How A Critical Care PA Learns To Think And Speak Under Pressure | Jordan Kestler, PA-C

Not knowing is not the problem. Hiding it is.

Jordan Kessler works as a critical care PA in a neuro ICU, where the alarms are loud, the decisions are fast, and uncertainty is constant. We talk about the skill nobody grades you on in PA school or pre-med tracks: how to communicate clearly when you are not sure yet. That single habit shapes patient safety, team trust, and how quickly you grow from “new grad” to steady clinician.

We also take a look at the real ICU ecosystem, including the clinicians people forget to mention, and how Jordan’s early career in trauma shifted into intensive care during COVID. From pressors and procedures to three-hour rounds, we break down what an ICU day actually looks like and why the best teams rely on repeatable frameworks like a strong one-liner and SBAR style communication. Jordan shares why mentorship can be excellent in critical care and still feel inconsistent day to day, plus how she is building practical tools through ICU Clinician’s Compass to close the gap between knowing the medicine and fitting into ICU culture with confidence.

If you are a pre-health student, PA student, or new clinician considering critical care, we also talk through what post-graduate critical care fellowships typically include and who they can help most. Listen, share this with a friend who is stepping into a new clinical role, and then subscribe, leave a review, and tell us: what do you say when you do not know yet?

Connect with the guest: LinkedIn | Website

Transcript

Ashley Love 0:01

What if the thing holding you back in medicine isn't what you don't know, but how you show up when you don't know? Today I'm talking with Jordan Kessler, a critical care PA working in the ICU where decisions happen fast and uncertainty is constant. If you're a pre-health student, you've probably been told to focus on your grades, your hours, your resume. And you're doing all of that, but it still feels like you're not fully prepared. Because no one is teaching you how to think, communicate, and exist in high-stakes clinical spaces. And if you don't learn that early, it follows you. In this episode, we start to unpack what actually separates confident clinicians from overwhelmed ones. And it's probably not what you think. Welcome to Shadow Me Next, a podcast where I take you into and behind the scenes of the medical world to provide you with a deeper understanding of the human side of medicine. I'm Ashley, a physician assistant, medical editor, clinical preceptor, and the creator of Shadow Me Next. I invite you to join me as we take a conversational and personal look into the lives and minds of leaders in medicine. This is Shadow Me Next with Jordan Kessler. Jordan, thank you so much for joining us on Shadow Me Next today. You work in critical care, and I honestly think that you guys are just the coolest parts of medicine. The amount of things that you manage on a day-to-day would blow anybody's mind. So I cannot wait to dive into that with you. Awesome. Yeah, thanks so much for having me. Can't wait to talk about it with everybody.

Choosing The PA Path Early

Ashley Love 1:36

I'd love to start when you um, let's go back a little bit. When you were on your pre-med, pre-PA, pre what do I want to be journey? How did you decide for sure that you wanted to go to PA school?

Jordan Kestler 1:50

So my journey to PA school might not be quite the same as everybody else's because I was pretty set on PA from the start. Right. I didn't have a lot of uh, do I want to go to PA school? Do I want to go to med school? Do I want to go nursing? Um, I had exposure to uh PA when I was pretty young. I broke my leg, I had a PA to take care of me, my ortho PA, and I was like, this is so cool. That's what I want to do. And so I kind of had a little bit of a one-track mind after that. Of course, you know, I did my shadowing, I went and uh did pediatric plastic surgery for shadowing, which was super cool. Um and so once I did some of that, I was like, okay, I'm sold. You know, I love that PA school gives me the opportunity to continue to grow, evolve throughout my whole career, you know, not just in your career, but with your life. Um so, you know, once I decided that, it kind of was like even as I was going into college, I'm like, these are the prerequisites I need to line up to get into PA school. And that was pretty much my focus always.

Ashley Love 3:02

It's nice that you didn't have to take a bunch of shifts and a bunch of roundabouts because I think that is a lot of people's stories, right? Um, but there are so many people, especially nowadays, who know about the PA profession and have been treated by a physician assistant and they think this is exactly what I want to do. And and very similar to you, they have everything mapped out very, very well. Jordan, tell me, was there anything looking back, and you've been a practicing PA for six years now? Yep. Amazing. Is there anything looking back before PA school that you would have done differently, or maybe you wish you had done also?

Jordan Kestler 3:39

I do think, you know, looking into it, people should explore other opportunities. I say that to my mentees now. You know, I'm like, you want to know why you want to be a PA versus one of these other things. There are so many different options. They're all part of the big team, they all have important roles. They all have a little bit of a different role. You know, you want to make sure that what you're getting into is going to work for you long term. So typically, I know I'd not recommend just having a one-track mind. I think you should kind of expand a little bit. Uh, if nothing else, to be able to explain in your PA school interviews, this is why I want this specifically, because it is so common to look at all of the different, you know, available options in healthcare.

Ashley Love 4:23

Thank you so much for saying that because I feel the exact same way. I very much knew I wanted to be a PA, went to PA school, got here, and was just blown away by the amount of healthcare professionals working in medicine and what they do and their different roles. And then, of course, fast forward 10 years and on this podcast, I'm still learning so much every single day. And it is just, it's so wonderful. But I hear you, pre-health student, who's screaming at us through their computer or through their headphones saying, y'all, I can't find shadowing hours. I can't find shadowing opportunities. It is so hard for clinicians to take me on. Number one, I can't even get in touch with them. Um, and we hear you. And that's exactly why we have established Shadow Me Next and other platforms like this, so that you can at least get an idea. Do I understand where they're coming from? Do I want to do what they're doing? Do I like the way they think about problems? You know, it's it's such a unique look into medicine. Um, and it doesn't replace shadowing. I'm sure you would agree with that. In-person shadowing is the things you get to see, the way the clinician interacts with the patients, those things are irreplaceable. But platforms like Shadow Me Next at least give you a taste, right? And um, and I just a taste can definitely shift the trajectory. I mean, do you guys work with speech language pathologists and critical care? Because oh my gosh, I think speech language pathologists are also so stinking cool.

Jordan Kestler 5:53

We do. Uh I'm in a neuro ICU, so oh, for sure then. Patients are TBI patients.

Ashley Love 6:00

Pretty much everybody gets to see speech. Amazing.

The ICU Team You Do Not See

Ashley Love 6:03

So before we dive into a day in your life, I would love to talk about the team actually. Let's talk about this. Let's talk about the different members of healthcare that you work with. And obviously, we know we know the primary ones. I'm sure there are MDs and DOs on your floor. What are other people that you're interacting, interacting with on a daily basis? And maybe mention some of the people that we might not initially be thinking about.

Jordan Kestler 6:26

There are so many team members, and this is like a revolving door of people coming through the ICU. And so, you know, the main team, of course, that I work with and you get to spend a lot of time with is going to be my attending physician, uh the other critical care PAs, NPs, the nurses. Most of us are on the unit pretty much all the time. But you have tons of people, you know, cycling in and out. You have, you know, neurosurgery PAs, you have all the therapies, physical therapy, occupational therapy, speech therapy. You have people coming up and down from the OR, our patient transporters are so important for getting all of our patients to their scans. You know, our texts, if we're lucky enough to have one on the unit with us, are so helpful in getting those things done. We have unit clerks who are helping to coordinate visitors coming in and out of the unit, taking phone calls, directing them to wherever they need to go. Um, and so that even what I just listed is a small number of people who are making everything work in the ICU. And there's just constantly people coming in and out, and all of them are important to getting things done for the patients.

Ashley Love 7:43

Yeah, I'd imagine.

From Trauma To ICU In COVID

Ashley Love 7:44

When you first graduated PA school, did you go directly into ICU critical care medicine? I did not. So tell us about that.

Jordan Kestler 7:54

I uh I had done a neurosurgery and trauma rotation as my last rotation of PA school, and I loved it. It was near home where I wanted to be. Um, and they were actually creating a new trauma PA role as I was graduating. Wow. So I was able to interview for that and step into that role as soon as I graduated, which was really cool. It was like a continuation with all the same people. I knew the environment, I kind of knew how things worked. So being able to build on that was so cool. Um, but I started my career in November of 2019. So bad timing shortly after that, COVID started. Um, for some of my training for trauma surgery, I'd gone and spent a couple of weeks in the ICU. Uh, you know, trauma patients go to the ICU. There are procedures that need to be done in the trauma base. So I went and did a little bit of training with them. Not even a month later, you know, the hospital starts talking about redeploying people. You know, we need more people who are going to be working in the ICU, we need more people who are gonna be, you know, working in the ER. And I had just been in the ICU, so it was natural for me to go up there. I knew everybody already. So I moved up to the ICU. Um, I was sort of there full time for, I guess, probably six to nine months. Um, and then I was bouncing back and forth between trauma and ICU. Probably for like the next year at one point, I didn't end up making the switch primarily to critical care because I just loved the team environment and constantly being around everybody. Um yeah, so COVID really actually changed the trajectory of my career, I would say, in a pretty positive way.

Feeling Overwhelmed And Catching Up

Ashley Love 9:42

How overwhelmed were you? Because I know PA school and I know that I was so prepared coming out of PA school. And I also had an ICU rotation last night. I just remember being on the ICU going, This is a this is the wild, wild west, man. I mean, did you have moments when you first started where you yes, where you felt very prepared, but also did you have moments where you thought, I am in way over my head? Oh, for sure.

Jordan Kestler 10:10

I didn't even I didn't even do an ICU rotation in school. I had just had that couple weeks there, you know, a month before. But I was really lucky. It was a small group. I was in more of a community hospital. I had a lot of really experienced physicians there with me, a lot of really experienced ICU nurses. And so I had a lot of support. Um, you know, they are really what made me want to work in critical care. They helped me so much. Uh, you know, that being said, of course, there are still overwhelming pieces. You know, I'm talking about pressers, and I'm like, I've never heard of norepinephrine before. I don't know how you know the dosing works for that. I don't know how to talk about these things, you know, all of that, there's always going to be some degree of being overwhelmed, especially in the ICU, because we just don't cover or really even touch on a lot of the things that you're going to do there. And it makes sense because we cover so much in PA school anyway, but there's a big learning curve on the job.

Ashley Love 11:22

There's a couple of ways that I want to go with this. And um, I think the first direction I want to take is going to be talking about mentorship. And then the second direction I want to take is going to be talking about continuing education. So starting with mentorship, something that has come up really, really frequently, especially in my conversations with PAs, um, and actually with MDs as well and DOs is the fact that as PAs, we're expected to have a fantastic team surrounding us, especially straight out of school. Like you just said, you didn't have an ICU rotation. You had you had very little training comparatively on ICU, and yet you're expected to go into the ICU. The reason we can do that is because we are trained as a generalist, but then we also have mentorship from from our MDs, our DOs, um, our our lead PAs, lead MPs there on the floor. Has critical care preserved that mentorship? Because I think there are areas of medicine where a PA shows up day one and there is no supervising anything, and you are just meant to float and figure it out. Has the ICU really been able to maintain that mentorship, especially for new PA grads?

Jordan Kestler 12:38

I would say yes and no. Um I think protocol care probably does a better job than a lot of other specialties, I would imagine. Um, you know, there's lots of fellowships out there now. In my hospital, we have three to four months of orientation that you're paired up with a really experienced PA or NP. So the structure is there. I think where it gets challenging is that there are so many things to do now. There are so many moving pieces that even with the structure in place to have that mentorship, I think it's challenging. Schedules are rotating. You may be with somebody different. People, you know, do things differently from their colleagues sometimes. And, you know, somebody telling you this is the way to do it today, you might do it that way tomorrow, and you're with somebody else. And they're like, oh no, this is the way I do it. Uh flavor, flavor of the day. Yeah, there's lots of meetings to go to, there's lots of administrative tasks that we have now. So I think the structure stays in place for critical care, but having the direct attention and being able to give your focus specifically to your orientee can be challenging. And I think that mentorship has maybe eroded a little bit in that way. Um, just because we're not always able to give the attention and support that I think that new practitioners or even people who are just new to the ICU really need.

Culture And Communication In Critical Care

Ashley Love 14:14

Which is an accidental and perfect segue into mentioning something that you have created after seeing this gap. Describe it for us a little bit, and then we'll go into what you mentioned, which is fellowship, continue education, like we talked about. So interesting.

Jordan Kestler 14:31

Yeah, for sure. So, as I mentioned before, you know, walking into the ICU is a new PA, new NP, resident, really any sort of provider. There's so much medicine that you haven't covered in school that so much of the focus is on learning that medicine, and rightfully so. You know, that needs to be something that we all know to be able to function in the ICU. But I think that there's a gap between learning the medicine, being able to function theoretically, you know, from a practicing perspective, and the realities of the culture communicating in the ICU, how to fit in in the ICU and how to do it confidently. So I'm starting to create some resources essentially to address a little bit of that gap. It's hard when you walk into the ICU and you already are feeling insecure about not knowing so much of the medicine, to then not know how to communicate that, to not know how to say, I don't know, you know, without feeling embarrassed or insecure. These are things that I think that we can improve significantly, not just to help the team around you, but to help, you know, the clinician themselves uh to identify some of those areas that they need to learn more and be able to say, this is what I know, this is what I can tell you so far, this is where I'm getting stuck.

Quality Question

Ashley Love 16:08

And this is a great time to pause for quality questions. This is a segment on the show where we talk about potential interview questions that you might hear on your own pre-health interview. So, what Jordan Kessler is talking about here is one of the most important questions that you could be asked. Tell me about a time when you did not know the answer in a high stakes or professional setting. How did you communicate that uncertainty? And what did you learn about yourself in that moment? Medicine is full of uncertainty. You are not expected to know everything, but you are expected to recognize when you don't know, communicate it clearly, and keep moving forward safely. Students who struggle are often the ones who feel like they need to hide that uncertainty. Strong clinicians do the opposite. They name it, they frame it, and they keep thinking. If you can show that in your answer, you're showing your interviewer how you will show up in real patient care. And it doesn't just stop at quality questions. There are more resources for you as a prehealth student on ShadowMenext.com to include our newly released application readiness course. So head on over to courses.shadowmext.com and check it out.

Jordan Kestler 17:30

Um, you know, so being able to communicate when you don't know, being able to just communicate in ways that share language with everybody else in the ICU who has been there for a long time. You know, we all learn about S-BAR and whatnot. What does that actually consist of? You know, and learning to communicate confidently in that same language helps to reduce the burden for the clinician themselves and everybody else around them. So if we're not having to spend a lot of time sifting through what are you actually getting at, what are you trying to say here, it gives us the ability to focus in on what we really need without spending too much time trying to even get to that point.

Ashley Love 18:16

It's incredible. It's such a great idea and it seems so obvious. And yet, like you mentioned, a lot of times we dive so fast into medicine and norepi and pressers and all of that craziness that we we kind of just assume that you're gonna get all the other stuff, and you will. You did, you do, but it's um it's a journey for a painful journey.

Jordan Kestler 18:38

Yeah, there's comfort and you know, stepping into rounds for the first few months, and there's tons of people around and they're listening to you talk, and you're like stumbling over your words, saying, I don't really know how to do this. I watched somebody do it yesterday, so I'll try and piece it together today, but it's uncomfortable. And I think that you know we can eliminate some of that discomfort.

Ashley Love 19:00

Absolutely. I will link your site in the show notes below for the ICU Clinician's Compass, and you can get the ICU one-liner blueprint, is available right now. But Jordan, definitely keep us updated as you continue to release this absolutely incredible resource. And you know, I would really encourage students to check this out. Even if you don't know if ICU is for you, check out what Jordan has created because you know it's gonna give you a really intimate look at her life in ICU medicine right now and critical care medicine. So it's for everybody. Um, it I honestly I'm gonna take a look at it just to relive the past and um maybe uh soften some of the PTSD I have from being on the ICU. Um, so this is a great introduction to you know ICU medicine and critical care. Tell us about the fellowships that exist. So um these would be post PA school fellowships for people who are interested in critical care medicine.

Jordan Kestler 20:00

Yeah. And so there are a lot more of them out there now. I know my hospital has developed one over the last couple of years, and it looks different slightly in different places. Um, but my exposure to the one at my hospital, it's one year long, which I think is pretty typical of all of the critical care fellowships. And it's essentially an extension of your rotations with more responsibility and a lot of again, that mentorship and oversight. Um, and so you know, our fellows get to spend extended periods of time on one single unit to really learn the medicine specific to the neuro ICU, and then learn the medicine specific to the cardiovascular ICU, learn the medicine specific to the trauma ICU. Uh, and they get to rotate around and get all of that support. They try to stick with the same preceptors as often as they can, and then they add in academic uh lectures on top of that. So I think that's helpful too to you know have that supplemental reinforcement in addition to practicing from day to day. You still get some of that more formal instruction. Um so far, it seems like everybody has enjoyed the experience of doing the fellowship. You work more hours than you may work going straight into practice. But I think in something like critical care, that's helpful. Um, you know, if you go days without seeing something, you start to lose some of it a little bit. So having that reinforcement, seeing the same patients day after day, uh, I think can really help people to feel more comfortable with the medicine in the ICU.

Ashley Love 21:47

Thanks for describing that. Because for for so long, I expected these fellowships to just be something that you would already be doing anyway, right? I mean, you're already showing up to work anyway, but you really highlighted some of the differences between just, you know, walking into the ICU and Working as a PA versus accepting one of these fellowships. And it really is more intensive training so that you can be a more confident clinician a little bit faster.

A Real Neuro ICU Workday

Ashley Love 22:12

Um Jordan, tell us about a day on your life in the ICU. So what kind of procedures are you doing? Are you doing procedures all day long? Um are you sitting at a computer charting all day long? What does your life look like? Yeah.

Jordan Kestler 22:27

So I'll preface this by saying in I've worked in the ICU in two different hospitals, and it may look a little different from place to place. It sort of depends. Are you in a big academic center or are you in a smaller community hospital? I'm in a bigger hospital right now. And so the typical day, you're gonna get there just before 7 a.m. You'll get if it's a day shift, you'll get sign out from the night shift, get sort of that one-liner that I was telling you about on every patient to give you an overview of why they're here, what's going on, bringing kind of up to speed on where the patient is right now, any sort of overnight events, anything to pay attention to throughout the day. Um you'll get that on the whole unit. And then there are multiple providers, so you kind of split up who's gonna have which patients for the day. You'll do all of your chart review, looking through vitals, uh, looking at lab results, looking at any imaging, notes from yesterday. Um, you of course then will go see your patients because none of it means anything if you don't put it into context by seeing the patient. Uh, and then by 9 a.m., we'll usually start our rounds with the ICU team. And so that's gonna be, you know, all of the APPs, the physician, the nurses, we're gonna go around from room to room and talk more in depth about each patient. Our units are like 10 to 14 patients, usually takes about three to four hours to round. Oh my goodness. Yep. So after you finish that, then you're going to start actually doing all the things you talked about on rounds. So, you know, calling consultants, following up on their recommendations, writing your notes, following up on whatever labs you've been trending throughout the day, because in the ICU you probably are trending labs on people. So you're gonna have more labs to look at and address throughout the day. Uh, if you have any procedures to do, you're gonna be doing those procedures. Because I'm in a bigger academic hospital, uh, we actually continue to have academic lectures for CME sort of built in throughout the week. So you'll probably go to a meeting like that. Uh, we'll do neuroradiology rounds where the radiologist will review some of the imaging of our patients so you can learn more about that. You're gonna be talking to families, uh, writing your notes if I didn't say that already. We have a little sign out system that you're gonna be updating also to make sure that you know the night shift can take a look at what's been going on, what you've done throughout the day. Um and so that's usually gonna be the core of your day. We're in the ICU, so it doesn't always look like that. Of course not. You know, you may get the admission that rolls in at 7, 10 a.m. Who is on two pressers and doesn't have any lines and is not yet intubated. And so that'll throw off your whole day. You know, you need to obviously address the critical life-threatening things first immediately, uh, and then build the rest in kind of around that. But typically it's you know, a lot of the same things that anybody inpatient would be doing um procedures kind of ebb and flow. Uh I'll do a lot of central lines, arterial lines, but I may not even be doing one of those every shift. Just all depends on you know what the patient needs. We, of course, don't want to be doing things if they don't truly need them. So the those sort of are not necessarily as consistent as all of these other things that we're doing throughout the day.

Finding Calm Inside ICU Chaos

Ashley Love 26:14

When I think about the ICU, I think of a really high adrenaline, a really constant high adrenaline environment. And from what it sounds like, it seems very rhythmic in the ICU. And it seems like your day's kind of time blocked out, right? And it's just such an interesting difference between like clinic work, for example, where it's a new patient every 20 minutes, you kind of reset every 20 minutes, where really it's your whole day, is it's just one day kind of macro view. And then what you're doing throughout that day is kind of time blocked. I it's a really interesting pattern. Have you found that it is like super high adrenaline, crazy crazy all the time? Or are there moments of calm, or is it more calm?

Jordan Kestler 27:02

I think it can be an overstimulating environment. There's any alarms going off, like I, you know, we talked about earlier, people walking in and out of the unit. I think grounding it in some of that time blocking, uh, some of those frameworks, or what help you survive that and make sure that you know things are going as they need to. So when that patient comes rolling in at 7:30 and you need to do all of these things, you know, well, this is where I was in my day, and this is what I normally do. So I haven't forgotten what else needs to be done because I just have this structure of I do X, Y, and Z. Uh, and it helps you stay on track. So I think the calmness comes from building these structures into our day. Personally, I feel that I can handle the chaos more when I'm working from you know, a good baseline of I know that this is, you know, what we normally do. So when you throw in a curveball, it's okay. Because my whole day is not going to be chaos. I can build it in.

Ashley Love 28:14

That makes a lot of sense. Jordan, absolutely, like I said, you I critical care PAs, MDs, DOs, NPs, you guys are really just so cool. And um, we're so appreciative of what you do. And you usually are seeing people at their absolute worst and hoping to never see them again. So um, thank you. Thank you for the job you do. Thank you for sharing it with us today, and thank you for creating this ICU one-liner blueprint. Again, I'll link it in the show notes below. Definitely check it out, guys, um, and see if the ICU life might be for you. Jordan, thank you so much. Thank you so very much for listening to this episode of Shadow Me Next. If you liked this episode or if you think it could be useful for a friend, please subscribe and invite them to join us next Monday. As always, if you have any questions, let me know on Facebook or Instagram. Access you want, stories you need, you're always invited to Shadow Me Next. Please keep in mind that the content of this podcast is intended for informational and entertainment purposes only, and should not be considered as professional medical advice. The views and opinions expressed in this podcast are those of the host and guests, and do not necessarily reflect the official policy or position of any other agency, organization, employer, or company.