Dysfunctional Collaborations

mattsmom81 · Jan 8, 2004

Medical assistants I suspect were created due to doctor's displeasure with nurses as they moved into their own realm/profession, ceasing to be the extension/handmaiden they wished.

Physician's assistants can be seen as a similar response to the NP role...how dare nurses try to compete/move beyond their role we (MD's)want them to be in?? We'll create 'our own' practitioner!

I see MD's as a largely egotistical profession with a lot of lobbying power trying to control/manipulate the situation.

I've been nurse for many years and watched how doctors operate as a group, so this is kinda business as usual, IMHO.

hbscott · Jan 8, 2004

Cognitive theory provides the framework for the Manual for Classification of Ego Development. For further reference see http://www.psychodiagnostics.com/Egomain.htm or do a Google Search on "Ego Development". We have all heard that some Physicians have huge ego issues that may or may not be a byproduct of the medical education and training regiment. But more to the point...

Is "EGO" (Doctor's are better than nurses) the root of Nursing Vs Medicine Practice Issues or is it "GREED" (that's my turf and you better not touch it because you are taking my money) that is the real issue? Why isn't nursing more effective in "marketing" our advanced practice roles?

-HBS

:confused:

Dave ARNP · Jan 9, 2004

There is a push right now to get NP's out in the open. When was the last time you looked in the phone book and found a listing of NP's? To my knowledge, I am the ONE OF ONLY TWO NP's in my STATE that are listed.

What about our names on the door, or the sign out front? That IS getting better. My best friend just started in a practice and she got those w/o having to ask.

What about when we write a script, or call in a medication? To this DAY there are NP's who's name's don't appear on the bottle as the perscriber. I had a patient argue with the pharmacist because the RPH listed the doc I work with on the bottle (simple legend drug). She infromed him that she had NEVER seen doc and had no plans to ever. So why should her bottle say that HE was the one giving her medication? -I can CERTAINLY see her point.

What about admitting a patient. How many FNP's outside of major cities have admitting privilages ( I do, but I have a major attitude when someone tells me I can't do something I can )

Not having hospital privilages means we are forced to take a sick patient and admit them into a facility only to receive their care from a DOCTOR, and one who (very often) has never met them, and knows nothing about them. (Thus, all my patients meet Doc, and all his meet me. Meeting someone five minutes before they code... well, they ain't a good way to start things off).

I really think that until we correct things like this, any marketing of NP's is going to be wasted. Yes, patients need to know who we are, but what good will it do if NO ONE ELSE recognizes us?

Dave

kc ccurn · Jan 9, 2004

Well said Dave!

hbscott · Jan 9, 2004

Originally posted by MD Terminator
I really think that until we correct things like this, any marketing of NP's is going to be wasted. Yes, patients need to know who we are, but what good will it do if NO ONE ELSE recognizes us? Dave

Well if you accept the idea that effective marketing educates consumers then that might make it easier to gather support when lobbying legislators for greater autonomy as noted above. A great idea with little public support doesn't go very far.

-HBS

Agnus · Jan 12, 2004

Originally posted by hbscott
Why isn't nursing more effective in "marketing" our advanced practice roles?

Please, give your own question some thought. Who is the mysterious marketing person you call "nursing" who you want to do your marketing?

You are nursing.

People often thow around a simular word "they". They want this, or they say this, or they do this, etc. When pinned down the individual speaking often cannot tell you who this mysterious "they" are. The person then realizes how invalid these statements are, as there is no "they."

I am a RN. I am not a NP. However, I am also a business person.

Marketing is something each business does for itself. If You are the only one in the phone book then perhaps there are no other NPs who are in an individual private practice.

Being a nurse does not endow you with business skills or know how. Actually being a nurse you probably have fewer business skills and know how than anyone else.

If you are in business for your self. If you wish to market and sell your services and promote your practice to the public then you need to do it.

NO ONE automatically does this for ANY type of business automatically. What I mean is I have a retail car business. The DMV or who ever you might imagine is the "auto industry" does not promotes my business for me. I have to do it. Even if I had a franchise where I sold say Cheveys, I must still promote my particular dealership. Chevy promotes their cars but I am responsible for promoting my dealership.

So you might say that the industry promotes car sales. Yes, but lets look at who that industry is.

That indusry is the individual manufactures that promote thier cars and the individual dealerships that promote themselves.

It might seem like there is a "they" in this case because car sales are promoted so well and widely. The truth is it only seems this way because of the volume of cars and dealers that are out there doing individual promoting.

NPs particularly NPs in an independent private practice are not particularly common. So you do not see the huge volume of promotion that you see by car dealerships or even by private practice MDs

NPs are not business oriented, (think sales and marketing oriented)

The reality is when you are in business and you want to be promoted you need to be able to SELL that is a dirty word to many people outside of business. Selling is NOT dirty. Learn this skill, or pay big buck for someone to do it for you.

It is really easier to sell your services yourself because no one knows better about what you do than you.

If I choose not to promote my business myself and or choose not to sell my cars myself then I must hire someone to do it for me. There is no mysterious "they" who will automaticly step in and do it for me.

No one advertises for businesess without the business paying for it.

True some business get together (say a car mall, or in my case a group of car related business or a group of MDs) and pool thier marketing efforts. Often in the form of one stop shopping promotions.

I see in my area some NPs doing just that with Medical Practioners and others.

When you are in business you promote, you market, and you sell, OR you HIRE (read pay) someone to do it for you.

The BON regulates nursing, the ANA is our professional organization. The DMV regulates my business there is no ANA There are a couple of comercial trade organizations that cost big bucks for a dealship to join that might be an ANA equivalent. The DMV does not promote us nor does the BON promote us. That is not thier role.

The ANA does promote as do the trade organizations of any industry. However, as in ALL industries the promotion by the trade organization is extreemly limited and much of it is within the industry it self.

If you want your type of practice promoted you must do it. That is the the way of the world. There is no "they" that will do it for you.

NPs are a raity. NPs who truly are in business independently and not employees of another business are ever rarer.

Every new emerging busness industry has gone though what you are experienceing. You are the pioneer in promoting NP as an opiton for the public. Lets face it many NPs work in clinics or under the business license (I did not say medical license) of an MD. The clinic promotes the services of a clinic. The MD promotes his practice.

If you find yourself in one of these situations and want the clinic, Hospital or MD to promote the feature that there is also a NP then you need talke to them. If they feel this added feature might be a drawing card for patients then they will do it.

Keep in mind though if you are practicing this way rather than as an independent business then your services are only one of many features of that over all clinic, hospital or medical office.

Also keep in mind if your clinic or what ever is going to promote your practice will lead with the benefits of the clinic and follow with the features. For a MD or clinic to advertise the benefits of a NP is not necessairly in the best interest of that type of entity. So they will likely restrict it to the feature.

You know the benefits of a NP. The feature is "the clinic offers the services of a a NP"

Agnus · Jan 12, 2004

Originally posted by MD Terminator
[b any marketing of NP's is going to be wasted. Yes, patients need to know who we are, but what good will it do if NO ONE ELSE recognizes us?
Dave [/b]

I diagree. The market is consumer driven. However to simply tell them who you are is not enough. No one cares who you are when it come to purchasing health care or anything else.

Consumers want to know WIFM. What is in it for me. In other words why should I go to a NP when I can go to an MD. What are the benefits to me of using a NP over an MD?

Number one rule of business LEAD with the benefits, not the feature. The feature is you are a NP.

But frankly no one cares UNLESS they understand the benefits first.

As for your remark about phone listings. You do you think is the "they" that pays for the listing? Some one pays for it. If a clinic contract says it will pay for an individual listing for each MD then they do. However, may clinics that hire MDs do NOT pay for seperate listings.

If it is an independent practice the MD pays. Consider either negotiating for payment of a seperate listing in your contract or pay for the listing yourself like other business people do.

You need to stop thinking in terms of helplessness and start thinking in a business mode.

hbscott · Jan 12, 2004

Originally posted by Agnus
Consumers want to know WIFM. What is in it for me. In other words why should I go to a NP when I can go to an MD. What are the benefits to me of using a NP over an MD?

True but I was looking more at the roles of Nurse Practitioner Vs Physician's Assistant and CRNA Vs AA. To compare a Nurse to a Physician is "apples and oranges." Both can be good for your health.

Agnus · Jan 12, 2004

Originally posted by hbscott
True but I was looking more at the roles of Nurse Practitioner Vs Physician's Assistant and CRNA Vs AA. To compare a Nurse to a Physician is "apples and oranges." Both can be good for your health.

Let me play devils advocate for you a little here. ( just trying to stir the thought processes in an effective marketing direction).

So what is so good about a NP that I should see one as well as a MD or PA? Or why should I see a CRNA as well as the AA?

I realize these may not be simple to answer but as a consumer I need to know indorder to buy.

Telling me you are a NP is not enough. Telling me what you do is not enough. I absolutely will not pruchase anything and neither will you without knowing or believing there is a benefit in it for me.

Quite honestly you have some selling to do because the consumer knows or at least beleives they know the benefits of an MD and they don't have a clue why they should see a NP too or instead. Why not put all my care in the hands of one persons and the person I preceive to be the best expert the MD.

Now as for promoting the PA really the PA practices under the MD's medical license and cannot practice independently as a NP can.
So the only reason to promote a PA is to benefit the MDs practice. The MD benefits financially by using a PA so he will show his patients that they are not getting a lower quality of care albite a lower level by seeing the PA because the PA is woking under his direction.

You are not under his medical license. You are under your own license. You are not a subspeciality of medicine. It would be like a Chiropractor or physical therapist shareing office space with the MD. They acknowlege each other, colloberate, and refer to one anothr but their practices are seperate.

They may advertise as one stop medical shopping as mentioned earlier. But they are seperate. So are you. Unless you are actually an employee. Then the facility needs to promote you just as it would promote a PT or other professional employee.

As an employee you do not have much power. Neith does the PT. it is not your/nor the PT's business.

hbscott · Jan 12, 2004

Now as for promoting the PA really the PA practices under the MD's medical license and cannot practice independently as a NP can. So the only reason to promote a PA is to benefit the MDs practice. The MD benefits financially by using a PA so he will show his patients that they are not getting a lower quality of care albite a lower level by seeing the PA because the PA is woking under his direction. [/b]

So true. So true. I still however would like to see "nursing" more effective in educating the consumer on our advanced practice roles. The public at large (generally speaking) has in their "mind's eye" an image of nursing that is a bit subservient. Although the public trust for nursing is high (that is a good thing) most in the public still don't see nurses as an independent practitioner. It seems that nursing culture has evolved from the subordinate handmaiden paradigm and perhaps that legacy is what holds nursing back?

-HBS

athomas91 · Jan 13, 2004

i agree w/ the general thoughts posted in that greed and ego have been primary reasons for the AMA to oppose APN practice.. Personal experience has made it very clear to me that there are those who are great at what they do and those that are horrid (both APN and MD's) - so it is not really a question of which "profession" is better but which practioner is better. I feel that CRNA's have a huge benefit in the work that the AANA does - it is a driving force in why they have such a liberal license to practice....and it has alot to do w/ the fact that CRNAs are seen as a "profession" rather than a job or subtitle.

We must not forget there is power in numbers - over 96% of all CRNA's belong to the AANA - which is a huge motivating force in making good things happen....not many other APN associations have such a high number of participants and thus their numbers are not represented well.