As Needed: What 4 PRN jobs taught me about myself
By George Barnes MS CCC-SLP
My decision
Deciding to go per diem has been the best and worst decision of my life. For a while, it was great. More money, more freedom, and more experience. I loved and still love meeting different people, seeing different cases, and experiencing the spicy variety that 4 different hospital positions affords me. Yes, I worked long hours, but I love work and I love my job… well, jobs.
I can credit per diem for giving me the opportunity to work in the hospital setting to begin with. I got my first per diem job working weekends in a hospital system in South Jersey. With that experience, I was able to land a coveted per diem position in a major hospital system in New York City. With that on my resume, the rest was easy. Working in 4 different hospitals has given me 4 times the amount of clinical experience I would have gotten otherwise. With the hours I put in, I feel like I’ve seen a whole career’s worth of patients in just the last five years.
“When do you sleep?”
Whenever I tell people I work at 4 hospitals the first question was always the same, “When do you sleep?” Let’s be honest, I ALWAYS make room for sleep; don’t you worry. Next is, “How do you remember which hospital to go to?” Seriously? Google calendar people. It’s not complicated. As long as you stay organized, plan ahead, and know what to expect, the rest comes easy. Plus, jumping from place to place is thrilling and makes it hard for the typical workplace drama to catch up to you. I never minded being on the road driving from place to place either. It was a reason to catch up on my podcasts, audiobooks, or Spanish learning programs. Plus, driving down the highway with the windows down is a nice respite from the stale air and windowless hallways of the hospital.
Let me be frank, the extra money played a big part in my decision to go per diem. The rate is a huge jump from what I made working full time in a SNF. Plus, I can work as many hours as I want as long as the need is there; which for the most part, it has been. Need to pay for a vacation? Catch a few extra weekend hours this month. Want to buy a nice present for my wife? This hospital is looking for Friday evening coverage. The rate and the opportunity provided a financial cushion that I never had before.
The crisis
But all of this changed with COVID-19. Many of the full time SLP’s in outpatient moved to inpatient. The census was all over the place, but often very low as many people were scared to even go near the hospitals. Plus facilities were trying to figure out who they could admit without posing risks to their patients and staff. In the end, I was working less than 20 hours a week. Without paid time off, I started to feel the pain of relying only on per diem work. I couldn’t believe it- we were in a health crisis and I work in HEALTHcare- Where was the job security? The crisis caused a crisis of my own and it made me question my decision to go per diem in the first place.
A new day
I spent all of the time I wasn’t able to work at home taking care of my 2 year old son. Since we couldn’t go to the park, I got creative. We made musical instruments and telescopes out of toilet paper rolls and spaceships and castles out of cardboard boxes. We did arts and crafts until the kitchen table looked like a smurf exploded on it. Instead of singing the newest radio hit, I now find myself singing childhood songs and poems in the shower at the top of my lungs without even realizing it. It wasn’t all fun and games of course, but even the hard times were wonderful because I was with the two people I love most in this world, my wife and my son.
Thankfully, over time, things started to change for the better. The LTACH I work in became a designated COVID-19 recovery unit for the region and began accepting patients from the acute care ICU’s that no other facilities were willing or able to take. The 50 bed facility has successfully weaned, decannulated, and discharged almost that many patients in only a few weeks. I had never been so busy before in my life. We grew in reputation and now have a steady flow of both COVID and non-COVID patients.
Learning balance
I got lucky but I never forgot that feeling of instability. I also never forgot the importance of spending enough time at home with my family. I have decided to promise more of my time to the LTACH because it has been more reliable and consistent than the other hospitals. I absolutely love my work there and I feel that as an SLP we can make a huge difference in the lives of our patients. With such a medically complex caseload, strong team building is needed for problem solving and our expertise is highly valued. Plus, a helping hand goes a long way for people that have been on ventilators for weeks. There is honestly no feeling like giving somebody something to eat or drink after a month or two of NPO or giving them the power of voice with a speaking valve so they can tell their family they love them.
After some creative budgeting, I am now able to be home most afternoons with enough time to hone my juggling skills so I can entertain my son (It’s really only entertaining when I mess up, which is perfect because I’m not very good). After building a trusting relationship with the other hospitals, I can still rely on them for a few hours here and there. My hope is that I can pick up more hours there in the future if the census changes in the LTACH.
Working per diem is all about balance. Dedicate too much time in one place and you may find you lose an opportunity somewhere else. We can’t be everywhere at once. And where I want to be more than anywhere else, is home with my family. And if per diem helps me do that, that’s where I’ll stay.
George Barnes MS CCC-SLP has clinical experience in a variety of settings including acute care, acute rehab, skilled nursing and long term acute care. This variety has developed his specialization in dysphagia management with a focus on diagnostics through instrumental swallow evaluations. His concentration is on geriatric patients with complex medical status. He is the co-founder of FEESible Swallow Solutions, a mobile speech pathology company dedicated to improving access to high quality dysphagia services for patients in the skilled nursing setting. He has a track record of supporting the field of speech pathology by paying his knowledge forward to other professionals via graduate level education, clinical fellowship and student supervision, the Student to Empowered Professional (STEP) mentorship program, ASHA special interest groups, peer review for ASHA course material, the SIG13 dysphagia editorial committee, and participation in various interdisciplinary teams and committees in the hospital setting. He is a multiple ASHA ACE Award recipient for his dedication to continuing education. George actively conducts and supports new research aimed to improve efficiency and accuracy in dysphagia diagnostics, management, and care.
