There are two NPs in my practice, myself and a woman I'll call Zelda. I am a FNP, and have been in practice for 3 years. Zelda is an ANP and has been in practice for 9 years. All of her experience is in internal medicine.
Zelda, by nature, has a somewhat closed mind. This applies to all things, not just the practice of our art/science. She does not consider points of view contrary to her own and in my experience does not change her mind when confronted with new evidence. She is very competent. It happens from time to time, that I have occasion to see a patient of hers if she is out of the office for some reason. Zelda does a number of things I would not do. For instance, she treats all sinus infections with antibiotics. We have discussed this several times, and she feels the current EBP is in error. She knows that she feels better when she takes a z-pack, all of her patients feel better, and that at some point it will turn out that the evidence was "wrong" and the recommendation will reverse itself and everyone will have to admit she was right all along. She feels that when I see her patients, I should do for them what I know she would do. I disagree. They are seeing me, not her. I follow EBP. If they have had symptoms for 2 days and have not tried any conservative measures, yada, yada, yada, they are not getting an antibiotic. This has been a point of contention for a while.
A patient of hers came back from the diabetic educator saying they told her an A1c of 8.0 was OK. She went berserk and was about to call the BC-ADM and tell her what an idiot she was; I let her know that that is the new recommendation for A1c in older adults. She thinks it is ridiculous and announced she will refuse to follow them and isn't sending anymore patients to the educator. This sticking her head in the sand routine is beginning to get frustrating!
We went through this again last week, only over antibiotic prophylaxis for a benign flow murmur before a simple dental cleaning. Under no circumstances was I going to prescribe for that, and it turns out, she always does, regardless of current guidelines. Her opinion "better safe than sorry." The patient was extremely upset that I refused and called her at home, and Zelda called it in for the patient. I am not upset about that, that is Zelda's choice. I think it is the wrong one, but it's on her.
We talked it out later, and Zelda and I are OK. She does feel frustrated that I "don't capitulate to her greater experience in these things." I learn a lot from her. She does have a lot of good tips, and has been a lot of help to me in the last three years, and I am appreciative. But I am more up to date on a lot of things than she is, I read more, study more (I have to, I have a much steeper learning curve!) and investigate more. I have some things I could share with her, but she just is not willing to learn anything new or unlearn anything she learned 10 years ago.
So, if you are a novice NP like me, how do you navigate these types of issues? And if you are a more experienced NP and see it a bit from the other point of view, what advice do you have for me? Or what are your thoughts in general about how colleagues with varying experience and backgrounds learn from one another?
