Help! ideas on getting along with a MD who dislikes NPs

[westcoastgirl]

greetings fellow nurse practitioners!

I am in my first job as an NP and liking it for the most part, I am the only mid-level there except for a locum who occasionally works there.

my mentors are several experienced MDs who have been good teachers to me. It is actually the lone new graduate MD who has been less than professional on several occasions to me as well as others at the clinic.

She has been frustrated by other things at the workplace and so I've just steered clear of her. However recently she told me to my face that if things were up to her to decide I would just be seeing otitis media and URI patients.

I have always stayed professional in spite of whatever she does and I even go out of my way to be nice to her. It's hard not the take the latest comment personally. Now it's affecting the way I feel about going in to work, I feel like I'm a convenient scapegoat for her. The experienced MDs review my charts and have been satisfied with my work so far. Fortunately they are the decision makers about what sort of patients I see.

I don't want to bring this up to the medical director, I'm too new to be making waves and everyone else is a MD anyway. Any advice?

[bsnanat2]

duplicate post

[nomadcrna, DNP, CRNA, NP]

LOL, You still did not answer my question, are you an NP?

Its a shame you have to become personal. That is usually the answer when you really don't have an argument.

Are you even a nurse?

On the mid-level side, if NP give "mid-level" care, why are we judged at the same level of care as physicians?

Why do the major credentialing organizations feel as I do?

I've been doing this a long time. I do provide care at the same level and my treatment of patients is judged at the same level as my physician counterparts. Whether I"m doing anesthesia or family practice or covering an ER in a rural town. If I make a mistake, the courts don't compare my care to other just other NPs, my care is compared to the standard of care, which includes physicians and NP providing that type of care. If I have an anesthesia mishap, I'm compared to the current practice standards, MDA and CRNA. The same goes for when I'm doing inpatient or ER medicine.

So you can take it personally since the facts do not support you.

I see that you are a BSN student. Maybe you should get some experience, become a RN then NP and walk the walk a bit before you open your mouth. At least get your RN license then come back.

[caroladybelle, BSN, RN]

thank you for the replies, I have been reading them and taking them to heart, focusing on doing my job, promising myself I won't let her opinions influence mine because once I did second guess myself by listening to her medical advice on a patient.

For reasons too detailed to list here, I quite like the workplace and co-workers (aside from this unprofessional person) and it is a good opportunity for me. Even my supervisor has observed how I get along great with everybody else in the clinic. I don't see hurrying out to get a new job as a good solution right now.

Lo and behold, this new grad MD has now recently and rather publicly slammed PAs also. :uhoh21::angryfire:uhoh3:

Some young MDs are threatened by midlevels. They have had it drilled into them that y'all have a lesser education, did not have the same grueling residency, nor the high student loans to repay. A quick overview over at SDN forums will show you the issues from some MDs viewpoints.

And you should seek out assistance if you are unfamiliar. MD colleagues do that frequently, for the good of the pt. If this MD is new, she may be unsure and perhaps a bit defensive - so you may want go with one of the more experienced mDs.

I would not push the hostile workplace bit, unless there is an issue that actually interferes with good care or is abusive. There is no better way to get midlevels barred out your business than to start pushing issues like that. Having a certain belief about the place of midlevels does not rise to abuse level and makes you look bad. It also makes the other partners uncomfortable with you, and less likely to support you. It also almost insures that you won't be getting jobs locally, if you do leave.

[traumaRUs, MSN, APRN]

Hey guys - can we can we get back on topic?

Let's help pedsNP figure out some workable solutions.

If you want to discuss the term mid-level - how about another thread?

[traumaRUs, MSN, APRN]

Okay guys - I've started a thread about what to call us:

https://allnurses.com/nurse-practitioners-np/terms-used-describe-566785.html#post5134601

[bsnanat2]

nomadcrna,

i have a great deal of respect for np's and should not have made it personal. a forum like this can allow one to become a bit more aggressive than in person. believe me when i say that i want np's to come out on the winning side in this, but i know your argument will never get it done. i never said np's provide mid-level care, i said np's address illnesses at the mid-level of acuity. there's a big difference there. no, i am not an np. i just graduated with my bsn, but this is a second career for me. in my previous life, my work entailed working as the chairman on the board of a nurse-managed clinic and dealing with physicians. my actual job dealt with working out scope-of-practice issues in another profession in a manner very similiar to what's going on with np's and md's. with that said, i'm not new to this. previous experience tells me that your line of reasoning will not get you what you want.

as far as the original post, you must 'send the mail to the correct address'. deal with the person directly. acknowledge their expertise. tell them you want to clear up any misunderstandings because you would like to feel that you could go to them for a consult if needed. don't lie, but be gracious. if you make the other person feel that they are respected, you've taken the 'fight out of the dog'. if that doesn't work, talk privately with another md and ask them to be present while you speak to the offender (in the same gracious manner). this way you have a witness to your efforts. if all this fails, ignore it or file a formal complaint with hr. best wishes.

[nomadcrna, DNP, CRNA, NP]

Congrats on finishing your program.

As a CRNA and NP, my patients are of all acuities. I provided anesthesia services to patients from ASA1-5 in an independent, usually solo practice. As a NP, I am also practicing independently. When I cover the ER 2 days a week, it is just me and I get all levels of acuity.

I'm not doing anything special. CRNAs practice independently in many states as do NPs. There are a few NPs on this board that practice in an intensivist role. Their patients are most assuredly not mid-level acuity.

My point is that we don't just see mid-level acuity patients. We practice according to our education and training not according to the patients acuity level.

With that said, it is NOT MY line of reasoning although I fully support and agree with the AANP and other nurse practitioner organizations. Even the institue of medicine is on board with these goals.

http://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Nursing%20Scope%20of%20Practice%202010%20Brief.pdf

Conclusion

Now is the time to eliminate the outdated regulations and organizational and cultural barriers

that limit the ability of nurses to practice to the

full extent of their education, training, and competence. The U.S. is transforming its health care

system to provide quality care leading to improved

health outcomes, and nurses can and should play

a significant role. The current conflicts between

what APRNs can do based on their education and

training and what they may do according to state

and federal regulations must be resolved so that

they are better able to provide seamless, affordable,

and quality care. Scope-of-practice regulations

in all states should reflect the full extent not only

of nurses but of each profession's education and

training. Elimination of barriers for all professions

with a focus on collaborative teamwork will maximize and improve care throughout the health care

system.

[bsnanat2]

i don't think we actually disagree. i realize that my post was a little harsh, but the md's and their lawyers are worse. my point is that the argument as originally presented simply will not fly. physicians (with their deep pockets and powerful lobby) will not have it that way. if by some chance the presented argument comes to pass, many physicians will be adversarial. the argument needs to be couched in such a way as to stroke their egos and for physicians to see np's as an asset, not a nuisance. md's now see od's as providers whose goals are nearly the same, but approached from a different vantage point. np's need to work at being seen in the same vein. one of the problems is the lack of continuity within the np community itself and the myriad of certifications. "we are equal" won't work, but "we are similar" just might. i personally use an np who has an independent practice for my family's care and like it better, but she will refer to a physician if needed. the physicians in town love her but really dislike some who blow the "we're the same" horn. notice too that i say physicians and not doctor. we as nurses need to get away from that bad habit. your points are good and your second argument is much more compelling. we just have to make it compelling enough for physicians to sign on.

[globalRN]

the new MD sounds insecure.

Agree with posters that u need to talk with her first before taking it up the chain of

command.

Let her know that sort of hostile communication is unacceptable in a firm and pleasant manner