Hate my first job out of PA school

[pa2008]

I am writing for advice/support. I graduated from PA school last year, so excited about the PA profession. I have been at my first job for 4 months and become more and more dissatisfied and unhappy every day. I've taken a rural surgical job. I love surgery and spend about 50% of my time in the OR - while this aspect of my job is still interesting, it is still only a portion of my job. The other 50% of my job is spent in a small office with one other PA and 2 RN's - we are the "pre-admission" team - designed to interview patients pre-op. There is NO room for clinical thinking/decision-making. We are to follow a checklist and check with surgeons/anesthesia concerning ANY abnormalities; no room for autonomy at all. A secretary could do my job. Really. I am so upset and discouraged. My main questions are: is there hope? Will I someday be a more autonomous PA who is able to diagnose, treat, and most importantly THINK?!?!? And, is it detrimental to look for jobs prior to "a year of experience?" I don't know if I can stick it out for a whole year. Thanks for your input.

[jmj11]

I am writing for advice/support. I graduated from PA school last year, so excited about the PA profession. I have been at my first job for 4 months and become more and more dissatisfied and unhappy every day. I've taken a rural surgical job. I love surgery and spend about 50% of my time in the OR - while this aspect of my job is still interesting, it is still only a portion of my job. The other 50% of my job is spent in a small office with one other PA and 2 RN's - we are the "pre-admission" team - designed to interview patients pre-op. There is NO room for clinical thinking/decision-making. We are to follow a checklist and check with surgeons/anesthesia concerning ANY abnormalities; no room for autonomy at all. A secretary could do my job. Really. I am so upset and discouraged. My main questions are: is there hope? Will I someday be a more autonomous PA who is able to diagnose, treat, and most importantly THINK?!?!? And, is it detrimental to look for jobs prior to "a year of experience?" I don't know if I can stick it out for a whole year. Thanks for your input.

 

My first job out of school was the job from hell . . . won't go into it. I did leave after 6 months (after many sleepless nights over the decision) but took a job from Heaven. I went, overnight from being paid extremely poor, treated like crap, to being paid at the top of the scale and treated like a saint.

 

But my advice for you is to give your first job a year. A year will seem like nothing over time. It looks much better to keep a job for a year than to leave sooner. By the end of the year, if there is no hope of fixing what's wrong with your present job, move on and you will find that great job. Unless your present job is intolerable, try to stick it out. As an employer, I would hesitate to hire anyone who was in a job for less than a year.

[swooshie1]

Will I someday be a more autonomous PA who is able to diagnose, treat, and most importantly THINK?!?!?

 

This sounds like a question for your employer.

[andersenpa]

Preop evals can be formulaic, but you still need to have your clinical hat on and look for red flags. It sounds like the issue is anything you notice is immediately bumped up. With all due respect, with <1 year experience it probably should be. I wouldn't put too much into the fact that you aren't independent at that role.

 

Each of us has aspects of the job that feel clerical. There IS something to be gleaned from those experiences, as mundane as they may be.

I agree with with w/ Mike. Give it some time, see if it gete better. Most importantly, communicate any job dissatisfaction with your docs. If they see that you are hungry for more autonomy, they will 1) give it to you, which is what you want, or 2) not, in which case its best to know that right now. If they are restrictive with your practice, tell them what you see as your practice goals and ask how you can get there...graduated increase in responsibility, benchmarks, etc.

[pa2008]

This sounds like a question for your employer.

 

Thank you. Very insightful. I didn't want to go into the details, but have done this and there is very little room for growth, particularly when it comes to autonomy. Bummer.

[pa2008]

Preop evals can be formulaic, but you still need to have your clinical hat on and look for red flags. It sounds like the issue is anything you notice is immediately bumped up. With all due respect, with <1 year experience it probably should be. I wouldn't put too much into the fact that you aren't independent at that role.

 

Each of us has aspects of the job that feel clerical. There IS something to be gleaned from those experiences, as mundane as they may be.

I agree with with w/ Mike. Give it some time, see if it gete better. Most importantly, communicate any job dissatisfaction with your docs. If they see that you are hungry for more autonomy, they will 1) give it to you, which is what you want, or 2) not, in which case its best to know that right now. If they are restrictive with your practice, tell them what you see as your practice goals and ask how you can get there...graduated increase in responsibility, benchmarks, etc.

 

Thanks for the advice. I do, indeed have my clinical hat on for red flags, and appreciate this responsibility. But, you're right: the problem is that anything I notice is to be immediately bumped up. And you're also correct that I am a new grad, and am CERTAINLY still learning. I feel that I am not the type to with hold any information to my "superiors" if I need help - I will ALWAYS err on the side of asking for help - there seems to be no TRUST.

I also have communicated my dissatisfaction to my supervisors - also gread advice, thank you. Unfortunately, my supervisors are RNs and I work for a hospital, rather than for Doc's. The Doc's actually seem to be my ally, but have their hands somewhat tied due to the fact that they are not my employers. I have also unfortunately been met with a great deal of resistance from my supervisors about room to grow, clinically (this is all supposedly based on hospital "policy and procedure").

 

Regardless, I really appreciate all of the advice here. I sadly think the best thing for me to do will be to stick it out for a year. I do have fears that I will be nearly starting from scratch at any new job in the future, as I have very little room to LEARN or PRACTICE anything clinical here. Oh well, I'll just learn then, I guess... And keep reading and talking with colleagues elsewhere. Thank you again.

[andersenpa]

Thanks for the advice. I do, indeed have my clinical hat on for red flags, and appreciate this responsibility. But, you're right: the problem is that anything I notice is to be immediately bumped up. And you're also correct that I am a new grad, and am CERTAINLY still learning. I feel that I am not the type to with hold any information to my "superiors" if I need help - I will ALWAYS err on the side of asking for help - there seems to be no TRUST.

I also have communicated my dissatisfaction to my supervisors - also gread advice, thank you. Unfortunately, my supervisors are RNs and I work for a hospital, rather than for Doc's. The Doc's actually seem to be my ally, but have their hands somewhat tied due to the fact that they are not my employers. I have also unfortunately been met with a great deal of resistance from my supervisors about room to grow, clinically (this is all supposedly based on hospital "policy and procedure").

 

Regardless, I really appreciate all of the advice here. I sadly think the best thing for me to do will be to stick it out for a year. I do have fears that I will be nearly starting from scratch at any new job in the future, as I have very little room to LEARN or PRACTICE anything clinical here. Oh well, I'll just learn then, I guess... And keep reading and talking with colleagues elsewhere. Thank you again.

 

Well that says a lot. Unfortunatel many hospital systems place PAs under nursing in terms of staffing, pay scale, benefits, etc. There are enough stories about nursing admins who are overly restrictive on PAs to have some legitimate concern about the growth potential at this position.

 

If it was me I would address all my complaints with the fact that I have a supervising physician (which you should have as part of your state practice plan), and your delegation of responsibility should be from THEM, not RNs. Nurses do not have the authority to supervise PAs.

Second, I would find out TO THE LETTER what these "policies and procedures" are. If they make it difficult to get them, it likely means there are none and it is typical nursing territory issues.

 

Unfortunately you may be in the position of advocating for yourself ALONE, and many PAs don't want to fight that fight...and end up moving on to a better job. Good luck and keep us posted.

[ventana]

RN's as supervisors for PA's should NEVER be done

 

immediatly request that you report to someone above your medical pay grad not below

 

look for another job

[swooshie1]

Thank you. Very insightful. I didn't want to go into the details, but have done this and there is very little room for growth, particularly when it comes to autonomy. Bummer.

 

I realize that my response may have come off as being snarky; it wasn't meant to be. Is there anything in your employment contract that you could point to regarding the supervision aspect? How does the other PA feel about this situation? I guess if it were me, I would continue to deal, get a year under the belt and then get out of there, though certainly along the way, and respectfully, continue to discuss with your doctors how you feel the supervision scenario limits your potential as a provider. I wouldn't necessarily believe that the doctors don't have some say in such matters, especially if they feel they may ultimately lose a good PA as a colleague. I also wouldn't hesitate, in a new job interview situation, to say that you are leaving a job due to a stifling learning environment. Best of luck to you.

[OpSite]

I agree 150% that PA's should never report to an RN, but not because of pay scale (I, personally, will be taking a pay cut to become a PA from an RN). It is out of the scope of practice for an RN to supervise a mid-level practitioner (and really very insulting to the PA) AND isn't it within the licensure of a PA to have a supervising physician? Not an OK circumstance and opening up the facility to many legal issues. I think I'd leave as soon as possible. It's not just a lack of respect for the role that PA's play in healthcare, but could potentially be a dangerous situation.

[burnpac]

My advice is to hang in there for 12 months. With 50% time in the OR, you are getting invaluable experience that will translate into strong marketability in a lucrative specialty.

[pa2008]

Thank you all so much for the insight/advice. To clarify, I do have a supervising physician, but my "boss" in the pre-admission department is an RN (and her boss is an RN), who clearly doesn't trust/understand the scope of practice of a PA. I do report to my physician regarding anything in the OR (the one place I'm happy). The other PA who works in pre-admission with me is on the exact same page as I am - we feel totally stifled. The doc's have gone to bat for us and we've made MINUTE changes because of that - we are now going to be allowed to actually order necessary pre-op diagnostics for patients, but only according to an ALGORITHM (again, not THINKING for ourselves, the way we were trained). Also, in our most recent meeting, in which we were told of these changes, we were also told that in our department "the nurses and the PAs are NO different, except for our ability to order tests, something which the nurses cannot do." (insulting?!?!) Also, they are asking us (the PAs) to bring the two nurses up to speed with taking an appropriate HPI/PMH,FHx from the patient (pertinent pos/neg, etc., etc. - you know, all of the stuff we learn in PA school...), and also with how to appropriately present to a physician. I somehow find this somewhat inappropriate, as well - I was trained in the medical model, it seems that if they did not learn a great deal of this in school, they shouldn't be doing it; or if they should be doing it, they should have a nurse, rather than a PA train them to do it. Furthermore, one of these nurses that we are expected to train is our "team leader" (boss?, not to mention - this particular nurse is NOT very clinically-minded....) - how is it that I am supposed to bring my BOSS up to speed clinically? Seems so backward. And, clearly frustrating. Wow, I guess I really needed to vent - sorry for going on and on. This really is a great forum, and I GREATLY appreciate everyone's advice and input!

 

One last question: should I work 12 months before I even start APPLYING to another job????

 

THANK YOU all SO much!!!!

[emspa58941]

My advice.. Go to work, smile, do your best, and at 12 months begin to look for another job. There is a disconnect at that place and I probably would have left or been fired with that mentality. What you are describing is a power trip that happens at hospitals everywhere. I'll quit my job before an RN becomes my boss.

[Contrarian]

Well... true to my name, I'm gonna post a "contrarian" perspective to what has already been posted.

 

1.) There is actually NOTHING wrong or improper about a PA having a RN as a supervisor. A "supervisor" at one of my jobs is a RN and at another of my jobs is a Licensed Social Worker. Thing is... they are merely "Administrative Supervisors." They defer to MY clinical decisions and work to make sure that I have what I need to do the job. They don't question or challenge my clinical decisions. I "answer" to and defer to them on administrative issues (hireing, fireing, diciplining of ancillary staff, non-medical policies and procedures, time, attendence, schedualing, etc). They sign my timesheets, and my yrly evaluations (after talking to my SPs). These "Supervisors" are department heads and therefore the "supervisors" of the medical staff (MD/DO/PA/NPs) that work in/for these departments. As a matter of a fact... at one job... the acting Medical Director is a ARNP. She has been the "acting" Medical Director since 2007 and "medically" directs 20 MDs/DOs and 12 ARNPs/PAs.

 

Anyone who has spent a considerable amount of time working in or around large healthcare organizations KNOWS that the majority of the department heads/unit directors out there are NURSES. Its just the way it is. As such... its really not a problem, as long as they under/overstand their roles administratively and clinically. Hell... it is my understanding that many/most military (?Army?) PAs that are not assigned to a combat unit regularly have nurses as their "supervisors" (think O-4/O-5 Nurses in MEDDAC).

 

I'd posit that anyone "trippin" on the fact that a nurse or any other non-physician is or can be a "supervisor" of physicians and PAs IS on a EGO-Power trip. Its really NOT about the administrative titile its the function.

 

Now I have worked in settings where supervisory and other nurses have tried to insert themselves into my clinical decision making loop... or have tried to direct my clinical care. These were always easy to handle by simply treating them as I do my PA students. I would simply smile then start "Pimping" the Schitt out of them. Generally, halfway through their first round of "Jeopardy- The Medical Grist"... they and EVERYONE around within earshot knows that they shouldn't have gone there... and its usually clear to all within 15 feet of this exercise that they have NO business trying to direct my clinical care which in and of itself requires a level of understanding that far exceeds their training, knowledge and scope of practice.

 

 

2.) The part about being expected to teach the nurses how to function as PAs is nonsense. I wouldn't do it and would simply suggest that they attend a program. Hell... I'd even keep a stack of PA program applications on hand and distribute them each time they ask. To keep it interesting... I'd give them a application from a different PA school each time they asked.

 

 

3.) As was alluded to above... as a NEW GRAD... IN SURGERY... how much "autonomy" do you expect..??? Aside from "minor" surgical procedures, You can't practice surgery autonomously (as a PA)... then outside of the OR... the reigns are held tight (as a New Grad). Things would surely be different IF you weren't a hospital employee ... and would likely be different IF you had experience... but thats not the case.

 

Would add that this is the reason why I think ALL non-residency trained new grads should work in Primary Care for 2-3yrs before subspecializing. Doing so allows one to "plant their feet" firmly under them and inculcate (instead of simply memorize) the "art" (and some of the concrete science) before devoting ones-self to simply focusing on a narrow aspect of medicine. A exception to this would be when a new grad is working in a specialty that they have EXTENSIVE pre-pa experience in such as: EMT-P --> EMPA... or CCRN--> Hospitalist/CCPA... Respiratory Therapist -->Pulmonary PA... etc.

 

Just my initial thoughts for now...

 

Contrarian

[Contrarian]

Well... true to my name, I'm gonna post a "contrarian" perspective to what has already been posted.

 

1.) There is actually NOTHING wrong or improper about a PA having a RN as a supervisor. A "supervisor" at one of my jobs is a RN and at another of my jobs is a Licensed Social Worker. Thing is... they are merely "Administrative Supervisors." They defer to MY clinical decisions and work to make sure that I have what I need to do the job. They don't question or challenge my clinical decisions. I "answer" to and defer to them on administrative issues (hireing, fireing, diciplining of ancillary staff, non-medical policies and procedures, time, attendence, schedualing, etc). They sign my timesheets, and my yrly evaluations (after talking to my SPs). These "Supervisors" are department heads and therefore the "supervisors" of the medical staff (MD/DO/PA/NPs) that work in/for these departments. As a matter of a fact... at one job... the acting Medical Director is a ARNP. She has been the "acting" Medical Director since 2007 and "medically" directs 20 MDs/DOs and 12 ARNPs/PAs.

 

Anyone who has spent a considerable amount of time working in or around large healthcare organizations KNOWS that the majority of the department heads/unit directors out there are NURSES. Its just the way it is. As such... its really not a problem, as long as they under/overstand their roles administratively and clinically. Hell... it is my understanding that many/most military (?Army?) PAs that are not assigned to a combat unit regularly have nurses as their "supervisors" (think O-4/O-5 Nurses in MEDDAC).

 

I'd posit that anyone "trippin" on the fact that a nurse or any other non-physician is or can be a "supervisor" of physicians and PAs IS on a EGO-Power trip. Its really NOT about the administrative titile its the function.

 

Now I have worked in settings where supervisory and other nurses have tried to insert themselves into my clinical decision making loop... or have tried to direct my clinical care. These were always easy to handle by simply treating them as I do my PA students. I would simply smile then start "Pimping" the Schitt out of them. Generally, halfway through their first round of "Jeopardy- The Medical Grist"... they and EVERYONE around within earshot knows that they shouldn't have gone there... and its usually clear to all within 15 feet of this exercise that they have NO business trying to direct my clinical care which in and of itself requires a level of understanding that far exceeds their training, knowledge and scope of practice.

 

 

2.) The part about being expected to teach the nurses how to function as PAs is nonsense. I wouldn't do it and would simply suggest that they attend a program. Hell... I'd even keep a stack of PA program applications on hand and distribute them each time they ask. To keep it interesting... I'd give them a application from a different PA school each time they asked.

 

 

3.) As was alluded to above... as a NEW GRAD... IN SURGERY... how much "autonomy" do you expect..??? Aside from "minor" surgical procedures, You can't practice surgery autonomously (as a PA)... then outside of the OR... the reigns are held tight (as a New Grad). Things would surely be different IF you weren't a hospital employee ... and would likely be different IF you had experience... but thats not the case.

 

Would add that this is the reason why I think ALL non-residency trained new grads should work in Primary Care for 2-3yrs before subspecializing. Doing so allows one to "plant their feet" firmly under them and inculcate (instead of simply memorize) the "art" (and some of the concrete science) before devoting ones-self to simply focusing on a narrow aspect of medicine. A exception to this would be when a new grad is working in a specialty that they have EXTENSIVE pre-pa experience in such as: EMT-P --> EMPA... or CCRN--> Hospitalist/CCPA... Respiratory Therapist -->Pulmonary PA... etc.

 

Just my initial thoughts for now...

 

Contrarian

[pa2008]

Well... true to my name, I'm gonna post a "contrarian" perspective to what has already been posted.

 

1.) There is actually NOTHING wrong or improper about a PA having a RN as a supervisor. A "supervisor" at one of my jobs is a RN and at another of my jobs is a Licensed Social Worker. Thing is... they are merely "Administrative Supervisors." They defer to MY clinical decisions and work to make sure that I have what I need to do the job. They don't question or challenge my clinical decisions. I "answer" to and defer to them on administrative issues (hireing, fireing, diciplining of ancillary staff, non-medical policies and procedures, time, attendence, schedualing, etc). They sign my timesheets, and my yrly evaluations (after talking to my SPs). These "Supervisors" are department heads and therefore the "supervisors" of the medical staff (MD/DO/PA/NPs) that work in/for these departments. As a matter of a fact... at one job... the acting Medical Director is a ARNP. She has been the "acting" Medical Director since 2007 and "medically" directs 20 MDs/DOs and 12 ARNPs/PAs.

 

Anyone who has spent a considerable amount of time working in or around large healthcare organizations KNOWS that the majority of the department heads/unit directors out there are NURSES. Its just the way it is. As such... its really not a problem, as long as they under/overstand their roles administratively and clinically. Hell... it is my understanding that many/most military (?Army?) PAs that are not assigned to a combat unit regularly have nurses as their "supervisors" (think O-4/O-5 Nurses in MEDDAC).

 

I'd posit that anyone "trippin" on the fact that a nurse or any other non-physician is or can be a "supervisor" of physicians and PAs IS on a EGO-Power trip. Its really NOT about the administrative titile its the function.

 

Now I have worked in settings where supervisory and other nurses have tried to insert themselves into my clinical decision making loop... or have tried to direct my clinical care. These were always easy to handle by simply treating them as I do my PA students. I would simply smile then start "Pimping" the Schitt out of them. Generally, halfway through their first round of "Jeopardy- The Medical Grist"... they and EVERYONE around within earshot knows that they shouldn't have gone there... and its usually clear to all within 15 feet of this exercise that they have NO business trying to direct my clinical care which in and of itself requires a level of understanding that far exceeds their training, knowledge and scope of practice.

 

 

2.) The part about being expected to teach the nurses how to function as PAs is nonsense. I wouldn't do it and would simply suggest that they attend a program. Hell... I'd even keep a stack of PA program applications on hand and distribute them each time they ask. To keep it interesting... I'd give them a application from a different PA school each time they asked.

 

 

3.) As was alluded to above... as a NEW GRAD... IN SURGERY... how much "autonomy" do you expect..??? Aside from "minor" surgical procedures, You can't practice surgery autonomously (as a PA)... then outside of the OR... the reigns are held tight (as a New Grad). Things would surely be different IF you weren't a hospital employee ... and would likely be different IF you had experience... but thats not the case.

 

Would add that this is the reason why I think ALL non-residency trained new grads should work in Primary Care for 2-3yrs before subspecializing. Doing so allows one to "plant their feet" firmly under them and inculcate (instead of simply memorize) the "art" (and some of the concrete science) before devoting ones-self to simply focusing on a narrow aspect of medicine. A exception to this would be when a new grad is working in a specialty that they have EXTENSIVE pre-pa experience in such as: EMT-P --> EMPA... or CCRN--> Hospitalist/CCPA... Respiratory Therapist -->Pulmonary PA... etc.

 

Just my initial thoughts for now...

 

Contrarian

 

Thank you for a fresh perspective. I have no problem with nurses overseeing me administratively, but they unfortunately oversee me clinically here as well. AND, I'm certainly not looking for more autonomy in the OR - as I mentioned above, I'm happy with my work in the OR. Perhaps autonomy is not even the correct word - I am currently following an algorithm in my pre-admission portion of my job - no room for thinking at all - I'm more than happy to discuss/report to a physician (in fact, I would love this type of interaction!), it's just that I'm being taught/learning nothing, as my hands are tied - it's just "yes or no" on a checklist and no clinical thought is allowed/encouraged. I'm just wishing I could LEARN/THINK more in my job.

[pa2008]

Well... true to my name, I'm gonna post a "contrarian" perspective to what has already been posted.

 

1.) There is actually NOTHING wrong or improper about a PA having a RN as a supervisor. A "supervisor" at one of my jobs is a RN and at another of my jobs is a Licensed Social Worker. Thing is... they are merely "Administrative Supervisors." They defer to MY clinical decisions and work to make sure that I have what I need to do the job. They don't question or challenge my clinical decisions. I "answer" to and defer to them on administrative issues (hireing, fireing, diciplining of ancillary staff, non-medical policies and procedures, time, attendence, schedualing, etc). They sign my timesheets, and my yrly evaluations (after talking to my SPs). These "Supervisors" are department heads and therefore the "supervisors" of the medical staff (MD/DO/PA/NPs) that work in/for these departments. As a matter of a fact... at one job... the acting Medical Director is a ARNP. She has been the "acting" Medical Director since 2007 and "medically" directs 20 MDs/DOs and 12 ARNPs/PAs.

 

Anyone who has spent a considerable amount of time working in or around large healthcare organizations KNOWS that the majority of the department heads/unit directors out there are NURSES. Its just the way it is. As such... its really not a problem, as long as they under/overstand their roles administratively and clinically. Hell... it is my understanding that many/most military (?Army?) PAs that are not assigned to a combat unit regularly have nurses as their "supervisors" (think O-4/O-5 Nurses in MEDDAC).

 

I'd posit that anyone "trippin" on the fact that a nurse or any other non-physician is or can be a "supervisor" of physicians and PAs IS on a EGO-Power trip. Its really NOT about the administrative titile its the function.

 

Now I have worked in settings where supervisory and other nurses have tried to insert themselves into my clinical decision making loop... or have tried to direct my clinical care. These were always easy to handle by simply treating them as I do my PA students. I would simply smile then start "Pimping" the Schitt out of them. Generally, halfway through their first round of "Jeopardy- The Medical Grist"... they and EVERYONE around within earshot knows that they shouldn't have gone there... and its usually clear to all within 15 feet of this exercise that they have NO business trying to direct my clinical care which in and of itself requires a level of understanding that far exceeds their training, knowledge and scope of practice.

 

 

2.) The part about being expected to teach the nurses how to function as PAs is nonsense. I wouldn't do it and would simply suggest that they attend a program. Hell... I'd even keep a stack of PA program applications on hand and distribute them each time they ask. To keep it interesting... I'd give them a application from a different PA school each time they asked.

 

 

3.) As was alluded to above... as a NEW GRAD... IN SURGERY... how much "autonomy" do you expect..??? Aside from "minor" surgical procedures, You can't practice surgery autonomously (as a PA)... then outside of the OR... the reigns are held tight (as a New Grad). Things would surely be different IF you weren't a hospital employee ... and would likely be different IF you had experience... but thats not the case.

 

Would add that this is the reason why I think ALL non-residency trained new grads should work in Primary Care for 2-3yrs before subspecializing. Doing so allows one to "plant their feet" firmly under them and inculcate (instead of simply memorize) the "art" (and some of the concrete science) before devoting ones-self to simply focusing on a narrow aspect of medicine. A exception to this would be when a new grad is working in a specialty that they have EXTENSIVE pre-pa experience in such as: EMT-P --> EMPA... or CCRN--> Hospitalist/CCPA... Respiratory Therapist -->Pulmonary PA... etc.

 

Just my initial thoughts for now...

 

Contrarian

 

Thank you for a fresh perspective. I have no problem with nurses overseeing me administratively, but they unfortunately oversee me clinically here as well. AND, I'm certainly not looking for more autonomy in the OR - as I mentioned above, I'm happy with my work in the OR. Perhaps autonomy is not even the correct word - I am currently following an algorithm in my pre-admission portion of my job - no room for thinking at all - I'm more than happy to discuss/report to a physician (in fact, I would love this type of interaction!), it's just that I'm being taught/learning nothing, as my hands are tied - it's just "yes or no" on a checklist and no clinical thought is allowed/encouraged. I'm just wishing I could LEARN/THINK more in my job.

[Contrarian]

.... [brevity edit]... Perhaps autonomy is not even the correct word - I am currently following an algorithm in my pre-admission portion of my job - no room for thinking at all - I'm more than happy to discuss/report to a physician (in fact, I would love this type of interaction!), it's just that I'm being taught/learning nothing, as my hands are tied - it's just "yes or no" on a checklist and no clinical thought is allowed/encouraged. I'm just wishing I could LEARN/THINK more in my job.

 

Umm... sounds like "Clinical Pathways" to me... which again has seemed to be a inherent detail on/in the landscape of Large Healthcare Organizational care.

 

Clinical pathways, also known as care pathways, critical pathways, integrated care pathways, or care maps, are one of the main tools used to manage the quality in healthcare concerning the standardization of care processes. It has been proven that their implementation reduces the variability in clinical practice and improves outcomes. Clinical pathways promote organized and efficient patient care based on the evidence based practice. Clinical pathways optimize outcomes in the acute care and homecare settings.

Generally clinical pathways refer to medical guidelines. However a single pathway may refer to guidelines on several topics in a well specified context.

 

In the hospital setting, these guidlines/pathways have generally been formulated by multidiciplinary commitees (physicians, nurses, LAWYERS, etc) with the intent of standardizing and improving care, patient outcomes while decreasing mistakes, miss-steps, liability and poor outcomes. The notion that the neophyte, new-kid on the block wants to come in and start over-thinking, deviating, and possibly altering these protocols will be met with resistence

 

If you don't want to function in this manner (clinical/critical pathways)... I'd suggest that you avoid working for or in all Large Healthcare Orgs and hospitals.

 

Yep... it sounds like you have out-grown your current job... and its time to find a new one.

[Contrarian]

.... [brevity edit]... Perhaps autonomy is not even the correct word - I am currently following an algorithm in my pre-admission portion of my job - no room for thinking at all - I'm more than happy to discuss/report to a physician (in fact, I would love this type of interaction!), it's just that I'm being taught/learning nothing, as my hands are tied - it's just "yes or no" on a checklist and no clinical thought is allowed/encouraged. I'm just wishing I could LEARN/THINK more in my job.

 

Umm... sounds like "Clinical Pathways" to me... which again has seemed to be a inherent detail on/in the landscape of Large Healthcare Organizational care.

 

Clinical pathways, also known as care pathways, critical pathways, integrated care pathways, or care maps, are one of the main tools used to manage the quality in healthcare concerning the standardization of care processes. It has been proven that their implementation reduces the variability in clinical practice and improves outcomes. Clinical pathways promote organized and efficient patient care based on the evidence based practice. Clinical pathways optimize outcomes in the acute care and homecare settings.

Generally clinical pathways refer to medical guidelines. However a single pathway may refer to guidelines on several topics in a well specified context.

 

In the hospital setting, these guidlines/pathways have generally been formulated by multidiciplinary commitees (physicians, nurses, LAWYERS, etc) with the intent of standardizing and improving care, patient outcomes while decreasing mistakes, miss-steps, liability and poor outcomes. The notion that the neophyte, new-kid on the block wants to come in and start over-thinking, deviating, and possibly altering these protocols will be met with resistence

 

If you don't want to function in this manner (clinical/critical pathways)... I'd suggest that you avoid working for or in all Large Healthcare Orgs and hospitals.

 

Yep... it sounds like you have out-grown your current job... and its time to find a new one.

[WatchTheSky]

I would be inclined to leave, with 2 reasons backing my decision.

1) I would think that future employers would respect my reasoning for leaving, i.e. wanting to learn/grow/expand, rather than just be an instrument for following a protocol and learning nothing.

2) If I did stick it out and left after 12 months, I would feel wayyy behind the learning curve for a 1-year-post-grad PA. I would hate for my new employer to think "Wow, this girl was a PA for a year?! She doesn't know anything!" simply because my first job was NOT conducive to learning.

 

Best of luck. A good 1/4 of my classmates left their first jobs after less than a year. I was with my 1st employer 9 months before I was approached by another group to join. (I made the official switch after finishing out 12 months because of negotiations, hospital credentialing, & I wanted to give my 1st job ample time to train a new PA that was hired instead of leaving my former coworkers in a tizzy.) Best. Decision. Ever! I am a thousand times happier. Remember to look out for yourself in times when no one else might.

[WatchTheSky]

I would be inclined to leave, with 2 reasons backing my decision.

1) I would think that future employers would respect my reasoning for leaving, i.e. wanting to learn/grow/expand, rather than just be an instrument for following a protocol and learning nothing.

2) If I did stick it out and left after 12 months, I would feel wayyy behind the learning curve for a 1-year-post-grad PA. I would hate for my new employer to think "Wow, this girl was a PA for a year?! She doesn't know anything!" simply because my first job was NOT conducive to learning.

 

Best of luck. A good 1/4 of my classmates left their first jobs after less than a year. I was with my 1st employer 9 months before I was approached by another group to join. (I made the official switch after finishing out 12 months because of negotiations, hospital credentialing, & I wanted to give my 1st job ample time to train a new PA that was hired instead of leaving my former coworkers in a tizzy.) Best. Decision. Ever! I am a thousand times happier. Remember to look out for yourself in times when no one else might.

[SocialMedicine]

.Random thoughts ...

 

Consider PA surgical residency? Could be a good way to get experience in order to become mroe autonomous and make valuable connections professionally.

 

Many PAs enjoy autonomy ... even full autonomy expecially in internal med/primary/urgent settings. Surgery is always going to be more limited limited.

 

I would complete the year. Start applying for new positions at the ten month mark. Most clinical positions will allow for you to give a 4 week notice at your previous position. When applying for new positions you can describe how this was a well supervised, learning experience, with alot of OR timeand now you are ready to branch out. Maybe you can participate in consults and grow in your next position.

 

Medicine is a process. Nobody starts off doing anything glamorous. Look at interns. Pay your dues and you will see rewards. But yea ... do not pay your days reporting to an RN. That makes no sense.

[SocialMedicine]

.Random thoughts ...

 

Consider PA surgical residency? Could be a good way to get experience in order to become mroe autonomous and make valuable connections professionally.

 

Many PAs enjoy autonomy ... even full autonomy expecially in internal med/primary/urgent settings. Surgery is always going to be more limited limited.

 

I would complete the year. Start applying for new positions at the ten month mark. Most clinical positions will allow for you to give a 4 week notice at your previous position. When applying for new positions you can describe how this was a well supervised, learning experience, with alot of OR timeand now you are ready to branch out. Maybe you can participate in consults and grow in your next position.

 

Medicine is a process. Nobody starts off doing anything glamorous. Look at interns. Pay your dues and you will see rewards. But yea ... do not pay your days reporting to an RN. That makes no sense.

[ventana]

 

Would add that this is the reason why I think ALL non-residency trained new grads should work in Primary Care for 2-3yrs before subspecializing. Doing so allows one to "plant their feet" firmly under them and inculcate (instead of simply memorize) the "art" (and some of the concrete science) before devoting ones-self to simply focusing on a narrow aspect of medicine. A exception to this would be when a new grad is working in a specialty that they have EXTENSIVE pre-pa experience in such as: EMT-P --> EMPA... or CCRN--> Hospitalist/CCPA... Respiratory Therapist -->Pulmonary PA... etc.

 

Just my initial thoughts for now...

 

Contrarian

 

 

 

STRONGLY support this!!

 

I think there should be a 1 yr internship just like doc's that teaches you how to apply what you have learned - any hospital could have it - and it would act a nice feeder to bring new grads into a new area.....

 

 

I do disagree in general with an RN being your supervisor - it is just to confusing who is on top of the pile - the RN might well know more then a new grad PA but hugely less then an experienced PA and then all of a sudden you have needless power struggles. This is not saying an administrator can't be your boss - just not a practicing clinical RN

 

Heck some of my best bosses were just administrators but not nurses - sounds like I am grinding an axe but in my local area the nurses are unionized and exceptionally powerful and really are not a PA's friend for administrative issues. They make over 100k per year with out shift differential, and can make a lot more with over time and weekends - and this creates a very challenging situation that is best avoided as many times the are not correct in their assessment (or if they are right they have not through through the possible pitfalls and dangers).

 

In some ways the Doc supervisor for administrative issues is also a problem as they start to inject their own thoughts on what a PA should and should not do and many times do not realize how much we can do.

 

I STRONGLY think the doc is ultimate clinical supervisor, but PA/NP should manage themselves with a formal Department of PA Services in a hospital system and we should be voting members of the medical staff

[ventana]

 

Would add that this is the reason why I think ALL non-residency trained new grads should work in Primary Care for 2-3yrs before subspecializing. Doing so allows one to "plant their feet" firmly under them and inculcate (instead of simply memorize) the "art" (and some of the concrete science) before devoting ones-self to simply focusing on a narrow aspect of medicine. A exception to this would be when a new grad is working in a specialty that they have EXTENSIVE pre-pa experience in such as: EMT-P --> EMPA... or CCRN--> Hospitalist/CCPA... Respiratory Therapist -->Pulmonary PA... etc.

 

Just my initial thoughts for now...

 

Contrarian

 

 

 

STRONGLY support this!!

 

I think there should be a 1 yr internship just like doc's that teaches you how to apply what you have learned - any hospital could have it - and it would act a nice feeder to bring new grads into a new area.....

 

 

I do disagree in general with an RN being your supervisor - it is just to confusing who is on top of the pile - the RN might well know more then a new grad PA but hugely less then an experienced PA and then all of a sudden you have needless power struggles. This is not saying an administrator can't be your boss - just not a practicing clinical RN

 

Heck some of my best bosses were just administrators but not nurses - sounds like I am grinding an axe but in my local area the nurses are unionized and exceptionally powerful and really are not a PA's friend for administrative issues. They make over 100k per year with out shift differential, and can make a lot more with over time and weekends - and this creates a very challenging situation that is best avoided as many times the are not correct in their assessment (or if they are right they have not through through the possible pitfalls and dangers).

 

In some ways the Doc supervisor for administrative issues is also a problem as they start to inject their own thoughts on what a PA should and should not do and many times do not realize how much we can do.

 

I STRONGLY think the doc is ultimate clinical supervisor, but PA/NP should manage themselves with a formal Department of PA Services in a hospital system and we should be voting members of the medical staff