I swear!! Well...unless they're unique like the Stone growler.

Sequoia-Kings Canyon National Park is beautiful and can't wait to go back again to do more hiking. However, I'm excited to take Chuck to Yosemite as well. We still have a lot to explore of California as well as other places on our list to visit!!

PT Licensure

I just took the California jurisprudence exam and am impatiently waiting for the results. Of course, it would be nice to know immediately after taking the test. I am not sure why they don't as it's taken on the computer and would be easy to let the test taker know of their results instead of worrying about it for weeks! Yes, they said it could a up to a few weeks to obtain the results. However, I did google "how long does it take to know the results of the CLE (California Law Exam)" and a few people noted that they got their results the next day. I'm hoping so!! I hate being in limbo.

Angie, the recruiter at Career Staff, emailed me wanting to know the status of my application. She is curious as to when I'll start working...well, I hope soon! I told her as soon as I get a passing score on the exam and am officially licensed by the PT Board of California, I'm ready to work. So far, the Board has been pretty efficient with my application and hope to be licensed, that is, if I passed the exam by the end of July. And once again, I'll be a working girl!

Wedding Pictures

I've been having a wonderful time reminiscing on our wedding as I'm finally sifting through our pictures. I'm in the process of making a few photo albums, framing our favorite pictures (which are many!) and sending copies to friends. Please be patient as I manage slowly and hopefully successfully through this massive project!

I want to thank Kim and Adam Bamberg of La Vie Photography for their amazing and beautiful artistic job in capturing this very special moment in our lives.

Our New Apartment

Chuck and I moved into our new apartment complex Las Casitas de los Amigos in Hillcrest. Since we are still organizing and unpacking, I'm holding off pictures of the inside until it's ready. Our apartment is in a great location as Hillcrest is centrally located within San Diego and is close to many restaurants, shops and cafes. We are also two blocks from Balboa Park and within walking distance to the San Diego Zoo.

View from the entrance to the apartment complex.

There are eight cottages and we are the second one on the right. We only share a wall with the first cottage. At the back of the complex is a building with four apartments.

Approaching our cottage.

The complex, being old as it is, is well-maintained. Every Monday, as it wakes me up in the morning, the landscapers are mowing, edging and pruning. And at 4 a.m. the sprinkler system wakes Chuck up bright and early...though he has no problems going back to sleep!

I've added a few more greenery to the entrance by proudly displaying my herb/veggie "garden". I love the San Diego weather as it's prime weather to successfully grow plants. I didn't have much of a green thumb in Seattle, but I've done pretty well here in sunny and warm San Diego!

My cherry tomatoes. I also have another tomato plant growing well, though since I bought it later, is still in its premature stage.

In front of my tomatoes and herbs is my hot pepper plant. No peppers yet, but it is flowering.

My "herbs" as Chuck likes to call them, emphasis on the quotations! From left to right, rosemary, basil and oregano. Unfortunately, we haven't been in the cooking mode and haven't made use these flavorful herbs. But we have been freezing the basil as it grows so frequently and hope to use it soon. I'm thinking pesto, Caprese salad...And down below is my peppermint plant which I'm hoping we'll be making refreshing mojitos soon!