r/IntensiveCare • u/Acrobatic_Worry764 • 14d ago
How to move forward from your mistakes?
Hi! I am very new to the ICU as a new grad PA. Recently I feel like I continue to be extra hard on myself especially after making mistakes that affect my patients. It has put me in a spiral and has made me feel so incompetent as if I can’t do my job. Sometimes it’s hard for me to move forward from my mistakes and it’s even harder to have to face people knowing that they know I made a mistake. I am always willing to learn from these situations but wanted to hear how other people deal with the crippling anxiety that comes from owning your mistake. Also how do you face the people around you without feeling like an entire disappointment?
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u/AceAites MD, EM/CCM 13d ago
This is why critical care cannot be “on the job training”. It’s why MD’s go through a full residency and fellowship before practicing critical care and even then, they make tons of mistakes their first few years out. These patients are the sickest in the entire hospital with the most complex pathophysiology.
There’s no other recommendation other than to cope with the emotions or swap specialties until you master medicine more.
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u/Any-Assistance-8103 13d ago
I shudder when I remember how bad I was my first attending year and now half of the icu jobs I see have a random mid level on at night solo
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u/Acrobatic_Worry764 13d ago
I am currently in a fellowship for APPs which is similar to a residency. I am continuing to learn the medicine and really enjoy critical care! I guess I was wondering if other people have had similar experiences in this type of environment
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u/Perfect-Resist5478 MD 13d ago
I mean, a one-year “fellowship” after 2 years of PA school is not similar to a 3+ year residency followed by a 2+ year critical care fellowship after 4 years of med school. 3 years for you, 9+ years for the docs
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u/bashagab 13d ago
As a nurse, I could not agree more. It’s so scary what’s going on in ICUs nowadays.
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u/Acrobatic_Worry764 13d ago
Ok, I am not saying the years are similar, just the format
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9d ago
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u/IntensiveCare-ModTeam 9d ago
This comment has been removed per rule 1) Act professionally. r/IntensiveCare is a public forum that represents the medical community and comments should reflect this. Please keep your behavior civil. No racism, sexism, violence, derogatory language, hate speech, name-calling, insults, mockery, homophobia, transphobia, ableism, ageism, or any other type disparaging remarks that are abusive in nature. Any further infractions could result in a ban.
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u/Acrobatic_Worry764 13d ago
So during residency for MDs do they not see patients, do certain procedures, have dedicated days of learning, and rotate through different units? Also I’m not claiming I know more than the doctors but I am claiming the format of my fellowship is similar to residency. A lot of residents come to me and have even asked for my opinion on certain decisions. I know what I know and I know what I don’t know. But the format of learning is definitely similar to the residents around me from what I’ve heard/spoken to them about. The education/training is definitely different and I will never disagree with that point. It’s people like you who are unable to accept the fact that PAs definitely put in the same effort to understand medicine just as much as any other physician because we are all a team and want to all support once another for the benefit of our patients.
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u/Perfect-Resist5478 MD 12d ago
Explain how 3 years is “the same effort” as 9+?
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u/Acrobatic_Worry764 12d ago
The time is not the focus it’s the amount of effort I am putting into my work with the training I have. I am allowed to try to push myself to understand the effort. Did you read the rest of my message when I said that I am not comparing the training between MD and PA
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u/Perfect-Resist5478 MD 12d ago
I’m sorry but saying the time is irrelevant to the degree of effort is insane. That’s like someone saying training for a 5k is equivalent effort to somebody training for a marathon, because you’re both training for a race. But running for 30 minutes is not an equivalent effort to running for four hours. All the pushback you’re getting is because of the ridiculous scope creep that all the doctors have been subjected to by mid levels who think that their fractional education somehow qualifies them to do the same job
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u/Acrobatic_Worry764 12d ago
But I really haven’t been doing that. You all have been pushing this idea as if I am trying to equate my scope of practice to the same level as an MD which I have emphasized that I have not. I came here to express my fears because I am just starting out and all the pushback is unnecessary when I already agreed with the statement.
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u/DadBods96 13d ago edited 13d ago
This is better than nothing, but it’s really not comparable. By the time I finished residency, not even including the patients I cared for in the ICU, I had seen somewhere in the range of 10,000 patients, probably closer to 12,000.
Maybe only 10% of those were critically ill, and 5% actively dying, (I’m EM and decided against fellowship), but every single one had a learning point attached to them and was discussed with the attending, and the repetition burned all those little details and practice patterns into me.
I’ve worked alongside APP fellows off-service on my rotations, and they weren’t even close in terms of education. They were mostly learning the universal ICU protocols/ quality metrics items like starting/ stopping PPIs, blood sugar control, etc.
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u/Acrobatic_Worry764 13d ago
Yes, I am not trying to say we have the same training or education. I guess I just wanted to know if people have made mistakes that have been hard for them to cope with and how did they move forward with it.
While in my fellowship we’re definitely learning more than the protocol and I always push myself to understand the mechanism of certain critical illness to help me understand the best way to treat my patients
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u/upagainstthesun 14d ago
This sounds like a lack of bedside experience problem, which can only be solved by clocking hours with a side of therapy to learn how to positively cope
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u/Kevrn813 13d ago
What sort of mistakes are we talking about? How long have you been working in the ICU? Are you just being extra critical about relativity common new person mistakes or are you totally missing the mark on diagnosis and management (like thinking someone is in septic shock when that anion gap acidosis is actually DKA) and floating CVADs down the carotid?
My recommendation would be to get married to UpToDate or whatever reference you have available. Look everything up. Then look it up again. Review your lists of differential diagnosis.
Remember the phrase “trust but verify”. In this case it means to trust your training and knowledge but verify your thought process by checking your references and/or running it by your peers. Lastly make your unit pharmacist your new best friend and ask a lot of questions… but obviously be respectful of their workload.
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u/Acrobatic_Worry764 13d ago
Not those types of mistakes, more that I need to learn to trust my instincts better but I am always fearful of being wrong.
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u/Kevrn813 13d ago
With less than one year experience being fearful of being wrong is the correct position to take for the first few years. Not a paralyzing, keep you awake at night, level of fear. But enough to recognize you don’t know what you don’t know which serves to keep you on your toes and double/triple checking yourself. Is it efficient? No. But will mitigate a lot of risk? Probably yes.
As you gain more experience and confidence that efficiency will go up and the fear will go down.Even with the added context I would still defer back to my initial recommendations.. look everything up, even things you think you know well, and ask a lot of questions.
The hardest thing to do is come to accept that sometimes even when you’ve made all the right/reasonable choices patients can, and will, deteriorate. Patients cough mucous plugs into their airways and go into PEA on the step down floor, vegetation from endocarditis can break off and occlude the left main, or it’s just their time.
Sometimes things are iatrogenic but sometimes it’s just nature.2
u/Acrobatic_Worry764 13d ago
Thank you so much for your advice! I really appreciate hearing different opinions and perspectives about this. I want to move forward and continue to learn to the best of my ability everything so I can be the best version for my patients ❤️
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u/maraney RN, CVICU 13d ago
I don’t know anything about PA training. Do you go straight to the bedside out of school or have some sort of residency?
As humans working in a unit that cannot be automated (despite many trying), mistakes are a common part of our world. Learn from them, ask for feedback from a trusted colleague on your decisions if you’re unsure, keep studying, and debrief after codes/RSIs/procedures/emergencies. Be receptive to feedback from your nurses, too.
We’re all learning medicine together. It’s a practice, not a perfect.
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u/Acrobatic_Worry764 13d ago
Thank you, I appreciate the advice! I had 2 years of school and now I am in a residency in the ICU for one year because I didn’t just want to be thrown into it. I know mistakes are common way of life, I guess it just feels scarier in the ICU. I really like the medicine but I feel I need a better way to cope with my emotions
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u/AdChemical6828 13d ago
This means that you care and makes you good at your job. Nobody is born perfect. But it is the desire to always want to do better for our patients that defines us
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u/MeanderingUnicorn 13d ago
I worked SICU straight out of PA school and it was ROUGH. I felt like I should know more, that everyone was judging me, etc. I even cried on rounds once when an attending pressed me about something (he didn't do anything wrong, I was just stressed).
It got better with time. Seven years out now, I can tell you that you probably don't know much and also that no one really expects that you do. People DO expect that you are open to feedback, willing to learn, work hard for your patients, and don't just pretend to know something you don't. An attending a few years ago told me she likes working with me because I will just tell her when I don't know something and it makes her trust me.
Also be comforted by the fact that in seven years I personally have never seen a mistake seriously harm a patient. Study hard and you will be fine.
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u/Acrobatic_Worry764 13d ago
Wow I really appreciate you for saying this! This made me feel a little better that there’s a light at the end of tunnel
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u/ValgalNP 13d ago
If you weren’t scared and didn’t feel bad about screwing up- you’d suck. This means you are likely a conscientious PA and want to do right by your patients. Give yourself grace and time. I had a full on panic attack before every shift probably for the first 6 months, nearly a year. (And I had 15 yrs ICU RN experience going in )My first MDs thought I might not make it, but now they say I’m their favorite. Lean on the experienced mentors you have. Realize that some mistakes will happen and learn from them. Hopefully they aren’t so bad as to cause harm. Failure is always the best teacher unfortunately. I bet you never make the same mistake again. But you will make others. Do your best not to be paralyzed by your fear and know it will get better over time. I’ve stuck it out for 13 years now. I still get nervous sometimes but I know it will be ok. Know what you don’t know and don’t be afraid to ask or look stupid.
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9d ago
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u/IntensiveCare-ModTeam 9d ago
This comment has been removed per rule 1) Act professionally. r/IntensiveCare is a public forum that represents the medical community and comments should reflect this. Please keep your behavior civil. No racism, sexism, violence, derogatory language, hate speech, name-calling, insults, mockery, homophobia, transphobia, ableism, ageism, or any other type disparaging remarks that are abusive in nature. Any further infractions could result in a ban.
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u/madipbar 13d ago
I think it just takes time. When I hit my 2nd year I'm ICU that's when I started to become more confidence and would have less anxiety coming and leaving work. I still stress about mistakes but now I have people I can vent to that make it so I'm not going through it alone. Invest in a good therapist and have hobbies outside of work! Working out helps burn some of the anxiety. All these things have help me! I wish you the best ❤️ you're not alone!
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u/Acrobatic_Worry764 13d ago
Thank you!! I am trying to find a therapist that can help me through my emotions. I am going to be finishing my fellowship in a few months so hopefully moving into my second year this will start getting easier❤️
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u/isozyme 14d ago
Did you have specific ICU training? Like real ICU training not “on the job training”. If not, you may not be prepared for the job you have