5 Lessons Learned in My First Month as an OTR/L
You walk on your graduation day, get your diploma, then stress out incessantly about taking the NBCOT® exam. You pass, then get your license! Such an emotional rollercoaster that ends with BIG excitement—but then what? I was blessed to have received job offers at both of my fieldwork placements, and I ended up accepting one of them. That weekend, waiting for my first day at work, was nerve racking. Mind you, this is my second career, and I’ve worked many jobs before this, but this one felt different because occupational therapy truly feels like my calling. Looking back, I had nothing to worry about, so I want to share with you five things I’ve learned so far during my first month that I hope will ease your transition too.
You’re not expected to know everything
We tend to pressure ourselves into thinking that others expect us to be experts at our jobs, even though we just graduated. The only expectation for entry-level is that you know the basics. Even though the bar may be a bit lower because you are a new practitioner, don’t sit back and expect knowledge to magically come to you. Review what you feel you need to reinforce so that you are as prepared as possible to provide the best client-centered, evidence-based care.
Ask, ask, ask!
Do NOT—I repeat, do NOT—be afraid to ask questions. I experienced hurdles with the documentation system, health insurance policies I wasn’t familiar with, etc. You should never be punished or made to feel less than for asking. Learning support was something I looked for when searching for my first job because it mattered to me. I was really happy to find out that I chose the right place when I was able to walk into my supervisor’s office, talk to her about my assessment choices for a new evaluation, and have her discuss them with me and give me the “green light.” I felt like I needed that second check, and I was thrilled that I got what I needed when I asked. Also, I asked many questions to the other practitioners in the building: Do we have this supply? Where can I find “X”? Asking questions will make the acclimation period much easier.
Trust yourself; you know more than you think
You have gained so many new skills that you may not even be aware of. I work in an outpatient pediatric setting, and even though the imposter syndrome was strong, I quickly realized that I knew more than when I showed up for my first day of fieldwork. I could now present an activity to a child and understand what I was observing—whether the activity needed to be graded up or down, whether the child was regulated enough to participate, what skills I was targeting, and what level of assistance was needed. Things will come back more easily than you expect, and you’ll feel bursts of confidence in those moments. Disclaimer: you may feel the opposite as well. You may have a client who leaves you feeling clueless, and that’s when you need to refer back to the point above: ASK!
Plan your day
If you have the luxury of knowing your schedule and who you will be seeing the next day, build a plan! Yes, you know more now, but it may require a bit more planning until you build a “toolbox” you can pull from. I created an Excel spreadsheet where I shortened clients’ goals, wrote the interventions I was planning, included a space for observations, and noted how they were usually dropped off at the clinic and who picked them up—or if they transitioned to another therapy service. Having a quick “cheat sheet” has been a lifesaver. I like presenting options to the kids for what we can do that day and letting them “lead,” while still ensuring I address the goals that need to be targeted. It’s much easier to deviate from a plan than to come up with everything on the spot.
Give yourself grace
I’m so hard on myself! I always expect perfection, and that’s something I needed to let go of quickly. Some sessions will go great, and others will feel like a hot mess—and that’s okay! Not every client will respond the way we expect, and our perfect plan may not work at all. But that’s where your clinical reasoning should kick in and help you reflect on what went wrong and how you can improve next time. Did the child need more time to regulate? Did they need a quieter space? Was the challenge too hard, causing frustration? Keep a log or confide in a trusted mentor to help guide you during these challenging moments.
I hope these five quick tips help you navigate the big leap of leaving your student hat behind and wearing that “OTR” or “COTA” title. You’ve worked hard for it, and you know way more than you think. Ask for help when needed, and in no time, you’ll realize you’ve been thriving all along and watching your clients make progress each day.
Julamy Serrano Arocho, OTR/L, is a 2025 graduate from Brenau University’s Hybrid MSOT Program. She currently serves as the Senior Editor of the OT Student Pulse and works at an outpatient pediatric clinic and her career interests are still torn between neurodevelopmental disorders in pediatrics and inpatient care. Outside of occupational therapy, Julamy enjoys spending time with her family, reading, and watching true crime shows.