Dear New Grad OT: Things I Wish Someone Had Told Me

Dear New Grad OT,

First, take a breath.

You made it through anatomy, fieldwork, boards, and at least one moment where you seriously questioned all of your life choices. That alone tells me you are more capable than you think.

Now let me tell you a few things I wish someone had told me when I was standing exactly where you are.

You Are Not Supposed to Feel Confident Yet

You are going to feel like everyone else knows what they are doing and you somehow missed a memo.

You did not.

Confidence in OT does not come from textbooks. It comes from repetition, mistakes, uncomfortable moments, and learning how to recover when a session does not go as planned.

Feeling unsure does not mean you are bad at this.
It means you are new.

I promise you, my first year looked like a group text full of panic. There were countless calls and messages with the friends I graduated with that all boiled down to the same thing:
“OMG… we did not learn this in school. What do I do?”

Turns out, that feeling is basically a rite of passage.

Side note: I also carried around a pocket size spiral notebook everywhere. Not for profound reflections, but so I could quietly write down things I heard in the hospital or saw in charts that I had absolutely never heard of before. Then I would go home, Google everything, and pretend the next day like I had known it all along.

No shame. Just survival and learning in real time.

You Will Not Find “Your Thing” Right Away

Some people graduate knowing exactly where they want to work. Some do not. Both are normal.

You might start in one setting and swear you will never leave it. Then you will.
Or you will leave and circle back years later.

Your career is allowed to evolve.
You are allowed to change your mind.
You are allowed to outgrow roles.

OT is a broad profession for a reason.

When I was in OT school, almost everyone swore they were going into pediatrics. It was the plan, the dream, the setting everyone talked about. Fast forward a few years, and very few of them actually ended up there. Not because they failed, but because real life, opportunities, and interests shifted. It was one of my first lessons that your first plan does not have to be your forever plan.

Productivity Is Not the Same as Value

Someone needs to say this out loud.

Your worth as an OT is not defined by units, productivity percentages, how fast you document, or how busy your schedule looks.

Good therapy is thoughtful, intentional, and human. None of that fits neatly into a spreadsheet.

Learn the rules so you can work within them, but do not let them convince you that you are replaceable or insignificant. You are not.

I still remember a travel assignment where I was written up on day two for not hitting 98% productivity. Day two. I barely knew where the bathrooms were, let alone how I was expected to function like a fully seasoned staff member. That moment made it painfully clear that productivity targets and real value are not the same thing.

Trust Your Gut, It Is Smarter Than You Think

If something feels off, it probably is.

If a client needs something different than what was prescribed, pay attention to that.
If a plan is not working, you are allowed to change it.
If a job does not feel right, you are allowed to leave.

Clinical reasoning is not just logic. It is intuition shaped by experience. Yours will grow faster if you listen to it.

One thing no one really talks about in acute care is how often therapists are the most consistent members of the treatment team. Nurses rotate, physicians round and move on, but therapy is often the steady presence day after day. We notice the small changes because we see patients move, think, and interact over time.

I once had a patient where something just felt off. I had seen her that morning and again later in the day, and the change in her mentation was subtle but different than anything I had observed in previous sessions. It did not sit right with me. I spoke up, pulled the alarm, and sure enough, she was having a series of mini strokes. That moment reinforced something I carry with me to this day. Clinical intuition is not guesswork. It is pattern recognition built from presence, consistency, and paying attention.

You Do Not Have to Do OT the “Traditional” Way

There is no single right path.

OTs work in hospitals, homes, schools, businesses, courtrooms, gyms, and places that did not even exist when your textbooks were printed.

Some OTs treat.
Some teach.
Some consult.
Some build businesses.
Some do all of the above.

You are not failing the profession by doing OT differently. You are expanding it.

Early in my career, I was intentional about working in as many settings as I could. I wanted to know a little about a lot. Especially as a travel therapist, being a jack of all trades mattered. Every new setting, population, and pace added another tool to my toolbox.

Even with all that variety, my heart kept pulling me back to hospitals, acute care, and ICUs. That foundation shaped how I think, how I assess, and how quickly I read a situation. Looking back, all of that experience has carried forward in ways I did not expect. It shows up now in how I problem-solve, how I run my own business, and how confidently I make decisions. None of it was wasted.

Burnout Is Not a Personal Failure

If you ever feel tired, frustrated, or disillusioned, that does not mean you chose the wrong career.

It means the system is hard.

Protect your boundaries early.
Rest before you think you deserve it.
Find people who remind you why this work matters.

You are allowed to care deeply without sacrificing yourself.

There is a reason a Facebook group called Alternative Healthcare Careers for Rehabilitation Professionals exists and has more than 67,000 members.

People walk away from therapy all the time. And if, down the road, that is truly what you want to do, that is okay.

But hear me when I say this.

Getting a little way into the profession and panicking does not mean you do not want to be an OT. It usually means you are tired, overwhelmed, or frustrated. That is very different.

One of the most powerful things about being an OT is how transferable our skill set is. We assess, problem-solve, adapt, communicate, educate, and think systemically. Those skills translate into a million other careers if you decide you need a change.

You can start your own business.
You can move into a non-clinical role.
You can pivot, evolve, or step sideways instead of walking away completely.

There are options. Many of them.

Burnout does not mean failure. It means something needs to change, not that you necessarily chose the wrong profession.

Let’s Talk About Documentation

Documentation is the devil.

There are days it feels like you document more than you actually treat, and it is hard not to feel bogged down and overwhelmed by the sheer volume of it. Real-time documentation at the bedside is not always realistic, no matter what anyone tells you.

I have personally tried to balance a laptop while toileting a patient. It is stupid. Full stop.

You need to figure out what works for you, because I promise you this. Documentation will burn you out faster than almost anything else if you do not have a system.

For some people, that looks like:

• Jotting quick notes on paper

• Using one of the newer AI scribe tools

• Point-of-service documentation when possible

• Writing brief notes after each session and finishing everything at the end of the day

There is no one right way. The right way is the one you can sustain.

That said, there are two documentation lessons I learned early that I will stand by forever.

First, document the same day before you leave, especially in acute care. Anything can happen between the time you walk out of a room and the next time you see that patient. They could discharge. They could fall. They could decline. They could even expire. Your note needs to clearly reflect what you saw, what you did, and how you left them so the chart is complete on your end when you walk out the door.

Second, document like you might have to defend that note someday.

I had a brilliant professor in OT school, Marcia Goodman-Lavey, who was both an OT and an attorney. She told us to write notes as if, ten years from now, we could be called into court and asked to explain exactly what we meant.

I took that to heart.

About six years into practice, I was called to a deposition and asked to discuss a note I had written during my second week at my very first job. Because my documentation was clear, detailed, and intentional, the case went exactly the way it should have.

So be clear. Be concise. Be specific.

You may never need to defend your documentation, but if you do, you will be grateful you wrote it like it mattered.

One Last Thing

You are going to make a difference in ways you may never fully see.

A comment that sticks.
A strategy that clicks.
A moment where someone feels understood instead of judged.

That is the real work.

So be patient with yourself.
Laugh when things get awkward.
Ask questions, even the ones you think you should already know.
Trust your instincts. They are developing every day.

And remember this. You are not doing this alone.

There are a lot of us seasoned therapists out here who genuinely want to help, teach, and cheer you on. We remember exactly what it felt like to be new, overwhelmed, and wondering if we were doing any of this “right.” You are the future of this profession, and you get to shape it in your own way, on your own terms. Those innovative, outside-the-box ideas you are worried might be “too much” are often the very things that move occupational therapy forward.

You belong here.

Signed,
An OT Who Once Googled “Am I Cut Out for This?” and Kept Going Anyway

P.S. Do not stress about memorizing every single framework. You will look them up, revisit them, and use the ones that actually fit your practice. We all do. And yes, you will also look up muscle insertions, origins, and cranial nerves more than once. That is not a failure. That is called being human in healthcare.