Overwhelmed at first job

[isoguidance]

Hi guys, I hope to see if I can get any guidance about my current situation.

I am a new-to-practice PA and started my job in CT surgery in February of this year. I graduated in August of last year. I am working in inpatient cardiac surgery and am currently still on orientation, but I am feeling quite overwhelmed and starting to wonder if this is not the right opportunity for me to have taken on as my first job out of school. To provide some background, the team I work on is 95% NPs, 5% PAs. The team is predominantly comprised of NPs that have had years of experience working on either the cardiac surgery floor or in the surgical ICU prior to becoming NPs. There is another new-to-practice PA that came about a year and a half before me, but I am the second new-to-practice PA that they have taken a chance with hiring. There is one other seasoned PA who has prior experience. I say "taken a chance with hiring" because the new-to-practice PA that had come before me was the trailblazer in that my manager was testing the waters to see whether new grads would be able to make it on this floor. PAs are typically in the OR for CT surgery where I work. The new-to-practice PA was on the verge of leaving but was encouraged to stay with the promise of an extension to her length of orientation (from 3 months to 6 months) and with her demanding that changes be made to how orientation for any future new-grad PAs be handled.

I am currently being mentored by the seasoned PA, as well as another seasoned NP. I take three of their patients (typical patient load for a provider is about and they try to follow behind me so that we can address aspects that I am missing. While there are some opportunities during the day to talk through some topics, oftentimes the rigors and rounding schedules of the floor only allow for us to touch base briefly and intermittently. There are no residents or fellows on the floor, so it is only the team of NPs and PAs that are running the show while the surgeons are in the OR. Because of this set-up, there is very minimal addition of new knowledge within this team. There are no lectures to attend to ensure that we are practicing evidence-based medicine, each surgeon notoriously prefers different styles of practice based on their training and experiences that is un-Google-able, and I feel that my main sources of learning rely on what I can try to teach myself at home and what my mentor can offer in the limited time that we have during the work day for teaching. I feel that being so many months out from graduation, I am trying to find my way to regain and effectively apply all the knowledge I once had from school into my new role as an inpatient provider, while also trying to learn cardiac surgery, a specialty I had been minimally exposed to during school/rotations. I find myself leaving work feeling completely defeated by how inefficient I am with having managed only three patients (though complex patients) that day, with my head feeling full of everything from navigating the EMR system, to putting in orders for medications that I now need to know the dosages and frequencies for, to remembering the information that my mentors had offered me that day, to remembering how to clinically manage patient conditions instead of managing pretend patients that had once been in non-real-life-threatening multiple choice formats, to realizing that not only the surgeons differ in their practices but the NPs and PAs differ as well.

My mentors are frustrated because it seems that I do not remember some topics we discuss, and while I can understand where their frustration is coming from I feel like I am drowning to try to keep up with absorbing all these things that are all new to me. I try to jot down notes whenever they say things, but there is not very much opportunity to ask why certain things are the way they are, nor are there always reasons why they are. Because of this, my memory feels like a "snapshot" memory and I am finding it difficult to then apply what I am being told to another situation that may be similar in the future. While I try to return home with what brain power I have remaining to review what we have gone over, there are ultimately gaps in my knowledge because there may have been aspects that I was not able to jot down quickly enough, or that I maybe didn't understand fully when the factoid was told to me in an isolated incident. I also find myself planning to research a whole laundry list of topics of confusion to find myself going down a deep rabbit hole just to feel like I have grasped the topic, only to find myself not making my way efficiently through my topic list and then returning to work and finding more topics of confusion. In the midst of my mentors' frustrations, it has now reached the point where I am afraid to ask questions because I am afraid that my mentors will say "we've already gone over this" when I truly do not recall it or when I only vaguely remember them saying something about that question but not in an in-depth way. I feel like they think they're being crystal clear and that the things they are telling me should be easy to remember the next time, and I wish I could ask them to be patient with me because it is a lot to digest. My manager's only consolation was "well in your interview you knew that this was not going to be a teaching floor," and I just wish I could find the voice to reply that even though I expected this to be hard, it doesn't make this any easier.

I dread going to work and it's very difficult for me to gauge whether this is simply a new grad experience, or if this is an opportunity that was not meant for me right now when factoring in my new grad status and the resources and environment that I currently have to get my footing as a new grad. My confidence and self esteem are in the dumps because I feel like an idiot that can't remember anything from school, let alone remember anything about CT surgery to make my mentors feel that I am making adequate progress as I approach the end of my third month on orientation. If anyone has any advice, I would greatly appreciate it.

[recentgrad]

I dont have much to add on the side of advice as I'm currently in a similar situation. Graduated back in December, just started a job in in-patient orthopedics at a high-volume trauma center about a month ago. I can 100% empathize with just about everything you're saying though. I've come home multiple times now from work questioning whether or not this is the right job for me and also feeling like an idiots for not being able to remember certain things from school. Following to see if anyone has words of encouragements

[MT2PA]

Look being a new grad is hard.  There's a BIG learning curve.  Some degree of uncertainty is normal.

OP why did you decide to go into CT surgery?  Folks that I know that go into it as a new grad had at least an elective rotation in a field very directly related.

It sounds like your employer was very up front about the training process for your position.  Just because a new grad has done it before doesn't mean that A: it's a good environment for a new grad or B: the right environment for you.

No one can tell you what to do here.  I think this is a combination of not a great environment for a new grad but also maybe just something you aren't cut out for.  Only you can decide if that's true or not.

[CAdamsPAC]

A new Grad PA in with CT Surgeons who after a few months on the job doesn't have a complete handle on the job? I say that you are about where you should be, knowing that you don't know and knowing to seek help is the level I'd expect from you. Keep working hard to learn and develop the skills that others took years to acquire don't stop asking questions and for help as needed. If your group isn't willing to give you the time to learn and grow, that could be a real problem for you.

[UGoLong]

First jobs can be like this. I'm not in CT surgery but have been with the same cards practice for almost 13 years now.

You are playing with live ammunition and dealing with fellow providers who probably are overloaded as well. I found that I had to be insistent when I needed help and also able to grasp new lessons quickly. Not all environments are the same, but working in a hospital often means dealing with complex patients, even from day 1.

The best advice I got was from my SP: go as fast as you can, but no faster! In the beginning, that sometimes won't be very fast at all. Get help when you need it but don't expect everyone else to be your 24/7 resource. But get their attention when you really need it. And make friends with EVERYONE you work with; they are all resources. Most people pretty much want to be helpful: that's why they work in a hospital. 

After months and months (and years), you'll be the go-to resource for the newbies. That's kind of how it works.

Best wishes!

Edited April 29, 2019 by UGoLong

[Cideous]

Man what a tough first job/field....

[GetMeOuttaThisMess]

What are you getting hung up on? CTS so CABG, valve replacements, lung resections/pneumonectomies. Heart transplants? Drips are alpha/beta adrenergics/agonists, and vasopressin. IABP. Vent (should be the responsibility of the pulmonologist/critical care doc). Need to know wedge pressures, etc. Having done in-patient card years ago the ICU/drips/vent could be overwhelming but back then it wasn’t my responsibility. I’m more curious as to what’s holding you up?

 

 

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[MediMike]

1 hour ago, GetMeOuttaThisMess said:

What are you getting hung up on? CTS so CABG, valve replacements, lung resections/pneumonectomies. Heart transplants? Drips are alpha/beta adrenergics/agonists, and vasopressin. IABP. Vent (should be the responsibility of the pulmonologist/critical care doc). Need to know wedge pressures, etc. Having done in-patient card years ago the ICU/drips/vent could be overwhelming but back then it wasn’t my responsibility. I’m more curious as to what’s holding you up?

 

 

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This. 

I think you need to identify the major areas you are struggling with and concentrate on them when you get home. Also focus on being an independent learner, finding resources to help yourself so as to not wear out your relationship with your coworkers.

I say this as an individual who started off as a new grad in an advanced heart failure/transplant academic CCU staffed exclusively by NPs. 

These patients are sick but post-op there is almost always a "pathway" to get them on to get them the hell out of the unit. If everyone does things their own way read the literature/guidelines and develop your own style. 

Join APACVS and ask for help/resources on there, find a surgeon you trust to talk to and ask for help developing your practice. 

This timeframe isn't easy, this is your transition to practice where you start becoming responsible for your learning rather than anybody else I won't ask what drew you to this job but clearly it was something so dig into that and make it work.

 

[Joelseff]

If it makes the OP feel any better I am in a similar boat and am not a new grad. I was in GI/Hep my first year out and for the past 8 years I was in Primary Care. I recently went back to GI/Hep and while I don't feel like a fish out of water, I feel like a fish in a new aquarium, if that makes sense...

 

I echo what others have said. Identify your weaknesses and Lots and Lots of after work, before work, during work reading on topics you are weak at.

 

Engage your colleagues in conversations about said topics when possible, even if you think you have it down just to process it with another provider.

 

 

Attend dinner events if you have reps and attend cme conferences. I am scheduled for 3 CME conferences the rest of this year and have already attended 2 and I've only been at the new job for a month. Own your need to learn and humbly ask your colleagues for help PRN.

 

I wish you the best!

 

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[bovineplane]

After 6 years  of practicing this is the basics new grad talk I have with new PAs. 

It takes a year to learn how to be a PA. Through the second year you will learn to be a good PA. The third year you will become a good, productive PA. By the fourth year you will be a mentor  to young PAs. 

You are two months into this process. You don't know yet what you don't know. Ask lots of questions. Don't do anything you aren't comfortable with. Even 5 minutes a day with a surgeon will add to your mentorship. Never stop reading. At this point I don't know that I remember my first 6 months. Felt like I was always behind, never had the right answer. Give it 6 months and analyze where you are at. If it isn't a fit, start looking elsewhere. 

Good luck and keep updating your progress.