When looking for Occupational Therapy (OT) positions, there are a number of factors that require consideration, such as where you want to work, what kind of job you want to do and what will be expected of you as an autonomous practitioner. Having just finished my preceptorship year, I hope to offer some reassuring advice in this article, for those who are taking on their first jobs as newly qualified Occupational Therapists.
In the summer of 2018 I graduated from the University of East Anglia (UK), with a 2:1 in Occupational Therapy. Getting my degree was a struggle, as I intercalated halfway through my second year due to illness, meaning that I took a year out and sadly did not graduate with the people I started with. Nevertheless, I formed good relationships with the cohort I went into. Due to prolonged illness during the year I had out, as well as other pre-existing health conditions, I did my placements part-time, which meant three and a half days per week, over a ten-week period, (rather than full-time over eight weeks).
When I graduated I was initially nervous about applying for a full-time position, as I was worried about how I would manage this physically - which was limiting, as most OT positions are full-time. I knew from my placement experiences that I was most interested in working in mental health, as I had one community and one inpatient mental health placement, which were two of my most enjoyable. At this time, there were no OT jobs in mental health in the Norwich area, as Norfolk mental health services were in crisis. I managed to find a part-time job as a recovery worker for Mind (the mental health charity), which I enjoyed and was brilliant mental health experience. However, I realised that I was missing practising my OT skills. I decided to try working full-time and broadened my geographical area in looking for jobs.
Applying for an OT job
There are a number of websites which advertise for OT positions in the UK, but the one I recommend most is NHS Jobs, as this is specifically designed for National Health Service (NHS) staff. When looking at jobs, I started by looking at the whole of the UK, including the Isle of Wight.
Upon reflection, if you are moving for work, I think that it is important to move somewhere which you know will suit you; somewhere you are able to pursue your own occupational interests and where you have a good social network.
Having social support, especially in your first year, is important in maintaining your own mental health. Therefore, the Isle of Wight would not have been a particularly happy destination for me personally. I found two jobs in London which I was interested in; one was a permanent position in a community recovery team (CRT), the other a mental health rotation. I heard back from the community recovery team first; they invited me for an interview and offered me the job then and there. Following this, I was invited for an interview for the rotational post, but having already accepted the other job, I turned this down.
Thinking about who you want to live with can be a significant factor in deciding where you want to work. This may be influenced by obligations you already have or financial factors. I live with my partner, who is doing a PhD, so fortunately he is able to be flexible with where he works. We found a flat just round the corner from the main office, where the community recovery team is based. I had my interview just before Christmas 2018 and started the job in February 2019, so it was a quick process of moving from Norwich to London. We got the keys for the London flat on the Wednesday the week before I started, so it was quite stressful! When looking at jobs and going for interviews, when you will be expected to start a new job is definitely something to consider.
What type of OT job to do?
I was fortunate in that I knew I wanted to work in mental health. However, many leave university unsure of which area they are most interested in. For people who are unsure, doing a rotation is a good idea; it enables you to try out a range of different areas for much longer than you would ever do on placement, before deciding on a particular area you are interested in working in. If you are considering doing a rotation, it is also important to consider where the different rotations may be and what your capacity for travelling to those different areas is.
You may also want to explore a setting which you did not have the opportunity to work in during placement. During my preceptorship year, I met a number of people who were trying new areas; it sounded like the staff where they worked were very supportive and easing them in gently.
Fortunately, OT skills are highly transferable, so if you work in one area and decide you want a change, this is always possible.
What does my job involve?
I am a care coordinator, in addition to being an OT, in a multi-disciplinary community mental health team (CMHT). This means that I work with clients who have a range of different mental health diagnoses, including obsessive compulsive disorder (OCD), bipolar disorder, paranoid schizophrenia, anxiety and depression. Now that I have finished my preceptorship year, I have a maximum caseload of 20 people, who I see minimum once a month, maximum once a week. I complete home visits on my own to clients and use my OT skills with them:
graded exposure work, such as travel training
independent living skills development, such as with finances and cooking
psychological interventions, such as mindfulness and self-care activities
I can refer my clients to other professions in the team (such as to psychology) and refer to a range of community-based services. I attend medical reviews with the psychiatrists and my clients. I also help in facilitating our recovery group, of eight sessions over eight weeks, which we run three times a year. I complete occupational therapy assessments via referral from other care coordinators, which could be assessing functional baseline needs, for adaptations, equipment and for social prescribing.
Starting my first OT job
The first two weeks of the new job were induction weeks off-site, training us in company procedure and protocol, setting us up with laptops and basically introducing us to the Trust. Following this, I shadowed other professionals in our team on visits and was gradually given my own caseload. After about six weeks in the Trust, I had 14 cases. At times this did feel a little overwhelming. Although I had already worked at Mind for six months before starting my OT role, I had only ever had a caseload of nine people maximum. On placement, whilst you may be given the sense of managing a caseload, you are never fully responsible for these clients - so it did feel like a huge amount of responsibility. I remember being shocked to discover that some of my more senior co-workers had caseloads of up to 30 people, thinking that it was utterly amazing they could care coordinate this many. However, they have had years of experience and plenty of time to develop their skills. Working with people who have this experience is really good for your own development, as you can draw on the skills and advice of others in your team. I felt that my team was very supportive and always there for me.
It is really important to be kind to yourself in these earlier stages and not compare yourself to anyone else. I found this difficult when I first started to work with some of my clients; they would talk about how good their old care coordinator was, but I realised they had worked with that person for a long time and had formed a good relationship with them, so this change was also difficult for them.
It is easy to think that, now you are qualified, you should know everything and to feel the urge to prove this. The reality is, nobody expects you to be the finished article straight out of university.
In fact, no one is ever the finished article; everyone has their own weaknesses and areas for development and we all have our good and bad days. If you are unsure of something, you should speak to your supervisor or someone else in the team before taking action; as with placement, you should continue to have regular supervisions, which are a good place to discuss any concerns.
In light of this, I attended a Band 5 development group once a month, where other newly qualified practitioners would present a case study of someone they had worked with. We were given time to talk to each other and discuss any problems we might be having at work. This was a really good opportunity to develop our skills and learn more about the different areas of OT. I also attended preceptorship training. This seemed to be very directed towards nurses; they made up the majority of the attendees and there were complaints about this. I understand that they are changing the programme, to make it more generic. I’m sure that how preceptorship programmes are run is different in other places.
I would also recommend having a look at what events the Royal College of Occupational Therapists (RCOT) is running, or those of your country's professional body. These are brilliant for your CPD and learning, really well run and a good opportunity to meet other professionals. You should also have a reduced caseload in your first year, to allocate more time to your learning and development.
Managing the demands of your own life
Working in healthcare is demanding. During one of the preceptorship days I attended, another girl summed it up well: "Sometimes it is difficult going to see clients, when you feel like rubbish yourself." With my clients I create care plans; it is important to think about this for yourself, to avoid burnout. For example, having a list of self-care activities and taking time away from everything to look after your own needs.
Think about what you would recommend for your clients and apply this to yourself; for example:
diet and exercise
social interaction (outside of work)
occupational engagement in enjoyable activities
Basically, think about the self-care/leisure/productivity model. As I mentioned earlier, I have my own health conditions; following this model of self-care is what has enabled me to successfully work full-time.
I have included this as it was something that I found hard to adjust to, especially coming straight through school and university and having friends as teachers (who get the school holidays off). Going from 18 weeks off a year to five is quite a change! I know that this is something many new starters find is an adjustment, even those who have worked prior to doing their university courses; it is easy to get used to long holidays. This is also important to include, as it plays into the self-care aspect of avoiding burnout. I would recommend structuring your annual leave, so that you don’t take it all at once and you have time off every few months. Whilst you may want to go full speed into the job, I recommend thinking at the start about when you would like to take your annual leave.
Overall, I feel that I have learned so much from the last year, which I will take forward on my career journey. I love being an occupational therapist. I love feeling that I am bringing meaning and purpose to the lives of others and supporting them to fulfil their potential; I wouldn’t want to do anything else.