NP invisibility

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Specializes in ER, critical care.

There are days at work where I think I have reached new levels of invisibility. I must admit there are days when I think wistfully about the pre-NP days. Days where I was reguarded as an authority on issues of my choosing and assigned projects to complete.

Perhaps this is just an anamoly but in the area where I work, one of the ER doctors has referred to my NP colleages and I as HIS nurse practitioners. We aren't HIS. He didn't hire us, he doesn't pay us, and he isn't our supervising physician (whom we don't belong to either).

So skating close to the edge that day as I was, I just jumped off the edge. Told him I wasn't his girl but if he needed to hire a girl I would see if someone could find the classifieds for him. Perhaps a suitable girl could be found above the fold.

Then the administrator came down with a new physician (ENT) and introduced him to said ER physician. I was sitting right there, I decided I must be behind some sort of invisibility cloak so I stood up, introduced myself and gave my title. Told the ENT that we saw a lot of patients that would benefit from his services and that I looked forward to working with him should he decide to join the medical staff. The administrator was looking at me like I was on fire or had sprouted a second head from the side of my neck. Picked up the next chart and said, "Why here is one now, ear pain in a 2 year old." Smiled at the dumbfounded administrator and walked off.

If that wasn't enough, one of the hospitalists was asking me what I thought about opening a clinic near where we live. Told him I thought it was a great idea because there weren't enough providers in the area. He asked me what it would take to get me to work for him.... I looked him square in the eye and told him there was no amount of money that would get me in a clinic to work for him. Went on to say if he wanted to work with me it would be a partner relationship or no relationship. To date there is no clinic and I have since decided he wouldn't make a great partner either.

Finally, the last of my haughty moves. One of the ERs I work in has whiteboards in the rooms. Every shift the nurses run around putting the doctor's name and the nurse's name on the board. I noticed that I wasn't on the board but I was seeing patients in these very rooms. I took a marker and went around adding my name and title to all the boards.

So am I just haughty or am I on to something?? What do you think? Do you ever feel invisible.

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That makes me sad to hear. I am just a nursing student, but I have great respect for the NPs that I have worked with or have helped me in school or that have taken care of me. I have always recieved better care from NPs verses an MD. In my experience Nps spend more time with you and will take the time to find out what is really going on. They seem to be smart and humble and better at creating a good relationship with the patient. And between the 2 years or pre reqes, 4 years of nursing school, 2 years of nursing before you can get into NP school and the 2 year NP program you really have very close to the education that the doctors have as well as a more well rounded experience. Kudos to you for standing up for your self. You are the kind I look up to and strive to be like. Good Luck!!

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Specializes in ER, critical care.

thank you and good luck

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Specializes in Nephrology, Cardiology, ER, ICU.

Gee whiz! Nope - wouldn't put up with that either. My background before I became an APN was 10 years in a level one trauma center. We had no mid-level providers and it was painfully clear that the MD's did not, did not want any! It was well-known that I and another equally qualified RN were in school. The ER dept head was quite vocal (in front of us and behind our backs too), that no mid-levels would be allowed in "his" ER.

So...ya know what? I left that hospital and I now get $30,000 more than they would pay me, much better bennies and the doctors that I work for respect me!

I am sorry that you are going through this. I certainly don't think you're being haughty at all - just providing good care - which is what APN's do!

Hey, I have an idea? Why don't you advocate for getting rid of the MD's and hiring all mid-levels? Tee hee hee!

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There are days at work where I think I have reached new levels of invisibility. I must admit there are days when I think wistfully about the pre-NP days. Days where I was reguarded as an authority on issues of my choosing and assigned projects to complete.

Perhaps this is just an anamoly but in the area where I work, one of the ER doctors has referred to my NP colleages and I as HIS nurse practitioners. We aren't HIS. He didn't hire us, he doesn't pay us, and he isn't our supervising physician (whom we don't belong to either).

So skating close to the edge that day as I was, I just jumped off the edge. Told him I wasn't his girl but if he needed to hire a girl I would see if someone could find the classifieds for him. Perhaps a suitable girl could be found above the fold....

Wow, interesting...you might find it interesting too that my sister-in-law is a Pediatrician and as an aside, she used to look really young. She got patronizing B.S. for many years from male physicians. Its a dose of the guy thing, it seems. And then of course, its also some of that same ole, same ole thrown in (CRNA vs. both ANA and Anesthesiologist, and NP versus BOTH PA and Dr.)...always someone feels threatened...

Good for you for speaking up- nice to see you have the 'ovaries' to do that!

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Specializes in ICU, ER, HH, NICU, now FNP.

You bad girl you!

I argue with radiologists who insist on reading stat results to my collaborating physician rather than to me. Or i put them on the phone with him - and he punts them right back to ME :)

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I argue with radiologists who insist on reading stat results to my collaborating physician rather than to me. Or i put them on the phone with him - and he puts them right back to ME :)

I read this as 'passive aggressive'. This is how the Drs quietly protest the use of NP's, by pulling little insulting B.S. things like that. Once, OK. But if same radiologist calls AGAIN and asks for Dr. and Dr. again gives call to you...then he KNOWS the score and is simply making a statement each time he does it. Hey Docs, fight it all you want, but the cost of healthcare will continue to go up- FOREVER-and therefore so will the need for mid-levels.

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Specializes in Critical Care, Cardiothoracics, VADs.

Perhaps some more education about the scope of practise of NPs would help more than getting eveyone offside? Good for standing up for yourself though - you've earned the title and respect.

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Specializes in ER, critical care.

Hey, I have an idea? Why don't you advocate for getting rid of the MD's and hiring all mid-levels? Tee hee hee!

What's funny?? I HAVE made such a suggestion already!!

I hope no one thinks I am lying awake at night about anything in my OP. The doc that wants to claim ownership of "his NPs" only works occasionally but he sure did manage to rub me the wrong way that one day.

The radiologist has given up on not giving me reports on tests that I ordered. There was only one of those kind of radiologists anyway. I just picked up the phone and told him the doc couldn't come to the phone but I would be happy to take the report since I ordered the test. After a few repetitions of the same, he gave up.

The CMO also works as a hospitalist and he decided that we shouldn't call for patients that needed to be admitted. We were to give report to the ED physician and he could call for admission. That was until my friend and colleague caught him in the ER one day to "get a few things nailed down". I would have paid money to have been present for that conversation, because as haughty as I am I don't hold a candle to her.

As for education, all the players have become well educated. It is a matter of "small town, small mind". That's all. Apparently those who came before us have been alright just maintaining the status quo which was circa 1920.

I have never been a status quo girl, so my first order of business when taking this job was to revamp the delineation of privileges to coincide with the actual century in which we were living.

We have come a long way and I love it. Are the majority of you guys telling me that this stuff never happens and it is just a regional anamoly?

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Specializes in ER, critical care.
Gee whiz! Nope - wouldn't put up with that either. My background before I became an APN was 10 years in a level one trauma center. We had no mid-level providers and it was painfully clear that the MD's did not, did not want any! It was well-known that I and another equally qualified RN were in school. The ER dept head was quite vocal (in front of us and behind our backs too), that no mid-levels would be allowed in "his" ER.

So...ya know what? I left that hospital and I now get $30,000 more than they would pay me, much better bennies and the doctors that I work for respect me!

quote]

I had to go back for this part. Where I worked while in school also had no mid-levels. I made a great case, I had 5 of 7 on my side for creating a position. But none of them had the "ovaries" to stand up to the business guy in their practice. He didn't want it because he thought it would mean more night shifts for him. He hired 2 new docs instead. I got the pleasure of telling him he had just made the most ridiculous business decision I had ever heard of. It was great.

So I took the job I have now, which for the most part is good, at about the same amount of increased money that you received trauma. This past summer I went back to visit some friends in that town. Not the least of whom was one of my physician preceptors in school.

The best thing happened... the business guy for the practice approached me and asked if I would consider coming to work for them. I got to tell him "I doubt you can afford me." It was fabulous. He quoted the package offer and I told him "I was right, you can't afford me anymore." That boat has sailed.

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Specializes in ICU, ER, HH, NICU, now FNP.

I got a visit today from the marketing director of the radiology department - he wanted to know what they could do as a department to keep and/or gain the business of the NP's and PA's of the practices in the area - I was fairly blunt about it. I told him about the experiences I have been having. He was rather appalled.

So we'll see how things go...

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Specializes in Nephrology, Cardiology, ER, ICU.

ERNP - the hospital where I worked had a large ER residency program and they didn't want the mid-levels to have the "good" cases! tee hee hee

I do not have the cloak of invisibility anymore. In fact, today, the medical director came to the dialysis unit where I was working today to discuss with family withdrawing of dialysis. He took me aside and thanked me for the assessment and the heads up. He and the other physicians (all 11) are wonderful. We have 11 MD's, 4 PA's and 4 NP's in the practice and daily I'm thankful that I took this position.

Gauge14IV - how is your job coming? I'm kinda gathering not well? I don't remember what you ended up doing - can you refresh my memory?

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