NC for this.
I would agree with you, Killerpinkflamingo, that a big part of the problem is that you were sheltered from the reality of life as an SLT by having most of your placements in your Uni clinic. As you have discovered, it is nothing like the real world. You are not the first NQT SLT to need some time to get over the shock to your system and acclimatise.
This is going to sound a bit, "We lived in a paper bag in a hole in the road, ate grit for breakfast and our dad beat us with a stair rod" but I am saying it to illustrate that it can be far worse and yet still possible to survive and even actually enjoy a "challenging" first job that was not at all what was expected.
It took me a year to find my first SLT job because I wanted to work with adults and even split Adults/Paeds jobs were rare as hen's teeth. When I finally found a job advertised as "Adults" I had to move to a town where I knew no one. I found a place to stay in a street that seemed quiet and suburban but turned out to be occupied mainly by men who had recently left prison or the local psychiatric hospital. I was warned not to leave windows unlocked because of burglars and mad men climbing up drainpipes to get in.
My bedroom looked out on the house next door, a B&B for Irish lorry-drivers who stayed up all night drinking, singing, playing the accordion and fighting.
On my first day at work I was driven around a huge rural area where there had not been any SLT cover for six years and was shown all the villages, clinics and schools I was to cover. In two places I was told that there was no base for me to work because there had never been any SLT, that I would have to make enquiries to find free premises to run a clinic, maybe at a GP Surgery, Church Hall or "just ask around".
When I queried that this was supposed to be an "Adults Job" I was told, "We lied to you. We advertised it for two years as Community Paediatrics and no one applied, so we lied. Remind us now and again that you'd like some adult work and we'll find something for you."
When I reminded them after 6 months they said, "We haven't forgotten!" When I asked again after a year they said, "We thought you'd be happy to tick-along for at least a couple of years!" When I insisted, they found me a psychiatric hospital to cover where there had never been any SaLT, which was interesting. I also started to look for a new job.
There were no staff meetings and no planned supervision.
The only thing that actually terrified me was that, like you, I didn't know where to start with individual patients. A woman who I had trained with, who had had a job lined up months before we qualified, told me,
"Just assess like crazy and write up your notes very thoroughly - it will all come back to you and start to make sense".
That worked, so I recommend trying it.
Also try to make the most of whatever opportunities there are to enjoy the day. I timed my car journey between locations to coincide with radio programmes that I liked to listen to and scheduled visits to coincide with market days so I could nip out for a few minutes at lunch time to browse the stalls.
If you are stuck in a hospital, seek out places indoors and outdoors where you can sit quietly with a book, listen to music, sew, whatever, or just pay attention to the sounds around you and feel the movement of air on your face and body. If you prefer to remain "in work mode", practice transcribing into IPA or anything that takes your mind off actual work.
In my next job I ran an evening clinic one day a week after working a normal day. To make sure that I stopped between sessions, I used the hour before the start of the evening session to teach myself how to juggle and play the harmonica - not at the same time :-) Be creative and take back control in whatever way you can.
On the clinical side, you will do yourself and your patients a great favour if you stop thinking of "Stroke Rehab" and "Voice" as completely separate categories. The fact that you do is not your fault, it is an artefact of the way subjects are taught and the way jobs are funded, which reflect medical specialisms. It does not reflect the needs of all patients or the skills and knowledge that you have at your disposal to help them achieve their potential.
When you see a new patient try to think of a Venn Diagram where what you think of as "Voice work" overlaps with how they might improve communication. This is often easier with dysarthria so start there.
Definitely ask for at least one session with Voice work. I would also recommend getting a session with bog-standard paediatrics if you can. A little bit of work with children can be a respite from adult work and really uplifting.
I loved voice work so I understand the attraction.
I also did a bit of work with some male transgender patients. However, I would now give them a wide berth. It is a controversial specialty from a feminist perspective and WPATH SOC8 reflects a disturbing ideological shift and breaks away from previous editions in key aspects.
IMHO SOC8 is incompatible with HCPC Standards, eg.the inclusion of "Eunuchs" as a "gender identity" with live-links in the SOC document to a Eunuch fetish website and forum that includes child-abuse fantasies of rape, torture, castration, "forced feminisation" and murder.
You also need a strong stomach if you venture down the Autogynephilia rabbit-hole. For a taster of what to expect, see https://www.transwidowsvoices.org/ and several Mumsnet threads for the "Transwidows Escape Committee"
https://www.mumsnet.com/search?query=Trans+Widows+Escape+Committee&date=all
That aside, to echo what others have said:
NEVER work as an SLT for free or by pretending to do something else
NEVER work with voice patients without an ENT referral
NEVER work with transgender patients unless as part of a MDT
IMHO the most valuable input an SLT could currently have to trans patients is attempting to mitigate the harm to females who take testosterone in terms of their vocal anatomy.
If you are of a pioneering bent then, looking to the future, the NHS is eventually going to have to address the needs of the growing ranks of detransitioners, most of whom will be female. Those whose larynges have been permanently damaged by testosterone will have a different clinical presentation and different intervention needs to men who wish to "pass" as women.
Detransitioners are often reluctant to return to the MDTs that facilitated their transition. If this is recognised by Commissioners then it is possible that provision will have to be made within general Voice Therapy services rather than specialist trans/gender dysphoria services.
Some relevant resources that you will not find referenced by RCSLT, given that the current Chair is a member of WPATH:
Suing Over Medical Transition: The Case Against Considering WPATH as a Competent, Reasonable Body of Expert Opinion
https://genspect.org/suing-over-medical-transition-the-case-against-considering-wpath-as-a-competent-reasonable-body-of-expert-opinion/
SEGM (Society for Evidence-based Gender Medicine)
https://segm.org/
CAN-SG (Clinical Advisory Network on Sex and Gender)
https://can-sg.org/
Thoughtful Therapists
https://thoughtfultherapists.org/
Critical Therapy Antidote
https://criticaltherapyantidote.org/