SLP's and Graduate Clinician's-- Advice please?!!

I am in my last sem of grad school and one of my rotations is in a SNF. My supervisor is incredibly new to working with adults (she only started the job 1 1/2 weeks prior to my internship-- I was supposed to have another SLP who was promoted). She often says she is learning from me. Red flags went up when she didn't know what CVA, TIA, thrush were, or how to mix water to a honey-thickened consistency. It is very much "do as I say, not as I do". I completely understand as students we just have to do as our supervisors tell us. However, she is having me do OT and PT exercises with pts (teaching them to use a sock aid, and actually doing PT exercises lifting legs, counting reps and all!). To give a clear example, she had me talk with a pt during a co-treat with PT and OT to "fully educate" them on pressure sores and explain why standing was good for leg muscles. I am at a complete loss as to how this has ANYthing to do with SLP. She even said it was not her responsibility to educate on this topic, but she took it upon herself. Additionally, she wants me to "fully educate" pts on nutritional facts that I feel go beyond hydration and nutrition for dysphagia (e.g., protein in diet, calcium, osteoporosis, potassium, etc).

I am the type of person who will always ask for help when I don't understand something-- and as a grad student in my last semester, this is one of the last chances I will have to utilize the advice and help of my supervisor before being an indep. clinician. However, when I respond to questions (none of which I've been taught!) with "I'm not quite sure" or "I would need some help with that" I was told: "You need to stop making excuses when we're trying to learn. It was so upsetting and disheartening because I just want to learn but I do need some guidance on the way.

The QUESTION: I have the option to pull the placement at midterm since I have another placement as well. What would you all recommend doing? This placement is roughly an hour and a half away and I feel I am being somewhat taken advantage of with the COTA and the PTA's when I'M doing their 45 min session in the "co-treat". Additionally, I don't appreciate the feeling of being degraded by being told I'm making excuses when I say I dont know something and genuinely mean it. She did get defensive when I said that it was a hurtful comment-- I feel so confused as to what to do. I personally feel like I want to pull. I would love to hear anyone else's opinions/ if anyone else has been in this same boat.

Thanks so much!
My final internship was at an LTAC (long term acute care). My days consisted of: place Passy Muir valve, watch patient's vitals for 30 minutes, remove valve, repeat. If the patient could verbally communicate, we would make small talk, otherwise we would watch soap operas with them in silence. Approximately a quarter of our patients were cognitively involved but I was told we did not do language/cognitive therapy because it was too hard to meet goals with ventilated patients. Maybe twice a week we would do a blue dye test or watch a doc do a FEES (SLPs weren't allowed to operate the scope).

My supervisors were not bad therapists, but the whole internship felt like wasted time and I didn't feel like I learned anything I could use in a future job. I don't know if I could have switched mid semester but I wish I had tried.
Honestly, I would talk to my graduate clinician coordinator and try to get out of there. Your coordinator may not be aware of the situation. You are there to learn, seem to know more than the person who is there teaching you.

You stunned me when you wrote:
"she didn't know what CVA, TIA, thrush were, or how to mix water to a honey-thickened consistency"
I mean those are basic things an SLP in a SNF setting need to know. I mean its good she is trying to explore new settings , but I would think most SLP's would do some CEU's before switching to a totally new setting like she did.

Anyway,your gut is right, don't waste your learning opportunities (and tuition)
The second she asked me what a CVA was after seeing it on a pts hospital report, I e-mailed my clinical director and notified her of the situation. She, like I, was not aware that she was new to the facility/ population. She said she would never have placed me had she known that. But like you and others mentioned, I'm going to follow my gut and try to get out at midterm. But on a side note-- you're right-- I was taught about CVA's, TIA's and thickening liquids as a junior at my undergraduate. I was shocked when I discovered my sup. was not familiar with the terms.
I had a horrible experience at my SNF placement and when I had the option to quit at midterm (my supervisor was leaving) I jumped on it. Honestly, it's not worth your time. I am spending my time doing independent readings and trying to learn about worthwhile clinic skills. My supervisor would make me do things like talk to a late stage dementia patient (didn't know his own name, can't follow simple commands, can't attend to tasks) for 50 minutes at a time 5 DAYS A WEEK ("speech therapy"!). To me it just basically seemed like Medicare fraud and I hated it. It's a really crappy feeling that as a student you're not learning anything, and I really found myself resenting that. My supervisor barely let me look at a pt's chart to see why they were even there. To sum it up, LEAVE!! (In my opinion :))

Edited at 2013-03-09 06:23 am (UTC)
Thanks SO much for your reply. I'm 100% taking that advice and trying to get out at midterm-- possibly earlier if I can. I am def experiencing similar things to what you mentioned you did at your SNF placement. I, too, can't help but feel like its fraudulent sometimes. I truly do not think all SNF's are this way or that all SLP's in SNF's practice this way. BUT it is quite frustrating--I'm glad I'm not alone in the experience and have fellow SLP's to turn to for advice on LJ! :)
It's not ethical for you to be doing PT exercises (OT, too, but I find that line to be much fuzzier). Working as part of the therapy team is one thing, but she can't have you doing things that she is not trained to supervise (ie not within her scope of practice).

You might want to read through the first two principles in ASHA's Code of Ethics. It might be good to reference when you talk to your placement coordinater.
There's a couple of things to consider:

1) You are PAYING for this. It is your RIGHT as a student to be in a learning and supportive environment. If that isn't happening, get out. (which I'm glad to see you've decided to do)

2) It sounds as though there are ethical issues involved as well. If she is supervising you, then it must be within her job description to be performing the same duties she has you doing. If so - and if she knows as little as you state - she is acting in an unethical manner and potentially putting her clients at risk.

I would strongly suggest you speak with your clinical director and share your concerns FULLY. There may be an ethical obligation to report her to her supervisor. At the very least, there should be no other students placed there.
Holy crap! That's insane!

Like it was said above, you're PAYING for this experience. I second, thrid, whatever. Get out!

That's just so unfortunate. I don't think every SLP or SNF SLP is like that, but it's my (biased I'm sure) opinion, that the pressure to commit fraud is rampant. This is just extreme though. Your supervisor is acting completely against our code of ethics--especially as she is representing competencies with skills that she clearly doesnt have.

I'd be out of there like woah and use it as an experience of what NOT to do.

How sad, as I think co-tx with PT or OT can be extremely beneficial (I do them occasionally but not for a prolonged amount of time), but I stay within my scope (e.g. can the pt recall the steps for a safe transfer, NOT teaching the pt a safe transfer....or can the pt problem solve during a cooking task, NOT teaching them an ADL). That said, OT and PT can also charge for cognitive tx, so it can be tricky. Okay, I'll stop now as that is a tangent like woah. Sorry!