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Time to turn in your curettes? Read this first!

May 1, 2001
Are you donning a new hat for a hiatus from hygiene? Slow down and take a look at some opportunities surrounding you.
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I currently am on my third official hiatus from active clinical practice. The duration between each hiatus has shortened, and I must confess that, prior to retreating this time, I was practicing only one Saturday each month over a four-year period!

I remember one dentist scoffing at me as I revealed the infrequency of my clinical work. He abruptly asked, "Why do you even bother?" At the time, I was working part-time in dentistry with responsibilities that were marketing- and administratively-oriented. I also was the mother of a toddler, and it was important to me to decline 40-hour work weeks as long as finances permitted. I overanalyzed his comment, and worried that my infrequency of practicing would "rust up my curettes." Still, I wanted to "keep my hands in," however minimally.

Three years ago, I developed a lecture on hygiene burnout. The research for it afforded me the opportunity to reach out to hundreds of hygienists across the United States. I found an exorbitant amount of burnout and disillusionment pervading our profession. What saddened me more was that many of these women, however discontented, seemed more interested in complaining than in making changes that might improve their professional existence. I vowed to try to get a message of hope out.

The focus of this article is not really to help you decide when - or if - you have had enough, because I believe that this is a personal decision. However, we can focus on things you might do to affect positive change in your current scenario. Sometimes a subtle change is all that is needed.

One of the great things about a hiatus is that it can show you how time away helps you to appreciate what you left behind. During my first hiatus, I had completed graduate school. After seven years of clinical hygiene, I was set to leave our profession forever. My scrubs and Cavitron had been exchanged for a power suit and a smart-looking briefcase (it turns out the briefcase was smarter than its owner!). I was ready to take the business side of health care by storm. For the next three years, my only exposure to dental hygiene was during my own recare visits. It was a new world and a welcome change.

However, somewhere early in my third year, I began to realize that there must be more to life than the fancy briefcase and the corporate environment. A new marriage was on my horizon, and I was starting to think about motherhood. I left my job, moved to New Jersey, and yearned for nothing more than a return to the profession I'd left three years prior! Suddenly, having regular hours and a position that I could truly "leave at the office" looked good. I wanted to have a baby, and I knew that dental hygiene would afford me the opportunity to have a fulfilling part-time career. I moved forward with relicensing, became pregnant, and put the plan in motion.

Dental hygiene couldn't have been more perfect. I loved my practices and my patients, my stipend was satisfactory, and when I walked out of the door at the end of the afternoon, I didn't give what I had left behind me a second thought. This was a welcome change from the long hours and forever unfinished business of the corporate world. I was the envy of all my mall-mom friends, whose only options in their respective professions were full time or no time.

What I also discovered was just how much I missed direct patient care. The relationships hygienists have the op por tunity to cultivate with patients are unique and special. I had found nothing quite like it in the business world.

What is the point of all this personal pontification? Simply to let you know that a person's perspective can change, depending on external circumstances. I am so grateful that I chose not to permanently turn in my curettes! No one knows what tomorrow may bring.

My first suggestion is that, if you do take a hiatus, seek out inactive status if need be, but make every effort to keep up your license. I had abandoned mine in the state of New Jersey, and it was a major headache to make up the fees and continuing education for the decade I'd been away.

An added value to career

If you are experiencing monotony in your dental-hygiene practice, many options are available. Explain to your doctor that you are fearful of burning out and would like to do something about it before the situation gets out of control. A savvy employer will not want to lose a business asset like you. Good hygienists are difficult to find! Within your traditional clinical role, are you scheduling a nice variety of treatment beyond basic continuing-care visits? Hygienists obviously are limited by the constraints of state laws, but why not seek out whatever possibilities exist within those parameters?

Do you provide "added value services" for your patients, such as a top-shelf, oral-cancer screening; a pulse/blood-pressure check; fluoride/desensitizing treatments; and an occlusal exam? Do you provide a soft-tissue management program? Nutritional counseling? Have you tried anything innovative to educate your patients? Do you make an effort to scope out your patients' overall health and well-being ... beyond the oral cavity? Are you attentive to your patients' esthetic concerns? Hygienists - if they choose and if they are practicing in a setting that allows for this level of care - can be so much more than the "cleaning machines" that frustrated hygienists feel like.

Why not ask your boss to consider allowing you to diversify your responsibilities beyond your traditional clinical role? Perhaps you could help the practice by assuming some marketing or public relations duties. One hygienist, for example, revitalized her role within a practice by eliminating one recare patient each day. She then took on marketing responsibilities during that time frame. She spent an hour involved in activities such as producing a newsletter, creating hygienist/ patient correspondence, making several focused hygienist/ patient "we care" calls, creating educational sheets for the practice, and much more. The diversity of this work enabled her to return to her traditional clinical role with renewed enthusiasm. It was a win/win for the practice, because the doctor now realizes the benefits of an ongoing marketing program.

Visit the other operatory

Offer to spend time observing your doctor at chairside, perhaps pinch-hitting as an assistant or helping with lab work occasionally. Trust me, it is not my intent to demean this work. I recognize that you would require training, but it also is true that many hygienists enter the profession with strong assisting backgrounds. Dust that background off, and use it to help break up your day! Ask your doctor to bring you into the treatment room periodically to "show and tell" anything that might be interesting.

Make an effort to learn one new thing about some aspect of dentistry every day. Inviting your doctor to assume a teaching role is a winning proposition for both of you. (What can you teach your doctor?) Make an effort to learn from your co-workers as well. Why not take on more recall- system responsibilities? Learn to use the office computer system, and assist the front-office staff regularly.

Keep yourself motivated by continually attending CE programs (mandated or not). Stay on top of new developments within your profession. Check out the Internet for educational information. You'll find Web sites through our professional association that will allow you to correspond with other hygienists nationally on key issues. Read your own journals and industry magazines, and ask your doctor if you might take a look at his publications. It will expand your horizons. I know a doctor who makes a point of sitting down once a month to read his hygienist's journals, so that he sees things from the hygiene profession's perspective. Now this is an enlightened manager!

Offer to facilitate staff meetings on a regular basis. (Actually, all staff members should rotate doing this). Volunteer to research an area of interest for the practice, and report back on it at the next meeting.

Ask your doctor to join a study club, preferably one that offers staff programming. None available? Start one of your own! Ask the specialists you refer to if you might spend a couple of hours observing in their practices. Once they have observed it themselves, hygienists are far better able to articulate to patients what they will experience during their visit to a specialty practice. Better yet, take on an ambassador role for your practice and accompany a patient to his or her surgical procedure!

Obviously, you can't do this every week, but let's say you wish to view an implant surgery. You will learn so much by seeing the surgeon or periodontist place the actual implant. This is a win/win proposition for all. You gain the experience of seeing a procedure and having the opportunity for the surgeon to respond to your questions right there. (Continuing education doesn't get any better than this!) The patient gains because you have stood by his/her side as his home-office hygienist. You will have firmly cemented a bond between yourself and your patient, and the benefits will come back tenfold. It's guaranteed - this patient will go out and tell five others, "My hygienist held my hand during my surgery!" Incidentally, I absolutely feel that hygienists should be paid for this time!

The old school

Spend one afternoon looking at your notes from hygiene school.You'll find it to be an eye-opening experience!

Make a point of attending or keeping some contact with your hygiene alumni. If you are the only hygienist in the practice, it can be very isolating. I can't overemphasize the importance of joining the professional association. It provides you with the opportunity to stay networked with your colleagues. If you choose not to be active, that is your decision. At some point, I believe we all have an obligation to give something back to the profession. You will have achieved this by simply contributing the $200 annual membership fee.

Consider it your way of assisting those dedicated hygienists who volunteer their time to lobby against preceptorship. Preceptorship is hovering in the shadows, a predator not likely to disappear soon, and it threatens to infiltrate our profession. I implore you to somehow raise your level of consciousness regarding this most important issue. All that you have ever taken for granted professionally is potentially at stake.

Consider participating in local health fairs, or get involved in National Children's Health Month. Create a mini-presentation and see if you can give it at your children's school or any school within the community. It's fun and, once again, you are assuming a public relations role for your practice. Donate some time doing pro bono work. One letter that I received from a hygienist who had donated care for the homeless brought tears to my eyes. Offering your time to provide services like this will forever change your perspective.

Go back to school! If you have your associate's degree, start working on your bachelor's. If you have your bachelor's, start working on your master's degree. Education opens more doors. If you take one class at a time, it may take you years, but having a distant goal is exciting and empowering. More opportunities are opening up for hygienists with advanced degrees. If higher education is not your forte, take a class for fun.

Send a resume to your local dental hygiene program, and go in for an informational interview. Find out what it would take to be hired as a part-time clinical instructor. Write an article and submit it for publication. Think you can't do it? Write from your heart and the words will flow. Worried about grammar and punctuation? That's why editors were invented!

I probably could go on and on, but space does not permit. However, I think that you'll find much to consider in this article. I have not practiced clinically since last April, yet I feel no desire to jump back in. But, you know what? I'm not going to completely toss those curettes out yet! Given my batting average on hiatuses - and my deep-rooted (pun intended) respect for the wonderful profession of dental hygiene - it might be premature to speculate that I will never again be in active clinical practice. Best of luck to you on your journey of discovery ... and carpe diem in your rejuvenation efforts!

Eileen Morrissey, RDH, MS, is a dental practice management consultant in Perrineville, N.J. Currently, she lectures, writes and provides customized workshops for doctors and their staffs. She can be contacted by phone at (732) 446-1461 or via e-mail at [email protected].

Is it time to leave?

How do you know whether or not it's time to walk away permanently? I believe it's a strong indicator when you have virtually exhausted yourself for weeks and months trying to find the positive in what you are doing. Then, you need to consider some type of change. It's quite possible that you need a break from dental hygiene ... but there are other things that you can try to implement first.

If your dissatisfaction is with your employer: you have three choices:

  • Communicate with your employer. It's possible that he or she is unaware of any issues nagging at you. You will not resolve them by letting them fester. In my research, the greatest number of hygienists on the brink of leaving had complaints regarding their work environments and/or employers.
  • Make your peace with the realization that it is your employer's practice, and accept the fact that some things will not change. In fairness to many hygienists, a significant percentage have tried to talk with their doctors, but found them unwilling or unable to change.
  • Make a change to a different employer. Demand exceeds supply in the hygiene marketplace. If you are truly unhappy, if you have communicated with your boss to no avail, if it's only the patients that are keeping you going, then this is not a peaceful professional existence and you need to get out of this situation.

The number of hygienists who stay in bad situations is amazing! Although many are unhappy, they worry "ellipse but what about my patients?" That kind of loyalty is heart-warming, but there comes a time when you must think of yourself first. Yes, there are those who fear a new situation more than staying in an undesirable one. But the bottom line is: If you are not where you want to be, you should not be there! It's an injustice to the patients, the doctor, and, most of all, to you.

Attitude adjustments

If you can't quite put your fingers (pun intended) on what's bugging you, an attitude adjustment may be in order. Are you certain it is dental hygiene that's getting to you ... or is it life in general? Sometimes, we simply need to see things in a different light or to count our blessings.

Balance your personal life outside the office, and attempt to integrate a bit of the extraordinary into your routine. For an enlightening reference, read about the delightful experiences that Gayle Lawrence detailed in an article in the January 2001 issue of RDH. This woman swims with dolphins! Create your own spiritual retreat by taking up the practices of meditation and/or reiki and participating daily. I speak from experience ellipse there is nothing like a routine dialogue with your soul to set you straight! You will find no monotony there.

If physical issues are the problem, this can be a tougher nut to crack. There is no question that dental hygiene is physically demanding. The postures we assume, and the necessary repetitive motions we must make, can take a physical toll on us through our years of practice. I must emphasize the importance of addressing ergonomic issues. Regular exercise also will help you here. (A Massage is not a bad idea, either!).