Out of my graduating SLP class of 25-ish people, I would estimate that about half wanted to work in a medical setting. Going to school in "The Triangle" in NC meant that there were some amazing universities and teaching hospitals (UNC, Duke, REX, Wake Med) that we were able to luckily have internships and fellowships with. However, with all of those opportunities comes a LOT of competition! I applied for as many local hospitals as I could for my clinical fellowship year and I must have sent out around 50 applications to hospitals all across the country. I think I received one phone interview and I didn't wind up getting the job. One of the frustrating things about the nationwide shortage of SLPs is that there is an even smaller pool of SLPs that are able to become a mentor to a new grad. And let's be honest, most buildings don't want to pay two SLPs if they can get by with one. So I turned to skilled nursing facilities (SNF). I found an SNF only about 2 hours away from my hometown in VA, in an awesome college town that was willing to provide me with a mentor. I sent out that one application, and was hired after a phone interview and a tour of the facility. The pay was very good, the location couldn't be beat. Yes, I felt a little let down that none of the hospitals seemed to want me, and I had heard the rumors that SNFs could be challenging. But I figured that I could handle it.
Let's just say it was pretty much a vertical learning curve. One positive of my first placement were that I was covering short term rehab, long term care, outpatient, and home health so I really learned a lot and gained independence very quickly. I had a good mentor, even though she wasn't onsite with me. I had some amazing coworkers, and the facility itself was awesome with a swimming pool, a huge gym, beautiful gardens and screened in porches to work with the patients. But the same problems plaguing almost all SNF rehab departments plagued mine. I was NEVER able to meet my productivity due to all the paperwork requirements, I felt pressure to pick up every 98 year old with dementia for cognitive therapy, I was the only full time SLP on staff, I was specifically told NOT to work off the clock but if I didn't then my boss would take me aside and talk to me about watching my productivity, and the ultra annoying practice of having to work 12 hour days M, T, and W to get everything done, only to be told to just come in for just 2 hours each on Th and F...just enough to ruin both days but right under the 40 hour mark so they didn't have to dip into their pockets and pay me overtime.
The amount of turnover in the department was crazy- right before i arrived, the previous SLP and the OT resigned, and in my 6 months (yes I was only there 6 months), the PT, COTA, and DoR all resigned, there were three traveling OTs within 6 months and one traveling PT. And the new DoR as well as a regional manager were let go. I ended up leaving the position for a different SNF about 30 minutes away which had a much better productivity standard (75%) and all the therapists had been working there for years- one had been there since the building opened I think around 20 years prior. However, literally the ink was not dry on my new contract when I found out that the awesome company I had just signed onto was being sold (because the smaller companies who don't commit ethics violations can't seem to hang on anymore), and when the change took place 3 months later, it seemed to become worse than my first one, maybe because I had briefly tasted the sweet life of not being treated like a robot undeserving of even a bathroom break. I finished my clinical fellowship year and stayed at the new place for about 9 months before buying my RV and hitting the road, working in acute care hospitals.
My recommendation to anyone considering an SNF is that if you see a productivity number higher than 80% you run far away. Even ask about the assistants productivity level, and if you are hearing 90% or 95%, it is probably not a company you want to work for. I found 75% as a therapist to be ideal. In an interview I would ask about the rate of staff turnover, and build a raise into your contract at the completion of your CF. If there is any travel between buildings, make sure to ask about how you will be reimbursed. And I would specify a written schedule to meet with your mentor, on company time. Maybe every other Friday for example, or at least once a month. Also, try hard to find smaller in-house rehab facilities. They are quickly disappearing and being gobbled up by national chains, but in my opinion they are the ones you are most likely to be happiest with.