Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

5 ways to ease the integration of NPs and PAs

Tracy Cardin, ACNP
Policy
November 10, 2014
Share
Tweet
Share

shutterstock_226224511

I talk a lot with different physicians about integrating NP/PA providers into their practice.  I am frequently astonished by the level of reluctance, resistance and downright animosity from these physicians.  Many times a doctor will have a medical “horror story” with the NP/PA  playing  the  villain.  One bad encounter or event seems to  justify a complete rejection of the many positive attributes and contributions of these NP/PA providers and negates the many studies that reveal comparable and safe care and outcomes.  Besides I have a few horror stories of my own, and guess who the villains are?

I’m always mystified by this.  I practice in a very supportive environment.  This culture extends from the hospital leadership, both medical and nursing, which seems to understand what we do and values the care we provide, to my section leadership, to the consulting services, to the RNs I work with and most of all, to the patients to whom I provide this care.  Rarely if ever do I get an “I need to talk to your attending” type interaction, or get a request to see a physician.

But it hasn’t always been this way.  Our program is very mature, and it is easy to forget the bumps and bruises me, and all of my NP/PA colleagues, have experienced on this road.  And I’ve had other clinical experiences, in other institutions, where I have had to swallow my outrage and anger at being treated like a second class citizen, or as a handmaiden, or worse, as a brainless robot acting completely on someone else’s orders.

But still I wonder:  Why in this day and age does this type of attitude persist?  Again, if you look at our numbers, we are here.  We aren’t going anywhere.  Our impact is only growing.  And it doesn’t sound to me like this is only a territorial issue — despite the persistent positions of the AMA.

Whenever there are issues in a relationship, personal or professional, I’m a firm believer in a two-party system.  Rarely are these problems completely one-sided.  We all have our part to play.  And NP/PAs have a responsibility, a role in some of the long standing difficulties that sometimes exist with our physician colleagues.  Check out this list:

1. Shift worker mentality. Ever since a doctor was toddling around in his doctor diapers he was told and taught over and over that the patient was his or her responsibility, that no one else was responsible.  This persistent culture of responsibility may make it hard for a physician to let go of some control.  But this is totally compounded by NP/PAs who want to come in, see a patient, leave, but not really own the patient. These providers don’t want to be responsible for post-discharge care or decision-making.  They want to get in and get out.  If this is you, you get out.

2. Flabby decision-making. How many times, when faced with a difficult clinical decision, did I  want to immediately reach out to mom or dad and have them make a decision?  It’s easy to be lazy, to avoid using the muscles of critical thinking and let the doctor do all the heavy lifting.  Do not do this!  You have a brain, you are educated, use both of those tools, actually take time to consider the clinical conundrum.  Of course, if after calculated thought a clear course remains foggy, reach out with glee to your attending.  But walk the walk before you talk the talk.

3. The unspoken agreement. This is where the physician complains that the NP/PA doesn’t do what they were hired to do, and the NP/PA states that the physician won’t let them do what they were hired to do. Part of this may be a lack of understanding about the appropriate scope of practice for NP/PA provider.  But often, both sides are perfectly happy with the NP/PA not working within scope of practice.  Change is hard and painful, like giving birth, but when you are finished you have a bouncing, baby, NP/PA practice that will advance the care of patients in a positive way.  Start the conversation and the pitocin!

4. Lack of consistent quality. Easy to say, but not easy to fix. Over and over again I have heard physicians tell me that they like PA/NPs “when they are good,” but that they have seen some bad ones.  Part of this may be related to misunderstanding the needs,  scope of practice and requirements for mentorship of new graduates and novice providers. Part of it also may be lack of quality and consistent programs. Experienced providers need to mentor our newbies and help hospitals and physicians understand the steepness of the learning curve.

5. Professional development. As an NP/PA provider you are a professional, your work is not just a job, it’s a career. Act like it.  Start developing your career which includes asking, or demanding, the things you want and need from your profession/role, developing your skill set and knowledge base in step with your (hopefully) growing responsibilities, connecting and staying active within your professional organization, advocating for other members of your profession, communicating in a direct and powerful way with your physician colleagues.

You are not a passenger in the canoe of your life. Grab an oar.

Tracy Cardin is a nurse practitioner. This article originally appeared in The Hospital Leader.

Image credit: Shutterstock.com

ADVERTISEMENT

Prev

Interviewing people is hard: A medical student keeps trying

November 10, 2014 Kevin 3
…
Next

When the patient treats the doctor

November 10, 2014 Kevin 1
…

Tagged as: Emergency Medicine, Nursing, Primary Care

Post navigation

< Previous Post
Interviewing people is hard: A medical student keeps trying
Next Post >
When the patient treats the doctor

ADVERTISEMENT

More by Tracy Cardin, ACNP

  • Reach out to your colleagues: This can have more impact than you can imagine

    Tracy Cardin, ACNP
  • NP/PA vs. physician: Why is there a productivity gap?

    Tracy Cardin, ACNP
  • The 4 types of low-functioning health care team members

    Tracy Cardin, ACNP

More in Policy

  • Unused IV catheters cost U.S. hospitals billions

    Piyush Pillarisetti
  • Why your health care dashboard isn’t working and how to fix it

    Dave Cummings, RN
  • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

    Robert E. White, Jr. & The Doctors Company
  • How new loan caps could destroy diversity in medical education

    Caleb Andrus-Gazyeva
  • Why transplant equity requires more than access

    Zamra Amjid, DHSc, MHA
  • Ideology, not evidence, fuels the anti-trans agenda

    Andie Riffer, PhD and Shawn E. Parra, LCSW, MSW
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
    • How doctors can think like CEOs [PODCAST]

      The Podcast by KevinMD | Podcast
    • A surgeon’s testimony, probation, and resignation from a professional society

      Stephen M. Cohen, MD, MBA | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN can use worldwide [PODCAST]

      The Podcast by KevinMD | Podcast
    • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

      Yousuf Zafar, MD | Physician
    • Psychiatrist tests ketogenic diet for mental health benefits

      Zane Kaleem, MD | Conditions
    • The hidden rewards of a primary care career

      Jerina Gani, MD, MPH | Physician
    • Why physicians should not be their own financial planner

      Michelle Neiswender, CFP | Finance
    • Why doctors regret specialty choices in their 30s

      Jeremiah J. Whittington, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 19 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
    • How doctors can think like CEOs [PODCAST]

      The Podcast by KevinMD | Podcast
    • A surgeon’s testimony, probation, and resignation from a professional society

      Stephen M. Cohen, MD, MBA | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN can use worldwide [PODCAST]

      The Podcast by KevinMD | Podcast
    • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

      Yousuf Zafar, MD | Physician
    • Psychiatrist tests ketogenic diet for mental health benefits

      Zane Kaleem, MD | Conditions
    • The hidden rewards of a primary care career

      Jerina Gani, MD, MPH | Physician
    • Why physicians should not be their own financial planner

      Michelle Neiswender, CFP | Finance
    • Why doctors regret specialty choices in their 30s

      Jeremiah J. Whittington, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

5 ways to ease the integration of NPs and PAs
19 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...