I have been working as an FNP in the Urgent care setting for the past year and a half. I have 10 years experience as a nurse with ER and inpatient experience, but the new grad learning curve made me feel like a newbie again. I worked at an extremely business focused urgent care chain right out of grad school that severely burned me out, seeing 40-50 patients a shift with little support from management and supplemental staff. I stuck it out as this was the only place that would hire me as a new grad, then I finally quit after accepting a new job offer at another urgent care. I gave myself a month off to recover before starting my dream position at this well-esteemed hospital system in my city. When I interviewed, the APP manager was awesome and the job seemed very supportive and everything I was looking for. However, I feel like I was shafted. After the long credentialing process and on my first day working, I found out the manager that had interviewed me quit, and my orientation got cut short by 2 weeks. I have had virtually no management or support since I started at this clinic. I have had issues managing the workload and acuity of patients in clinic as I am running the clinic as the solo provider with 1 MA. However, the MAs I am working with do not do their job correctly, do not notify me about abnormal vitals, and don't collect any intake information when they triage the patients (meds, allergies, pharmacies) as they should be, making me have to absorb their responsibilities in addition to my own. I also get attitude and pushback when I ask them to do a task. This results in me working late and having to take home 2-4 hours of charts after each shift.

Even though I am only seeing about 20-30ish patient in the shift, I am also managing incoming patient calls about results which can be 10-15 minutes at times in addition to the patients in the clinic. I have had several near misses due to the overwhelming workload and no help from my support staff. I have relayed my concerns to the clinical operation manager with little acknowledgement or solutions. We still have no new manager and I have no one to talk to. I have cried multiple times on shifts when it is busy and find myself in the same mental state of burnout at my last job, which I thought I was escaping.
As a newer NP, I have crippling anxiety about the workload and missing something, or something happening to a patient because I was too overwhelmed or something happens because a patient is waiting too long. This is a good hospital system but the management and workplace environment is causing so much stress.
I don't want to leave the job because I just started 2-3 months ago, and I don't have the financial means to quit and try to find another job. How can I help to manage my mindset and anxiety during these shifts? I feel like I am having imposter syndrome as this patient population is very complex and I am so nervous about doing something wrong. Please help - I feel so defeated as I thought this was going to be my "dream job" and I feel it is just as bad as my last job and I'm not sure how much more I can take. Any advice is appreciated!

Sincerely,
Burned out and barely surviving

ANSWER:
Hello there.
Thanks so much for bringing this here. Oh man, I'm so sorry this is happening. I can absolutely feel your disappointment and defeat in your reflection. The new job isn't what you thought it would be. Your reality isn't meeting up to your expectations of the job, the leadership, the load and that feels bad. On top of that, and because you care about what you do, there is also the matter of building trust in yourself and your abilities to do a BUSY job with COMPLEX patients and a newly expanded scope of work as a FNP.

Ok friend. We don't dole out advice here, but we can help you start to unravel the the knot of yarn up there. I am NOT going to sit here and tell you just "think positive", or say "I'm sure you're doing great, it will get better". Because those things won't feel true or be helpful. I'm also not going to jump "into the pool" to agree that the new job is terrible, that leadership sucks, etc. Because, even if that is true, it won't help you move forward either.

I'm going to invite you to reflect on a few questions here, and I truly hope you bring them back for more coaching. Let's keep untangling the thread, OK?

In Better Together, we use "the Model" to think about our thinking. Let's take what we can from your reflection and plug it into the lines of the model

C= CIRCUMSTANCE (neutral facts, objective, everyone wound agree). In this case: you have 10 years of experience as an inpatient and ER RN. You went back to school to become an FNP. You worked at your first job for x months, and you've been at your 2nd job for y months. The supervisor you interviewed with for the 2nd job has left the position. You are expected to see 20-30 pts per shift and take phone calls.

T= THOUGHT- Thoughts are the meaning our brain makes of the circumstances. we have SO MANY THOUGHTS at all times because our brains are meaning making machines. When looking at a model, we pick ONE thought (sentence) out of the reflection. For our purposes here, I've chosen:

"I thought this was going to be my dream job, but it's just as bad as my last- I'm not sure how much more I can take"

F= FEELING- This is the feeling or emotion you experience when you think that sentence. You did a great job and named several feelings in your reflection. The one you linked to the sentence above was "DEFEATED"

A- ACTIONS- these are the things we do or don't do that are driven by that feeling. When you are feeling DEFEATED, what do you see yourself doing? what do you not do? I have some guesses, but I want to invite you to fill this part out. Can you make a list of all the ways you relate to yourself and your work when you are feeling defeated? (do you look for proof that you're doing something wrong? Do you look for proof that you don't belong? what do you NOT do when you are feeling defeated?

R- RESULT- The result is the sum of those actions/inactions for you. So we'll know more after you make your list of actions, but the result is always proof of the original thought, in this case you don't give yourself the chance to show yourself what you are capable of, you second guess yourself, and relinquish your power of believing yourself to things outside of your control.

I suspect the reason this feels so bad is because you care deeply about your work, your patients, doing a good job, and also being able to support yourself in the long term (not only financially, but emotionally) in what is a challenging field. And operating from "Defeat", is not aligned with what you are here on this earth to do.

So my questions for you:
1. Can you flesh out the Model above with as many actions as you can that are driven by the emotion of "defeated"?

2. What comes up for you as you read my response above? Can you name the emotion?

3. It makes a lot of sense to me that you're feeling disappointed that this job isn't what you thought it would be. how would you define success when it comes to supporting yourself through this disappointment?

OK friend. Please bring this back (or to a live call) for more. We've got you.

I work as a APP in Urgent care, and struggle with push back from medical assistant staff not wanting to complete basic orders, x-rays, and complaining all the time. I tried to befriend them, but I don't know how to find that leadership voice and speak with them

also I struggle with setting boundaries with patients, and sometimes, feel as If they will retaliate or "attack" me, all stemming from needing validation and approval from all to find my worth

please help and advise

burnt out, broken in Michigan
==============================
ANSWER:

Hi there, and welcome! You are perfect just as you are here. Thank you for sharing this. Let's put this thought download into a "Thought Model." I see two separate ones here, the one with MAs and the one with Patients. I'm going to work on the MA model with you, but I want you to try to put your patient thoughts into a model as well- just reply to this thread!

To do that, I'll need your help getting crystal clear on your circumstance - it has to be the exact words (or as close to as you can manage) that the MAs say here:

Circumstance: You work as a APP in Urgent care. You work with MAs who say ______ sometimes about my requests to do basic orders, x-rays, etc. They also say things like "_________"

Thought: "I want to address this push back but I don't know how to find my leadership voice here"

Feeling: ??? _____ (how does this thought feel?)

Actions: people-please, try to be friendly, be what they want me to be. Don't address the behavior. (____ what else?)

Result: You never find a leadership voice and signal externally that you are ok with the situation, and internally that you prioritize others over yourself.

A few questions:
1) You have a belief that the MA's should not push back on your orders, however this thought is not getting you closer to them changing. What is this belief doing for you here? Is there another way to look at the situation (allowing the MAs to push back) that gets you closer to your goal of showing up as a leader?

2) What would it look like to step into your leader voice? Get specific- what words, actions, pitch, etc would you need to embody? How would you carry yourself? What would you eat, dress, etc?

3) What is your inner people pleaser trying to help you with? What is it's goal?

Welcome to Ask for Coaching!

Here is a guide for how to get the most out of this type of coaching:

1) Title your question with something memorable for you. Unless you identify yourself in the title or in your request, your coaching request will be anonymous to other readers. If you want (and to make it easier for you to search and find your old posts later), you can add a tag unique to you (Ex: #abc)

2) Think of a topic you would like coaching on and do a thought download on it here in this space.

3) Try to pull out a thought and run it through a model (C-T-F-A-R) right below your download. It doesn't have to be perfect, just give it your best shot.

4) Hit "submit" at the bottom and one of your coaches will reply HERE within ~ 1-3 days. (Your request won't show up here until we post it with our response)

5) Come back here and search for your post (try to remember the title and scroll down until you find it), and you will see our answer in the text below your question.

6) Read the questions and coaching your colleagues receive - chances are lots of the coaching topics here will apply to you too!

7) Use this as much as you like, 24/7, for coaching on ANY topic. There's no wrong way to do this. There are no gold stars or failures. The more you ask for coaching, the more you will learn, grow and benefit from this course. We will keep our answers succinct and offer 1-3 questions for you to consider and bring back for more coaching. Feel free to respond back in a new post (there's no way to respond in a "thread"), or consider bring any follow up to a group coaching call.

8) Remember that this space is completely anonymous and of course confidential to our group. It's totally fine (and welcome!) to share successes, give support, shout-outs or love to your colleagues here too, doesn't always have to be a place for problems.

Bring it on, friends!

Hi!
I have had a difficult relationship with my mother basically since my 7 year old was born. I feel guilted into doing things that I wouldn't want to do, just to appease my parents (but mostly my mom). I'm not really even sure where to start with the healing of this relationship, or the transition to healing within myself and acceptance of our relationship as it stands, and not to feel so guilty about it.

ANSWER:

C: Mother exists, 7 year old exists. Mother has wishes
T: I should appease my mom.
F: Guilt
A: do the things she wants (it sounds like at the cost of things you want?) What else???? Are you in judgement? Worry? People-pleasing? What else are you doing and not doing from guilt?
R: Resent your mom, disconnect from your parents. Ignore yourself.

I'm happy you brought this here, especially seeing that you are interested in healing.
What, specifically, would this healing look like for you?

If we put "healing within myself and acceptance of our relationship as it stands" in your RESULT line and work backwards, what might that look like? See if you can fill this out and bring it back and we can really dig into your thoughts:

R: healing within myself and acceptance of our relationship as it stands

A: ????

F: ?????

T: ?????

C: Mother exists, 7 year old exists. Mother has wishes

Hi!
I've been struggling off and on for the past week with guilt. It's my daughter's spring break and I have things that I'd like to do, but don't really think that my family wants to join in. I feel guilty about "forcing" them to do something that they would not have chosen to do, just to appease me.
Please help!

ANSWER
Hi there, thanks for bringing this here! Let's plug it into a model:

C: Daughter's spring break
T: I don't think my family wants to join into the things I want to do, so I'd have to force them.
F: Guilt
A: ??? What have you been doing? (are you saying nothing and doing what you think they want? Are you "forcing" yourself to do things you aren't choosing?)
R: You set up a lose-lose situation here (either you "force" or don't get what you want).

I want you to examine that thought a LOT- where could there be possible thought errors?
Are you sure you know what (exactly) your family wants to do? What evidence do you have that they do or do not want to do the things you prefer?

How would you force them? In what ways? With words, physical force, manipulation, etc - and are you sure these techniques count as forcing?

Are you sure they have a goal of appeasing you? Could they have other goals? What could they be?

Whose desires are more worthy, yours or your family members? Why?

I would like to benefit from individual coaching

Answer:
Hello! Wonderful!

You can sign up by going to the top right corner dropdown--> "Coaching"--> "1:1 Coaching".
https://app.bettertogetherphysiciancoaching.com/1-1-coaching/

From there, there are two ways to schedule.
1. Click the button on the top of the page "Schedule a 1:1 session". This will give you the greatest availability/flexibility to schedule, and you'll be booked with whichever one of our coaches has availability during your preferred time .

2. Select the coach you prefer- to do this, scroll down and read about our coaches. When you click on them, there will be a link to schedule directly with that coach. Please note that this will generally be less availability and less flexibility than the option above.

Please let us know if you have any questions!

Hello,

When I was working through the "How to Feel Better" section there was a question about indulging in emotions and getting stuck in emotions. I do this frequently with doubt. Like I doubt myself and the decisions I make for patients which results in me calling colleagues to ask advice, following their chart for multiple days, or checking the Epic in the middle of the night. I also feel doubt when it comes to larger life decisions, for instance I don't know if I should back down my clinical time, I don't know where I should take my career, and I question if I should even remain in medicine sometimes. I think the doubt and second-guessing kind of paralyzes me and I just end up doing the same thing over and over because I can't make a decision.

I'm not sure how would not indulge in this emotion. I don't know how to move forward sometimes. Do you have any recommendations for this?

ANSWER: Wow, great insight! Doubt is a classic emotion to indulge in. I am curious if you know what thought is leading to your doubt? This is the place to start working when you want to move forward. I took a guess at a thought that leads to doubt and plugged it into a model, but please correct me here if this isn't your actual thought:
C: There is a decision to be made (around pt care, or your own life)
T: I might get this wrong, and that would be horrible
F: Doubt
A: Second guessing, call colleagues/friends to ask advice, engage in perseverative "checking behavior", continuously try to "solve" the decision in the right way.
R: You are paralyzed (and prove to yourself that it's very important that you be "right" about decisions).

In this general model, you are creating a narrative that
1) There is a "right" and "wrong" choice to be made
and
2)that there is something inherently "bad" about making the wrong one.

Questions for you:
-So what if you get this wrong? Why (exactly) would that be horrible?
-Do you generally expect yourself to get things right all the time? What are you missing out on because of this? What's the gain and what are the risks

Play out the future scenario where you find out that you made a decision that you wish you hadn't. What's the worst part of this for you?

Bring you answers back!

I generally struggle with a combination of perfectionism and imposter syndrome, and oftentimes I find it really difficult to distinguish between when to push myself (I tend to avoid as a coping mechanism) to get out of my comfort zone vs. when to accept my own limitations. For example, I have always struggled with public speaking. It was an actual phobia at one point and was something I would avoid to the degree that I would shape my course selection around whether it was a requirement. I've improved a lot, out of necessity, but it's still something that will keep me awake for days leading up to an event where I'll need to give a talk, which in my job happens at least every couple of months.

So my question is, how do I balance the desire to keep going in a career that requires public speaking with the knowledge that after all this practice, I still get physically ill for days before a talk (even the small ones)? Is this the kind of issue that warrants considering different career paths if only to promote a more peaceful life, or should I keep pushing myself? And how do I know when that balance tips to one side or the other?

ANSWER:
Thanks for bringing this here! You are correct that perfectionism and impostor syndrome go hand in hand :).
The question you bring queries: Is this "healthy uncertainty" or even "healthy striving" or is this real "imposter syndrome."

The way to answer this is to see if your thoughts are serving you or not, and we can use a thought model to see!
C: Public speaking is required in your job.
T: I have always struggled with public speaking
F: ?? (fear?)
A: avoid it for the most part. If you do have to give the talk, you stay awake for days leading up to an event, worry, phrase the task as "pushing myself" and dread it.
R: You continue (and worsen?) the struggle.

Now, you have a choice here. You can absolutely change your "C" and decide that this is not something you want to do the work on. You always get to decide what's worth your time and energy and what's not. There will be consequences of declining speaking offers it sounds like, but you get to decide if the relief of not speaking is worth the consequences.
In order to make this decision, you need to clean up any thoughts you have tied to "worthiness" of being a public speaker (let's be clear, you are just as worthy of a human being whether or not you are publicly speaking, just as valuable, just as wonderful). If that's a sticky point for you, then this is your work, and come get some coaching!

Once you sink into the fact that you are worthy either way, you get to decide if you want to continue to publicly speak either because you want the result of conquering/excelling at this skill, or just simply because you want to keep your job as it is (both are great reasons, just make sure you like them!).

If you want to continue to publicly speak, then let's work on the THOUGHT that you struggle with public speaking.

-So what if you struggle with it? Why is this struggle bad?
-Do you think you shouldn't struggle with aspects of your job?
-What if it's not the fear from your public speaking thoughts that is the struggle for you but rather your reaction TO the fear?
-Can you process the fear without reacting to it? (If you haven't done this before, dig into this weeks worksheets and webinars for a how-to, and then come get some coaching around it!)