I'm a new grad and need advice

Hi everyone, I'm a newly graduated PT and I just recently started working my first job. It is in cardiorespiratory care - cardiac care specifically. I'm starting to realize that the things I learned in school aren't helping me too much on my job.

I find that I'm always second guessing myself and questioning myself. I know that I'm a registered PT and I should be confident in my skills and what I do. However, the nurses, other PTs and other staff have worked the job so much longer than me, and I sometimes feel pressured to question my own decisions because of my own lack of experience.

I'm stressed because I feel like I'm not pulling my weight in comparison to the rest of the team but I'm not sure what to do. I feel stupid about asking too many questions regarding things I should already know. It's just very different when you are working with real patients. The cases are more complicated and nothing is as straightforward as what I learned and practiced in school.

Does anyone have any advice?

Hi Canadian PT

This is a normal part of entering the workforce. Often in your entry level training you don't get the complexity of cases that arise. You have to start somewhere. They are probably better off having you there than not having you there and for any organisation investing time and energy in helping junior staff get up to speed pays ample dividends. Here are some suggestions:

Don't be embarrassed about being on the back foot or having to ask questions. or if you can't shrug the embarrassment off why not disclose this to your supervising physio - often clearing the air about feeling inadequate can help get things sorted and help you get the support you need.

Sometimes staff may be a bit negative towards your clinical naivety simply because the pressure is on them to get through their case load. Making it clear how much you value and need their input from time to time can often improve matters.

Actively ask for feedback - This is one fundamental way of improving. Be thoughtful about a good moment to ask but make sure you do. see if you can get someone to sit in on a part of your session or for you to present the case to them and for them to be constructively critical about your performance.

Does your hospital have a policy or procedure on formal supervision? Having an opportunity to talk through issues and tricky cases with a supervisor on a regular basis in a relaxed way when you both have a bit of time, can be a great learning opportunity.

Do you practice reflective learning? Taking the time to plan ahead an evaluation or a treatment, then taking time after it is over to reflect on your performance, what worked, and what can be improved, and planning how you would apply what you learnt to future practice - can really help.

Don't brush over your achievements! Celebrate successes when you have really helped a patient in need.

Being involved in acute medical work carries its own stressors - patients are really ill and what you do can make a huge difference either way - it may not always be good. Patients will sometimes die - we do what we can but sometimes nothing will be enough. A significant proportion of patients will not survive their time in ICU and cardiac care. Personally I found this really hard and for me the decision early in my career was find another avenue. I settled on rehab and that was perfect for me. However whether CP physio is for you or not it is still a great learning experience. So keep a bit of distance on what you are doing.

What are you using for textbooks and are you continuing to brush up on your underling theory? I am sure you had some good texts recommended on your course. Make sure you use them. Keep applying the theory to your specific situations your patients are in. Do you include looking up the physiology (normal and abnormal) of the heart and lungs?

However one which may be a good addition to your standard texts is An On Call Survival Guide to Emergency Physiotherapy:

Emergency physiotherapy - Google Books

It is in that pocket book series so great to carry around with you.

I am not a very medically oriented physio so when I had to get involved in the acute/tertiary care setting I also invested in a pocket book that gives me all the medical tests that you might come upon in acute inpatient care was good - helped me understand what the patient was having done and why and what the results might mean with all the norms at hand.

Perhaps some cardiopulmonary physios could make some further suggestions for good reference material.

The last comment I would make is that first year is really crucial. It is probably the hardest in many ways but it is a real learning curve. When it is over you will look back on it and be amazed how much you learnt.

All the best with the job!

Your feelings are pretty normal especially if you get put into cardioresp. straight out of school. That said you should have done some useful clinical placements in that area.

We have a couple of really useful texts on our shop

Physiotherapy for Respiratory and Cardiac Problems, 4th Edition - Adults and Paediatrics

Respiratory Physiotherapy 2nd Edition - An On Call Survival Guide

The Physiotherapist's Pocketbook 2nd Edition

Chest X-Ray Made Easy, 2nd Edition

Most importantly talk to your boss. Tell them how you're feeling as to off load it in a professional manner should ease your mind. Rest assured a couple of months in and you'll be feeling like you've been working there for years.

Hang in there! I have found that this is a normal experience for new grads, although, many people just don't talk about it. Look up "impostor syndrome" and you will see how common it is.