New grad with hand on his head

5 Big Mistakes to Avoid as a New Grad Therapist

Are you a new grad therapist? Without ample experience, you’re bound to make a few mistakes here and there. We all have! Now, you could learn from these mistakes the hard way. Or you can keep reading for 5 big mistakes new grad therapists typically make in the field—whether in the clinic, in home health, or on the road as traveling therapists.

Leading Patients in Clinical Rotations

Clinical rotations are designed to help students gain hands-on experience, meet working therapists, and ease the transition from being a student therapist to a working therapist. Now as a PT myself, I’ve worked with various student PTs in their clinical rotations. One thing I’ve observed is that many lack confidence in leading and progressing patient exercises.   

I’ve been there. I remember as a student therapist the hesitancy I felt leading and progressing exercises in the clinic. It was easy to stand beside a PT in my clinical rotation and observe every move. But eventually, the PT would ask me to take over the patient’s treatment, and that switch from passive observation to active participation—even leading—was a little more daunting.

It’s ok to feel hesitant or unsure when you’re just starting out. This isn’t your boards exam, and you aren’t a failure if it turns out you make these mistakes. Rather, you can call them oversights, blind spots, or missed opportunities. By avoiding them, you’ll deliver more efficient and effective care—right from the start.

Travel Therapy Jobs

5 Mistakes Travel Therapy New Grads Make in the Clinic

Mistake #1: Waiting to Start Your Assessment

We all know the acronym for therapy notes is SOAP—subjective, objective, assessment, and plan—but you don’t have to go in that order as you interact with your patient. Your assessment can begin right away, as soon as the patient enters the room.

What do I mean? You can learn a lot from your patient’s body language before ever exchanging a word. How’s their gait? As they walk towards you, take note of any compensations they may be taking from pain or immobility. How easily did they take off their coat? See any pain in their face? Nonverbal cues can reveal how someone is feeling without you having to ask.

But of course, you will ask. The questions you pose to your patient can immediately inform your assessment; just ask them in relation to a functional task. For example, ask your patients, “What kind of things this week were easier to do around the house?” or, “What are you still struggling to do at home?” Their response—whether it’s “reaching high overhead” or “getting in and out of the car”—will clue you in on specific therapeutic exercises to work on later.

Remember, skillful observation is one of your most important assets as a therapist. Couple it with strategic questions and a proactive approach, and you’ll jumpstart every assessment.

Mistake #2: Not Allowing Room for Progress

A common mistake I see in many new grad therapists is choosing a challenging therapy over a simple one, right off the bat. It’s almost always better to start simple, especially early in the patient’s plan of care. If the patient is overwhelmed or overchallenged, they may get discouraged or—worse—injured further. 

For example, one of the simplest exercises in physical therapy is the single-leg stance. It requires minimal explanation or equipment, and the patient will likely be able to comply, to some degree, without much effort. Even a small victory—like completing a simple movement correctly the first time—can boost a patient’s morale and prevent Day-1 discouragement.   

But just because it’s simple doesn’t mean it’s easy. For some patients, standing on one leg is enough of a challenge. As they progress, you can advance the single-leg stance to include side-steps, toe-taps, and other dynamic balance exercises that work on alignment and muscle activation. What started as a simple exercise can be the foundation for a whole series of movements.

Finally, starting simply can help you watch for potential problems later. For example, how a patient shifts their weight to one leg may reveal small movement patterns and compensations that might be harder to decipher and correct in more complex movements.

New grad travel therapy mistakes.jpg

Mistake #3: Not Planning Ahead

Don’t just stop at one exercise; think 2–3 exercises ahead. Planning for a series of related exercises will help optimize your patient’s time and economize their movement across the clinic.

Imagine you’re the patient. If walking is difficult for you, wouldn’t you rather ambulate to the parallel bars once, instead of every time your therapist thinks of something for you to do there? By grouping exercises based on location and equipment, you’ll save time and your patient’s precious energy.

Besides, it’s easier to remember a few series of exercises as opposed to a string of seemingly unrelated movements. In memory this is called “chunking.” When your patient goes home, they’ll better retain and follow an organized plan, whether that’s a balance series or a band workout.

So when you lead your patient, plan ahead and anticipate the next two or three exercises that will best continue your therapy economically and effectively. 

Mistake #4: Not Knowing Your Options

There’s more than one way to cook an egg, and your options for treating each patient are even more diverse. When one exercise isn’t working—because it’s become too painful, or the equipment isn’t available—don’t panic! Simply swap it with something else that will achieve the same effect.

Knowing the full range of tools and treatments available to you is one of the best ways to boost your confidence in the clinic. That’s why I encourage every new grad therapist to write down 15 different exercises (and their modifications!) for treating each situation we commonly encounter. Whether that’s for balance training, shoulder rehab, or total knee replacement recovery, a cornucopia of relevant tools and treatments exist—you just have to know what they are.

Now, if you’re a traveling therapist, what’s available on site may change as you switch clinics and encounter different equipment. But that’s even more of a reason to keep a long list of possible exercises in mind. Not only will a broad familiarity of treatments help you problem-solve in a pinch, it will also keep you out of a boring rut of doing the same handful of exercises for every patient, every week.   

Mistake #5: Starting Documentation from Scratch Every Time

The final mistake holding back many new grad therapists is disorganized documentation. If your note-writing begins as a blank slate, then you’re wasting time and energy.

For many new grad therapists, myself included, we don’t know a better way of writing notes. It’s not something we learned in school. But if, with every patient, you follow the same pattern of evaluation questions, objective measures, and assessment outcomes, then you’re better off using a template.

Documentation templates can help you save time by providing on paper the familiar framework you already follow in practice. Whether you’re in outpatient care or home health, a template will save your brain from writer’s block and help the important details flow freely. 

The best templates include prewritten documentation phrases that you can tweak and recycle. A simple copy-and-paste will keep you from needlessly typing the repeating, recurring events of your treatment so you can focus on what made each session unique.

For example, when I treat a patient with total knee replacement, I usually include ankle pumps, heel slides, mini squats, quad sets and straight leg raises—all standard for that situation. But instead of describing each exercise for every knee replacement, with a template I can instead focus on reporting the patient’s performance, pain perception, and plan for further treatment.

Whether you just started a new job in a clinic or are jumping into travel therapy, there’s still lots to learn to become a successful therapist. But being proactive, planning ahead, and utilizing all your resources—documentation templates included—will help you provide high-quality care to your patients without the rookie mistakes.

Whether you’re an SLP, PT, or OT, we’re here to help make your new grad experience memorable with our Clinical Fellowship and New Grad Programs! Enjoy the freedom to choose where, when, and how you work, with the support and exclusive benefits to kickstart your career with confidence.

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Tim Fraticelli is a Physical Therapist, Certified Financial Planner™, and founder of PTProgress.com. He loves to teach PTs and OTs ways to save time and money in and out of the clinic, especially when it comes to therapy documentation or therapy continuing education. Follow him on YouTube for weekly videos on ways to improve your physical and financial health.

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