Physician Hostility - page 7

Why are so many physicians threatened and hostile toward NPs? What are the strategies in dealing with these types of professionals,and in what ways can we make it easier to practice together?... Read More

  1. by   fab4fan
    Hmmm...here I am, just a puny old RN who cares for hospice pts. I'm supposed to know nothing about nothing, according to some of our guests.
    Yet this is what happens when I call the doc when there's a problem:

    I call doc. Doc listens (usually). Doc says, "What would you suggest?" I give my suggestion to the doc. He says "Fine."

    Now, I am not just talking about pain mgmt.; I am talking about all of the varied symptom mgmt needs a pt may have during the dying process. I'm not talking your run of the mill stuff.

    Do I think I can practice indep.? No, but obviously, I have my own little niche in which the docs I deal with feel comfortable with taking my suggestions. And please don't diminish this with a comment like, "Oh well, your pts are dying anyway, so what could it hurt?" It can hurt a lot if symptom mgmt is not handled aggressively.
  2. by   karenG
    Quote from fab4fan
    Hmmm...here I am, just a puny old RN who cares for hospice pts. I'm supposed to know nothing about nothing, according to some of our guests.
    Yet this is what happens when I call the doc when there's a problem:

    I call doc. Doc listens (usually). Doc says, "What would you suggest?" I give my suggestion to the doc. He says "Fine."

    Now, I am not just talking about pain mgmt.; I am talking about all of the varied symptom mgmt needs a pt may have during the dying process. I'm not talking your run of the mill stuff.

    Do I think I can practice indep.? No, but obviously, I have my own little niche in which the docs I deal with feel comfortable with taking my suggestions. And please don't diminish this with a comment like, "Oh well, your pts are dying anyway, so what could it hurt?" It can hurt a lot if symptom mgmt is not handled aggressively.
    hi

    you are working within your competencies... you may not know as much as the doc but you have learnt how to care for your patients and are working to a high level of practice. and if someone EVER told me my patients were dying anyway, so how could it hurt............. I'd probably kill them!! my hat goes off to you for working in such a difficult field...

    Karen
  3. by   zenman
    I spend many hours explaining to patients and their families what the DR thought that they had explained adequately.

    Posted by yersinia21: So what?
    I hope yersinia21 realizes the importance of patient education and of being able to talk to patients of all educational levels in a manner they understand.
  4. by   Gump
    Tenesma, did you ever inquire as to how long those PAs/NPs had been practicing in that role?
  5. by   Greekmed
    Hello everybody!

    Hi Helllllo Nurse,
    I take some issue with your post. PAs are also practicing a learned profession. As a matter of fact there is currently much talk in the PA community to change the name to physician associate. This better reflects the role that PAs play in the learned profession of medicine and emphasizes the medical model approach to patient care. I personally think that Physician Assistant is a poor title. But I don't blame you, lousy titles can often convey the wrong information. When I was a Paramedic people called me ambulance driver because it was an term that many older folks were familiar with. Well I got tired of correcting people all the time and I'd just smile and let it go. But I'll tell you this, when I was juicing up their grand-daughter whose in stat-ep with some Ativan or consciously sedating and cardioverting grandpa's SVT they knew I wasn't the milk truck driver. PAs are just as much practitioners of medicine as NPs. It simply would not be proper to have called them Physician Practitioners (could be confused with physician proper) or even Medicine Assistant (which could be confused with medical assistant). The title of Nurse Practitioner was a good and convenient title to describe this advanced form of care NPs provide at the midlevel practitioner level and Nursing holistic approach to care. Simply stated PA and NP are both midlevel practitioner health care providers.
    Aside from this issue, I want to say that I find this site very interesting and appreciate all of the information on it. I'd also like to ask you good folks to come on over and take a look at the PA website: www.physicianassociate.com I think alot of good can come from a free exchange of ideas, philosophy, from all of the midlevel providers in medicine. Besides a little hot debate is good for the soul! Talk to you folks later!


    Quote from Hellllllo Nurse
    Right back at ya', Dave! :kiss

    Another point I'd like to make is that physician's assistants are just what the title indicates: assistants to physicians.

    Nurse Practitioners are Nurses who "practice a learned profession."*

    Nursing is a very seperate profession from medicine. Of course, Nursing and medicine do overlap in some areas. However, an NP is a practitioner:. A PA is an assistant.




    *The noun "practitioner" has 1 sense in WordNet.

    1. practitioner, practician -- (someone who practices a learned profession)
    Last edit by Greekmed on Mar 2, '04
  6. by   Greekmed
    The website is actually called physician associate.com , aka PA forum just in case the link above doesn't work.
    Last edit by Greekmed on Mar 2, '04
  7. by   NCgirl
    I'm so tired of these debates and arguments--why can't all the doctors just go back to their sandbox (bulletin boards), and get out of this one? I welcome input on clinical issues where useful knowledge is shared, but this is getting ridiculous. I think I'm just tired and cranky tonight, so I'll just hush and go to sleep on that note.
  8. by   racecity1
    A little cut and paste of 3 messages from the studentdoctors.net message board of 3 of PACtoDoc's postings (just search by author or look in the PA forum), who was posting in this thread as PA-C,DO. When all many seek is discusion and peace, this is certainly a sad commentary.



    #1
    "NP's are scary!!
    Holy crap guys, if you want to see a group of crazy renegades, take a stroll over to allnurses.com and peruse their NP forum!! These people truly have no clue about medicine and scare the living sh%% out of me! These people really do think they are the equivilant to physicians, and they think PA's are sub-par. I even tried to have an intelligent conversation with them but its like fighting a group of illiterate inmates!! They have power in numbers and it is truly scary that with one sign of the pen, the nursing boards can dictate practice however they like it!!!"

    #2
    "Holy triple sow cow!! I went incognito over to the allnurses.com web forums and hung out in the NP forum for awhile. You want to talk about a group of people who hate the world, most especially doctors and PA's!!! Go check it out in a stealth way. I was the guy posting as PA-C, DO, and read what I wrote. I wasn't even being rude, but I got banned from posting further responses. These women are locked and loaded and ready to take aim at anyone not bowing down to their profession. Go check it out!!!

    www.allnurses.com

    then choose the discussion board. It is amazing how they think!! They must think under the nursing model even in their daily lives"

    #3
    "Funny thing is MDterminator wrote me a private message telling me that he was going to be going to medical school because he just realized after my post that an FP can do OB and minor surgery in the rural areas. What an epiphany!! He told me not to tell anyone he had written me because he would get banished from the NP forum forever!! So I better not tell anyone"
  9. by   Hellllllo Nurse
    I am a lowly ADN RN. However, I often have to care for pts without physician involvment or input, and I've had to do so for most of my 12 year nursing career.

    Simply put, most docs just do not want to be bothered with their pts needs and concerns.

    I resent having to act alone, and yes, write orders that the docs sign weeks later, without even looking at them.

    It is very unfortunate that many docs yell at nurses, hang up on them, or just talk over them without listening to what is going on with the pt.

    If only we could work together, collaborate for the benefit of our pts.

    I think it would be very beneficial to everyone involved if medical school curricula included classes on nursing- what it is that nurses actually know and do- as well as classes on promoting positive nurse-physician working relations and collaboration. Lectures on the "nursing shortage" and the physicians' role in creating the pseudo shortage would be wonderful.
    Last edit by Hellllllo Nurse on Mar 5, '04
  10. by   NP'sspouse
    Quote from Hellllllo Nurse
    I am a lowly ADN RN. However, I often have to care for pts without physician involvment or input, and I've had to do so for most of my 12 year nursing career.

    Simply put, most docs just do not want to be bothered with their pts needs and concerns.

    I resent having to act alone, and yes, write orders that the docs sign weeks later, without even looking at them.

    It is very unfortunate that many docs yell at nurses, hang up on them, or just talk over them without listening to what is going on with the pt.

    If only we could work together, collaborate for the benefit of our pts.

    I think it would be very beneficial to everyone involved if medical school curricula included classes on nursing- what it is that nurses actually know and do- as well as classes on promoting positive nurse-physician working relations and collaboration. Lectures on the "nursing shortage" and the physicians' role in creating the pseudo shortage would be wonderful.

    i was just wondering what you mean by "the physicians' role in creating the pseudo shortage"
  11. by   Hellllllo Nurse
    "i was just wondering what you mean by "the physicians' role in creating the pseudo shortage"



    http://www.expresshealthcaremgmt.com...ational1.shtml

    Study says 'disruptive physician behavior' has contributed to nurse shortage

    As healthcare staffing studies continue to paper the industry with startling statistics, yet another one is highlighting what could be a big problem for nurse retention: doctors.

    Despite relying on nurses for important caregiving functions, physicians may be driving them away from the profession, according to a new study by healthcare alliance VHA. And if Irving, Texas-based VHA is right, the exodus of dissatisfied nurses comes as a healthcare workforce shortage reportedly grows.

    Citing as one of the factors that contributes to low morale among nurses, the study said 30 per cent of nurse respondents reported knowing of a nurse who had quit because of poor treatment by a physician. '

    Like the American Hospital Association and other groups that have addressed the staffing problem with studies and strategic recommendations, the VHA believes its study on the physician-nurse relationship helps to identify root causes of the nurse shortage that are often difficult to discuss or even recognize. Rosenstein said he had trouble finding information on the possible link between physician behavior and nurse satisfaction. Seeking answers, he launched the study in part to ''develop policies to deal with it.''

    The VHA report reflects responses from 1,200 nurses, physicians and healthcare executives at VHA hospitals. Rosenstein said 92 per cent of respondents said they had witnessed disruptive physician behavior, such as inappropriate conflict involving verbal or even physical abuse of nurses. All the respondents identified a direct link between such behavior and nurse recruitment and retention challenges. Yelling and ''condescending behavior'' constituted the vast majority of the abuse doctors inflict on their nurse colleagues, Rosenstein told Modern Healthcare. Nurses who have seen such behavior in their daily work weren't surprised to hear that it can affect nurses' satisfaction with their jobs, and even whether they decide to stay. ''Nurses aren't (physicians') subordinates (who) they can treat with disregard when they're having a bad day,'' said Erin Murphy, executive director of the 16,000-member Minnesota Nurses Association. ''Once nurses say this is not right, I think the physicians will change.'' Murphy, a former practicing nurse, said ''degrading and insensitive'' behavior is all too common among physicians, who tend to ''view themselves as the leader of the healthcare team and think other team members should be able to deal with their outbursts.''

    The study also cited a disconnect between nurses and physicians, saying that when physicians think their behavior is acceptable or improving, nurses don't necessarily view it that way. Long-held habits, healthcare team. ''It is a team, but it's hard for some of the older physicians to adapt to that because they're used to just giving orders and leading the floor,'' said Peter Halford, M.D., chief of staff at Queen's Medical Center in Honolulu.

    Halford, who reviewed the VHA study, said the collaboration necessary to prevent disruptive behavior is much easier said than done. The relationship between doctors and nurses is ''like a marriage,'' Halford said. ''You have to continually look at what you can do to promote communication, which translates into safer, better, more efficient care.'' Halford cautioned that although the VHA study highlights an important problem, physicians' treatment of nurses is not the only factor in their diminishing morale. Nursing, he said, ''doesn't pay what it should given the amount of work and stress involved, and the physical and mental demands. It's a tough job. You have to be on your toes.''

    With nationwide staff shortages haunting health system executives, VHA earlier this year released another study suggesting the workforce shortage is unlike any before it, and that hospitals must address the problem to prevent sinking morale from negatively affecting financial performance, quality of care, customer satisfaction and market position. The study is similar to one conducted earlier this year by the AHA, which found 84 per cent of hospitals were experiencing a registered nurse shortage. VHA's report characterizes the healthcare workforce shortage as ''not a short-term blip, but a long-term crisis.''

    (Source: Modern Healthcare Magazine)
    Last edit by Hellllllo Nurse on Mar 5, '04
  12. by   Hellllllo Nurse
    http://www.nursingworld.org/AJN/2003/march/health.htm

    Health & Safety

    American Journal of Nursing - March, 2003 - Volume 103, Issue 3

    Verbal Abuse in the Workplace
    How to protect yourself and help solve the problem.

    By Vicki Carroll, MSN, RN


    A few doctors at my facility verbally abuse the nurses. As a result, some nurses suffer from stress-related illnesses and find it difficult to come to work. How can we address this problem and protect ourselves from more abuse?

    Verbal abuse in the workplace must not be tolerated. Violence often begins with verbal abuse and escalates to physical abuse. In surveys over the past several years, nurses have said that patients, physicians, and other health care workers yell, swear, intimidate, demean, publicly scold, and sexually harass them. In addition, 82% to 90% of 1,000 nurses surveyed in at least seven states included verbal abuse in their definition of workplace violence.

    Alan Rosenstein's report on the nurse-physician relationship (AJN, June 2002) indicated that daily interactions with physicians strongly influenced nurses' morale. Carol Farina, a Denver psychiatric clinical specialist who has facilitated communication for health care teams, states, "When nurses experience abusive treatment by physicians and feel unsupported by administration . . . they are left feeling powerless to respond appropriately. Staff members may harbor resentments for being treated disrespectfully, which can manifest as any one of a number of psychological symptoms, including anxiety and depression, as well as somatic complaints such as GI symptoms and headaches."


    Verbal abuse can lead to staff turnover. An analysis of the first 1,200 responses from nurses, physicians, and hospital administrators in the Rosenstein study indicated that all respondents directly linked disruptive physician behavior and nurse satisfaction and retention. Verbal abuse can also affect the quality of patient care. Research since the 1980s has indicated that when collaboration between nurses and physicians is promoted, patient care improves, often with fewer costs.

    What can you do? Try not to react emotionally to arrogant, hostile, or condescending behavior. Remain courteous and professional, and concentrate on the issue. One helpful question to ask is: "If we were looking for a solution to this issue, what would we be doing?"

    Report the incident in writing as soon as possible to your immediate supervisor. If the incident is not addressed satisfactorily, consider filing a formal complaint with the peer review committee. In 2001 the ANA released its Bill of Rights for Registered Nurses, which states: "Nurses have the right to a work environment that is safe for themselves and their patients." Cite these rights when asking your administrators to address the issue of verbal abuse. Ask them to offer training in the management of aggressive be*havior; institute a conflict resolution program; and develop a disruptive conduct policy, which should have a formalized peer review system and outline clear consequences for unacceptable behavior. Consider eliminating "zero tolerance," which translates as arbitrary, unfair, and without the opportunity for reasonable and careful decisions. Instead, consider posting policies or "no violence" signs.

    Nurses and physicians must be able to relate to each other with respect and professionalism. To be part of the solution, nurses must not excuse or tolerate abuse. Use these and other strategies to make your workplace safer and healthier and to enhance patient outcomes and professional satisfaction.

    Resources

    See Issues Update on page 65 to learn how the ANA's Commission on Workplace Advocacy and nurses are addressing verbal abuse. To order the ANA Bill of Rights for Registered Nurses poster and user guide, go to www.nursesbooks.org or call (800) 637-0323.

    Vicki Carroll is a clinical instructor at the University of Northern Colorado School of Nursing, a consultant in the area of health care workplace violence, and a member of the Colorado Nurses Association and the ANA Commission on Workplace Advocacy.



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  13. by   NP'sspouse
    Quote from Hellllllo Nurse
    http://www.nursingworld.org/AJN/2003/march/health.htm

    Health & Safety

    American Journal of Nursing - March, 2003 - Volume 103, Issue 3

    Verbal Abuse in the Workplace
    How to protect yourself and help solve the problem.

    By Vicki Carroll, MSN, RN


    A few doctors at my facility verbally abuse the nurses. As a result, some nurses suffer from stress-related illnesses and find it difficult to come to work. How can we address this problem and protect ourselves from more abuse?

    Verbal abuse in the workplace must not be tolerated. Violence often begins with verbal abuse and escalates to physical abuse. In surveys over the past several years, nurses have said that patients, physicians, and other health care workers yell, swear, intimidate, demean, publicly scold, and sexually harass them. In addition, 82% to 90% of 1,000 nurses surveyed in at least seven states included verbal abuse in their definition of workplace violence.

    Alan Rosenstein's report on the nurse-physician relationship (AJN, June 2002) indicated that daily interactions with physicians strongly influenced nurses' morale. Carol Farina, a Denver psychiatric clinical specialist who has facilitated communication for health care teams, states, "When nurses experience abusive treatment by physicians and feel unsupported by administration . . . they are left feeling powerless to respond appropriately. Staff members may harbor resentments for being treated disrespectfully, which can manifest as any one of a number of psychological symptoms, including anxiety and depression, as well as somatic complaints such as GI symptoms and headaches."


    Verbal abuse can lead to staff turnover. An analysis of the first 1,200 responses from nurses, physicians, and hospital administrators in the Rosenstein study indicated that all respondents directly linked disruptive physician behavior and nurse satisfaction and retention. Verbal abuse can also affect the quality of patient care. Research since the 1980s has indicated that when collaboration between nurses and physicians is promoted, patient care improves, often with fewer costs.

    What can you do? Try not to react emotionally to arrogant, hostile, or condescending behavior. Remain courteous and professional, and concentrate on the issue. One helpful question to ask is: "If we were looking for a solution to this issue, what would we be doing?"

    Report the incident in writing as soon as possible to your immediate supervisor. If the incident is not addressed satisfactorily, consider filing a formal complaint with the peer review committee. In 2001 the ANA released its Bill of Rights for Registered Nurses, which states: "Nurses have the right to a work environment that is safe for themselves and their patients." Cite these rights when asking your administrators to address the issue of verbal abuse. Ask them to offer training in the management of aggressive be*havior; institute a conflict resolution program; and develop a disruptive conduct policy, which should have a formalized peer review system and outline clear consequences for unacceptable behavior. Consider eliminating "zero tolerance," which translates as arbitrary, unfair, and without the opportunity for reasonable and careful decisions. Instead, consider posting policies or "no violence" signs.

    Nurses and physicians must be able to relate to each other with respect and professionalism. To be part of the solution, nurses must not excuse or tolerate abuse. Use these and other strategies to make your workplace safer and healthier and to enhance patient outcomes and professional satisfaction.

    Resources

    See Issues Update on page 65 to learn how the ANA's Commission on Workplace Advocacy and nurses are addressing verbal abuse. To order the ANA Bill of Rights for Registered Nurses poster and user guide, go to www.nursesbooks.org or call (800) 637-0323.

    Vicki Carroll is a clinical instructor at the University of Northern Colorado School of Nursing, a consultant in the area of health care workplace violence, and a member of the Colorado Nurses Association and the ANA Commission on Workplace Advocacy.



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    very interesting and rather disturbing....i think i would be looking for a job somewhere else if i was in an environemnt like that....
    our best friends are both physicians and they would never do anything like that.....and my spouse has never been in a situation like that and she has been practicing awhile...

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