Disagreeing with your supervising doctor

nalie2, ADN, BSN, MSN, RN, NP · Dec 26, 2023

In my experience, they cannot force you to follow the supervising physician's plan of care. If you strongly disagree with the physician's plan of care then I would kindly remind them of the policy and have them take over the patient's care.

Neuro Guy NP, DNP, PhD, APRN · Dec 26, 2023

Agree with above. Also, do yourself a favor and stop using the term mid-level. The quality of care you give is not mid-level, right? You strive to give top notch care according to your training as an APRN, I'm sure. Remind him of the policy and speak with the chair of emergency medicine about the issue and see what he or she advises. Frame it as a quality issue. You could say something like: 'So and so changes orders without communicating with me. This results in me being unaware of the change in plan of care and unable to properly follow up on tests and manage the patient. Additionally, if he disagrees with my management, per the policy, he needs to assume management of those patients.' You could also go over a couple cases and see if your chair gives you any feedback.

Ideally, you could have a conference including the problem physician and your department chair and see why he finds this behavior necessary. Does he believe you need to develop your knowledge base more? Why does he believe that and what evidence is there to refute or support that assertion? Or does he do it just because he believes he can and he has some axe to grind with nurse practitioners and physician assistants?

P.S. Work with him as little as possible!

BeatsPerMinute, BSN, RN · Jan 1

Im a nurse with nearly a decade of critical care experience and have seen techs/RTs/nurses/PAs/NPs taken advantage of , pushed beyond their limits by MDs. IDK for sure, but it kind of sounds like youre being taken advantage of. I've been taken advantage of. Theres a point where you gotta say "no, I am not going to tolerate this behavior anymore" and follow through with it. If its bothering you enough to where it keeps you up at night, its time to take action. Get HR involved. Speak to the MD directly & set some boundaries. Or leave, It's just not worth it to work with people who are like this / treat their colleagues poorly.

RN_SummerSeas, MSN, APRN, NP · Jan 3

First things first, stop using the term "midlevel" it is derogatory and misleading. Many of us are trying to end the use of that term as it implies we give middle of the road care rather than a high level of care. We are nurse practitioner providers, we don't call any other provider or health care worker a low level or high level. Sorry rant over.

If you have a policy that states in the event of a disagreement the physician takes over, then that is what you say to this person. They can't make YOU do something, but they can do it themselves. I'm not sure which state you are in or what your practice authority is, but that plays a role also. I personally have no desire to work in a hospital setting as they do things however they want despite the fact that we are a full practice authority state. I prefer my independence with a supportive mentor physician. There is no need, nor room in health care for the "scope creep" arguments. I wish you all the best going forward. If this one provider continues to be difficult maybe you can bring this to the attention of the ED supervisor.

Advanced Practice Columnist / Guide · Jan 10

I think I need more context from the OP. What orders does he change and how does his plan deviate from your original plan? I work in a collaborative relationship with physicians. I see the patient, assess, formulate my plan and write orders. I discuss these with the physician and for the most part, we are on the same page. In medicine, there are many gray areas...for instance, there are incidences when I feel more aggressive with pursuing a test and the attending feels otherwise. It helps to discuss those situations together and come up with a mutually agreed upon game plan. This works for me though it sounds like this physician is really just the "obstructionist" type when it comes to NP's. I think his behavior should be reported especially if it's a pattern and can risk delay in patient care.

RN_SummerSeas, MSN, APRN, NP · Jan 10

juan de la cruz said:

I work in a collaborative relationship with physicians. I see the patient, assess, formulate my plan and write orders. I discuss these with the physician and for the most part, we are on the same page. In medicine, there are many gray areas...for instance, there are incidences when I feel more aggressive with pursuing a test and the attending feels otherwise. It helps to discuss those situations together and come up with a mutually agreed upon game plan.

You run every patient and your assessment and plan by the physician? That seems like a lot unless you are brand new and still unsure. I have a lovely collab going physician, I run things by her only if they are complex, something I've not treated or I get push back from the LPNs at the facility.

This OP post is why I don't want to work at a hospital. Being called "mid level" and being unable to work at the top of my license, it just doesn't work for me.

I hope things work out for OP!

djmatte, ADN, MSN, RN, NP · Jan 12

paramedic-RN said:

According to our policy if there's a disagreement between a midlevel and doc about how to manage a patient then the doc has to take over that patient I don't think they can just force the midlevel to do what they want.

If this is the policy, then this is how you deal with said situation. Let that doc take over care and move on.

RN56123 · Jan 19

Hospitals I know of refer to NPs and PAs and APPs, Advanced Practice Providers. To be referred to as a "midlevel" says something about the organization. What state are you in?

djmatte, ADN, MSN, RN, NP · Jan 19

RN56123 said:

Hospitals I know of refer to NPs and PAs and APPs, Advanced Practice Providers. To be referred to as a "midlevel" says something about the organization. What state are you in?

Not all places or groups use the same terminology. I grew into my own where mid level was a standard acceptable term. APP. MLP. They're standard catch all phrases that people truly need to stop losing sleep over. It's different terminology, utilize to characterize a group of people in an effort to differentiate doctors from those other staff. Yet it seems mostly NPs that lose their proverbial excrement over such an innocuous term.

RN56123 · Jan 24

Djmatte, LOL, no excrement has been lost. This mishmash of terminology, so many different acronyms, its confusing to people, especially to the public what the various roles are. Standardization would help. I think APP, with the word "advanced" in it, is certainly preferable to a term with "mid". But if you prefer being called mid something then go for it.