Examples of OT switching into hand therapy setting
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[00:00:00] Hey, have you ever had this thought that's crossed your mind that oh, I can't do that. That's too hard. Just because you haven't personally seen or known anyone to have done it. I know that's happened for me when, I was first coming out of occupational therapy school. I've heard about therapist.
[00:00:23] Getting jobs and going straight into outpatient and becoming a certified hand therapist within, the five years and all this stuff. But I didn't personally know anyone when I was in school. One of my internships I worked with a certified hand therapist, like you work with them for a short period of time, but you don't really know them.
[00:00:44] More often than not you're stuck in your realm, you're in your head, or also surrounded by people who say, oh, that's too hard. I don't know. I don't know if you can do it right. So then that idea gets stuck in your head I don't know, it's so hard. I'm not really [00:01:00] sure if I can do it.
[00:01:01] Or maybe you believe in yourself and you say, I can do it, but it just seems so impossible and so hard at that moment when you're going through it. I've been there, done that. And I wanna share with you some stories of people who have done it right. And I wanna share, 'cause I asked, I posted this question on Instagram and a lot of people wanted to hear real life examples.
[00:01:24] So not just my own I'll share mine but other occupational therapists I've worked with. My name is Hoang Tran. I'm an occupational therapist and certified hand therapist. I own. A clinic, hands-on Therapy Services in Miami, Florida. And I also help and mentor other occupational therapists and physical therapists who wanna specialize in hand in arm injuries.
[00:01:46] So if you're thinking it's either too hard, I just don't know if I can do it. This this video, this podcast may be for you. I think sometimes this The world of therapy [00:02:00] paints this ideal picture of you graduate from school, you come out and you get this job in exactly the area that you want, and somehow you're supposed to know everything you're supposed to do.
[00:02:11] And that's not how it works. The school just gives you, an entry to play type of car, do you pass, you get your license and you start to practice. And a lot of people come out and they feel like they just don't know enough. And it's true. You just don't know enough, and that's okay. I've worked with therapists who have worked in a lot of different settings and then moved into outpatient.
[00:02:33] So a lot of people follow me and they come and they ask me questions about if I've been working in a skilled nursing facility, if I've been working in peds, if I've been working in these areas, how am I supposed to get into outpatient? How am I supposed to get into outpatient hand therapy when I don't have the experience and nobody hires me?
[00:02:51] Nobody hires me 'cause they don't have the experience. So you feel like you're stuck between a rock and a hard place? I had this one OT who I actually started with [00:03:00] south Texas, and she. She actually was in peds, I think she joined my mentorship program when I first started, like for a month.
[00:03:13] Like I think she joined for a month and then she was like, I'm out. And part of it was because she was in PEDS and she wanted to get into outpatient and she just couldn't see her path. And I told her, I said All your peds kids, they have hand and arm problems. They're coming to you for maybe developmental delays for sensory integration types of things.
[00:03:41] Like there's a slew of pediatric conditions that you could be working with. But if you're in an outpatient peds setting, every once in a while there's gonna be a case that comes. Onto your schedule. That's like a hand fracture or [00:04:00] a finger fracture, or a hand anomaly, a trigger finger handwriting issues, right?
[00:04:09] Handwriting issues. These are huge things. And they all count. They all count as long as you count them. Nobody is keeping track, but you have to give yourself that benefit to say, that counts. And so I think she was in for let's say one or two months and she learned what she could. And I was hoping that to give her the perspective of If you can say that you worked with those types of people with those types of injuries, then you start to take a class or two and then you fix up your resume and you start applying for those positions, you have to apply.
[00:04:47] You cannot jump from setting to setting without applying for the position. Fast forward. I'm now four years into doing the mentorship [00:05:00] program. And she comes back and she sends me an email and she's I just got the job. I don't know if she just got the job, but I, let's just say I just got the job.
[00:05:08] I'm in an outpatient setting. I'm seeing tons of upper extremity and I feel really, really unsure about what I'm doing right. And she's what should I do? So she ended up coming into the mentorship program. Again, and this time she's in the position, right? She's in the position.
[00:05:30] So I just wanna show you that example of someone going from pediatrics. Into an outpatient hand setting. Obviously I'm sharing with you stories of, my students because those are the stories that I have. But sometimes hearing that you can go from peds into hands. It's totally possible.
[00:05:52] And then you just you feel like you're drowning. She's I feel like I'm drowning. I'm so overwhelmed about all these cases. What do I do? There's [00:06:00] another student, actually. She, I met her, I wanna say I met her like a year and a half, maybe two years ago. And she is from Miami. And I think I met her when I was hosting some free stuff at my clinic and she was doing peds and I think some other type of position, but she always knew she wanted to do hands and she just wasn't finding the opportunity here in Miami.
[00:06:29] So she ended up she ended up moving, she got married and she ended up moving to another part of Florida. And in that part of Florida, she got a job in an outpatient, very busy outpatient workers' comp type of setting. I'm like, that's my jam. I love helping people who've been injured at work.
[00:06:51] So it's just it's a whole different Like group of people, when you help people with work injuries, just because it can be pretty [00:07:00] severe and it can be pretty chronic at times. So she finally got this job, she's I'm out in the, no, I'm out in nowhere. I'm like, what? You're not out nowhere?
[00:07:09] Like you're new Tampa. I'm like, I have some people in Tampa. She got the position and she actually started inside the mentorship program. Three weeks before she started her job and it was to download as much information as possible. She was going from peds as well into this really busy outpatient setting, and she just wasn't really sure if she was gonna be able to cut it.
[00:07:33] She's I'm, where do I start? What books do I read? And one of the things I tell people is don't start reading books. Yeah. You'll, if you start reading. Rehab of the hand, you're literally gonna stop at chapter one. Don't start reading. It's, it can be very discouraging if you're getting started.
[00:07:52] It feels so overwhelming. So here's what I tell people when you're moving from one setting into [00:08:00] another setting, you got that job, right? So definitely for sure, the mentorship program was a place for her to get started, and then she could just start downloading a lot of the information, start listening to the videos and stuff like that.
[00:08:11] But if you were to go from one setting, from a ped setting into a hand setting or another student of mine from Tampa, she started in, I digress. She started in skilled nursing. So here's another example before I go into the strategy of it. She has been in skilled nursing. For a really long time, for a majority of her career.
[00:08:34] And she's always been interested in hand. She's something's gotta give. I need to do this. She was actually inside the mentorship program for months. We fixed up her resume. We, started sending it out. She actually connected with some, at an event that I was at, and she got the job in an outpatient setting, real busy.
[00:08:58] Lots of [00:09:00] post-surgical cases and she had already been studying, she'd already been practicing with her older patients, with her geriatric patients. Now she was just going into a more post-surgical, younger pop, more active, younger population, patient population. And she also had so much time to get started.
[00:09:19] It's like, where do you start? Do I start studying from, what books do I need? Do I need to dive into anatomy? And here's what I say. So even it doesn't matter if you're in PS and skilled nursing and home health, this, if you're just now shifting over into that hand, upper extremity outpatient center, here's what you do.
[00:09:41] Right before you get, before you start you interview all that good stuff before you start, ask them for some key cases and examples of patients that will be on their schedule, right? They'll know if you don't start for another two weeks or three weeks, you [00:10:00] ask them, what are the patients that are on your caseload right now?
[00:10:03] Can I get some samples? Can I start to do chart reviews of some cases that you have? Even if they're not going to be on my case, even if they're not gonna be on my caseload, it is gonna allow you to start studying very specifically for those. For those cases, right? Oh, I have a hand fracture, I have a tendon laceration, I have a distal radius, I have a nerve compression.
[00:10:28] So then you start to study specifically those particular types of diagnosis because hand therapy is huge and to think that within two weeks or three weeks that you're going to somehow learn everything that you need to know you're just not. You're just not, so what you start to do is you say, okay, I would I'm gonna have a couple of distal radius fractures on my caseload.
[00:10:52] Okay, let me study distal radius fractures. Where's the distal radius? What kind of surgeries do they do? You can [00:11:00] either, from a conservative standpoint, you can have a fracture and it could be casted and immobilized for four to six weeks until it's stable. And Then once they come out of the cast, you can start doing active motion and then start doing pass range motion.
[00:11:13] So you start to study the protocols, the general protocols, right? While they're in the cast, they wanna be doing Tendon Glide. What does tendon Glide exercises look like? Obviously the cast is gonna stop them from fully having full range of motion. So when you start working with them, you start to think, okay, I have to have great.
[00:11:32] Finger range motion. I need thumb range motion because those are the joints that I can move and that I'm safe to move because nothing happened to them. They're not broken. I'm allowed to move them. How would I move them? And then, okay, I'm now allowed to start doing range motion of the wrist.
[00:11:49] And I'm allowed to do range of motion of supination. Pronation. Okay. So what kind of ac exercises and activities can I do? That will [00:12:00] facilitate. Better movement, right? And so then you start to think, and this is where you're gonna dial into your OT brain and be like, activity analysis. All right?
[00:12:09] Activity analysis people as much as I talk shit about universities and OT programs activity analysis is like a huge foundational. Educational component that the university hopefully taught you. And if you're not putting it into practice, that's your own damn fault. I didn't put it into practice for a really long time.
[00:12:31] 'cause you just think, oh my God, I gotta move this wrist. But take a moment, say, okay, how much motion do they have? How much motion are they supposed to have? And then let me pick an exercise that will actually. Get that motion right. So that's how you start thinking about it. If I've got 50% motion, I can either have them self stretch like this, which is really hard.
[00:12:53] Or I can have them if they do a prayer stretch like this, they [00:13:00] might be able to do it better 'cause they're using their full hand and then they're gonna stretch their tendons of the fingers and the wrist. If I use a table, I could get them to slide and get more range of motion. You can't see me because I've got, I'm standing, but I've got my hand in front of me and I'm sliding my palm towards me, and that's going to increase.
[00:13:21] The amount of passive active assisted risk extension, finger extension motion to get that full very similar prayer stretch type of position. I could use a wall and get the same thing. So that's how you break it down and start to think, oh, what do I do? Number one, you go based on what your clinic or your caseload might look like, and you start studying those cases.
[00:13:45] That way it cuts the overwhelm, right? The other thing that you can essentially do is look at what the therapist before has done, right? This is only possible [00:14:00] if you. Have, are if you're working in a clinic where there's another therapist, another occupational therapist and you're coming in because they, they're so busy that that you're gonna be taking over some of their cases or someone quit and you're taking over their cases, right?
[00:14:15] So what you do is you copy what the other person has done, right? You look at what the other person has done and you essentially copy it, and then you say, okay, now that I've gotten a gist of what they've done, I can now put into play what I should be doing. So that's what I do. When I moved from acute care into outpatient, I started studying the different cases that were come in.
[00:14:39] If I had a stroke, I would study the stroke. If I had a dis radius, I would study the DYS radius. If I had a flexor tendon or study the flexor tendon, I took over some cases. So for shoulder stuff, I didn't. Know what I didn't know. So I reviewed what was done. So they did hot pack and sem. Great. I'm gonna do hot pack and sem.
[00:14:58] They did ultrasound. Perfect. I'm [00:15:00] gonna do ultrasound. They did these exercises. Great. I'm gonna do the same exercises. Until I get a lot more familiar. So you only need that one session to really see, okay, what you know, what else have you done? What have you done that has worked that you like doing? Okay, great.
[00:15:17] We're gonna do that today. And then you might do one thing that's a little different, and then the next visit, because you already saw what that person did the first time you're working with them. Then the second time you have a, a. Like a snapshot image of what that is. And so the next time you can say, okay, the next time I'm gonna work with you, since we worked on, forward flexion and abduction, the next time we're gonna really work on some shoulder extension and rotation.
[00:15:42] I'm just giving you an example. This time I did a lot of manual therapy and range of motion stretching. Next time we're gonna make sure that we paired up with some strengthening and active exercise to, help you continue towards your goal. And those are two prime examples of what you could do if you're, just coming in from [00:16:00] different settings.
[00:16:01] I've seen it happen, I've seen it happen for therapists who work in various settings. I've seen it from peds into hands. I've seen it from sniff into hands. I've hired. I've hired myself, several therapists. One of my very first therapists I hired, she was in a she worked in a skilled nursing facility and I, I hired her because at the time I.
[00:16:29] I was looking and I couldn't find anyone with the kind of experience that I was looking for, but also the attitude that I was looking for a very particular attitude. Can do attitude. I'm willing to do whatever attitude, right? So at the time, I didn't have a full time. Outpatient position.
[00:16:47] I had a part-time, outpatient, part-time home health, and I needed someone who was willing to do both until I grew the outpatient position. And there was a lot of therapists, [00:17:00] who work in outpatient who were, snooty about, no, I will only do hands, I'll only do outpatient hands, right?
[00:17:07] I don't even wanna do the shoulder. I'm like, get the fuck outta here. I like, I got everything. I'm a small business. I need this, right? So I had a need and I needed to find someone who matched it and she matched it and I hired her. And even though she was from a skilled nursing facility she had the attitude, and guess what, she ended up being an outpatient the whole time because I ended up losing that home health contract that I had.
[00:17:32] So I was no longer needing a home health person. Like sometimes I, I just think it just works out. And she stayed with me for a year and a half and then she ended up moving to another She was supposed to move to another state, ended up moving to another part of the state, and from one outpatient setting, she ended up getting into another outpatient setting.
[00:17:52] And then she ended up studying for the C h C exam. It became a certified hand therapist, right? So if it's something you do, if it's [00:18:00] something you want to do, you just have to see that it's possible for yourself, right? Nobody's gonna see that possibility for yourself. Every person that I've spoken to that have seen the success or the jump from a different setting into the hand therapy setting or into more of a post-surgical setting or whatever they have.
[00:18:23] Done the work of number one, first, they have to believe that they can do it right? So part of it's even if it's hard, it's safe for me to do it, even if I've never seen anyone personally do it. I've heard that it's possible and I can see that it's possible for me. I'm capable of doing hard things right.
[00:18:46] And then the belief has to be there. And then number two they have to take action, right? Action is number one. A number two to the belief. So if you believe it, but you don't take action, then over a [00:19:00] period of time you won't. Believe it anymore. So I would have to ask you, if you no longer believe it's possible for you or it's too hard, I would ask you, is it because you haven't taken any action?
[00:19:12] Because it's through action that builds up your belief to see it's possible more and more. It doesn't matter what kind of. Course you take, take a course that's very specific in getting into hands. Don't take a very detailed advanced course. I was, I think I was like one or two years post post degree, right?
[00:19:35] And I took, I was like I'm gonna get into hands. And I took a very specific risk. Course. Holy shit. It was so detailed in the anatomy and kinematics. I could not understand these people. I'm like, are y'all people speaking English, talking about the whatever supination and pronation and scaffold.
[00:19:58] I'm what does that mean?[00:20:00] How is it turning? So much about the risk, kinematics was taught anatomy, kinematics, and then a certain amount of manual. But by the time they freaking got to a manual, my brain was burnt because I didn't understand anything else. And then I didn't know what to do.
[00:20:19] So much of how I teach and stuff like that is a. Is a reflection of. What I went through and how I learned and I was like, what I liked and what I didn't like. But if you're gonna take a class, take something that's going to help you take the next step. I started with a PAMs class so that I can just even have the possible remoteness of getting into outpatient.
[00:20:45] I was doing a lot of wound care in the hospital. Hospital where I was working at. So I just took a wound care class. I was I took the risk class, I took an upper extremity class, like a general upper [00:21:00] extremity class. So I took certain classes just to build my confidence to go, and back then everything was an in-person course.
[00:21:08] And so it's not as easy as it is now. It's funny 'cause I feel like it's so much easier for everyone to educate themselves now, but there's so much, so many options that you can become stuck in the optionality of it all. Oh my God, there's so many options. I just don't even know what to do.
[00:21:25] Like I'm paralyzed. Or just do something. Just do something. If you like it, do it again. Do more of it. If you don't like it, find another one. Find a different path. Find someone who you resonate with. Find someone who you like their style. Maybe it's more of a technique. You wanna be more manual. You want to be more.
[00:21:44] Exercise based, something that like feeds you on what you wanna do, even if you take a class that wasn't as helpful. Like that risk class, oh my God, was like totally over my head and it wasn't helpful for me at the time, but several years later it became [00:22:00] helpful. So I don't think you can go wrong with how you're educating yourself, I think as long as you're taking action, it's so belief, action. And then the action of it is actually, To apply for the jobs. You gotta apply for the jobs. You gotta say, what's that one hard thing that I'm gonna do this year? And I'm gonna go all in and I'm gonna do it right. When I was first starting out, splints or always like easy for me, I was, yeah, splints were always relatively easy.
[00:22:33] I got it, I felt like the artist in me was coming out, but But you know the, I had a hard time with the dynamic splints, static, progressive splints. Those were a little bit more challenging for me. I just made sure I took a class, right? And then I took another class. And so what's that one thing you wanna do this year that, that will help you propel one?
[00:22:57] What is the one thing you need to do so you have more [00:23:00] belief in yourself, right? That you can do it. What do you need to see? Who? Who is an example? I. I tell people, the students in my program, I was like, you've now joined this community where if you don't see it's possible, come in and see who else is doing it because they're doing it.
[00:23:18] If you're an older therapist and you're like, I don't know how I can make that jump there's people in the mentorship program, there's people in the exam prep program who are older who are making that leap. And maybe you just need to see that, that it doesn't matter if you have 20, 25, 30 years of experience like you can make that leap.
[00:23:36] It's possible sometimes you're just like, I need to see it, I need to connect with that person. And so I just connect them. I'm like, Hey recently oh, the Central Florida girls, right? Ladies shouldn't say girls, but. Those ladies, they're like, new in hand therapy and I was like, y'all people need to connect, right?
[00:23:53] So I connected them and then I connected a couple of other people inside. But inside the mentorship program is like, [00:24:00] Hey, you guys are all new. So one of the things that we did that's. That's new is we created a self study room. So it's a place where they can really connect. They can come in, they can hash things out, they can talk about their experiences.
[00:24:11] They can, in a safe and open spot. It's not recorded. It's, it's just, they make the arrangements to get together and talk things through where they can connect and say oh my God, you're doing it. I can do it. And that's the whole point is like sometimes we just need, we need proof.
[00:24:27] We need proof that someone did that hard thing first. 'cause I'll tell you what, if someone did it before you, that means that it's possible. It's not new. I did not see it was possible for me to go from a skilled nursing acute care into outpatient and know how long it was gonna take me. But I did it and I.
[00:24:50] I got into the outpatient setting, I was like, holy crap. Now what? Everyone's expecting me to become a certified hand therapist. I'm expecting myself to [00:25:00] become a certified hand therapist. It is a thing that I wanted to do. And then at some point I was like, I wanna be a business owner. I wanna have my own clinic.
[00:25:10] And that's for a whole nother conversation, but I didn't know. Too many people back then, there wasn't as many examples as there are now. So yeah, just know that if someone else did hard things and they could do it, that means you could do it too, right? But no one's gonna push you. No one's gonna make you, you have to one, have the belief in yourself to take action. Those are the only two steps. All right. Those are the only two steps, and then you take them over and over. You take this, the action steps, then it's gonna build your belief. You believe it. Then you'll take another action step, right? You take the course, you'll fix up your resume.
[00:25:54] You'll apply for the job. They said. No, that's okay. That's okay. [00:26:00] That wasn't for you then. That wasn't for you. Now you apply again. Apply again. Apply again. Apply as many times as you need to until you get that. Yes. But you gotta do the, you gotta do the work. That's my alarm to say.
[00:26:15] Okay, that's it. I'm gonna wrap it up. So I hope this. Podcast video helped to give you a few examples of OTs doing hard things by moving from one setting into, another setting. And I'm giving you examples of ped skilled nursing, this, acute care, home health into outpatient hands.
[00:26:38] But if you're an occupational therapist and you're listening to this, believe it. Believe me when I say if you're in hands and you don't like hands and you wanna move to another setting, you can do it too. You can do it too. It's okay for you to do hard things and you should do hard things. So I hope that helps.
[00:26:57] If this message [00:27:00] resonated with you give me a leave me a comment. Take what you need, leave what you don't, and consider sharing this with any OT that you know. Trying to do hard things. All right, thanks again. My name is Hoang Tran and I will see you soon. Thanks. Bye.
