Struggling in a leadership role...

[Guest ERCat]

I have been the lead PA for my small group of ER PAs for a couple years now. I think I was chosen because I am smart, do a good job taking care of patients, I don’t miss things often, and I was the one who gave a crap about the group and going to meetings. Unfortunately I am finding these traits don’t translate into being a great leader because I lack other traits that matter.  

I am disorganized at times. Not very proactive. When I’ve tried to be proactive in the past a few times, I ended up making a decision that was overruled by the physician director, which has totally killed my credibility, and now sometimes my team goes above me for questions and concerns which kills me. Ultimately nothing is really up to me and gets overruled by the lead docs so I just feel like I am constantly deferring to them. Leaders hold meetings - I am not the type of leader to have meetings just to have meetings (but I check in with my APPs from time to time to see how they are, and we all attend the group meetings with the physicians so I feel like that counts). I make their schedules, which thank GOD, they seem happy about...and show up to meetings at the hospital where I provide zero useful feedback or insight. The way I would describe myself as a leader is lame. Ha.

The worst part is I feel like a bad role model in that I am not the wonderful, professional provider who floats in and out of the ER with a smile on my face, drama free. I still get “talking tos” occasionally about the way I am in the ER. Once I asked that a patient with swelling of the perineum not be put in the fast track zone (which didn’t seem fast track appropriate and I am apparently allowed to make those calls) and did so in a VERY nice fashion (I will say for all my faults I am genuinely nice to coworkers) and I was complained about by the nursing director directly to the CEO who called me a bad role mode for refusing patients. Since then I feel like I am on nursing’s bad side. I have been also reprimanded for having long discharge length of stays (which I worked on) and ordering too many tests. Today I upset the charge nurse who said I was picking up too many patients (we are damned if we do and damned if we don’t) and therefore not going to the rooms to dispo in a timely manner. I also apparently walked away when she was talking to me - inadvertently, my mind was elsewhere, and she called me on that too, which was valid. But it only takes so many of things like this to make me feel like a scatterbrained, unprofessional idiot - NOT fit to be a leader. 

I had really high hopes for this leadership role but I don’t feel like I am growing much within it. It is getting easier but I still hate it - because who likes something they feel they are bad at? I fantasize about stepping down from the position and just being able to go to work just to take care of patients! Only crappy thing is I would lose control of my schedule and it wood also be like demoting myself. I really do want to be a good leader but it’s hard to to like it and be motivated when you feel bad about it. I have thought about talking to the lead ER doc about this but I don’t know what that would accomplishe. 

As an aside - this entire post seems self deprecating but I do recognize I have many qualities that make me a rock star PA. I know I am smart and have good intentions. There are just a lot of things that aren’t translating well into leadership. 

Not sure why I am even posting this but it’s oje of those nights that it kind of hurts and stings to think about and I guess I am just looking for some insight to get me out of this frame of mind and move forward  (or backward if need be).

[ventana]

welcome to PA in admin...

 

Nurses run the roost, as soon as we are above them

some of it might be your personality and learning, but I suspect most of it is that we are an "Assistant" and we are not leaders due to this.  We are dependent and not trained well enough.  We are not smart enough, we do not have enough training......

 

(all said with sarcasm.....  this is why we need a terminal doctorate and to come out from underneath organized medicine)

 

I am leaving a job which had similar issues....  good luck

[Cideous]

Tough to be thought of as "the boss" or "a leader".......When you are an "ASSISTANT".

People judge on the pettiest of things, but their title IS #1 and we will never get past it unless our name changes.

Edited June 18, 2019 by Cideous

[BruceBanner]

I dont know how your group is structured but it sounds to me like your main job is to represent the PAs, not so much "manage" them. So really you just need to show up to meetings,  be a good example clinically, speak on behalf of the PAs when pertinent, and be a diplomat who represents your cohort. This means having friends up and down the chain. Especially nursing---I would make it a point even if it pains you to try and make friends with nursing staff. I do this by jokes and commiserating with them on some small issues. Not complaining per se, just relating.  

Another thing I think you should do is stop calling yourself a bad leader, even in your head. It becomes a self-fulfilling prophecy.

Nursing has way too much power in most organizations and all they have to do is pull the "patient" card and it's like you've already lost. This is how they get what they want, that and majority representation. If you argue against it, it makes you seem defensive, if you go along with them you are just bending under their will. 

 

[GetMeOuttaThisMess]

I was in a similar position in a cardiology group in the late 80’s-90’s. Didn’t have to do much other than be the sounding board to the docs to pass up/down input to the respective parties. I DO have it posted on my CV as the “senior PA” for a group of seven of us at the time. Probably got the title since I was their first for a couple of years. Now they have none the last time I checked.

 

Ask them to have someone else assume the position and still note it on your CV.

[rev ronin]

The first time your boss overrules you without talking to you beforehand about what was wrong with the decision and why it needed to change, you're done. You can't have authority without responsibility, and the #1 job of a mid-level manager is to make the managers underneath him or her successful, which often means sticking by marginal decisions so as to not undermine your subordinates.

You need to have a decent (not necessarily perfect, but decent) direct supervisor to succeed in first level supervision.  It doesn't sound like that is happening here.

[Cideous]

Not trying to be a jerk, but the position you are describing sounds like a provider who does the schedule so the Doc doesn't have to.  That's not an admin...

[Guest ERCat]

41 minutes ago, Cideous said:

Not trying to be a jerk, but the position you are describing sounds like a provider who does the schedule so the Doc doesn't have to.  That's not an admin...

You are not a jerk! I am confused by what my role means. I think I am a little more than a scheduler, though. I do the interviewing and hiring (hiring with approval of the head doc, of course), chart reviews, working with the hospital to determine credentialing requirements, helping find coverage in emergencies, addressing behavioral issues, setting up educational lectures, those kinds of things.

[Guest ERCat]

4 hours ago, BruceBanner said:

I dont know how your group is structured but it sounds to me like your main job is to represent the PAs, not so much "manage" them. So really you just need to show up to meetings,  be a good example clinically, speak on behalf of the PAs when pertinent, and be a diplomat who represents your cohort. This means having friends up and down the chain. Especially nursing---I would make it a point even if it pains you to try and make friends with nursing staff. I do this by jokes and commiserating with them on some small issues. Not complaining per se, just relating.  

Another thing I think you should do is stop calling yourself a bad leader, even in your head. It becomes a self-fulfilling prophecy.

Nursing has way too much power in most organizations and all they have to do is pull the "patient" card and it's like you've already lost. This is how they get what they want, that and majority representation. If you argue against it, it makes you seem defensive, if you go along with them you are just bending under their will. 

 

Quote

 

Thanks for this. Strangely it is comforting to realize maybe the expectation is I am a representative of the APPs rather than a manager. That kind of takes a little bit of the pressure off. Maybe I am the one creating unrealistic expectations.

[Marinejiujitsu]

Thanks for this. Strangely it is comforting to realize maybe the expectation is I am a representative of the APPs rather than a manager. That kind of takes a little bit of the pressure off. Maybe I am the one creating unrealistic expectations.

And ER groups are infamous at making you work your but off clinically. I tend to feel I just cant get around to stuff due to time constraints and family.

Sent from my SM-N950U using Tapatalk

[sas5814]

Don't be afraid to step out of the role if appropriate. You need fairly thick skin to be in charge and a good balance of diplomacy and combat skills because sometimes you need one and sometimes the other. You have to be able to use both with alacrity. 

This is a position where you have responsibility and no authority (or precious little) which is a failure of management in the most basic sense. Also if you don't have a very clear job description, again, management has failed you in the most basic sense. These are very basic things but the world is awash is crappy non-managers who are in charge of something. I call it tiny tyrants in tiny kingdoms. You have some room for growth but it is leadership's responsibility to give you the tools. If they won't step down.

Me? I don't give a tiny little damn what people think about me. I can count on one hand the number of people whose opinion of me gives me pause. So if crappy management makes crappy decisions I don't mind saying so and then ignoring the whining. I hate back channel office politics and tend to go strait to anyone trying to end run me or back stab or anything else. It really makes a difference and cuts through a lot of nonsense to any real issues.

Problem solving at the lowest level should be everyone's mantra. 

[SHU-CH]

Leadership is a skill, and like any skill it can be developed. (Sometimes through painful experience!) If your position is causing you nothing but aggravation, skip it. But if you want to develop your leadership skills for this place or somewhere else, it might be worth keeping at it. 

As noted above, it seems like you might have some formal authority through some title they put on you, but no actual authority. You can develop it. How often do you meet with "management"? How often do you meet with your staff? You should not be a one-way conduit of crap from admin to your staff - how can you advocate for your staff?

Tell your boss if they want you in this role they need to send you to some conferences/workshops related to leadership and management. If they refuse to do so, they are probably just using you as window dressing. 

[surgblumm]

I think that its time to say goodbye. Not just to the leadership role but to the facility as it sounds like it stinks. The reason I stayed a PA so long was because I enjoyed it, felt fulfilled and was appreciated most of the time. Don't burnout----get out!