Clinical Judgment Consensus Document “Organizations Take Stand to Preserve Clinical Judgment Under Productivity Demands” (November 2014) is great—however, it does not help those working in SNFs [skilled nursing facilities] who are constantly under pressure to meet the needs of their employers. Since returning to work after time off for child care, I have had ... Inbox
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Clinical Judgment Consensus Document
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Inbox   |   January 01, 2015
Clinical Judgment Consensus Document
The ASHA Leader, January 2015, Vol. 20, 4. doi:10.1044/leader.IN.20012015.4
The ASHA Leader, January 2015, Vol. 20, 4. doi:10.1044/leader.IN.20012015.4
Organizations Take Stand to Preserve Clinical Judgment Under Productivity Demands” (November 2014) is great—however, it does not help those working in SNFs [skilled nursing facilities] who are constantly under pressure to meet the needs of their employers.
Since returning to work after time off for child care, I have had three speech-language pathology positions. All resulted in constant friction due to productivity and challenges to my clinical judgment. Last spring, during yet another “reprimand,” I was reminded that I work under a “business model” not a “health care model.” I was soon replaced by a new graduate. Apparently they come cheaper and are less likely to question being told to treat patients who are not appropriate for services or to treat a patient requiring both communication and dysphagia services with 23 minutes daily.
Tomorrow I start a therapeutic staff support position with a dramatic cut in pay to transition to a mental health career. No long commute, no nurses and managers trying to override my judgment. After 20 years in SNFs, I am grateful for family members who thanked me for helping their loved ones, for some great nurses and therapists, and for patients who appreciated my judgment and the progress they made. The system as it exists will not protect ethical therapists who need their jobs, because there will be repercussions. I only hope that the national organizations will work with insurance companies and Medicare more to improve workplace ethics and restore some dignity to the profession.
Wanda L. Pearce Thomas, Punxsutawney, Pennsylvania

Thank you for your letter. ASHA continues to work with other professional associations, Medicare and post-acute care facilities about clinical judgment, productivity pressures and patient-centered care.

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FROM THIS ISSUE
January 2015
Volume 20, Issue 1