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Hello. I'm a new-ish grad PA. I graduated in Dec 2019 and started my first job in Sept 2020. The job is a combination of clinic and OR in Orthopedics/Sports Medicine. The clinic is run by my SP and myself. Since I am new, I mainly see the patient first (or whatever I get the chance to do before my SP comes into the room). So firstly, I've never had any interest in Orthopedics/Sports Medicine. As a new grad, I applied to every position I came across and a received only a handful of interviews afterwards. (partially due to COVID..finding jobs/hearing back for even an interview has been tough). This job was one that I applied to and forgot because like I said I was never to interested in it. I got called for an in-person interview, and it went well. Two weeks later, I get the job offer. I excepted because this job was the only one to actually offer after months of applying and waiting around for interviews. Its also a part-time job. I took it because like I said, jobs were hard to come by this year due to COVID.    

Long story short, I knew I don't have much passion for the specialty. The job is filled with office work, peer 2 peers, independent medical evaluations, record reviews, in-office procedures, and surgery. I love procedure work so I don't mind surgery at all. It's interesting. My SP is older and experienced so he's super knowledgable and has his own set ways. He's the type that if he wants you to do something now then you have to do it NOW. Meaning you drop whatever you were working on at that moment. 

I will admit my lackings. I am not so great with my orthopedic examinations and coming up with proper diagnosis, and treatment plan. I have realized this myself internally. I dread going into patient's rooms because I lack confidence. I know the flow of things during a visit but actually interpreting the physical exam findings into the diagnosis and subsequently a treatment plan has been very hard for me.  

My SP got upset with me today and had the talk. So about 3 weeks into my job, we have a patient who required knee surgery. I completely missed the she was taking OCPs. Since I missed that, recently the patient developed calf pain s/p surgery and had to go into the ED. She did develop a DVT and was placed on a blood thinner. When my SP found out that I had missed the OCP and didn't place the patient on Aspirin. He was very upset and rightly so. He said that he needs me to look over those little details because that is my job. I felt extremely bad for the patient and for not being as helpful towards me SP as I should be. Luckily, it did not develop into a PE. I know I missed the mark by missing such a small yet huge thing that could have been prevented. Also today, I wrote the wrong diagnosis for a patient's physical therapy script s/p surgery. It was anything serious but this error on top of the DVT issue just made him have that talk with me right outside the patient's room. He said that if the pace is too fast for me then this might not be the right fit for me. I felt so embarrassed and incompetent that just 1.5month into my first job and my SP is already having doubts about me and most likely made up his mind to let me go. He also said that I am on 90-day probation so I really need to prove myself with the remaining time left. But I have a feeling that he already feels a certain way about me.             

Any advice, criticism, wake up call you guys have for me will be appreciated. I just feel like a failure to have made such mistakes this early on into my career. I am actually looking at other jobs because I feel he will let me go within the 90-days so I'm looking for a back up job now.        

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7 hours ago, nsvalsad said:

Any advice, criticism, wake up call you guys have for me will be appreciated. I just feel like a failure to have made such mistakes this early on into my career. I am actually looking at other jobs because I feel he will let me go within the 90-days so I'm looking for a back up job now.        

I doubt that any of us will tell you anything you haven't already thought.

If you want this job you need to work for it.

Improve your ortho exam skills, study the books, find online resources, videos demonstrating techniques

Learn your SP's style, what they like, the quirks they have in treatment plans etc.

More attention to detail.  People screw up, it's unfortunate that the lack of DVT prophy wasn't caught but this is a team environment, if he wanted someone completely up to speed and ready to hit the ground running he shouldn't have hired a new grad.

Emphasize the need for more "hand holding", education and time when you discuss your future at the practice with him/her.  Simply not reasonable to have a brand new PA running completely independent.

The 9 month gap you have in employment sounds rough.

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welcome to being a professional medical provider

it is now time to treat you job like a profession, have pride, learn, work exceptionally hard

first year out of school you still should be hitting the books every night, absorbing like a sponge

your time to hit cruise control is about 3-5 years away

 

If you are not able to do this you best leave before your confidence is totally shot

 

Sorry to be blunt but you are getting out of the job exactly what you are putting into it, very little by the sounds.....

 

 

This is not just limited to you, even in these hard times we just let an15 yr provider go after 3 weeks, it was obvious they were not a fit for the clinic and like you were not willing to invest time energy and effort in learning medicine (at 15 yrs out of schooling this is a different issue). Point is that you need to work incredibly hard and prove to yourself (yes yourself) that you can do this....

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I may have missed it.  Where you involved in the surgery and post op instructions??  Or did you just see the patient in the office?  As mentioned above it's usually a team when someone has surgery so not sure how you are responsible for the missed OCP.  

I agree I'd be looking for a new position.  Continue to do your best now in your current job your SP may want to keep you after all.

 

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A good supervising physician would be sitting down with you professionally (not outside of a room like an elementary school teacher with a student acting up) and trying to mentor you. The proceedings moving forward are on him. He does not seem to be willing to train you or help you through this, as referenced by the statements of you needing to get it together and "Turn it around". He should be helping you turn it around. My guess is she is an arrogant provider who has time only for himself and can't reflect the fact that if he did not train you properly, that's also on him. I would have a frank conversation with him and remind him that you are a new provider and if he does not feel he has time to appropriately train you to care for patients at a high level as part of his team, then probably he should avoid hiring an PAs or NPs and you should pack your bags. 

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You are a new grad at their first job. You aren't ready  to function on your own and you won't be for a while. As stated above study, work, learn. You will get there.

I just started a new job in a new field (occupational med) and there has been a steep learning curve with precious little training and I make mistakes every day. They are mostly paperwork type things but, after being an area expert in my field for more than 30 years, it is maddening. All I can do is dedicate time every day to getting things right. I ask questions of ANYONE who knows more than me. There are people in our home office who have done nothing but gather drug tests for years. They aren't medical in any way. They know more about the paperwork and how to complete it properly than I'll ever know. Everyone you meet every day knows something about medicine I don't.

Keep working. Keep studying. Give yourself a little time to get up to speed.

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I am almost 30 yrs in - learning is a daily thing.

I read so much everyday - so much changes - not always for the better and then it swings back the other way a few years later. 

Aspirin wasn't considered venous thrombotic beneficial in 2009 (only arterial then) but now is - stuff changes overnight.

My suggestion - make yourself templates and check lists. 

I think a lot of us older PAs on here will say that we do things the same way every time - it becomes normal and you don't forget stuff if you do it the same way.

Make a pre-op checklist - Xrays - what system, MRI - what system, Allergies, DM status, etc. 

Don't be afraid of pen and paper diagrams or check lists for exams of shoulders, knees, etc. It will help you teach the patient anyway.

YouTube didn't exist when I was in school. There are some good exam videos (and some stupidity, be careful) - be a sponge.

Your SP should allow you to shadow on new evals - WATCH carefully. 

You have to grasp this and want this - this isn't just a job - it is people and their outcomes and livelihoods. If you don't want it - move on to something you do want.

Speak plainly to your SP - ask for guidance, write stuff down - show initiative and drive.

As above in other posts - you are still on training wheels and it will take a few YEARS to get confident solo.

 

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10 hours ago, Mayamom said:

I may have missed it.  Where you involved in the surgery and post op instructions??  Or did you just see the patient in the office?  As mentioned above it's usually a team when someone has surgery so not sure how you are responsible for the missed OCP.  

I agree I'd be looking for a new position.  Continue to do your best now in your current job your SP may want to keep you after all.

 

I am not privileged at the surgery place yet so I was observing during the surgery. I was part of post-op instructions like writing scripts and having my SP sign them. I did not see the patient in the office before the surgery because I was transitioning at that time so my first encounter with the patient was in the pre-op area. I think thats what my SP pointed out that I should have looked at the H&P from the PCP. Which he is right. None of our office notes have any medication history for this patient and this patient has had prior surgeries with my SP. So I guess the prior PA got lucky or might have caught the OCPs.    

Thank you for your advice.  

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12 hours ago, ventana said:

welcome to being a professional medical provider

it is now time to treat you job like a profession, have pride, learn, work exceptionally hard

first year out of school you still should be hitting the books every night, absorbing like a sponge

your time to hit cruise control is about 3-5 years away

 

If you are not able to do this you best leave before your confidence is totally shot

 

Sorry to be blunt but you are getting out of the job exactly what you are putting into it, very little by the sounds.....

 

 

This is not just limited to you, even in these hard times we just let an15 yr provider go after 3 weeks, it was obvious they were not a fit for the clinic and like you were not willing to invest time energy and effort in learning medicine (at 15 yrs out of schooling this is a different issue). Point is that you need to work incredibly hard and prove to yourself (yes yourself) that you can do this....

I do agree with your points. My confidence is already shot and I feel embarrassed after that talk. Especially around my SP. If you have some good resources to help me bridge the gap between physical exam and diagnosis/treatment, please do share them.  

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8 hours ago, Reality Check 2 said:

I am almost 30 yrs in - learning is a daily thing.

I read so much everyday - so much changes - not always for the better and then it swings back the other way a few years later. 

Aspirin wasn't considered venous thrombotic beneficial in 2009 (only arterial then) but now is - stuff changes overnight.

My suggestion - make yourself templates and check lists. 

I think a lot of us older PAs on here will say that we do things the same way every time - it becomes normal and you don't forget stuff if you do it the same way.

Make a pre-op checklist - Xrays - what system, MRI - what system, Allergies, DM status, etc. 

Don't be afraid of pen and paper diagrams or check lists for exams of shoulders, knees, etc. It will help you teach the patient anyway.

YouTube didn't exist when I was in school. There are some good exam videos (and some stupidity, be careful) - be a sponge.

Your SP should allow you to shadow on new evals - WATCH carefully. 

You have to grasp this and want this - this isn't just a job - it is people and their outcomes and livelihoods. If you don't want it - move on to something you do want.

Speak plainly to your SP - ask for guidance, write stuff down - show initiative and drive.

As above in other posts - you are still on training wheels and it will take a few YEARS to get confident solo.

 

I will try the list method, especially for the physical exam. Also, now for pre-op because I don't want to miss anything major as such again. Since you have been working for many years, do you have any helpful resources that could help me get from physical exam to proper diagnosis and treatment plan?  

I would ask for guidance from my SP but now i just feel embarrassed. Like moving forward, if I ask clarification or explanation on something, he will think I've hired a stupid PA. And many times before, he's very brief with his explanation so it makes feel like I should already know this or I'm just bothering him by asking.  

I tried having a more detailed chat with him regarding his concerns. And he kept saying I'm not sure how to help you, I can't pin this mistake on you being a new grad..you should know about giving ASA when a patient is on OCP. Pretty much, it gave me the vibe that he's already made up his mind that I am a loss cause that he won't wanna have around for much longer.  

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11 hours ago, trazodone said:

A good supervising physician would be sitting down with you professionally (not outside of a room like an elementary school teacher with a student acting up) and trying to mentor you. The proceedings moving forward are on him. He does not seem to be willing to train you or help you through this, as referenced by the statements of you needing to get it together and "Turn it around". He should be helping you turn it around. My guess is she is an arrogant provider who has time only for himself and can't reflect the fact that if he did not train you properly, that's also on him. I would have a frank conversation with him and remind him that you are a new provider and if he does not feel he has time to appropriately train you to care for patients at a high level as part of his team, then probably he should avoid hiring an PAs or NPs and you should pack your bags. 

I tried having a detail chat with him regarding his concerns. And pretty much, he kept saying that I'm not sure how to help you, I can't pin this mistake on you being a new grad.

Earlier the same day as the talk, we had a zoom appointment with a patient to discuss MRI results. The appointment was for 9am, we started the appt at 9:02am (just me, my SP was not even in the office). I started talking to the patient about how his pain has been. I had read the previous note which stated that the treatment was to get a MRI and start prednisone taper. The patient stated that the prednisone helped for a little bit but the pain returned. To that, I asked did you finish the entire course and the prednisone was prescribed by Dr. (my SP), right? After I asked that question, the patient got upset and said that didn't you read the last note..first of all, you start the appt late and you don't fucking know anything, forget it, I'll find a different doctor. And ended the call. 

I told my SP once he arrived to the office and he got upset that I had tried to confirm that the prednisone was prescribed by him or not. He said that you dont do that, it makes you look unprepared. I just said that I was just double checking/confirming since I am new. He said that, that might have been how you were taught in school but that's not how I do things. 

Basically that pissed him early morning and later in the day, he saw the wrong diagnosis on the physical therapy note. And the DVT incident from prior day resulted in the talk.   

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13 hours ago, MediMike said:

I doubt that any of us will tell you anything you haven't already thought.

If you want this job you need to work for it.

Improve your ortho exam skills, study the books, find online resources, videos demonstrating techniques

Learn your SP's style, what they like, the quirks they have in treatment plans etc.

More attention to detail.  People screw up, it's unfortunate that the lack of DVT prophy wasn't caught but this is a team environment, if he wanted someone completely up to speed and ready to hit the ground running he shouldn't have hired a new grad.

Emphasize the need for more "hand holding", education and time when you discuss your future at the practice with him/her.  Simply not reasonable to have a brand new PA running completely independent.

The 9 month gap you have in employment sounds rough.

Do you recommend any good online resources? I feel embarrassed now to have the "hand holding" conversation.    

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9 hours ago, sas5814 said:

You are a new grad at their first job. You aren't ready  to function on your own and you won't be for a while. As stated above study, work, learn. You will get there.

I just started a new job in a new field (occupational med) and there has been a steep learning curve with precious little training and I make mistakes every day. They are mostly paperwork type things but, after being an area expert in my field for more than 30 years, it is maddening. All I can do is dedicate time every day to getting things right. I ask questions of ANYONE who knows more than me. There are people in our home office who have done nothing but gather drug tests for years. They aren't medical in any way. They know more about the paperwork and how to complete it properly than I'll ever know. Everyone you meet every day knows something about medicine I don't.

Keep working. Keep studying. Give yourself a little time to get up to speed.

Do you suggest that I look for other jobs? I feel the 90-day judgement might not be in my favor, based on his behavior with me so far. 

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Your SP sounds like a stereotypical surgeon who is above it all and expects to be pandered to.

This gig might not work out for you based on this and a few other issues.

YOU HAVE TO SPEAK UP and ask questions. Feeling embarrassed won't cut it - YOU COULD HURT SOMEONE.

Telling the SP that you want to learn and do things the way he/she wants it is a good thing in Ortho - they are the surgeon and there is no true independence in ortho. 

If the SP isn't prepared to take anyone, much less a new grad, and mold them into what they want then you are just a warm body and not someone who can make or break them.

Your SP doesn't know what a new grad SHOULD know versus what he/she EXPECTS which sounds unrealistic at this point.

How many PAs has this doc gone through before you? How long do they stay? What does the surgeon's license look like online? How many complaints does he/she get? How is the turnover on office staff? Can he/she even remember your name most days?

This sounds like a poop show.

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I'm confused, is a blood thinner not standard protocol after a knee replacement? Aspirin is standard for us after a hip replacement, doesn't matter if they are taking OCP or not. This honestly sounds like he is expecting too much from you as a new grad. You are a few weeks in, trying to learn a specialty, trying to learn his protocols, etc. Don't be so hard on yourself. Speak up if you have questions. Look things up on orthobullets. Watch physical exam and procedure videos on youtube. You got this!

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Funny just reread your post.  I find it odd that you describe yourself as newish. 
 

my goodness you have a whopping 2 months of work experience.  I wonder if not accepting your true abilities. I don’t pretend to know anything about you, but wound about the following Thinking everything comes easy. Getting by in school.  And now the stark realization of not everyone winning all the time is settling in.  
 

I just ? Level of self honesty    You are brand new. Period.  
 

 

btw this is not bad, you have a great education and the world ahead of you but as I have always said everything up to and including passing boards for the first time is merely the price of admission, now the fun begins.  

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1 hour ago, AbeTheBabe said:

I'm confused, is a blood thinner not standard protocol after a knee replacement? Aspirin is standard for us after a hip replacement, doesn't matter if they are taking OCP or not. This honestly sounds like he is expecting too much from you as a new grad. You are a few weeks in, trying to learn a specialty, trying to learn his protocols, etc. Don't be so hard on yourself. Speak up if you have questions. Look things up on orthobullets. Watch physical exam and procedure videos on youtube. You got this!

The patient had a meniscal repair. And ASA isn't the standard for my SP. The PA before me just gave Norco and Colace. When I informed him that the patient developed a DVT, he initially said maybe its my fault for not including ASA after surgery..its my fault for not telling you to do it. Then once he found out the patient was on OCP, his statement changed to you shouldn't have missed this. You should have looked at the H&P. And he remains on this stand now. So I'm taking the blame.  

I've never heard of orthobullets. Thank you so much for recommending it - I will be utilizing it (even if I don't stick in this job).  

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50 minutes ago, ventana said:

Funny just reread your post.  I find it odd that you describe yourself as newish. 
 

my goodness you have a whopping 2 months of work experience.  I wonder if not accepting your true abilities. I don’t pretend to know anything about you, but wound about the following Thinking everything comes easy. Getting by in school.  And now the stark realization of not everyone winning all the time is settling in.  
 

I just ? Level of self honesty    You are brand new. Period.  
 

 

btw this is not bad, you have a great education and the world ahead of you but as I have always said everything up to and including passing boards for the first time is merely the price of admission, now the fun begins.  

I only said new-ish because I graduated back in December 2019 so many people might not consider me that new, especially if a newer batch graduated in May/June 2020.  

But yes, very first job started in Sept so I am brand now.  

I definitely don't think I know everything (if anything at all). I've admitted to my lackings in my very first post because that's how I truly feel inside. I am having a hard time connecting exam findings to diagnosis & treatment plan. And yes, stark realization of being the real world is hitting me. Being out of the safety net of school.   

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1 hour ago, Reality Check 2 said:

Your SP sounds like a stereotypical surgeon who is above it all and expects to be pandered to.

This gig might not work out for you based on this and a few other issues.

YOU HAVE TO SPEAK UP and ask questions. Feeling embarrassed won't cut it - YOU COULD HURT SOMEONE.

Telling the SP that you want to learn and do things the way he/she wants it is a good thing in Ortho - they are the surgeon and there is no true independence in ortho. 

If the SP isn't prepared to take anyone, much less a new grad, and mold them into what they want then you are just a warm body and not someone who can make or break them.

Your SP doesn't know what a new grad SHOULD know versus what he/she EXPECTS which sounds unrealistic at this point.

How many PAs has this doc gone through before you? How long do they stay? What does the surgeon's license look like online? How many complaints does he/she get? How is the turnover on office staff? Can he/she even remember your name most days?

This sounds like a poop show.

I know he's had at least 4 PAs in the past. The one prior to me worked for 3 years so he's probably not terrible. I am probably the issue. He's nice to the patients, the way he behaves with staff sometimes is a different story. He's older and set in his own way. And like I said before, if he asks you to do something then you better do it right now (whether that's me, the office manager, surgical coordinator, etc). After he had the talk with me, he went and told the office manager on how he wanted me to improve. He told her what he expects from me. I found that out when I went to speak to the manager regarding something else. Then later on, when I tried to have the detailed discussion with my SP..he didn't mention how he expects me to improve like how he told the manager. I was just a little confused like shouldn't you tell me in private what expectations you have from me and how I should improve instead of having the manager relay that information. During our conversation, he just kept saying I don't know how to help you..I can't pin this as you being a new grad. He said you have the remaining days of your 90-day probation to turn things around and gain my trust. Also, why did he wait 1.5-months into work to mention if I'm not meeting expectations? I wish he has mentioned it a little earlier on. Now, it just feels like I reached the last straw already (due to the DVT being the major setback).        

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1 hour ago, nsvalsad said:

After he had the talk with me, he went and told the office manager on how he wanted me to improve. He told her what he expects from me.
That’s because to him, you are just the same as a retractor or a scalpel.  He wants his tools to do what they are designed to do, when he wants them to do it.  

During our conversation, he just kept saying I don't know how to help you..I can't pin this as you being a new grad.

It’s true.  He doesn’t know how to help you, as is obvious by his lack of follow up with you.  He also doesn’t see you as a highly trained professional, just a faulty piece of equipment.  In every scenario you mentioned he’s put the blame on you.  Blame shouldn’t even be brought up.  What’s the root cause and how can it be prevented?

He said you have the remaining days of your 90-day probation to turn things around and gain my trust.
 

Ultimatums are never good, and invariably a sign that one party is looking for a way out.  The gain his trust part?  Another way of putting blame on you.  

 

I put my comments up above.  Some situations are not for new grads.  Could you have done things differently?  Yeah.  As we all can.  Wasting time with self pity only hurts you.  
I know you don’t want to hear this:

1.  You’re going to have to get out.  You’ve lost any good relationship between this goof and yourself.  You need a good supportive relationship that will help you grow.  
2.  You knew what you didn’t want going in, and that didn’t help.   The world is a big place and there’s a place for you, you just have to find it.

Can’t think of much more.  You can Im me if you want, I’ve lived through some hellacious jobs and I’m still here.

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Sorry but this just sounds awful.  I tried to help out in an office where the DO had been working for 50 years.  His notes and charts were a mess.  I had a lot of patient get pissed when I asked them a lot of questions.  Same thing isn't it in my chart.  Very frustrating.  Please get your resume out there.  Lots of better places to work.  

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17 hours ago, nsvalsad said:

Do you suggest that I look for other jobs? I feel the 90-day judgement might not be in my favor, based on his behavior with me so far. 

I think if you feel you won't be able to meet their expectations in the time frame they expect it would be smart to start looking. It takes a while to find a new position and get credentialed so starting the process gives you a start in that direction but doesn't commit you. If this works out....great. If it doesn't your unemployed time will be much shorter.

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10 hours ago, Mayamom said:

Sorry but this just sounds awful.  I tried to help out in an office where the DO had been working for 50 years.  His notes and charts were a mess.  I had a lot of patient get pissed when I asked them a lot of questions.  Same thing isn't it in my chart.  Very frustrating.  Please get your resume out there.  Lots of better places to work.  

At least I'm glad to know that maybe it's not so bad to ask lots of questions and double check with patients. I honestly was thinking like okay maybe that was dumb of me to ask about the prednisone. I have started applying to other places. Hopefully I find my fit. 

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The only dumb question is the one you don’t ask.

I spend a lot of time verifying with my patient that they actually took a med, finished it, took it correctly and aren’t taking stuff leftover from 2004 or  purchased in Mexico.

Patients don’t remember instructions and are known to not tell the truth. 

Verifying their understanding and compliance is a normal part of medicine. Document confusion or noncompliance.

In a new job - questions should be treated as normal and expected. ANY SP should train or mentor. PERIOD. 

We have a new grad NP straight from our nursing pool who thinks she knows it all and rebuffs any attempt at mentoring. She is a 5 yr RN plus a short degree with lax clinical.  She is a problem that we will have to deal with and I hope she doesn’t hurt anyone. 

Learn every single day. Never stop asking questions.

Medicine is lifelong education.

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