Mentor Advice ForumOpinions on furthering my career in dental hygiene
Nancy Kiehl, RDH, MSSarah Staff asked 2 months ago

I graduated this May with a bachelor’s degree. I have been working in a small private practice for three months and I absolutely hate it. Everyone in the office is terrific but I wish I had taken into consideration how having older equipment and how the layout of the office would effect me before I accepted the position. I dread going to work everyday and I am experiencing quite a bit of anxiety. Should I stay in an office just because everyone is nice or would it be worth exploring my options to find a more up to date practice? Currently I am feeling that I want to leave hygiene all together. Has anyone else felt this way after such a short period of time working in private practice?
One area of hygiene I would love to learn more about is dental care in nursing homes. My grandmother was a resident in an assisted living facility for two months. During her time there I visited nearly everyday to brush and floss her teeth. She was always so grateful when I would do this for her and it made me think about all of the other residents who did not have anyone to care for them in this way. I would love to provide some type of hygiene care in nursing homes/assisted living facilities but I don’t know where to start. Does anyone have experience in this area or any advice?

4 Answers
Lucinda B. McKechnie, RDH, BSLucinda B. McKechnie, RDH, BS Staff answered 2 months ago

Interesting, I had a similar experience when I first graduated. My first job was in an antiquated office with no ultrasonic, little instrument selection, and one receptionist so it was a two-person show (mind you this was a few years back). Needless to say I worked for approximately 4 months before not being able to take it anymore. The difference for you is you like the staff. Before you look for another position, it may be worth talking with the dentist employer. Make a list of items you need to perform your professional responsibilities to their maximum efforts and talk it over with him/her, stating you need to meet the standard of care and the environment is prohibiting you from doing so. Honestly, it makes me crazy that dental hygiene staff are frequently relegated to the oldest equipment. He might ask you to assist in the payment, which I would not consider unless you plan to take it with you. My husband is a dentist and so our dental hygiene team is spoiled. If someone needs an item to enhance his or her expertise, there is little discussion about making it available.
Geriatric care is rewarding. Or perhaps you should consider establishing a position in a local hospital, caring for patients undergoing chemotherapy. Many choices lie ahead for you, so if the dentist is not willing to accommodate you and is too frugal to do so, then time for a change! Or if you are ever seeking a job in Stowe, Vermont, please let me know!

Tammy Filipiak, RDH, MSTammy Filipiak, RDH, MS Staff answered 2 months ago

It is important regardless of the setting to feel like it’s a match with the people and the culture. Many of us have experienced a setting or situation where things “didn’t feel right.” It is up to you now to determine what options you have to make a change. Thinking about hours, facilities, team, community, total compensation and benefits, and culture are all equally important in my opinion.
The settings in which you can work and the scope of practice that is allowed in each setting would be defined in the statutes/rules of the state that you are in. In my state, we can work in nursing homes and this is certainly a population that can benefit from our services. Angie Stone from Wisconsin is a well-known resource for elder care and you may want to reach out to her through her business HyLife. You can look on the American Dental Hygienists’ Association website for information on the scope in your state and also find more links to info that I think would be helpful.

JoAnn R. Gurenlian, RDH, PhDJoAnn R. Gurenlian, RDH, PhD Staff answered 2 months ago

There is nothing worse than being unhappy in your work setting. When you feel sick to your stomach when you walk through the door to the office every morning that is your sign to leave that setting. You have done nothing wrong and neither has anyone else—the fit is just not right for you. Do not think that the world has ended. This place is not for you. You will have this experience on occasion. There is a better place waiting for you. You already have identified that a long-term care facility type setting may be a better place for you and I have a contact for you that I would like you to consider making. One of my former graduate students, Lesley Harbison, RDH, MS, works in Oregon. She is a full-time faculty member at Pacific University, but also owns her own practice treating the elderly in long-term care facilities. Lesley would be a great resource for you. Here is her email—harblesl@isu.edu—so you can reach out to her and learn more about the ins and outs of working in this environment. Lesley’s thesis research involved interviewing other dental hygienists who also work in elder care and so she may be able to help you network with other colleagues to learn more. Getting started on this journey may take a little time and some resources, but you may be someone who finds your heart and passion in this field.

JoAnn R. Gurenlian, RDH, PhDJoAnn R. Gurenlian, RDH, PhD Staff answered 2 months ago

First, I’d like to let you know that you are not the first to wonder if you made the right career choice, especially if your first employment experience does not offer the job satisfaction you had hoped it would. Secondly, I would encourage you to think about what it is exactly that is getting your stomach in a knot each morning? What aspect of the experience is absolutely not what you are looking for? Try and isolate that piece, is it simple the outdated equipment or some part of the patient care experience? The rushed schedule perhaps, or something else? For me, I worked for a wonderful practice with the best practitioners and happy co-workers. However, each morning in our huddle we discussed production and who had met goals. It became this monster I dreaded and I walked into work with a boulder in my stomach each day. The feeling of not “producing” and having to explain why I fell short, was not an aspect I wanted for my dental hygiene career. So eventually I moved on, and it just so happened during that time I was learning all I could about working with direct access populations, especially the geriatric population.
Once you have identified what it is that is causing you dread each morning, consider your dream environment or your dream job. Setting small achievable goals that guide you toward accomplishing your bigger goals, is satisfying and often encouraging enough to keep you on the right path.

In your email you talked about your interest in working in nursing homes and in a direct access capacity. First I would say depending on where you live you’ll have various abilities and scope of practice. Print off you state’s practice act and learn exactly what is allowed within your scope of practice. In Oregon we must apply for an Expanded Practice Permit. It is a simple process but must be done before we can treat patients in direct access. Second, write down the process of care for treating an elderly resident in a nursing home. This can be a very simple summary of what you would anticipate you’ll be doing for care and what supplies you’ll need to accomplish those tasks. I can tell you from experience and you may agree from your experience with your grandmother, that it doesn’t necessarily take fancy equipment. You’ll want to consult with the facilities nurse or physician in order to access information regarding medical histories and current medications. You’ll need an armamentarium to remove biofilm and debride as much as possible while providing some therapy with fluoride and perhaps xylitol gel for dry mouth is often a perfect place to start. In Oregon I have used silver diamine fluoride quite often and will use chlorhexidine while I remove the plaque biofilm if the resident can tolerate liquids. I’ll bring in hand instruments, mirror and probe for assessments and deposit removal if I have a patient who is able to tolerate more treatment.
So how do you access a support network of people who are working in direct access that you can learn from or perhaps start working in collaboration? Often times direct access dental hygienist know of colleagues in other states and can help point you in the right direction. Social media is another great way! Simply logging onto one of the Facebook dental networking sights and asking if there is anyone active in your area may bring some local support. If there are any government programs such as school-based sealant programs, the directors of those programs may have information of local direct access dental hygienist. You may even talk with the administrators of the nursing home your grandmother was in, talk to them about the prospect of treating other residents.
I wish you great luck and please know that the profession of dental hygiene is an exciting one. We have so many opportunities to share our great knowledge of oral health and how that contributes to general health. Whether you work in private practice, research, public health, or create an avenue for yourself that is totally unique, I assure you the sky is the limit and your future as dental hygienist is bright.
Sincerely,
Lesley Harbison RDH EPDH MS