Adding a PA to Neurosurgery
The first couple of months were challenging, partially because the residents I was working with had never worked with a PA. None of them had trained in the US, so they did not know what PAs were about. The Alberta PA demonstration project had done a lot of leg work in educating the nurses and the physicians in what to what we could and could not do. And then there was the big, steep learning curve of Neurosurgery. Their attitude was ‘this was going to work’, and they were going to make it work. This particular department already had an IMG as a hospitalist. They also had a Nurse Practitioner prior to me and found with those two individuals it had not worked. They needed somebody, but they were not sure how it was going to fit in. They were very determined to find solutions to make this a successful endeavour.
PA Training in Neurosurgery
I spent the first month working alongside the physicians majority of the time. After which I was slowly integrated in with the residents. I would join them on morning rounds and get to see all the patients. I would shadow the chief resident and one of the senior residents on consults. I shadowed in the OR and learning some of the skills they needed me to have.
Over time I managed to realize there was a big void that I could fill as a PA in the Neurosurgery service. A lot of resident time is dedicated to learning skills in the operating room, however they needed someone to help cover the inpatient wards. This was a role I could fill.
In Neurosurgery, we treat patients that may not have great outcomes, and also educate and counsel patients of the family. Their loved one may have Glioblastoma, Gord Downie tumour where the life expectancy is very poor, or they’ve had a devastating trauma that has left their 20-year-old confined to a wheelchair and mentally incapacitated. We spend a lot of time with the families to help guide them through the time next steps are going to be. I spend 20% of my time counselling these families.
The majority of my time is spent on the wards. I have probably 30-50 patients at a time depending on the time of the year, the workload and how many staff are around. I spend the majority of my time performing general hospitalist duties. I do first-assist in the operating room when we are short residents. This can be one day a week, or two days a week depending on the load for what residents. Consults are only on Fridays since that is the academic day with residents. I spend the rest of the time studying, reading and keeping up my medical knowledge.
Procedures I perform include majority of the drains, removing of drains whether it be for back, or external ventricular drains, lumbar drains, subdural drains. I am in the process of learning how to put in EVD and I’m learning how to do lumbar drains which is a huge part of what we do. We are one of the few Neuro units with its one ICU. We have our own intensivist that run our ICU. We are starting to transition to learn how to do central lines and ART lines that are required.
Benefits of Adding a PA
Very similar to the study that was done, by I believe, the Sunnybrook Surgery team, there are fewer surgeries being cancelled, because I am able to free up the beds earlier in the day. There are faster discharges. We’ve seen a decrease in the amount of complaints coming in from the families, just because there has been somebody that has been able to sit down and talk with the families and guide them through the process. The overall coverage of inpatient/ward, the nurses are finding that demands are met easier because you are somebody that is able to get onto the wards way sooner than the residents can.
Benefits and Challenges of working in Neurosurgery
In Neurosurgery, the job is stressful because you do not get very many good outcomes. Most of our cases include patients dying of brain tumors, or suffering from traumas. When we get those nice ‘walk out of the hospital’ cases – we really hold on to those.
The most fulfilling part about this position is really the team that I work with. I work for 12 Neurosurgeons, three of whom are Paediatric Neurosurgeons. I do not do Paediatric Neurosurgery, but the Paediatric surgeons do adult procedures. They are an extremely supportive, close-knit great group of surgeons. The nurses, social workers, our nurses aids, and unit clerks are a phenomenal team. Everybody has everyone’s back. I found that the transition from going from a team in the military, to a team in the civilian has made that transition easier.
Work Life Balance
Anyone who is interested in any of the professions involve working with patients with certain outcomes (e.g. palliative care, oncology, neurosurgery) or even just working in Paediatrics – just because the nature of them can be quite stressful. You need to find a way to disconnect from work. This could be throwing yourself into your family, or family activities. It could be just taking an hour to unwind (e.g. have a bath, glass of wine, go for a run). It’s being able to turn off your brain, and realizing that ‘I am not at the hospital, I’m not talking about the hospital’. When it is weighing too much, you just find the people to talk to.
Living Across Canada
I’m originally from British Columbia, and have lived in one end of the country to the other because of my military career. We chose to come back to Alberta because of the health care support it offers our one child.