Ever have problems with RN's?

Well you seem to have tried to be nice but depending on your chain of command and your comfort level:

1) Talk with your supervising MD?

2) Talk with their supervisor?

3) Talk with HR?

Keep a running record of your problem interactions with the nurses and supervisors. This was one of the topics that was covered during my MSN program. Unfortunately some people are jealous, spiteful, or overly inquisitive...

Patient lives can be at risk when providers badger providers. With that said it could reach the level that it may need to be reported to your board of nursing.

I would like advice on how to handle RN's who challenge a new Nurse Practitioner. My nursing background is as an ER RN, and I have just started a new job as an ER NP. I'm finding the role transition difficult. There are a couple of RN's who follow me around letting me know they don't like "midlevels" in the ER and trying to play "pop quiz" medical trivia with me while I am working.

I have tried taking the high road and have quietly taken each aside and asked them for their support while praising their knowlege and experience. This has only worked temporarily.

This is a different facility than where I developed my RN practice, so there are only a few who know me in my RN role. Those who have worked with me in the past are supporting me wholheartedly.

Any suggestions on how to handle the ones who think they know both their job and mine and feel the misguided urge to "supervise" me?

Those RN's should be FIRED! I'm amazed that you haven't already reported them to HR. The last thing you need is an employee making your job more difficult and causing you to lose focus.

There were a couple of medical assistants who questioned one of my NP friends' orders. They would say things like, "Dr. Smith never orders that dose," or whatever. One of them told her that a patient didn't need a pregnancy test b/c they were on the pill and "everybody knew that was 100% effective" and these were MEDICAL ASSISTANTS! My friend had finally had enough of their badgering, so she reported them to the owner of the clinic. They were both fired!

Hello,

Not sure this is much help except to know you aren't alone. I graduated in May '08 and just started as an FNP in the ER where I used to work. I worked as an RN here for a couple of years and then worked in an informatics role in this ER supporting the electronic medical record. Only a few of the nurses worked with me as an RN.

I've had a tech tell me I needed to give an old fellow with a head injury morphine and question me when I didn't. A nurse ask me why a patient who'd fallen off a roof and had abd tenderness/pain needed a CT and another tell me not to order an hcg on someone since she'd had a tubal (she had an ectopic pregnancy so I was right).

Some of them don't seem to understand what a nurse practitioner is. I've had 2 RN's say, "You can't write prescriptions can you?" I'm the first full time FNP, the rest of the mid-levels are PA's.

I'm just plugging along. I'm learning alot and have the I'm new insecurity but it's important not to second guess yourself. It's getting better as time goes by and I've only worked 9 shifts. I've found it's better not to be too chummy. Keep the "wall" up and you aren't so approachable. If I can't handle it I'll talk to the charge nurse but I think ignoring them will work. What can they do anyway? They can't change our orders.

Hang in there!

T

I spent a lot of clinicals in the place where I was also employed as an RN. By far and away most of my coworkers were quite supportive. However, one had some definite issues. I thought it was me but the NP I was with remarked that she had problems with that individual also. Their method for dealing with this was to stay calm, not argue, just do the job. In the case where one RN refused an order the NP found another RN and wrote up a report for the unit manager. There was no further insubordination but that RN still has some major attitude. Even her coworkers have called her on it.

I can't say if it is jealousy or what. In this case I felt bad because as a coworker I'd had the greatest respect for this person both professionally and personally. Since she didn't want to "talk" I left it at that. I will let my professionalism speak for itself. I will admit that there are some things I don't know, however, I will never downplay what I can do well.

I think "the wall" is something to be cultivated but with great caution. You're not one of the gang any more. I have a hard time not sitting and chatting--no time for that now on rounds!--it is part of the acculturation process.

I've had a tech tell me I needed to give an old fellow with a head injury morphine and question me when I didn't.

The tech should be reported to his/her supervisor for making those comments. Tell him/her that you only take orders from someone with "MD" after their name and they're going to need about 12 yrs of education before they get to that point. Would that tech ever say that to a doctor?

A nurse ask me why a patient who'd fallen off a roof and had abd tenderness/pain needed a CT

Next time something like this happens say, "I can't believe you just asked me that. You should know that, you're a NURSE!" If you turn it around on them, they'll think twice before opening their mouth again.

and another tell me not to order an hcg on someone since she'd had a tubal (she had an ectopic pregnancy so I was right).

Once again, turn it around on them and say, "I'm just absolutely amazed that you don't know better than this. Where did you get your training?"

Some of them don't seem to understand what a nurse practitioner is. I've had 2 RN's say, "You can't write prescriptions can you?" I'm the first full time FNP, the rest of the mid-levels are PA's.

Once again..."How can you not already know this information? You're a REGISTERED NURSE!"

T

Funny, but yesterday when I was working in the minor emergency clinic, an elderly person walked in with all the S/S of CHF (we do get this occasionally). I ordered a chest x-ray and the x-ray tech said, "A chest x-ray for swollen ankles??" I informed her that her knowledge of CHF was seriously lacking, but since she was an x-ray tech, I was going to cut her some slack. Needless to say, she kept her comments to herself the rest of the day. I had a NP student precepting with me and she was very happy to see me take charge of the situation. If you don't take charge, these people are going to walk all over you.

Sorry to hear how much flack you're getting. I haven't seen our mid-levels treated with disrespect, but then our hospital is flogged with mid-levels.

To be perfectly honest, I was originally thinking of applying for jobs that would allow me privileges within my current hospital simply because I'm familiar with it but am now changing my mind. I think it would be easier to start somewhere I'm not known and can lay down the ground rules from the start. I think some of my coworkers will have a problem with me "telling them what to do" even if I collaborate with them. I'm actually thrilled that my first choice in employers just opened an office with privileges at a hospital where I've never worked. I'll let them know my preference for that.

In any case, best of luck to you. One piece of advice I can give is to simply treat them professionally and with respect. Let them know this is what you need and if they have any questions they may contact you later. It sounds to me like they're feeling inferior and want to intimidate you. They need to remember that the patient comes first, not them.

Best of luck!