“That parent is so annoying. They ask too many questions and never follow through on my suggestions . . . ”

“What do you think of the other SLP? They totally don’t know what they’re doing. They recommended thickened liquids yesterday. Who does that?”   

“What do you know about the incoming student? Is he smart? Will he work hard? Do you think he can handle this site?” 

Do conversations at your practicum tend to start like this? If so, you might be dealing with a challenging workplace culture. This can have a negative impact on your learning, well-being, and patient care. Fortunately, there are some strategies you can implement as a student to make the most of your time and let you focus on learning.

Recognizing Workplace Culture

All workplaces have a culture. As students completing clinical practicums, we get a glimpse into several different workplaces, and we may see both the good and the bad. A challenging workplace culture can be characterized by negative comments, attitudes, and behaviors directed at students, other speech-language pathologists (SLPs), and other professionals (like nurses, physicians, or teachers)—as well as patients and their families.

There is never an obligation or expectation to have clinical judgments or personal ideals to that are identical to those we work with. Likewise, it’s okay to think that you would have made a different decision or had a different goal than a patient. However, there’s a difference between (a) feeling disagreement or frustration and (b) speaking negatively about another individual. To create a positive workplace culture, everyone must hold themselves to a high standard of professional and courteous behavior, even when addressing disagreements and differences.

If you’re working with a clinician who participates in the negativity contributing to a challenging workplace, it’s important to note that this is a systemic—not personal—issue. This means that it’s the product of, and experienced by, the whole of an organization. Negativity is a common reaction to burnout, feeling undercompensated, moral injury, and unrealistic expectations such as productivity standards, extreme caseloads, and excessive overtime. Still, it has real effects on your experience, and it can be difficult to navigate—especially when self-advocacy might impact a future letter of recommendation, referral, or job offer. 

As a speech-language pathology graduate student at the University of Pittsburgh, I’ve been placed at various community settings since my first semester. Now at my seventh clinical setting, I’ve seen a wide range of workplace cultures. I’ve also been on both sides of this issue—as a student navigating a workplace culture and as a leader faced with building and maintaining an organizational or workplace culture free from toxicity. Reflecting on some particularly difficult scenarios, I decided to write the very resource I wish I’d had from the start.

Managing Expectations

Encountering a challenging workplace culture is likely, if not guaranteed, to happen. That’s why managing expectations is so important! From schools, to hospitals, to skilled nursing facilities (SNFs), and beyond, there’s no setting, specialty, or company that is exempt.

As a student, you’re limited in what action(s) you can take. Combating toxicity, like any systemic issue, is a slow and difficult task. Additionally, experiences within a negative culture are exacerbated by power imbalances, and the person with the least power is likely you, the student.

This is not to say you’re powerless—the NSSLHA Blog is full of incredible student advocates and initiatives that make the speech-language pathology profession—and the overall communication sciences and disorders (CSD) discipline—a better place.

Still, you should consider your role as a student: to learn. Your short-term goal is to make your time in a challenging culture a positive learning experience—through gaining perspective, increasing awareness, and developing resilience. This sets you up to make a permanent difference in the profession by helping create long-term systemic changes toward ending the perpetuation of toxic culture as a professional. 

Setting Boundaries

Setting boundaries means defining the behaviors and conversations that are acceptable to you. This helps us feel respected and comfortable—and can also help us avoid stress and anxiety.

Here are some examples of boundary setting in a clinical practicum environment:

• Your clinical supervisor tends to throw you into the deep end during patient sessions, so you say: “Can you please give some notice before asking me to demonstrate new or emergent skills with patients?”
• Your colleagues tend to gossip over lunch, so you tell them: “I’m going to step out during my lunch breaks, so that I can have a mental break.”
• Your clinical supervisor shares their negative opinion of a teacher at your school placement, so you say: “I’m not familiar with that teacher, so I can’t really comment on how they run their class.”

Boundary setting doesn’t always have to be overt or upfront. It can be a decision to remain silent, feign ignorance of workplace drama, or use other subtle ways to disengage when conversations head in a negative direction. 

Escaping the Negativity

Even if you catch yourself being bogged down in a negative work culture, it’s never too late to reorient. Remember, this is a systemic issue, and avoiding it isn’t always easy. Following the lead of others at your practicum is what we’re encouraged and instructed to do, and it can even serve a valuable purpose of building rapport with colleagues. 

Remember, it’s okay to not like a coworker, be frustrated with a decision, or experience any number of natural human reactions. However, you do have to act professionally and with courtesy. Start by reflecting on what makes the culture toxic—or what you find objectionable. Then, think about how you might re-establish boundaries using the examples above. 

Coping

If you can’t remove yourself from the situation, then it can be helpful to develop a coping mechanism that carries you through that short time. For example, you can see the toxic culture as a temporary learning experience, where you can develop your knowledge of professionalism and ethics by observing behaviors that actually run counter to those ideals. We can learn just as much, if not more, from the bad examples as we can from the good ones.

One exercise to consider is planning your career goals in terms of clinical or professional qualities. Maintaining a positive framing can be helpful to establish your mindset and to make goals achievable. For example, “I want to be an SLP who helps my colleagues grow and learn,” or “I want to be the SLP who really listens to their patients.”

Finding allies can also be immensely important, either at your practicum site or in your cohort, NSSLHA chapter, or other groups where people might have similar experiences. Faculty or clinical staff at your university can serve as excellent resources, as can students who previously had that placement and who may have thoughts or strategies on how to exist in that environment. 

In Conclusion

If you find yourself caught in a challenging workplace culture, know that you’re not alone. Although you might not be able to make change in one short semester, the experience can help you discover the kind of clinician you want to be—as well as set you up to make positive change in the overall CSD discipline.