Concerns about relatively “new” job…. Should I stay or go?

[KDB727]

Good morning all,

 

I’m a fairly new PA (graduated last March) and have found myself in a bit of a difficult situation when it comes to my career.

 

Immediately following graduation, I was fortunate enough to land a role as an ENT PA in a private practice. I have a background in speech pathology and audiology so this was a good fit for my background and interests. I wasn’t the biggest fan of my SP but overall it was good experience. Unfortunately, my father became sick about 6 months in and I made the difficult decision to leave the practice to move back home and be closer to my family. Including the notice period, I ended up working there about 9 months.

 

Now prior to going to PA school I worked at the local hospital system in my hometown as a tech and, since I would be moving home, thought it would be a good move to return to working there and get some broader medical experience in either internal med or emergency. I interviewed and landed a job in the emergency room and, to start, it seemed like a good gig. 14 shifts per month, alternating shift times and hospital locations but I would always be with another provider. I dove head-first into this new opportunity and was prepared to see it through til my 1-year.

 

Fast forward to about a couple months ago, a few months into my new role.

 

When I first started, I found out right away that a few PAs/NPs had resigned and were leaving to go UC or specialty. It’s the ER- I knew the burnout rate was probably higher than most places so I didn’t think much of it. As a result of this, I was made aware by the lead PA that my scheduling “wasn’t what they were hoping for me” as a new hire and they would have to place me at the smaller locations and on shifts where there wasn’t another PA or NP to go to for help. Again, I embraced the challenge and made the most of it. Just recently, they lost a PA who covered nights frequently so I was asked to help cover these as well. I did a few shifts at the larger hospital which, overall has better provider coverage and then I noticed they scheduled me at the smaller one where it’s just myself and a doc for a majority of the night. Now on paper I realize that this sounds reasonable as it’s smaller so obviously less coverage is needed but y’all have to believe me when I tell you that this “smaller” hospital tend to attract some very, very sick people needing emergent attention. I brought up my concerns about this to the lead PA as I was originally told I wouldn’t be placed there until at least 6 months in (I’m about 5 months in now), and he seemed to understand where I was coming from. Only, about a week or so later, he calls me up and says he talked to our director who told him to “reiterate the expectations with working nights and reminder her that it’s a 24/7 operation in the ER”… as if I wasn’t a team player and just didn’t want to work nights. He told me just to work the shifts, see how they go and come to him with any other concerns.

 

This recent conversation comes at the tail end of some other things I’ve noticed and experienced since starting. The emergency room has an observation wing where several PAs and NPs have also left, and as a result myself and some other new hires have been asked to cross-train so we can work there as well, only these shifts are scheduled on top of our full time schedules resulting in some of us working 60-70 hours or more in one week. During a string of working many hours in a week I recently got extremely ill with vertigo and a possible superimposed GI bug during which I physically could not sit up or get out of bed without forcibly vomiting. I texted the HR manager late at night when it started so as not to wake him but also make him aware of the situation, and told him I would call him first thing in the morning if I’m still not feeling okay. I wake up early, no response on my phone from him, only to call him and him say “yes, I got your message when I woke up, and you’re lucky it wasn’t at the time you sent it” and then told me I need to find my own coverage (keep in mind I did reach out to the lead PA for guidance on protocols for this as I haven’t had to call out for anything and was told to get in touch with him so HE could find coverage). No “hope you feel better” or anything.

 

I have inquired from some of the people leaving the unit and it seems a lot of them are either burned out, want a more stable schedule (there is no consistency with any of our schedules with regards to shift times, locations, or days we’re working), or have some concerns with management. One even told me he had concerns about new hires being at certain locations and working on certain shifts (similar to mine as above) and these were completely ignored.

 

I guess at this point I’m trying to decide the best way to proceed. I am learning a lot in my position but:

(1) the changes that they’re making with regards to my shifts and working conditions are concerning to me in the way of patient care and safety (and potentially my license if I miss a diagnosis or make a mistake)

(2) I’m starting to get physically exhausted from the hours I’m working, getting sick frequently and also getting stressed to the point where I throw up before shifts

(3) I don’t feel supported or like my management actually cares about me beyond the money I can bring in for the department. Now I know not every place will treat you like family but I was very disappointed in how things were handled when I got sick, especially when I’ve been putting in extra hours to help support the team.

 

Though at this point I do feel it would be best for my health to leave, I’m concerned about how this is going to look on my resume if I decide to resign, as I already have one position in front of this one where I left early due to personal reasons. I know they have vacancies in some of the private practices associated with my hospital so I have considered reaching out to recruitment to find out more information, as I do ultimately miss working outpatient and feel I’m ultimately better suited in a more structured environment than the ER, but then again I don't want to make a decision prematurely and regret it later.

 

I will accept any and all advice from those who more experienced and can offer some guidance on how I should proceed.

 

Thank you in advance!

[sas5814]

Well.... it sounds like a bit of a mess.

You only have, in the broad sense, a few choices.

1) stay where you are and ride it out. It may get better. It may get worse. In my experience people leaving creates a void and then its a bit of a landslide. People get extra hours and shifts and get frustrated or burned out and leave. Lather , rinse, repeat. Things generally self correct but it can take a long time. My current clinic was way understaffed when I got here. Short 2 of 5 providers and almost 50% of nursing. Now, 2.5 years later, we are close to being fully staffed and trying to expand a bit. It has been a painful time in many ways but things are pretty good now. I'm still eyeballing other positions but that is just habit. I like to always have an exit plan if I need one.

2) You can stay where you are and draw some hard line boundries. If you decide to do this you may get some concessions or they may show you the door. Have a solid plan for what it would take to make you more comfortable and, if they give you enough to keep you there, dig in and WORK. You negotiated an agreement and both of you have to work hard to make it go.

Somewhere very late in my career I found I could say no and the world didn't end. It was like getting a low-rent superpower. So when they try to give you too much work you can just say no and see what happens. Again, have an exit strategy. A wise man once told me you can only fall on your sword once. (BTW I have always found "find you own coverage" BS. Administrators get paid to manage schedules. Manage it.)

3) You can move on. One justifiable move in a short time isn't really going to trouble anyone. 2 starts to look like a pattern and will get the attention of some hiring managers. If you do this you will want to make sure wherever you land you are going to be there a while.

 

Good luck.

[KDB727]

3 hours ago, Hemmingway said:

Well.... it sounds like a bit of a mess.

It most certainly is.... 

3 hours ago, Hemmingway said:

1) stay where you are and ride it out. It may get better. It may get worse. In my experience people leaving creates a void and then its a bit of a landslide. People get extra hours and shifts and get frustrated or burned out and leave. Lather , rinse, repeat. Things generally self correct but it can take a long time.Good luck.

I definitely see the "lather, rinse, repeat" happening. I guess where I'm also concerned with this is whether or not I'd want to wait that long for things to change.... I knew very early on that I didn't see myself in EM for the long-term, so maybe that was my mistake by not acting sooner. 

 

3 hours ago, Hemmingway said:

You can stay where you are and draw some hard line boundries. If you decide to do this you may get some concessions or they may show you the door.

Do you have any insight on how to do this diplomatically? I (thankfully) have never been in this position before so want to make sure I'm doing things the right way (while also having that "exit plan") 

 

3 hours ago, Hemmingway said:

(BTW I have always found "find you own coverage" BS. Administrators get paid to manage schedules. Manage it.)

YES! Thank you for this. I was completely taken aback by the whole encounter. I've never had to do this even before I was a PA, and when I worked in nursing, my manager was always understanding, didn't ask questions and always said she would handle the rest and to focus on getting better (THAT'S a good manager...) 

Edited August 24, 2023 by KDB727

[sas5814]

10 minutes ago, KDB727 said:

Do you have any insight on how to do this diplomatically? I (thankfully) have never been in this position before so want to make sure I'm doing things the right way (while also having that "exit plan") 

Its really pretty easy. Decide what you think is a reasonable boundry. I'll work my regular shifts but no more. I'll work one extra shift but no more. I'll work x hours a month but that is all I can do.

You have to decide what you need, make it reasonable, and then stick to it even when they try to squeeze. I'd just say "this is what I need for my own well being and work/life balance." Then brace your self for blow back but just stay calm and factual. They will either give it to you or force you out.

[SedRate]

Great advice above. 

Personally, if I was in a similar position, I'd immediately start working on finding my next gig. And while interviewing, truly evaluate them, talk to all levels of staff and previous employees, see what kind of onboarding process they have, etc. And then put in my notice once I have a signed offer. 

In the meantime, protect your sanity and health, get rest and sleep, and only work your required shifts. Staffing woes aren't your problem. See if you can switch shifts with someone so you aren't switching back and forth from nights to days. You can work nights for a bit and then they can. 

Sorry this is happening. Bummer. 

[ventana]

Typical toxic ER.  
I have no words of wisdom other than do right by the patient.  
 

good luck and don’t kill anyone. 
 

btw you can not change the corporate culture.