First Job-Drowning in water

[beach27]

I am a new grad that works in the Surg ICU. When I had interviewed for the position, I had mentioned that I had no experience with ventilators, procedures, and ICU.  I asked if they would provide extensive training and guide me since I am a new graduate without experience.  They had stated yes.  It's been 15 shifts later, and Iar had my "one month" eval (I work 3-15 hour shifts a week).  Today, the doctor said I didn't have the experience (no shit sherlock, its your job to train me), and that I was equivalent to a fourth year medical student.  He said I lacked confidence and the knowledge.  He said for me to get it within the next month.  To be able to fully understand everything in the ICU in terms of medicine, rounds, procedures and train residents within another month (total two months)-it is ridiculous!!! Please help.

 

There is no contract with the hospital.  The doctor is letting go of a pregnant lady after she goes on maternity leave because she is not as fast as the fellow.  The doctor is also getting rid of a PA who has been there for about a year, since she is not up to speed.  What frustrates me is that they said they would spend time with me and train me....they lied!!!

 

Please advice.

[Gaijyn]

To be honest it sounds a bit like you are in a position that is not going to work as is.  As a new grad we CAN do ICU medicine, but we need a fair bit of hand holding or oversight for the initial part of it.  Realistically, it seems like the job basically decided you were enough to fill the slot and would have a revolving set of people until they found the right one or some other situation occurred.  I know of several Ortho and ER practices like that.  Realisitcally if the doc and practice won't train you, and you were up front with them regarding your practice experience and rotations, you probably should begin looking elsewhere.  What would concern me is that in you shoes, there is a lot of ways to screw up and cause some serious harm through your lack of experience.  

 

Further, your impression of the practice seems like it is not a very enjoyable place to be employed.  My vote is that if you are not going to be trained or educated regarding the particulars of the practice you should look for employment elsewhere if you can

[bradtPA]

It's looking like they do not have the time to train you; if critical care is your passion, consider. A good residency program.....

[ventana]

figure out what you have to do to get a good reference - do that, and leave

 

Doc's think that they can save all this $$$ by hiring a PA over another doc - then they see that experienced PAs are well over 100k, so they go with the new grad to save more $$ - and then are surprised that they need training....  seen it a 100 times, speaks poorly of the Doc and the facility, not of you.....  You however have to figure out how to survive long enough to leave on good terms.....

[beach27]

  Realistically, it seems like the job basically decided you were enough to fill the slot and would have a revolving set of people until they found the right one or some other situation occurred.  

 

SO TRUE!! They found someone who has 3 years of experience  who can start in Dec/Jan. I just feel like I got lied to.  He wants me to act as the fellow.  I can't do that unless he trains me.  A lot of turnover.  4 PAs have left since I have left since I have been hired.  I just hate this.  I have bills/lease and he said its not me -its my lack of training.  If I asked you to train me in my interview, why the hell was I lied too.  He stated that I am nice, compassionate, but lack ICU knowledge/training.  He said if you can read the ICU book within the month and develop plans in month and learn the procedures, it may not work.  I feel like he has made his decision.  Basically giving me a heads up, look elsewhere.  I hope karma gets this doctor for lying. Please advise me how I can get a reference and how to proceed.

[EMEDPA]

take the FCCS class. it will get you up to speed on many ICU issues in 2 days.

[Acebecker]

Second what EMED said...  I was thinking that after reading your initial post.  I haven't taken it, but I have seen the syllabus and it will get you much closer to where you need to be.  It may require travelling to get it done. 

[rpackelly]

This sounds like a nightmare residency rotation but permanent.  If you cannot do the FCCS class, what I suggest is spending several of your “days off” following the nurses and the fellow(s).  If you are very unfamiliar with the mechanicals, spending time with the senior ICU nurses can be a godsend.  From long ago personal experience, my first rotation in an ICU during a residency was like stepping into the spaceship Enterprise.  Only by spending many hours every day for a month (one day off) did I even feel like the language was familiar although I was still far from fluent.  The more you learn though, the easier it will be to learn more.   And if you were confident with your current fund of knowledge, that would be a disaster, so that’s not going to improve without time on task.   The fellow has had five years of a surgical residency!   And it will tell them that you are dedicated (although deciding whether they deserve that is a long shot).    If you can’t act up to their specifications in a month, it’s their loss, but you will have learned a tremendous amount and will be in a better position to get good recs.  

[Febrifuge]

FCCS is a great class. I was lucky enough to be able to attend (unofficially) during my Trauma Surgery rotation.

 

But aside from that, your experience sounds terribly similar to my first job, as a hospitalist. I was clear and emphatic about the need for support and training, and they made a lot of promises and reassurances, then failed to deliver. I felt terrible, like a failure, but my 90-day "no fault" probationary period passed and they kept me. They sat me down less than a month later, told me I was too slow, not confident enough, and not up to par. We had a couple of specific things to work on, which I did, and I figured when they called me to the office a few weeks later it was to review progress. Nope; they let me go. Bought me out of the contract, basically, so paid me 3 months' salary in a lump and said bye-bye.

 

After I came out of that depression and started looking for new jobs, the hiring manager at one competing group said my old group was kind of infamous for changing their strategies and plans on the fly, so she was not surprised they promised support and then left me hanging.

 

Bottom line, it's tempting to take this as a referendum on your skills, knowledge, and abilities. Don't let it become that. This is the opinion of one disorganized group, led by people who have a poor idea of what they want, and how to hire people who have it. They want autonomous, speedy, confident clinicians -- but they want to pay less, so they hire new grads. How can they not see the disconnect?

 

Get your ducks in a row and ditch these losers, or get them to pay you a lump sum in exchange for a non-compete. I had to agree not to work as a hospitalist for 1 year anywhere within 200 miles (not a problem), and to keep mum about any negative feedback I might have about the group for 1 year (and that year was up in early 2011). Groups like this are not uncommon. Don't let them rattle you.

[taotaox1]

A new grad PA student "only" at the level of a 4th year medical student.  You must be a complete failure as a person and a PA. :rolleyes:  This kind of idiocy must cost these employers more money than they ever save.

 

Stories like this make me so nervous about getting my first job in 9 months..... 

[beach27]

The thing is I have no contract.  So there is no lump sum available.  

[Febrifuge]

Mine was really just a severance deal. It seemed very generous at the time, but it dawned on me later that they were doing some CYA around the need to have me sign the non-compete and non-disclosure agreements. I'm not the sort of person who ever would have tried to damage their reputation, but I am an avid social media user and they likely knew that.

 

Anyway, it was a huge blow to the ego and a scary development for a newbie... but the check for five figures definitely accelerated the healing process. I hope you land on your feet, as well.

[UGoLong]

Regardless of the field, it is not unusual for new grads to leave their first job having learned some valuable lessons. The important thing is not to lose your confidence. Find a job that works for you. I'm guessing that you'll get a contract next time and ask more questions of the interviewer and some of the existing staff.

 

Good luck!

[bgdog]

what I suggest is spending several of your “days off” following the nurses and the fellow(s).  If you are very unfamiliar with the mechanicals, spending time with the senior ICU nurses can be a godsend.    Only by spending many hours every day for a month (one day off) did I even feel like the language was familiar although I was still far from fluent.  The more you learn though, the easier it will be to learn more.   And if you were confident with your current fund of knowledge, that would be a disaster, so that’s not going to improve without time on task.   

^^^^

Agree 100%

 

You said it's "his job to train me"

 

Yes and no.

 

In real life, it's his job to provide an environment where you can learn, which means you have access to doc's, fellows, other PAs, nurses RT's , charts, patients, etc. 

 

It sounds like you have access.

 

It's your job to have LOTS OF DRIVE and spend every waking hour either there, learning the basics of the space shuttle, on You-Tube checking out procedures, and/or buying lots of books and immersing yourself in that very difficult specialty.

 

Total immersion.

 

Total dedication.

 

Total PA Badass-ness.

 

Or...

 

I guess you can always work in the clinic at Target,

 

I hear they're hiring.

[beach27]

^^^^

Agree 100%

 

You said it's "his job to train me"

 

Yes and no.

 

In real life, it's his job to provide an environment where you can learn, which means you have access to doc's, fellows, other PAs, nurses RT's , charts, patients, etc. 

 

It sounds like you have access.

 

It's your job to have LOTS OF DRIVE and spend every waking hour either there, learning the basics of the space shuttle, on You-Tube checking out procedures, and/or buying lots of books and immersing yourself in that very difficult specialty.

 

Total immersion.

 

Total dedication.

 

Total PA Badass-ness.

 

Or...

 

I guess you can always work in the clinic at Target,

 

I hear they're hiring.

Yes, I have been following the team, coming early/staying late.  They do not want me on the off days.  But on the off days, I attend the learning seminars.  But the mid level that is supposed to be training me left after 2 weeks.  I have been paired with someone who is an experienced PA but new to the team as well.  Sometimes, you can try hard, but you can't change the environment due to huge turnover..which you do not find out until you get there.  So do not make assumptions.  I hear that assumptions are the mother of mistakes...So thanks for advice.  But it's tough, when you have this environment with huge turnover.   

 

Also the course you all have mentioned is like 1500 dollars!!!  Any free websites/books?  Thanks for advice. Yes it is a permanent rotation from hell.  Apparently there is alot of politics when you are at a hospital.

[Guest Paula]

Will your employer pay for the course as a part of your CME?  Oh,wait...you don't have a contract.  Do you have any benefits? It sounds like a really bad place to work and makes me queasy just reading about it. 

 

Are you looking for another job?

[Just Steve]

Oh I know I am going to get flamed for this but...

 

OP, you posted that you failed the PANCE is Feb of 2013.  Here we are in November of 2013 and you're diving into a job of Surgical ICU.  Holy Cow...what is going on? What sort of perspective do you have on your skill set? Why are you applying for a job that is rigorous with a high potential of killing a patient (as they are pretty fragile in the surgical ICU)?  Why are you not building up your base knowledge in a lower risk arena such as family practice (No offense to FP, don't get super excited, those patients will die too..just not as fast)

 

I can appreciate wanting to have a solid job with good pay and all that jazz but you're putting yourself at risk (you're about to get sacked from your first job, employers may already be scratching your head of why the long time between graduation and first job.  Now they are going to wonder why you didn't last at your first job very long).  I really hope you find a way to swallow the pride and dial back the ambition a bit.  The emphasis you shared in reporting your request for training at the interview makes it sound like you were hoping more for a training residency. I get the fact that you have bills to pay and all that but you may want to really consider some sort of residency.  You'll still get a bit of a paycheck and will get a great boost to both your abilities and your resume'. That resume' is going to need some damage control after this go around. 

 

There is no shame in primary care. It's a great place to get a great education. 

[problem child]

I just went through exactly the same thing in a cardiothoracic service. I was talked into applying by a recruiter bc it was "not an issue" that I had little to no ICU experience, but bc I was a PA with 6-7 years other experience, they put me right into the ICU with the same promises for training (promised during the interview, too; I was completely upfront about my experience and lack of relevant experience). during the interview they outlined a 3-12 month training template (SICU -> thoracic OR -> floor -> cardio OR). they put the other newbie PAs on the floor, and they too, were swimming in waters over their head.

 

2 weeks in I was told they expected me to be fully independent in 2 weeks. RIGHT. 2 months in, I was fired. sooooo humiliating. but I was sooooo glad to be gone. they wanted to send me off as "fired", I consulted a lawyer and at least got them to change my discharge to "laid off" so I could collect UE. AND.....they gave me 2 WEEKS SEVERANCE!! woo-hoo!!

 

I have still not landed another job and when recruiters call me about CT jobs, I just tell them NO EFFING WAY. I am looking for a position which fits me. I never again want to work in such a nasty and punitive environment.

[GetMeOuttaThisMess]

States of practices?

[Guest JMPA]

welcome to the real PA world. if you want to be trained and have confidence then you have to train yourself. pick up the ICU manuel and read it cover to cover. it will train you

[beach27]

thank you.  I am in Illinois.  I am applying to residency.  I think it will give me the confidence I need. I will work in internal/primary care until I can start residency.