Tackling Tough Contracts

3 Simple tips to always make the most out of a tough contract

*Disclaimer – If a facility is truly doing something illegal or unethical please by all means follow the proper procedures and report them.  This post is meant for the jobs that are simply less than ideal but not egregious enough to warrant legal action.

My current contract is simply a struggle.  I drive 50 min on windy, albeit beautiful, Kentucky back roads (up hill both ways), to a small rural skilled nursing facility.  Most of my patients are there as a result of one of two main root causes.  Both self-inflicted.  One being the negative consequences of intoxication – acutely (MVA) or chronically (Alcoholic encephalopathy).  And the other, being in Kentucky, is the obvious lifestyle disease cascade.  The inevitable complications of diabetes, obesity and COPD all rolled into one patient who is ignorant to the devastating effects each of these conditions carry at the terminal end of their natural progression.

As depressing as that all sounds it isn’t even the point of my writing this.  The tragedy of it all is actions and behaviors of the staff at the facility.  Patients are rarely up and ready for therapy sessions by the time I arrive (or even by 11AM some days), CNA’s spend 50% of their time out back smoking and the other half snapping at patients or other staff, and administrators penny pinch to the detriment of the employees and subsequently the residents.  The running joke in the rehab department is that you can tell what level of nurse you are talking to by the number of teeth remaining in their mouth.  It is a rough spot to be in.  (For the record the full RN’s we have are fantastic and I am amazed they can get done as much as they do with the surrounding help)

Now, you might be wondering “why on earth did you take this job!”  Well, good question.  As I have discussed before, Ellen and I have come to see most decisions through the lens of a goal hierarchy.  We are here for the main purpose of spending time close to family.  This was the best opportunity we had to do just that so we jumped at it.  Honestly, it hasn’t been all that bad.  Here is why.

“We cannot choose our external circumstances, but we can always choose how we respond to them.”  Epictetus – Stoic philosopher

For one reason or another I have learned along the way that in a losing situation there can always be something gained.  A silver lining so to speak.  With each contract will come different challenges.  For me currently, there are many.  Other jobs in the past there were very few.  No matter how difficult the contract may be, you too can come out on the other end better for having gone through it.  Much of life is about mindset and focus.  Controlling both can pull you through harsher challenges than a few incompetent nurses aides. 

“Courage doesn’t always roar.  Sometimes courage is the little voice at the end of the day that says ‘I’ll try again tomorrow.’”  – Mary Anne Radmacher  – found posted above my desk at the first job I ever had as a PT

Here are 3 simple tips to always make the most out of a tough contract.

1. Focus on efficiency

All of us have areas in our documentation or treatment that could tighten up a bit.  And if you have a contract with guaranteed hours, the faster you get out of the building the less you have to be in that toxic environment.  Time management skills are a hidden super power.  Being able to more effectively harness this non-renewable resource will provide you all sorts of ancillary benefits.  Struggling to find the right treatment for a difficult patient? Now you will have extra time at work to find the best evidence based care.  The overall stress level will begin to melt away as more and more of your day is spent on your own terms.  During a tough assignment, put the blinders on and challenge yourself to provide efficient and effective care.

2. Focus on personal/professional growth

One thing that all non-new grads understand is that we just have SO MUCH to learn. (sorry new grads, y’all just don’t know enough to know what you don’t know…you know?)  I couldn’t tell you how many Parkinson’s Disease patients I have treated in my career, but guess what, I sure could use some extra study on it.  Even within my own specialty of orthopedics.  I see patients all of the time with new procedures or new to me at least.  The less than glamorous contracts are perfect opportunities to dive deeper and build upon your skills.

3. Focus on patients

My final bit of advice comes from my overly empathetic spirit.  Regardless of how terrible a job is, the person in front of you still is in desperate need of your services.  When I get really frustrated with a job situation I find myself wishing I had more patients on my schedule for the day.  That way I can drive my energy towards providing someone with a good service rather than stressing out over the tone of voice the KMA (Kentucky Medication Aide – CNA who can pass meds) used when talking to me last.

Written by: Stephen Stockhausen