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Fellowshipping: Month 9

Sacramento, CA, USA

Month 9 of fellowship hasn't gone as smoothly as I had planned, maybe with the exception of my research presentation. 

Upcoming Uncertainties

Despite working hard to fill the knowledge gap on my days off and after having worked, I found out I was passed up for the one and only job opportunity with the department and the reason was this:  timing.

I know, I know. You're probably thinking "Well, you should have known that fellowships don't guarantee a job afterwards." Just like the many things we're expected to know. Contracts, negotiations, and the gamut of being a nurse practitioner. Yes, I knew that going into the fellowship would come with the price of no guaranteed job afterwards. Like with other fellows who started with me, there was this hope that there would be something for us at the end of the fellowship term. 

Really, what worked against me in this situation, as per the reason my supervisor gave me, was timing. As a fellow, I was told by my supervisor that I wouldn't be able to apply for a job until September, and so I waited...and waited. As soon as September 1st rolled around, I applied for the one and only position for the department. But, timing was the problem as someone more qualified had applied and already been interviewed a little before I was eligible to apply. 

Let me also add more to the context of my situation. There were about six new but experienced advanced practice providers who were hired in full time in 2019 before I had started the fellowship. Add in COVID-19 which caused a series of economical issues in general and the uncertainty with the upcoming elections, and you have this:  the tough job hunting situation I am in. A recruiter who recruits specifically for neurosurgery and neurocritical care positions had told me that these are the exact reasons that hospitals have been hesitant to open up more positions, although he is hopeful this will change in the coming months. I am sure hiring managers will question if or why the place I trained and completed fellowship didn't offer me the job, and I don't know if these reasons will suffice in their book, although it is the reality of the situation.

On the topic of timing, the news couldn't have come at a worse time. It came on the morning of my first shift (of four). Needless to say, I wasn't able to process everything until after I had completed the shifts. For someone who usually has an idea, or plan, or something set for the next step of the journey... for once, I really don't know what's next. 

I confided the situation to a co-worker who was hopeful I'd be hired in after fellowship. She strongly believed that having fellowship experience under my belt would be helpful for my next job search. I admit, I believed the same too. I mean, that's why I took a pay cut and went unbenefitted and why I took this risk of being unemployed afterwards, right? To invest now and make future career pursuits easier because I now "have experience." Not only this, but to have some training under my belt so I can build on and provide the best care for my patients. 

This training would have been helpful in times where there are actually more neurosurgery positions open and if I were willing to relocate out of state. But now, as I'm facing the challenge of having to job hunt in a market that has currently zero to minimal neurosurgery nurse practitioner jobs. I've even tried expanding my job search to primary care positions because that's what I was trained to do as a family nurse practitioner, but the issue now is that, while I do have experience as a nurse practitioner, I don't have experience as a nurse practitioner in primary care. In a way, it's like this whole year of training didn't count at all and I am back to where I was a year ago as a brand new graduate nurse practitioner. It is frustrating, to say the least.

I know some people may wonder why I'm trying to figure out and settle my next job while there is still a good three months or so until fellowship is over. First of all, the credentialing process takes time, maybe up to three months or longer. Even if I'm hired, I wouldn't be able to start until the credentialing is completed. This process matters, of course, if I'm starting with a new company/healthcare system. Second, the holiday season is rolling in. I love the holidays, but when job hunting, it would mean delays in applications getting reviewed, interviews taking place, or credentialing paperwork going through. 

I guess there's still a full-ish three months to figure this out and to see what happens.

The Month Overall

I wish I could say that I've been given a lot of lectures and things, and in a way, I have...although all of this came later in the month. At the beginning, I struggled with being new to the ICU environment and figuring out where to begin as I started to build on my learning of neurocritical care concepts. I studied (and still continue to) on my days off and when getting off from work, little by little, bit by bit, looking for resources on my own. And really, I'm just processing and repeating information and concepts, hoping that it will all finally "click" at some point like it did when I was on the neurosurgery side. 

As one of the new hires (experienced but not with the healthcare system) has begun working, I feel like I've had to work more independently. While there is still the team (attendings and residents) to ask questions, it's a little strange trying to figure out where I, as an NP trainee/fellow who is not going to be working in this department, fit into the scheme of things. My schedule has been changed from four 10-hour shifts to three 12-hour shifts, which is not necessarily a bad thing, but being scheduled at the end of the week means that I am on my own as the only NP on Fridays. I am not so sure how I feel about being the only NP working. I suppose it is a way to test my limits and a way to practice being more independent in a relatively protected setting. There are still procedures I have yet to be trained on to be "independent," but I suppose these can always be taught later on if required for a future role. 

Conditions I've learned about this month:

  • Subarachnoid hemorrhage
  • Intracranial hemorrhage
  • Traumatic brain injury
  • Hyponatremia/Hypernatremia
  • Management of cerebral edema

It's hard to process all of this -- the upcoming uncertainty, the paradox of having experience but not the right experience, and the feeling of training on my own. All I can say is this:  I made the best decision I could knowing what I knew at the time. 

Here's to hoping month 10 and the rest of fellowship will be better than this past month and that there is a light at the end of this tunnel.

Nicole G.

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