What does it take to completely reinvent your career path at age 30? Ryan Foley knows exactly how daunting this journey can be. Starting as a construction worker with a vocational high school background, Ryan made the bold decision to pursue medicine, beginning with remedial college classes and reverse engineering his way to becoming a physician assistant.
Ryan's approach was brilliantly methodical. Rather than rushing straight toward PA school, he first became a registered nurse—a decision that provided clinical experience, financial stability, and professional connections. "I had a goal in mind and engineered it backwards," he explains. This reverse-engineering process not only made his dream achievable but gave him invaluable perspective that continues to shape his practice today.
The conversation dives deep into the cultural differences between emergency medicine and other specialties. Ryan offers a memorable analogy: "When you're comparing the ED versus the ICU, it's the ADD kids versus the OCD kids." This perfectly captures how emergency medicine professionals thrive amid constant shifts in attention and priorities, yet paradoxically find calm during critical moments. "For as chaotic as a trauma can be, everyone's just very calm, knows their role... It kind of hits that flow state," he shares.
Perhaps most valuable is Ryan's insight on patient communication. Despite sophisticated diagnostics and technology, he emphasizes that simply asking patients what they think might be wrong and truly listening to their stories remains the cornerstone of effective medicine. "When patients feel listened to, they're going to trust you more," Ryan notes—a simple but profound reminder that medicine, at its core, is about human connection. Whether you're considering a career change, curious about emergency medicine, or simply fascinated by healthcare journeys, Ryan's story offers both practical guidance and genuine inspiration.
Virtual shadowing is an important tool to use when planning your medical career. At Shadow Me Next! we want to provide you with the resources you need to find your role in healthcare and secure your place in medicine.
Check out our pre-health resources. Great for pre-med, pre-PA, pre-nursing, pre-therapy students or anyone else with an upcoming interview!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ashley Love (00:00):
Hello and welcome to Shadow Me Next, a podcast
where I take you into and behindthe scenes of the medical world
to provide you with a deeperunderstanding of the human side
of medicine.
I'm Ashley, a physicianassistant, medical editor,
clinical preceptor and thecreator of Shadow Me Next.
It is my pleasure to introduceyou to incredible members of the
(00:22):
healthcare field and uncovertheir unique stories, the joys
and challenges they face andwhat drives them in their
careers.
It's access you want andstories you need, whether you're
a pre-health student or simplycurious about the healthcare
field.
I invite you to join me as wetake a conversational and
personal look into the lives andminds of leaders in medicine.
(00:44):
I don't want you to miss asingle one of these
conversations, so make sure thatyou subscribe to this podcast,
which will automatically notifyyou when new episodes are
dropped, and follow us onInstagram and Facebook at shadow
me next, where we will reviewhighlights from this
conversation and where I'll giveyou sneak previews of our
upcoming guests.
What happens when you take askilled emergency department
(01:06):
nurse and train him to become aPA?
You get Ryan Foley, acompassionate, sharp and
uniquely qualified clinicianwith a story that defies the
traditional path.
In today's episode, ryan opensup about his blue-collar
beginnings in construction,taking remedial college courses
in his 30s, and the strategicway he reverse-engineered his
(01:30):
dream of becoming a PA.
We dive into the contrastingroles of RN versus PA, the
reality of ED culture and whatit means to truly listen to
patients, to colleagues and toyour gut.
Please keep in mind that thecontent of this podcast is
intended for informational andentertainment purposes only and
(01:51):
should not be considered asprofessional medical advice.
The views and opinionsexpressed in this podcast are
those of the host and guests anddo not necessarily reflect the
official policy or position ofany other agency, organization,
employer or company.
This is Shadow Me Next withRyan Foley.
Thank you so much for joiningus today on Shadow Me Next.
(02:18):
I found you on LinkedIn and Iwas so excited because you are a
PA and you're also a registerednurse, and I had just had a
conversation with one of mynurse practitioner friends about
how the perfect practitioner,in our opinion, would be
somebody who is trained as aregistered nurse and then works
as a physician assistant.
So thanks for doing what you do.
Thanks for being here.
Ryan Foley (02:37):
We are so excited to have you.
Ashley Love (02:39):
Awesome, ryan, tell us a little bit about, just
generally, about your journey towhere you're at in medicine
right now.
Ryan Foley (02:47):
Yeah, yeah, it was.
It's definitely anon-traditional way to uh, to to
go.
Um.
So to give you like the reallylong story, uh, I was in
construction before I got intohealthcare.
Um, I did that for quite sometime and just felt like I wanted
to help people and felt like Icould do more, and from there I
(03:11):
never went to college.
You know, I went.
My high school was a vocationalbackground, so I was a machinist
by trade.
So for me to decide to go tocollege, I had to enroll in
remedial classes, so like introto mathematics and intro to
English.
So I had to pass remedial,non-college classes before I
could even get into, you know,college level.
(03:32):
So I started pursuing you knowmy prerequisites.
When I decided this journey, pawas my goal and at this time I
was around 30 years old, didn'thave any college background and
for me to be all right, 30 yearsold, knowing what the PA
process is like, having to getthe experience for me what made
(03:55):
the most sense was to become anRN.
The other portion of it was wealso know how competitive PA
school is and I wouldn't be ableto weather too many cycles and
not have that come to fruitionat some point.
So for me I was like all right,if I get my RN, I'm going to
get the experience, I'll be ableto make the type of salary I
(04:18):
need to make to continue livinga comfortable lifestyle.
I'll get all the clinical hoursI need, I'll be able to network
because I'm going to needreferences and whatnot.
So it was kind of I had a goalin mind and then I engineered it
from the back, you know,backwards.
So I started taking the collegeclasses, got into a community
(04:43):
college nursing program, whichwas amazing.
We were just hitting the groundrunning with clinicals right
away and from there really,really loved nursing.
You know, to be honest, it was.
I really started it as like,okay, this is a stepping stone
until I get where I want to beand just fell in love with it.
There was a point in time whereI was like, maybe I'll just
(05:04):
continue being APRN, but becauseI had that goal of PA, I really
wanted to go that route.
In addition to working in ahospital environment, I felt I
kind of knew what I didn't knowand there were some things I
just didn't know what I didn'tknow.
If that makes sense.
Ashley Love (05:23):
Right right.
Ryan Foley (05:24):
And I really felt that, after talking to a lot of
APRNs, a lot of PAs, talking toa lot of doctors, I really felt
that, for me personally,continuing on the PA route was
the best choice.
Ashley Love (05:38):
I love how you talked about this sort of
non-traditional vocationalbackground, but you didn't just
stop and say well, I don't havethe background that I need to go
into medicine.
I'm not some 19-year-old thatdecided she wanted, or he wanted
, to go right into nursingschool and my path is formed.
It's so interesting because oneof the primary questions that I
(06:01):
get from free health collegestudents is well, ashley, you
know I missed this one classlast semester.
Do you think I'm behind?
I mean, I'm just going todirect them right to your
episode, ryan, and I'm going tosay no, you are absolutely not
behind.
You are going at the pace thatis meant for you and you are
(06:21):
making the decisions that areright for you right now.
So, being so non-traditional, Ireally applaud you with kind of,
like you said, reverseengineering, literally the path
to your career, which is reallycool.
Ryan, tell us a little bitabout how the scope of practice
differs from what you were doingworking as an RN to what you're
(06:42):
doing now working as a PA.
I mean, they're vastlydifferent.
But how, how?
How does that look?
Ryan Foley (06:48):
So my background for my entire career as an RN and
as a PA has been an emergencydepartment.
So those you know being anemergency department RN, you
have a lot of.
You do have a lot of autonomy,a lot of skills, a lot of
knowledge.
I think the scope is different.
I mean for obvious reasons, andas an ERRN, there's a lot of
(07:15):
protocols, you see a lot ofthings and you could do a lot
within your scope, but you'renot making the final decision.
I think that's really where itcomes down to with the PA.
The PAs and providers aremaking the final decision on
which way we're going to go.
Now, that's not to say I mean,when you work with incredible
(07:37):
nurses there's and again, theway that healthcare is being a
team, like a team sport, likeeverybody has a role and it's if
you have a really good nurse,it just makes my job so much
easier, because sometimesthere's things I'm not seeing
because they're spending thetime with the patient much
(07:57):
longer than I am, and I thinkyeah, I think that's the big
difference the final decisionscome down to the providers, but
having the RN's eyes and earsthere are really helpful.
Ashley Love (08:14):
Oh, absolutely Like you said, oftentimes they will
see things that the cliniciandoes not see, just because
they're not in the room as muchand perhaps they're not having
the same conversations andthey're not in the room as much
and perhaps they're not havingthe same conversations and
they're not talking to thefamilies like often, like nurses
are doing.
So that is why the medical, theteam dynamic in medicine works
(08:36):
so well.
If the teamwork is there Ithink that's so important.
Did you have any challengesswitching just for yourself,
switching from being an RN intoa PA?
Did you ever find that you werekind of moving back into that
RN role every now and then anddoing things especially early on
, especially working inemergency medicine in both roles
(08:58):
?
Ryan Foley (08:59):
Being in emergency medicine now I think anybody who
is in that environmentunderstands that we're doing a
lot more with a lot less and Ihave a hard time because I know
that nurses are taking on morepatients than they can handle
sometimes and that's just kindof the environment that we're in
which causes delays.
So for me, with my skill,background and working in the
(09:22):
emergency, there's times thatI'll go in and I'll start my own
lines.
I'll get the blood work, I'lldo the swabs more than just kind
of be a good team member.
Now it's and to help the nursesout and to kind of and not only
help the nurses out but helpthe patients out, because you
(09:42):
know if a nurse is dealing witha trauma or really sick patient,
somebody who's intubated, andthere's a patient that is stable
and I know they're super busy,so I can go in and I'll
sometimes I'll start to work upfor them and I think that's been
my hardest struggle is to backaway from that and just because
(10:03):
I can do it and and to reallykind of take that backseat as a
provider, I think that's myhardest, hardest challenge at
times.
Ashley Love (10:13):
I would agree with that and you know there's a
bunch of different ways we cankind of take that.
But it really like you said, itis important if it's needed and
if your help can help and it'snot just micromanaging or being
showy that you can do this oranything like that.
(10:34):
If it helps, then by all meanshelp.
I'm sure that your colleaguesand the nursing staff that you
have just really appreciate thatSpeaking of colleagues and
nursing staff and I just reallyappreciates that Speaking of
colleagues and nursing staff andI'm really interested in this.
Do you ever find that you well,let me back up one step and say
not everybody in medicine is isa great team player.
Ryan Foley (10:58):
That's the kindest way I can say it.
Ashley Love (11:00):
Right and and and.
Unfortunately there are someclinicians, whether it be PAs,
NPs, MDs, DOs, PTs, et ceterathere are some clinicians that
might not be as kind to nursesperiod.
I mean, it's just the bottomline.
Do you find that because ofyour background specifically, do
you find that you step in asthat kind of liaison often, or
(11:23):
do you just feel this needsometimes to step in and say,
hey, you know, cut a break, orwhy don't you help out?
Ryan Foley (11:31):
Yeah, yeah, I think you know I've been really
blessed.
I work with a lot of reallygood providers and nurses and
teammates.
I haven't really seen a wholelot of providers being like that
to nurses, but I do, but it hashappened.
(11:51):
You know, unfortunately thoseare the times that I do can step
in with my perspective and it'sjust one of those things will
be in that will be like, hey,you know, provider to provider
will be like, oh, this workuphas taken so long or why can't
they get there?
They still haven't gotten a CATscan yet.
Like what's going on?
And you know, I think sometimesit's just people venting and
(12:14):
being frustrated.
But I can offer thatperspective of like, hey, man, I
don't know if you know, butlook, they got an intubated
patient, they were just givenanother patient.
You don't know if transport'sbacked up.
You know, because I've lived itRight, which helps a lot,
honestly with my nurses when I'mworking with them, because I
understand and I can always Idon't know I always try and come
(12:38):
from the angle of empathy of,instead of like hey, why is this
not going on?
And be like, hey, do you needhelp?
What's you know?
Really just kind of being likea what.
What can I do?
Is there something that's goingon that you haven't been able
to get this?
It's no big deal.
I know you're swamped.
What can I do to help you out?
Ashley Love (13:01):
Approaching it more with understanding a desire at
least to understand, thenaccusatory, or um you know a
blame game.
Uh I think that is.
It's just like the step one andbeing a good communicator first
of all.
Um, and like you said, you'velived it, you know, you know the
inner workings and what, whatthe holdups could be, perhaps,
um, whereas a lot of times theydon't teach you that in PA
(13:25):
school, they say order the CTand then read it.
You know they don't.
They don't tell you all thesteps that go to to getting to
that CT, which I do, ryan.
I'm so excited to talk about aday in your life, currently as a
PA and the ED.
Um, so we'll get to that next,actually, but before we do,
there is a segment on the showcalled quality questions.
(13:46):
This is one of my favoriteparts.
It's where we talk about somereally mind blowing interview
questions and sometimes justsome terrible interview
questions that we as healthcareworkers have heard in the past,
and this is supposed to help ourpre-health students prepare for
their own interviews one day.
So, ryan, do you have a qualityquestion that you'd like to
share with us?
Before we hear what Ryan'squality question is, keep in
(14:09):
mind that there's more interviewprep, such as mock interviews
and personal statement review,over on shadowmenexcom.
There you'll find amazingresources to help you as you
prepare to answer your ownquality questions.
Ryan Foley (14:22):
Yeah, all the interviews that we go through to
get into PA school and the jobsand whatnot.
There's just so many questionsand there's the typical like
conflict resolution, and the onethat really stuck out to me was
it was wild.
They said if you had six monthsleft to live, what would you do
(14:42):
?
Oh my gosh, yeah, and thatquestion.
For me it was.
It was an easy question.
You know, I'm married and Ihave four kids, so right away I
was trying not to cry in theinterview because I'm like I'm
just need to spend time with myfamily.
I'll quit my job and makememories and do whatever I can.
(15:08):
And the interesting thephysician that asked me that
explained the questionafterwards and he goes there's
one of two ways to answer this.
One is how you answered it,which is very selfless.
And then the other way is hey,I'm taking off and I'm traveling
for the next six months and I'mspending as much money as
possible, and that's the selfishway of answering it.
And he's like you don't want towork with that person.
Ashley Love (15:30):
No, no.
And Ryan gosh, I love thatquestion so much because,
depending on and in the ED,you're going to run into these
patients, right?
So you're going to see thepatient where you have to tell
them look, that headache thatyou've had, we just did a CT
scan and that's a brain med.
Ryan Foley (15:52):
Yeah.
Ashley Love (15:53):
And we're going to get you to the right people and
we're going to make sure thatyou get the care you need and
we're going to be hopeful.
But you might have to tell them.
You know you have limited timeon this earth.
So a lot of these clinicianshave maybe seen the looks behind
people's eyes when they tellthem these things.
You have six months left tolive.
So, you know, flipping thescript and kind of putting
(16:13):
yourself back in those shoes,especially during an interview
number one oh my God, that'llmake the room spin a little bit,
but it's a really interestingway to see how people work
through that situation, you know, and how, maybe how, you're
going to talk to your patientsabout it too.
Yeah, those are hardconversations and it's not
(16:35):
always about death.
As you know, in the ED the hardconversations with patients are
not always around end of lifecare or death or anything like
that.
I mean, have you experienced aconversation with a patient
where you know it was just?
It was really difficult.
Ryan Foley (16:50):
I mean lots of.
I mean I've had to tellnumerous people that you know
that I found METs, you know, andyou know some of the.
I mean those are incrediblydifficult conversations to have
and I've been grateful that I'vehad really good mentors and I
think, coming from a nursingbackground, really be able to
(17:10):
like connect with people aspeople and you know, really
taking the time to sit down andlike how you do it makes a big
difference.
Taking the time to sit down andlike how you do it makes a big
difference.
But honestly, I think some ofthe tougher conversations are
tougher in a different way.
Or like somebody's been sick forsix months and their doctor
(17:33):
sent them into the ED with theirhands up, being like I don't
know, go to the emergencydepartment and then still not
finding anything.
So the way I kind of approachthose is listen, my job is to
make sure that you're not dyingor you're not really sick.
There's things that I'd beworried about and I know you're
(17:54):
really frustrated and not thatyou want something wrong, but
you want answers and it's reallykind of making sure for me and
this might be against emergencyroom practice, but for me it's
just like I'm going to kind of Ihave the tools, I'm going to
leave no stone unturned.
And it can at least tell you I'mnot missing anything and then
(18:16):
from there try and get you tothe right people.
I think those are just.
Those are hard conversations inthemselves, because people just
want to know what's going onwith them.
And in today's healthcare it'sreally hard to get into a
primary care and it's reallyhard to get your whole story
heard and it's really hard forpeople to kind of listen to you
(18:37):
and listen to everythingholistically, to kind of get
down to the root of what mightbe happening.
Ashley Love (18:43):
As patients, we want answers.
I mean, nobody shows up andsays, can you just tell me
something ambiguous about why Ifeel so bad, Like, no, they
don't want that.
They want answers and sometimesan answer of reassurance this
is not going to kill you.
Reassurance you are not, thisis not going to kill you.
Um, you know, your lungs areclear, no-transcript, and that
(19:07):
sometimes is good enough forsome people, but a lot of people
want a specific answer and thatis a very typical conversation
when you have to say, when youhave to address those
frustrations, and you knowthat's not the case.
So thank you for doing that,Thank you for being that place
(19:36):
where people can come and atleast make sure that they're not
in dire straits, but then alsothank you for listening and for
helping them.
That's so important.
Ryan, talk to us about a day inyour life.
I would love to hear about this.
Okay, so do you do shift work?
Are you there every single dayfor 24 hours Like what, what,
what does it?
What do you do?
What do you do in the ER?
Tell us about it.
Ryan Foley (19:57):
So I do shift work.
It's the the one.
One of the drawbacks ofemergency medicine is the
schedule, but some of thebenefits is also the schedule.
It is rotating, so I could worka morning, afternoon and
overnight, weekends, holidays.
We're open 24-7.
So it really just depends onthe day, for where we go we have
(20:20):
it depends.
I've worked in multipledifferent emergency departments
as a nurse and as a provider.
So this really depends on whereyou go and how they essentially
want to use an APP.
I've been in some emergencydepartments where you're going
one for one with the physician,so one patient comes in, the doc
takes it.
Another patient comes in,whether it's a stroke alert, a
(20:42):
new SVT, a trauma, and it's thenext patient in you're taking it
.
So it really depends on howthey want to use the PAs taking
it there.
So it really depends on howthey want to use the PAs, um.
And then I've been in otheremergency departments where
you're kind of in the fast trackarea or urgent care ish, um,
(21:02):
where you still will see sickerpatients, but you're not.
You're not getting the, the,the ones and twos of acuity, um.
And so it really depends onwhere you're going and some of
them have you mix, like youmight be on what we would call
like main side one day, and thenyou'll be on the fast track
another day, which I think isreally beneficial.
(21:22):
I find that working in the fasttrack area could be more
difficult.
It's so ambiguous where, insomeone coming in in respiratory
distress, you know what's goingon for the most part.
You already have a dispo like,oh, they're going to be admitted
, I just need to stabilize anddo a couple of things, not to
(21:44):
say that you don't have reallycomplicated patients or
pathology on the main side, butbeing on when you're in the fast
track area, it's that ambiguous, like, hey, this has been going
on for six months, I've had allthis stuff going on and you're
like, oh, no one's ever done anultrasound on your gallbladder.
It looks like your gallbladderis coming out today.
(22:05):
So it's really interesting.
So, like the day starts, as Ialready know where I'm assigned,
so I go in, I set up on mycomputer, I get logged in.
If there's any charts orsomething I need to sign from my
previous shift, I'll get thosetaken care of and then just
(22:26):
start picking up patients,assign myself, go in, start
getting the workups going andkind of flows like that.
And you know, with theambulances coming in with more
criticals, you just really neverknow what's going to happen.
So, even if you're in a, youknow, somewhat controlled part
of the emergency department,you're still going to get the,
(22:49):
you know the direct to roomtriage.
You're going to get the directto room from the ambulance and
you kind of just take it as itgoes.
That's one thing about the ER,that you're kind of built for it
or you're not, yep, yep,because you're just at any given
point your day can just gosideways and you got to be able
to pivot and just go with it.
(23:10):
And on top of that you can geta super critical patient and you
still got to be able to get outof the room and see your
patient that was here for coughand congestion and just tested
negative for flu and COVID andjust has an upper respiratory
infection.
So it really kind of goes backand forth.
You know, you never know whatyou're going to get.
Ashley Love (23:33):
No, that's true, Ryan.
I'd love for you to address amisconception that I think I
have.
Are all people that work in theED, are they all adrenaline
junkies, or are there certainlypeople who are just like totally
chill, totally calm, like verysteady?
I mean, is there like a type towork in the ER?
There definitely is.
There's definitely a type thatworks in the ER.
I mean, is there like a type towork in the ER?
Ryan Foley (23:52):
There definitely is.
There's definitely a type thatworks in the ER.
I have worked with people thatare, you know, the, the smooth
and steady and and the reallychill, and I really admire them
because I am not one of them.
I'm like myself, if you askanybody, I'm pretty intense, and
but there are people that arejust like I'm like do you, does
(24:14):
anything make you upset?
Like do you get riled up?
Like I like how do you?
And they just they're just thesame every way and they never
get upset, they never getfrustrated.
It's really amazing.
But I think that just goes tothe type of person they are.
But the ER does attract a typeof you know, I always say, you
(24:37):
know, when you're comparing theED versus the ICU, it's the ADD
kids versus the OCD kids.
Ashley Love (24:46):
I love that.
That's a great comparison.
Ryan Foley (24:50):
You know, and we're just so like like so many things
are going on in the emergencydepartment.
You're so kind of likescattered, like things are just
happening.
You're, you're looking and it'slike squirrel and you know,
you're just.
But then in really intensesituations, that's where the
adrenaline kind of like takes,almost takes over and you go
(25:13):
into like a flow state andeverybody is very calm and for
as chaotic as like a trauma canbe um, everyone's just very calm
, knows their role, knows whatto do.
It kind of hits that flow stateum, where the adrenaline kind of
like when somebody takesadderall for ADHD and it makes
them calmer.
(25:33):
It's the same thing, like ourday could be spent around, you
know, getting tasks done, takingcare of patients, answering
call bells, taking care of, youknow, a newly crashing patient,
and then something comes in thedoor.
But then, when you know it'stime to like, somebody comes in.
It's an overdose, it's anintubation, a super sick patient
(25:54):
, everyone kind of like comestogether and it's very it's.
It's really interesting to see.
Ashley Love (26:01):
It's cool.
I mean it's.
I think there is so much aboutthe ER, the ED, whatever you
know, urgent care even that isthat is absolute chaos.
I mean, you are a dad of fourkids.
You understand chaos, but thenthere are those moments where
you just get this focused, calmand everybody starts working
(26:24):
together and, like you said,that flow state and I think a
lot of it is because, yes, inmedicine there is a lot of
things that we still don't knowand a lot of chaos, but there
are also a lot, of, a lot ofalgorithms and a lot of
procedures, and a lot of thecases that you are dealing with
have algorithms and proceduresand things like that.
And it's almost just like this.
Unfortunately, you've done it somany times that that repetition
(26:47):
is just, it's, it's comfortableand it's known, and you just
kind of, you just like musclememory, you step in and it just
goes you know pattern, patternrecognition.
Ryan Foley (26:57):
And the other thing is to you know, as a provider,
is is kind of.
You see the same things all thetime.
You're like, oh, I know whatthis is, but it's always having
to have in the back of your headwhat am I missing?
Yes, and I think that was thebiggest change from RN to PA.
As an emergency department RN,you see the same patterns over
(27:18):
and over and you're like, ah,it's very easy to say, ah, this
is what it is, ah, this is whatit is.
But as a provider, you have togo.
But what if it's not?
Ashley Love (27:28):
That's a really, really great example of how
they're different.
Ryan Foley (27:32):
Yeah, it's like is what am I missing?
What could I miss?
What are the zebras?
You know, what are the lifethreats that you're not thinking
of when?
And you can get caught up inthat pattern recognition and
that's where you're going to getbit Cause you always have to
have that like most likely notthis.
And when I have you know when Ihave, when I'm precepting PA
(27:57):
students in the ER, that's oneof the big key things I say to
them was like yeah, listen,common things are common, it's
most likely this, but you can't.
These are can't misses you haveto be able to rule out or at
least in your notes say Ithought of these things, however
unlikely, because those are thethings that can kill people and
you don't want to miss those.
Ashley Love (28:15):
No, exactly.
And I think what is sointeresting as the patient,
unless you explain these thingsto them, which in some cases you
might, I know in my practicethere are some, like, for
example, somebody comes in witha dermatitis and common things
are common.
Also, you know, this is mostlikely a contact dermatitis, you
very unlikely.
But these are other things,this could be.
(28:36):
And you know, sometimessomething I say triggers
something and we, you know, thepatient, says well, actually you
mentioned this, let's talkabout that a little bit.
We go on and that you know.
So, yeah, sometimes that doeshappen where you break that down
with the patient, but sometimesyou don't, and that is just so
much of the diagnostic procedurethat people don't really see on
(28:56):
the medical, consumer side ofthings and that we all know
about as clinicians.
Um, so I'm so glad you broughtthat up because that is such an
important point for for studentsis working through that
differential diagnosis and, uh,I think the ED always does that
so well, ryan, tell me aboutprecepting students.
That's fantastic, so you havethe opportunity to preceptor.
(29:18):
Um, these are PA students, sothey're in current current.
Ryan, tell me about preceptingstudents.
That's fantastic, so you havethe opportunity to preceptor.
These are PA students, sothey're current, probably second
year PA students, I wouldimagine.
Ryan Foley (29:25):
Yep, yes, correct.
It's actually pretty amazingthe PAs that come in.
I always ask them you know,first of all, what rotation you
want, because you kind of get anidea.
If this is your first rotation,then I really need to kind of
like hold your hand, which I'mtotally fine with, and then if
it's their last or second tolast rotation, I'm like, oh okay
(29:47):
, so you got this.
You know, like you know how todo a lot of things, so I always
like to get their baseline.
The emergency department iscompletely its own animal, so I
really like to set them up ofhow to do an HPI, how to do
their presentation and how torun through differentials,
(30:11):
basically like a step-by-stepprocess of like when you come to
me, this is how you reallyshould kind of break it down and
other providers, because it'ssuch a fast environment.
This isn't internal med.
When we're going over the last20 years, like I don't need to
know every surgical procedure, Idon't need to know every med
that they're taking.
I basically want to know what'sgoing on, how long has it been
(30:34):
going on.
You know little details likethat that really going to start
building my differential as soonas they start talking and you
know it might, it's kind of it'san intense thing for me to say,
but I tell them I like listenwhen you do your presentation,
take your time, form it, but youhave my attention for
approximately two minutes andthey just kind of like their
(30:58):
eyes light up and I go.
I'm not being a jerk, I'm not.
You know, I'm not going to stoplistening to you, I'm not going
to like walk away, but it'smore for when you talk to other
clinicians in the emergencydepartment.
We don't have a lot of time, soyou need to be very succinct and
to the point, not to say Idon't want all the information,
(31:19):
because as you're talking,someone's going to go.
Well, do they have a history ofthis?
And as a student you're goingto have to know that Right.
So really, in the beginning Iwork with them to kind of build
their you know theirpresentation, so they they're
not babbling and because youknow we've all had those
preceptors that you're just likecould you just be nice to me,
man?
You know like, can you give mea break?
(31:43):
Like I'm trying really hard.
So I try and set them up.
I'm like listen.
I may seem intense, but I'mreally laid back.
I don't want you to.
I want you to have a goodexperience overall.
So I really try and build theirfirst couple of times with me,
to help them with otherclinicians.
Ashley Love (32:02):
Well, it's important because, as a PA
student and also as a medicalstudent and, I would imagine, as
a student of the other areas ofhealthcare, every location that
you go, depending on how manyrotations you do let's say for
me it was 12 rotations in oneyear it's a sampling of medicine
, is really what it is andyou're trying to learn as much
as you do.
Let's say for me it was 12rotations in one year.
It's a sampling of medicine, isreally what it is and you're
trying to learn as much as youcan.
But, like you said, it's acompletely different beast.
(32:23):
Er from IM, from oncology, frompediatrics, they're all very
different and it is your job asa good preceptor, which you are
it is your job to teach them theculture of that aspect of
medicine you know, and and howthey communicate.
Like in dermatology, we have ourown language.
(32:45):
I mean, we speak differentlybecause we're describing things
all day in the way that I amdescribing something I need you
to know in three words what itis you know.
So, so, and so students willcome in and, like you, say kind
of babble, which to them itdoesn't sound like babbling,
they're just.
They're giving me threeparagraphs to describe something
and I need three words.
So you know, it's our job as agood preceptor to to teach that
(33:09):
culture, to teach thatcommunication and it's a it's
different.
I would sound like a crazyperson if I tried to present an
ED patient to you right now.
I mean, you'd probably be likeAshley, stop talking.
Ryan Foley (33:20):
Yeah, I mean same.
If I got a dermatology.
I'm like, oh man, I don't knowif this is a macular or papular,
Exactly.
Ashley Love (33:27):
Exactly so.
No, I think it is.
I think it's so fun, and Ithink it is.
It's not even tough love, it'snot even tough love, it's just
love.
You know, the fact that you'retaking the time to explain that
to students and actuallyteaching them the language and
teaching them the culture.
The only purpose of doing thatis to set them up for success.
You know, I think it's great.
Ryan Foley (33:49):
And even to the point you know they'll do an
abdominal exam.
And if they're first, ifthey're in their first like one
or two or three rotations, I'llgo in and be like, show me how
you're doing your domo exam andbe like, oh no, you're not
putting enough pressure, and ina good way, you know.
And be like I want you to seehow deep you go.
I want, and that's the, that'sjust how I do it, cause if a lot
(34:12):
of the preceptors will just belike, all right, go in the room,
come back, you don't know whatyou're doing.
Ashley Love (34:15):
No, no, no no.
Ryan Foley (34:17):
And it's a very intimate.
We're in a very intimateprofession and if you've never
been, you know fortunately, asRN I was used to being in other
people's spaces, right, and as anew provider that that's very
intimidating to.
Even with your stethoscopeyou're less than two feet from
someone.
That that's a really, you know,intimate space to be in.
Ashley Love (34:39):
No, it's wonderful.
Thank you for taking students.
Thank you so much forprecepting them.
It is truly a gift to tomedicine to share our knowledge.
I'm sure you enjoy it and thestudents will learn so much
better if they have a supportive, knowledgeable preceptor like
you.
So thank you for doing that.
That's incredible, ryan.
Before we wrap up, what is theone?
(35:01):
Just the pearl of advice thatyou give to your PA students
that come through?
Just something that, if theyhave learned nothing else on
their rotation with you, theyneed to learn this one thing.
Ryan Foley (35:16):
Oh geez, that's a tough question.
We have all this diagnosticsand all these imaging and all
this stuff and even asking, likethe patient, what do you think
is wrong.
It will give you so muchinsight and really listening to
their story, you know, and in atime like, you'll be able to
(35:36):
tease out follow-up questions,but really just listening to the
patient, I think that's thebiggest takeaway.
It transcends so many thingsbecause it's going to build
trust with the patient.
When you're listening to themand they felt listened to,
they're going to trust you more.
Ashley Love (35:49):
Right, right.
Patients want to be heard andthey do want to be heard
accurately.
And it seems like such anelementary thing to listen and
say, but it doesn't happen allthe time.
Ryan Foley (36:04):
You know what?
And the follow-up I'll say isask, if you don't know, I work
with a lot of great, great otherproviders, other APPs and
doctors, and just there's timesthat I just go up and go, hey,
you know, I'm kind of lost or Ithink this is where I'm at and
and it's better to ask aquestion and not know.
Then then then really like notdo right by the patient.
Ashley Love (36:27):
Absolutely no.
I think that's great, ryan.
Those are really great piecesof advice, and not just for gosh
, I mean, those are pieces oflife advice right, not just for
medicine, but generally speaking, ryan, thank Not just for
medicine, but generally speaking.
Ryan, thank you so much fortaking the time and speaking
with us on shadow me next, ofcourse, as I expected.
I still think that being an RNand then becoming a PA is the
(36:49):
right way to go in medicine andI'm glad.
I'm glad that you went back,took those remedial classes
powered through.
It's just an incredible story.
Thank you so much for sharingit.
Ryan Foley (36:58):
Oh, you're very welcome.
Thanks for having me and it wasgreat to you know, great to
share with everyone and ifanyone's ever has any questions
or anything, feel free to reachout because I'm always happy to
especially speak about thenon-traditional roles or
fabulous.
Yeah.
Ashley Love (37:13):
Great.
Thank you so very much forlistening to this episode of
shadow me next.
If you liked this episode or ifyou think it could be useful
for a friend, please subscribeand invite them to join us next
Monday, as always.
If you have any questions, letme know on Facebook or Instagram
Access.
You want stories you need?
You're always invited to ShadowMe Next.
Hello and welcome to Shadow Me Next, a podcast
where I take you into and behindthe scenes of the medical world
to provide you with a deeperunderstanding of the human side
of medicine.
I'm Ashley, a physicianassistant, medical editor,
clinical preceptor and thecreator of Shadow Me Next.
It is my pleasure to introduceyou to incredible members of the
(00:22):
healthcare field and uncovertheir unique stories, the joys
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It's access you want andstories you need, whether you're
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(00:44):
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me next, where we will reviewhighlights from this
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upcoming guests.
What happens when you take askilled emergency department
(01:06):
nurse and train him to become aPA?
You get Ryan Foley, acompassionate, sharp and
uniquely qualified clinicianwith a story that defies the
traditional path.
In today's episode, ryan opensup about his blue-collar
beginnings in construction,taking remedial college courses
in his 30s, and the strategicway he reverse-engineered his
(01:30):
dream of becoming a PA.
We dive into the contrastingroles of RN versus PA, the
reality of ED culture and whatit means to truly listen to
patients, to colleagues and toyour gut.
Please keep in mind that thecontent of this podcast is
intended for informational andentertainment purposes only and
(01:51):
should not be considered asprofessional medical advice.
The views and opinionsexpressed in this podcast are
those of the host and guests anddo not necessarily reflect the
official policy or position ofany other agency, organization,
employer or company.
This is Shadow Me Next withRyan Foley.
Thank you so much for joiningus today on Shadow Me Next.
(02:18):
I found you on LinkedIn and Iwas so excited because you are a
PA and you're also a registerednurse, and I had just had a
conversation with one of mynurse practitioner friends about
how the perfect practitioner,in our opinion, would be
somebody who is trained as aregistered nurse and then works
as a physician assistant.
So thanks for doing what you do.
Thanks for being here.
Ryan Foley (02:37):
We are so excited to have you.
Ashley Love (02:39):
Awesome, ryan, tell us a little bit about, just
generally, about your journey towhere you're at in medicine
right now.
Ryan Foley (02:47):
Yeah, yeah, it was.
It's definitely anon-traditional way to uh, to to
go.
Um.
So to give you like the reallylong story, uh, I was in
construction before I got intohealthcare.
Um, I did that for quite sometime and just felt like I wanted
to help people and felt like Icould do more, and from there I
(03:11):
never went to college.
You know, I went.
My high school was a vocationalbackground, so I was a machinist
by trade.
So for me to decide to go tocollege, I had to enroll in
remedial classes, so like introto mathematics and intro to
English.
So I had to pass remedial,non-college classes before I
could even get into, you know,college level.
(03:32):
So I started pursuing you knowmy prerequisites.
When I decided this journey, pawas my goal and at this time I
was around 30 years old, didn'thave any college background and
for me to be all right, 30 yearsold, knowing what the PA
process is like, having to getthe experience for me what made
(03:55):
the most sense was to become anRN.
The other portion of it was wealso know how competitive PA
school is and I wouldn't be ableto weather too many cycles and
not have that come to fruitionat some point.
So for me I was like all right,if I get my RN, I'm going to
get the experience, I'll be ableto make the type of salary I
(04:18):
need to make to continue livinga comfortable lifestyle.
I'll get all the clinical hoursI need, I'll be able to network
because I'm going to needreferences and whatnot.
So it was kind of I had a goalin mind and then I engineered it
from the back, you know,backwards.
So I started taking the collegeclasses, got into a community
(04:43):
college nursing program, whichwas amazing.
We were just hitting the groundrunning with clinicals right
away and from there really,really loved nursing.
You know, to be honest, it was.
I really started it as like,okay, this is a stepping stone
until I get where I want to beand just fell in love with it.
There was a point in time whereI was like, maybe I'll just
(05:04):
continue being APRN, but becauseI had that goal of PA, I really
wanted to go that route.
In addition to working in ahospital environment, I felt I
kind of knew what I didn't knowand there were some things I
just didn't know what I didn'tknow.
If that makes sense.
Ashley Love (05:23):
Right right.
Ryan Foley (05:24):
And I really felt that, after talking to a lot of
APRNs, a lot of PAs, talking toa lot of doctors, I really felt
that, for me personally,continuing on the PA route was
the best choice.
Ashley Love (05:38):
I love how you talked about this sort of
non-traditional vocationalbackground, but you didn't just
stop and say well, I don't havethe background that I need to go
into medicine.
I'm not some 19-year-old thatdecided she wanted, or he wanted
, to go right into nursingschool and my path is formed.
It's so interesting because oneof the primary questions that I
(06:01):
get from free health collegestudents is well, ashley, you
know I missed this one classlast semester.
Do you think I'm behind?
I mean, I'm just going todirect them right to your
episode, ryan, and I'm going tosay no, you are absolutely not
behind.
You are going at the pace thatis meant for you and you are
(06:21):
making the decisions that areright for you right now.
So, being so non-traditional, Ireally applaud you with kind of,
like you said, reverseengineering, literally the path
to your career, which is reallycool.
Ryan, tell us a little bitabout how the scope of practice
differs from what you were doingworking as an RN to what you're
(06:42):
doing now working as a PA.
I mean, they're vastlydifferent.
But how, how?
How does that look?
Ryan Foley (06:48):
So my background for my entire career as an RN and
as a PA has been an emergencydepartment.
So those you know being anemergency department RN, you
have a lot of.
You do have a lot of autonomy,a lot of skills, a lot of
knowledge.
I think the scope is different.
I mean for obvious reasons, andas an ERRN, there's a lot of
(07:15):
protocols, you see a lot ofthings and you could do a lot
within your scope, but you'renot making the final decision.
I think that's really where itcomes down to with the PA.
The PAs and providers aremaking the final decision on
which way we're going to go.
Now, that's not to say I mean,when you work with incredible
(07:37):
nurses there's and again, theway that healthcare is being a
team, like a team sport, likeeverybody has a role and it's if
you have a really good nurse,it just makes my job so much
easier, because sometimesthere's things I'm not seeing
because they're spending thetime with the patient much
(07:57):
longer than I am, and I thinkyeah, I think that's the big
difference the final decisionscome down to the providers, but
having the RN's eyes and earsthere are really helpful.
Ashley Love (08:14):
Oh, absolutely Like you said, oftentimes they will
see things that the cliniciandoes not see, just because
they're not in the room as muchand perhaps they're not having
the same conversations andthey're not in the room as much
and perhaps they're not havingthe same conversations and
they're not talking to thefamilies like often, like nurses
are doing.
So that is why the medical, theteam dynamic in medicine works
(08:36):
so well.
If the teamwork is there Ithink that's so important.
Did you have any challengesswitching just for yourself,
switching from being an RN intoa PA?
Did you ever find that you werekind of moving back into that
RN role every now and then anddoing things especially early on
, especially working inemergency medicine in both roles
(08:58):
?
Ryan Foley (08:59):
Being in emergency medicine now I think anybody who
is in that environmentunderstands that we're doing a
lot more with a lot less and Ihave a hard time because I know
that nurses are taking on morepatients than they can handle
sometimes and that's just kindof the environment that we're in
which causes delays.
So for me, with my skill,background and working in the
(09:22):
emergency, there's times thatI'll go in and I'll start my own
lines.
I'll get the blood work, I'lldo the swabs more than just kind
of be a good team member.
Now it's and to help the nursesout and to kind of and not only
help the nurses out but helpthe patients out, because you
(09:42):
know if a nurse is dealing witha trauma or really sick patient,
somebody who's intubated, andthere's a patient that is stable
and I know they're super busy,so I can go in and I'll
sometimes I'll start to work upfor them and I think that's been
my hardest struggle is to backaway from that and just because
(10:03):
I can do it and and to reallykind of take that backseat as a
provider, I think that's myhardest, hardest challenge at
times.
Ashley Love (10:13):
I would agree with that and you know there's a
bunch of different ways we cankind of take that.
But it really like you said, itis important if it's needed and
if your help can help and it'snot just micromanaging or being
showy that you can do this oranything like that.
(10:34):
If it helps, then by all meanshelp.
I'm sure that your colleaguesand the nursing staff that you
have just really appreciate thatSpeaking of colleagues and
nursing staff and I just reallyappreciates that Speaking of
colleagues and nursing staff andI'm really interested in this.
Do you ever find that you well,let me back up one step and say
not everybody in medicine is isa great team player.
Ryan Foley (10:58):
That's the kindest way I can say it.
Ashley Love (11:00):
Right and and and.
Unfortunately there are someclinicians, whether it be PAs,
NPs, MDs, DOs, PTs, et ceterathere are some clinicians that
might not be as kind to nursesperiod.
I mean, it's just the bottomline.
Do you find that because ofyour background specifically, do
you find that you step in asthat kind of liaison often, or
(11:23):
do you just feel this needsometimes to step in and say,
hey, you know, cut a break, orwhy don't you help out?
Ryan Foley (11:31):
Yeah, yeah, I think you know I've been really
blessed.
I work with a lot of reallygood providers and nurses and
teammates.
I haven't really seen a wholelot of providers being like that
to nurses, but I do, but it hashappened.
(11:51):
You know, unfortunately thoseare the times that I do can step
in with my perspective and it'sjust one of those things will
be in that will be like, hey,you know, provider to provider
will be like, oh, this workuphas taken so long or why can't
they get there?
They still haven't gotten a CATscan yet.
Like what's going on?
And you know, I think sometimesit's just people venting and
(12:14):
being frustrated.
But I can offer thatperspective of like, hey, man, I
don't know if you know, butlook, they got an intubated
patient, they were just givenanother patient.
You don't know if transport'sbacked up.
You know, because I've lived itRight, which helps a lot,
honestly with my nurses when I'mworking with them, because I
understand and I can always Idon't know I always try and come
(12:38):
from the angle of empathy of,instead of like hey, why is this
not going on?
And be like, hey, do you needhelp?
What's you know?
Really just kind of being likea what.
What can I do?
Is there something that's goingon that you haven't been able
to get this?
It's no big deal.
I know you're swamped.
What can I do to help you out?
Ashley Love (13:01):
Approaching it more with understanding a desire at
least to understand, thenaccusatory, or um you know a
blame game.
Uh I think that is.
It's just like the step one andbeing a good communicator first
of all.
Um, and like you said, you'velived it, you know, you know the
inner workings and what, whatthe holdups could be, perhaps,
um, whereas a lot of times theydon't teach you that in PA
(13:25):
school, they say order the CTand then read it.
You know they don't.
They don't tell you all thesteps that go to to getting to
that CT, which I do, ryan.
I'm so excited to talk about aday in your life, currently as a
PA and the ED.
Um, so we'll get to that next,actually, but before we do,
there is a segment on the showcalled quality questions.
(13:46):
This is one of my favoriteparts.
It's where we talk about somereally mind blowing interview
questions and sometimes justsome terrible interview
questions that we as healthcareworkers have heard in the past,
and this is supposed to help ourpre-health students prepare for
their own interviews one day.
So, ryan, do you have a qualityquestion that you'd like to
share with us?
Before we hear what Ryan'squality question is, keep in
(14:09):
mind that there's more interviewprep, such as mock interviews
and personal statement review,over on shadowmenexcom.
There you'll find amazingresources to help you as you
prepare to answer your ownquality questions.
Ryan Foley (14:22):
Yeah, all the interviews that we go through to
get into PA school and the jobsand whatnot.
There's just so many questionsand there's the typical like
conflict resolution, and the onethat really stuck out to me was
it was wild.
They said if you had six monthsleft to live, what would you do
(14:42):
?
Oh my gosh, yeah, and thatquestion.
For me it was.
It was an easy question.
You know, I'm married and Ihave four kids, so right away I
was trying not to cry in theinterview because I'm like I'm
just need to spend time with myfamily.
I'll quit my job and makememories and do whatever I can.
(15:08):
And the interesting thephysician that asked me that
explained the questionafterwards and he goes there's
one of two ways to answer this.
One is how you answered it,which is very selfless.
And then the other way is hey,I'm taking off and I'm traveling
for the next six months and I'mspending as much money as
possible, and that's the selfishway of answering it.
And he's like you don't want towork with that person.
Ashley Love (15:30):
No, no.
And Ryan gosh, I love thatquestion so much because,
depending on and in the ED,you're going to run into these
patients, right?
So you're going to see thepatient where you have to tell
them look, that headache thatyou've had, we just did a CT
scan and that's a brain med.
Ryan Foley (15:52):
Yeah.
Ashley Love (15:53):
And we're going to get you to the right people and
we're going to make sure thatyou get the care you need and
we're going to be hopeful.
But you might have to tell them.
You know you have limited timeon this earth.
So a lot of these clinicianshave maybe seen the looks behind
people's eyes when they tellthem these things.
You have six months left tolive.
So, you know, flipping thescript and kind of putting
(16:13):
yourself back in those shoes,especially during an interview
number one oh my God, that'llmake the room spin a little bit,
but it's a really interestingway to see how people work
through that situation, you know, and how, maybe how, you're
going to talk to your patientsabout it too.
Yeah, those are hardconversations and it's not
(16:35):
always about death.
As you know, in the ED the hardconversations with patients are
not always around end of lifecare or death or anything like
that.
I mean, have you experienced aconversation with a patient
where you know it was just?
It was really difficult.
Ryan Foley (16:50):
I mean lots of.
I mean I've had to tellnumerous people that you know
that I found METs, you know, andyou know some of the.
I mean those are incrediblydifficult conversations to have
and I've been grateful that I'vehad really good mentors and I
think, coming from a nursingbackground, really be able to
(17:10):
like connect with people aspeople and you know, really
taking the time to sit down andlike how you do it makes a big
difference.
Taking the time to sit down andlike how you do it makes a big
difference.
But honestly, I think some ofthe tougher conversations are
tougher in a different way.
Or like somebody's been sick forsix months and their doctor
(17:33):
sent them into the ED with theirhands up, being like I don't
know, go to the emergencydepartment and then still not
finding anything.
So the way I kind of approachthose is listen, my job is to
make sure that you're not dyingor you're not really sick.
There's things that I'd beworried about and I know you're
(17:54):
really frustrated and not thatyou want something wrong, but
you want answers and it's reallykind of making sure for me and
this might be against emergencyroom practice, but for me it's
just like I'm going to kind of Ihave the tools, I'm going to
leave no stone unturned.
And it can at least tell you I'mnot missing anything and then
(18:16):
from there try and get you tothe right people.
I think those are just.
Those are hard conversations inthemselves, because people just
want to know what's going onwith them.
And in today's healthcare it'sreally hard to get into a
primary care and it's reallyhard to get your whole story
heard and it's really hard forpeople to kind of listen to you
(18:37):
and listen to everythingholistically, to kind of get
down to the root of what mightbe happening.
Ashley Love (18:43):
As patients, we want answers.
I mean, nobody shows up andsays, can you just tell me
something ambiguous about why Ifeel so bad, Like, no, they
don't want that.
They want answers and sometimesan answer of reassurance this
is not going to kill you.
Reassurance you are not, thisis not going to kill you.
Um, you know, your lungs areclear, no-transcript, and that
(19:07):
sometimes is good enough forsome people, but a lot of people
want a specific answer and thatis a very typical conversation
when you have to say, when youhave to address those
frustrations, and you knowthat's not the case.
So thank you for doing that,Thank you for being that place
(19:36):
where people can come and atleast make sure that they're not
in dire straits, but then alsothank you for listening and for
helping them.
That's so important.
Ryan, talk to us about a day inyour life.
I would love to hear about this.
Okay, so do you do shift work?
Are you there every single dayfor 24 hours Like what, what,
what does it?
What do you do?
What do you do in the ER?
Tell us about it.
Ryan Foley (19:57):
So I do shift work.
It's the the one.
One of the drawbacks ofemergency medicine is the
schedule, but some of thebenefits is also the schedule.
It is rotating, so I could worka morning, afternoon and
overnight, weekends, holidays.
We're open 24-7.
So it really just depends onthe day, for where we go we have
(20:20):
it depends.
I've worked in multipledifferent emergency departments
as a nurse and as a provider.
So this really depends on whereyou go and how they essentially
want to use an APP.
I've been in some emergencydepartments where you're going
one for one with the physician,so one patient comes in, the doc
takes it.
Another patient comes in,whether it's a stroke alert, a
(20:42):
new SVT, a trauma, and it's thenext patient in you're taking it
.
So it really depends on howthey want to use the PAs taking
it there.
So it really depends on howthey want to use the PAs, um.
And then I've been in otheremergency departments where
you're kind of in the fast trackarea or urgent care ish, um,
(21:02):
where you still will see sickerpatients, but you're not.
You're not getting the, the,the ones and twos of acuity, um.
And so it really depends onwhere you're going and some of
them have you mix, like youmight be on what we would call
like main side one day, and thenyou'll be on the fast track
another day, which I think isreally beneficial.
(21:22):
I find that working in the fasttrack area could be more
difficult.
It's so ambiguous where, insomeone coming in in respiratory
distress, you know what's goingon for the most part.
You already have a dispo like,oh, they're going to be admitted
, I just need to stabilize anddo a couple of things, not to
(21:44):
say that you don't have reallycomplicated patients or
pathology on the main side, butbeing on when you're in the fast
track area, it's that ambiguous, like, hey, this has been going
on for six months, I've had allthis stuff going on and you're
like, oh, no one's ever done anultrasound on your gallbladder.
It looks like your gallbladderis coming out today.
(22:05):
So it's really interesting.
So, like the day starts, as Ialready know where I'm assigned,
so I go in, I set up on mycomputer, I get logged in.
If there's any charts orsomething I need to sign from my
previous shift, I'll get thosetaken care of and then just
(22:26):
start picking up patients,assign myself, go in, start
getting the workups going andkind of flows like that.
And you know, with theambulances coming in with more
criticals, you just really neverknow what's going to happen.
So, even if you're in a, youknow, somewhat controlled part
of the emergency department,you're still going to get the,
(22:49):
you know the direct to roomtriage.
You're going to get the directto room from the ambulance and
you kind of just take it as itgoes.
That's one thing about the ER,that you're kind of built for it
or you're not, yep, yep,because you're just at any given
point your day can just gosideways and you got to be able
to pivot and just go with it.
(23:10):
And on top of that you can geta super critical patient and you
still got to be able to get outof the room and see your
patient that was here for coughand congestion and just tested
negative for flu and COVID andjust has an upper respiratory
infection.
So it really kind of goes backand forth.
You know, you never know whatyou're going to get.
Ashley Love (23:33):
No, that's true, Ryan.
I'd love for you to address amisconception that I think I
have.
Are all people that work in theED, are they all adrenaline
junkies, or are there certainlypeople who are just like totally
chill, totally calm, like verysteady?
I mean, is there like a type towork in the ER?
There definitely is.
There's definitely a type thatworks in the ER.
I mean, is there like a type towork in the ER?
Ryan Foley (23:52):
There definitely is.
There's definitely a type thatworks in the ER.
I have worked with people thatare, you know, the, the smooth
and steady and and the reallychill, and I really admire them
because I am not one of them.
I'm like myself, if you askanybody, I'm pretty intense, and
but there are people that arejust like I'm like do you, does
(24:14):
anything make you upset?
Like do you get riled up?
Like I like how do you?
And they just they're just thesame every way and they never
get upset, they never getfrustrated.
It's really amazing.
But I think that just goes tothe type of person they are.
But the ER does attract a typeof you know, I always say, you
(24:37):
know, when you're comparing theED versus the ICU, it's the ADD
kids versus the OCD kids.
Ashley Love (24:46):
I love that.
That's a great comparison.
Ryan Foley (24:50):
You know, and we're just so like like so many things
are going on in the emergencydepartment.
You're so kind of likescattered, like things are just
happening.
You're, you're looking and it'slike squirrel and you know,
you're just.
But then in really intensesituations, that's where the
adrenaline kind of like takes,almost takes over and you go
(25:13):
into like a flow state andeverybody is very calm and for
as chaotic as like a trauma canbe um, everyone's just very calm
, knows their role, knows whatto do.
It kind of hits that flow stateum, where the adrenaline kind of
like when somebody takesadderall for ADHD and it makes
them calmer.
(25:33):
It's the same thing, like ourday could be spent around, you
know, getting tasks done, takingcare of patients, answering
call bells, taking care of, youknow, a newly crashing patient,
and then something comes in thedoor.
But then, when you know it'stime to like, somebody comes in.
It's an overdose, it's anintubation, a super sick patient
(25:54):
, everyone kind of like comestogether and it's very it's.
It's really interesting to see.
Ashley Love (26:01):
It's cool.
I mean it's.
I think there is so much aboutthe ER, the ED, whatever you
know, urgent care even that isthat is absolute chaos.
I mean, you are a dad of fourkids.
You understand chaos, but thenthere are those moments where
you just get this focused, calmand everybody starts working
(26:24):
together and, like you said,that flow state and I think a
lot of it is because, yes, inmedicine there is a lot of
things that we still don't knowand a lot of chaos, but there
are also a lot, of, a lot ofalgorithms and a lot of
procedures, and a lot of thecases that you are dealing with
have algorithms and proceduresand things like that.
And it's almost just like this.
Unfortunately, you've done it somany times that that repetition
(26:47):
is just, it's, it's comfortableand it's known, and you just
kind of, you just like musclememory, you step in and it just
goes you know pattern, patternrecognition.
Ryan Foley (26:57):
And the other thing is to you know, as a provider,
is is kind of.
You see the same things all thetime.
You're like, oh, I know whatthis is, but it's always having
to have in the back of your headwhat am I missing?
Yes, and I think that was thebiggest change from RN to PA.
As an emergency department RN,you see the same patterns over
(27:18):
and over and you're like, ah,it's very easy to say, ah, this
is what it is, ah, this is whatit is.
But as a provider, you have togo.
But what if it's not?
Ashley Love (27:28):
That's a really, really great example of how
they're different.
Ryan Foley (27:32):
Yeah, it's like is what am I missing?
What could I miss?
What are the zebras?
You know, what are the lifethreats that you're not thinking
of when?
And you can get caught up inthat pattern recognition and
that's where you're going to getbit Cause you always have to
have that like most likely notthis.
And when I have you know when Ihave, when I'm precepting PA
(27:57):
students in the ER, that's oneof the big key things I say to
them was like yeah, listen,common things are common, it's
most likely this, but you can't.
These are can't misses you haveto be able to rule out or at
least in your notes say Ithought of these things, however
unlikely, because those are thethings that can kill people and
you don't want to miss those.
Ashley Love (28:15):
No, exactly.
And I think what is sointeresting as the patient,
unless you explain these thingsto them, which in some cases you
might, I know in my practicethere are some, like, for
example, somebody comes in witha dermatitis and common things
are common.
Also, you know, this is mostlikely a contact dermatitis, you
very unlikely.
But these are other things,this could be.
(28:36):
And you know, sometimessomething I say triggers
something and we, you know, thepatient, says well, actually you
mentioned this, let's talkabout that a little bit.
We go on and that you know.
So, yeah, sometimes that doeshappen where you break that down
with the patient, but sometimesyou don't, and that is just so
much of the diagnostic procedurethat people don't really see on
(28:56):
the medical, consumer side ofthings and that we all know
about as clinicians.
Um, so I'm so glad you broughtthat up because that is such an
important point for for studentsis working through that
differential diagnosis and, uh,I think the ED always does that
so well, ryan, tell me aboutprecepting students.
That's fantastic, so you havethe opportunity to preceptor.
(29:18):
Um, these are PA students, sothey're in current current.
Ryan, tell me about preceptingstudents.
That's fantastic, so you havethe opportunity to preceptor.
These are PA students, sothey're current, probably second
year PA students, I wouldimagine.
Ryan Foley (29:25):
Yep, yes, correct.
It's actually pretty amazingthe PAs that come in.
I always ask them you know,first of all, what rotation you
want, because you kind of get anidea.
If this is your first rotation,then I really need to kind of
like hold your hand, which I'mtotally fine with, and then if
it's their last or second tolast rotation, I'm like, oh okay
(29:47):
, so you got this.
You know, like you know how todo a lot of things, so I always
like to get their baseline.
The emergency department iscompletely its own animal, so I
really like to set them up ofhow to do an HPI, how to do
their presentation and how torun through differentials,
(30:11):
basically like a step-by-stepprocess of like when you come to
me, this is how you reallyshould kind of break it down and
other providers, because it'ssuch a fast environment.
This isn't internal med.
When we're going over the last20 years, like I don't need to
know every surgical procedure, Idon't need to know every med
that they're taking.
I basically want to know what'sgoing on, how long has it been
(30:34):
going on.
You know little details likethat that really going to start
building my differential as soonas they start talking and you
know it might, it's kind of it'san intense thing for me to say,
but I tell them I like listenwhen you do your presentation,
take your time, form it, but youhave my attention for
approximately two minutes andthey just kind of like their
(30:58):
eyes light up and I go.
I'm not being a jerk, I'm not.
You know, I'm not going to stoplistening to you, I'm not going
to like walk away, but it'smore for when you talk to other
clinicians in the emergencydepartment.
We don't have a lot of time, soyou need to be very succinct and
to the point, not to say Idon't want all the information,
(31:19):
because as you're talking,someone's going to go.
Well, do they have a history ofthis?
And as a student you're goingto have to know that Right.
So really, in the beginning Iwork with them to kind of build
their you know theirpresentation, so they they're
not babbling and because youknow we've all had those
preceptors that you're just likecould you just be nice to me,
man?
You know like, can you give mea break?
(31:43):
Like I'm trying really hard.
So I try and set them up.
I'm like listen.
I may seem intense, but I'mreally laid back.
I don't want you to.
I want you to have a goodexperience overall.
So I really try and build theirfirst couple of times with me,
to help them with otherclinicians.
Ashley Love (32:02):
Well, it's important because, as a PA
student and also as a medicalstudent and, I would imagine, as
a student of the other areas ofhealthcare, every location that
you go, depending on how manyrotations you do let's say for
me it was 12 rotations in oneyear it's a sampling of medicine
, is really what it is andyou're trying to learn as much
as you do.
Let's say for me it was 12rotations in one year.
It's a sampling of medicine, isreally what it is and you're
trying to learn as much as youcan.
But, like you said, it's acompletely different beast.
(32:23):
Er from IM, from oncology, frompediatrics, they're all very
different and it is your job asa good preceptor, which you are
it is your job to teach them theculture of that aspect of
medicine you know, and and howthey communicate.
Like in dermatology, we have ourown language.
(32:45):
I mean, we speak differentlybecause we're describing things
all day in the way that I amdescribing something I need you
to know in three words what itis you know.
So, so, and so students willcome in and, like you, say kind
of babble, which to them itdoesn't sound like babbling,
they're just.
They're giving me threeparagraphs to describe something
and I need three words.
So you know, it's our job as agood preceptor to to teach that
(33:09):
culture, to teach thatcommunication and it's a it's
different.
I would sound like a crazyperson if I tried to present an
ED patient to you right now.
I mean, you'd probably be likeAshley, stop talking.
Ryan Foley (33:20):
Yeah, I mean same.
If I got a dermatology.
I'm like, oh man, I don't knowif this is a macular or papular,
Exactly.
Ashley Love (33:27):
Exactly so.
No, I think it is.
I think it's so fun, and Ithink it is.
It's not even tough love, it'snot even tough love, it's just
love.
You know, the fact that you'retaking the time to explain that
to students and actuallyteaching them the language and
teaching them the culture.
The only purpose of doing thatis to set them up for success.
You know, I think it's great.
Ryan Foley (33:49):
And even to the point you know they'll do an
abdominal exam.
And if they're first, ifthey're in their first like one
or two or three rotations, I'llgo in and be like, show me how
you're doing your domo exam andbe like, oh no, you're not
putting enough pressure, and ina good way, you know.
And be like I want you to seehow deep you go.
I want, and that's the, that'sjust how I do it, cause if a lot
(34:12):
of the preceptors will just belike, all right, go in the room,
come back, you don't know whatyou're doing.
Ashley Love (34:15):
No, no, no no.
Ryan Foley (34:17):
And it's a very intimate.
We're in a very intimateprofession and if you've never
been, you know fortunately, asRN I was used to being in other
people's spaces, right, and as anew provider that that's very
intimidating to.
Even with your stethoscopeyou're less than two feet from
someone.
That that's a really, you know,intimate space to be in.
Ashley Love (34:39):
No, it's wonderful.
Thank you for taking students.
Thank you so much forprecepting them.
It is truly a gift to tomedicine to share our knowledge.
I'm sure you enjoy it and thestudents will learn so much
better if they have a supportive, knowledgeable preceptor like
you.
So thank you for doing that.
That's incredible, ryan.
Before we wrap up, what is theone?
(35:01):
Just the pearl of advice thatyou give to your PA students
that come through?
Just something that, if theyhave learned nothing else on
their rotation with you, theyneed to learn this one thing.
Ryan Foley (35:16):
Oh geez, that's a tough question.
We have all this diagnosticsand all these imaging and all
this stuff and even asking, likethe patient, what do you think
is wrong.
It will give you so muchinsight and really listening to
their story, you know, and in atime like, you'll be able to
(35:36):
tease out follow-up questions,but really just listening to the
patient, I think that's thebiggest takeaway.
It transcends so many thingsbecause it's going to build
trust with the patient.
When you're listening to themand they felt listened to,
they're going to trust you more.
Ashley Love (35:49):
Right, right.
Patients want to be heard andthey do want to be heard
accurately.
And it seems like such anelementary thing to listen and
say, but it doesn't happen allthe time.
Ryan Foley (36:04):
You know what?
And the follow-up I'll say isask, if you don't know, I work
with a lot of great, great otherproviders, other APPs and
doctors, and just there's timesthat I just go up and go, hey,
you know, I'm kind of lost or Ithink this is where I'm at and
and it's better to ask aquestion and not know.
Then then then really like notdo right by the patient.
Ashley Love (36:27):
Absolutely no.
I think that's great, ryan.
Those are really great piecesof advice, and not just for gosh
, I mean, those are pieces oflife advice right, not just for
medicine, but generally speaking, ryan, thank Not just for
medicine, but generally speaking.
Ryan, thank you so much fortaking the time and speaking
with us on shadow me next, ofcourse, as I expected.
I still think that being an RNand then becoming a PA is the
(36:49):
right way to go in medicine andI'm glad.
I'm glad that you went back,took those remedial classes
powered through.
It's just an incredible story.
Thank you so much for sharingit.
Ryan Foley (36:58):
Oh, you're very welcome.
Thanks for having me and it wasgreat to you know, great to
share with everyone and ifanyone's ever has any questions
or anything, feel free to reachout because I'm always happy to
especially speak about thenon-traditional roles or
fabulous.
Yeah.
Ashley Love (37:13):
Great.
Thank you so very much forlistening to this episode of
shadow me next.
If you liked this episode or ifyou think it could be useful
for a friend, please subscribeand invite them to join us next
Monday, as always.
If you have any questions, letme know on Facebook or Instagram
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