In article by Jacquelyn Smith for MSN Money, OT was listed as one of the predicted “hottest” jobs for 2016. As a new graduate looking for work, the process was certainly overwhelming for me.
There’s a familiar argument between the opposing viewpoints that you should be a generalist initially, and it’s important to specialize and niche down. In an article in OT Practice, Sharma (2017) discusses this dichotomy, reporting that in “finding the right niche” one could take “short-term assignments to meet expenses.” Additionally, she states that one should be “cognizant of one’s strengths and skills, and how these could apply to various practice areas.” Sharma’s statement perfectly reflects my experience in PRN work.
Using a get a foot in the door method, I took up PRN work post-graduation to meet expenses, and am grateful today that I did. PRN work helped me cultivate my niche interests. However, having experience with PRN work, it certainly isn't for everyone. I will provide firsthand knowledge of what the experience of PRN work is like, as well as additional resources to support the efforts of the new grad job hunt.
What does PRN mean?
PRN stands for pro re nata, and is used to refer to "as needed" work.
In contrast to many positions — like, say, an Air Traffic Controller for an airport — for which job seekers often have to travel outside of the country to their assignments, OTs can find work in at least one type of setting practically anywhere they desire to look.
Of course, knowing where to start, getting your foot in the door, and what area of practice to begin with are also, all important considerations. This is where non-traditional and part-time positions can be useful. Possible terms may include:
- Flex work
Hospitals may use different terminology, but all these positions generally refer to part-time. It will be important to check carefully to see what specific scheduling the job description includes. Depending on the staff schedules at hospitals, PRN work is usually weekends, though in some situations it may be different such as Friday or Saturday.
The value of PRN staff
Both patients and treatment teams can benefit from PRN workers, who often bring new perspectives to existing problems. This might come in the form of new ideas for adjusting a universal cuff, or trialing a new transfer method.
There have been cases where, as a weekend staff member working with a new patient, I might have trialed particular tasks more intensely with success — simply because I was unaware that the patient’s functional level had hit a plateau. A fresh therapist can encourage a patient in a new direction; for instance, when working on independence with lower extremity dressing or peri-cares with toileting.
What a PRN workday is like
Working PRN most often means working weekends. People often sympathize with weekend workers saying things like “aw, I’m sorry you have to work this weekend.” I always respond by explaining how I like working weekends. First of all, one major perk is the lack of traffic for city work.
In all seriousness, while the rehab schedule remains as demanding as the weekday, patients’ schedules tend to be much lighter. This means, rather than running into scheduling conflicts with social workers, doctors, and other staff, rehab staff are the primary event of the day.
Still though, it can be hard to begin a weekend shift PRN. This is because it tends to be an entirely new set of patients. Because the patients are new, I do find one of the most critical habits of success to PRN work is coming in extra early on the first day.
Typically, in the acute rehab setting I work, I will have between 5-8 new patients. I prefer 45 minutes to a full hour to chart review all of the patients. More experienced therapists when working PRN may take only 30 minutes, while other new grads and new employees take a similar amount of time as myself. I find that taking the time to give every patient a thorough chart review has one of the biggest impacts on my confidence as well as the flow of the day.
Weekend staff typically involve a few core staff (full-time, etc.) and then a rotation of other rehab staff working PRN. Working in acute rehab I have noted co-workers in hand therapy, pediatrics, skilled nursing facilities, acute care, outpatient, or even no other work aside from the PRN alone. I myself, am primarily a mental health occupational therapist.
PRN can work quite well in combination with practically any other type of clinical or non-clinical work.
It should be noted, however, that staff support, interaction, and collaboration can often be less available on the weekend. The implications of this are that whatever setting you work PRN, you require a fair amount of readiness to:
- be independent
- advocate for yourself
- seek out doctors
- collaborate with unit staff
For this reason, since I work in mental health as my primary position, I have avoided highly technical PRN work such as treating burns, or making splints, which would be extremely difficult if I only practiced in this area of OT 1-2 weekends per month.
Adjusting to the new PRN job
From my personal experience, the least enjoyable aspect of PRN work as a new grad was a lasting feeling of being new. This was particularly because I don’t work in a similar setting during the rest of the week. However, having worked PRN at the same facility for just over a year, I am becoming far more acclimated and can finally say I don’t feel the new job jitters any longer. It did take a full year for those to go away, however.
One challenge of PRN work is that success is dependent upon the “hand-off” routine. It is sometimes difficult to know exactly what a patient's transfer status is or what the patient’s priorities are. While goals may be set for dressing, a poor hand-off might read in the plan of care section and notes “ work on functional mobility and activity tolerance” or “functional cognition needs.” This usually means more work is needed to read through previous treatment notes to determine what is needed.
The worst feeling (which does occur periodically) is introducing yourself and making a suggestion for the day’s treatment session, such as “let’s go look at the shower equipment and consider a transfer,” or “I was thinking meal prep in the kitchen would be helpful,” and then having the patient proceeds to explode into frustration about how they already did all of those tasks a dozen times and no longer want to.
This experience has a lot less to do with the facility, and a lot more to do with the human experience. Any person who finds themselves in a rehab clinic may be struggling with frustration or self-doubt. Therefore, it is even more crucial as an occupational therapist to be adaptable and ready to provide client-centered care by listening to the patient’s needs and adjusting treatment accordingly.
For this reason, I still carry my functional activity idea lists and cheat sheets I developed in OT school with me to work. I find it all the more helpful to have backup plans for my backup plans. I have found that my background in mental health has come in handy with PRN work too, as a holistic approach to all patients takes into consideration their mental health.
There are pros and cons to PRN work, a diverse experience certainly being a positive. However, it is worth noting that PRN work might not fit everyone’s strengths, interests, or financial needs.
3 considerations before starting PRN OT
- If you are considering a "non-benefited" position, it is helpful to consider health insurance costs. If you are already covered, combining part-time positions and PRN work may be beneficial if pocketing the pay that would otherwise go towards your employer health insurance coverage.
- The 401K or 403B retirement plan is another consideration. Employers won't often began matching a retirement plan until several months to a year after you begin a "benefited" position. Employers may not consider PRN OT work applicable for eligibility with retirement plan contribution matching.
- You can work multiple PRN positions, or look for part-time positions supplemented by PRN OT work. The benefit of this is to have a wide variety of experience in settings and locations. As a new graduate, you should try to develop diversity in your skill set, which can help you both find what area of practice you are passionate about and strengthen your resume for future positions.
High pressure, diverse roles
Of course, if a full-time position with great benefits fits your needs, by all means, take it! However, as a new graduate, it can often be difficult to find that dream job, even (or perhaps especially) if you know exactly what you want to do.
The truth is, I find acute rehab PRN work high-pressure work. The schedule is quite set with little flexibility. This may not be the case in other PRN positions, but in acute rehab, it can be difficult to stay on track. Sometimes I find myself documenting through lunch. It also requires a daily expenditure of courage to meet new people, introduce yourself, and sell why therapy is beneficial.
I have continued working PRN because of the diversity of experience that is so valuable this early in my career. I enjoy feeling valued as a healthcare worker. PRN OT work has especially helped me to understand the diverse role of OT while strengthening my ability to define OT. By working with other PRN OTs from pediatrics, school-based, skilled nursing facilities and hand therapy, I continuously learn about the role of OT in different settings. This experience has led me to be confident in my primary setting of mental health. In the case of beginning a career, knowing what’s out there can be incredibly valuable in making long-term career commitments or choosing to finally “niche down.”
Sharma, V. (2017, November). Finding the right niche as an entry-level practitioner. OT Practice, 22(21), pp. 16-17.
Smith, J. (2015, December). The 19 hottest jobs for 2016. MSN Money. Retrieved from http://www.msn.com/en-us/money/careersandeducation/the-19-hottest-jobs-for-2016/ss-AAfYBFr