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NP vs MA vs MD power struggle

NP   (2,977 Views 34 Comments)
by Ria21 Ria21 (Member)

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I started at an OBGYN office as an NP a month ago, was hired to replace an MD and help with influx of patients. There are 6 medical assistants, 1 RN and 6 MDs. This office has never had an  NP, so it's new role to the office and to the patients. I can deal with patients not wanting to see me, etc. But the most frustrating thing is the way I'm being treated by the staff. I feel like the role of an NP is not understood and at times disrespected

1. The MDs think I'm just their assistant, expecting me to "help" with the duties of the RN and the Medical assistants. Or they ask me questions like "can you prescribe?", "do u know how to give IM injections", "do you want to draw the bloodwork?"

2. The Medical assistants think they can tell me what to do bc they've been there for years and also in an effort to alleviate some of their tasks (bp weight, blood work etc). They don't recognize me as a provider.

3. The RN is also expecting me to alleviate her tasks by giving injections and returning phone calls. She said she was told that I would help her and her tasks.

When I interviewed, it was conveyed to me that I'd be a provider. I am super helpful and not typically the type to say "that's not my job". But it seems they misled me bc they want someone who will do all the tasks of RN and MA and also have a full panel.

I've been vocal about it and it has proven problematic. But I'm not a pushover😕Any thoughts on how to navigate this?

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457 Posts; 15,510 Profile Views

I think you're doing just fine by setting clear boundaries. Helping out here and there is one thing but that's not your "job"/role and should not be the expectation.

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29 Posts; 1,597 Profile Views

Yeah, that's exactly what I thought. Things are just harder bc I feel like I have to set the tone/standards bc they've never had an NP. But I also have to kinda teach everyone about the role without seeming stuckup. It's exhausting!

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3 Followers; 36,785 Posts; 96,984 Profile Views

Think about it awhile and come up with a time frame to effect a change in attitude.  Should that change not come about to your satisfaction, start thinking about alternatives if you think this situation is going to give your ulcers and headaches.

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LibraSunCNM is a MSN and specializes in OB.

1,200 Posts; 24,833 Profile Views

It's bizarre to me that they hired an NP, told you they wanted you as a provider, but seemingly know nothing about NPs and think of you as another RN.  Are they paying you more than an RN?  

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2 hours ago, caliotter3 said:

Think about it awhile and come up with a time frame to effect a change in attitude.  Should that change not come about to your satisfaction, start thinking about alternatives if you think this situation is going to give your ulcers and headaches.

Thanks,  sounds like a good idea. I want the experience and am willing to be a team player. However, respect is non negotiable.

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45 minutes ago, LibraSunCNM said:

It's bizarre to me that they hired an NP, told you they wanted you as a provider, but seemingly know nothing about NPs and think of you as another RN.  Are they paying you more than an RN?  

I agree that it's quite bizarre! I think the office is trying to cut corners as I'd be cheaper than MD. I do receive NP salary though, but I guess with the expectation of playing a dual role, which is deceiving. *sigh*

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LibraSunCNM is a MSN and specializes in OB.

1,200 Posts; 24,833 Profile Views

37 minutes ago, Ria21 said:

I agree that it's quite bizarre! I think the office is trying to cut corners as I'd be cheaper than MD. I do receive NP salary though, but I guess with the expectation of playing a dual role, which is deceiving. *sigh*

Do you ever see patients as a provider, or just help with RN duties?

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Neuro Guy NP is a DNP, PhD, APRN and specializes in Vascular Neurology and Neurocritical Care.

219 Posts; 7,192 Profile Views

Don't do anything the docs wouldn't do. That is the only way you'll reinforce what your role is. Allow no gray areas. You have plenty of things of your own to do instead of helping the RN. Ever.

 

You have the next patient to see, labs to review, insurance appeals to review, refills to sign off on, etc etc. If someone has unfavorable testing results, you have to prepare your script on how to convey the information in a compassionate, honest, and non-alarmist fashion.

Not that being a team player is bad, but these folks sound like they will expect it to be habitual if you do their Nursing tasks. "Give an inch, and they'll take a mile". Always keep it professional. And of course if they still don't get the concept, go some place else. 

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KatieMI is a BSN, MSN, RN and specializes in ICU, LTACH, Internal Medicine.

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20 hours ago, LibraSunCNM said:

It's bizarre to me that they hired an NP, told you they wanted you as a provider, but seemingly know nothing about NPs and think of you as another RN.  

It is bizarre but indeed quite common. 

In my experience, hiring "to help with the influx of patients" can mean literally whatever. If office personnel has no knowledge of what "NP" means and only hear the "Nurse" part, they very well can think that the person is "still just a nurse", with functions assigned accordingly. Random "helping here and there" just out of wish to be "friendly and helpful" only increases confusion. 

I would advise a meeting with practice owner/office manager and getting the job functions/expectations in written and in details. Explaining what you can do (prescribing, etc) can help. Then just act accordingly with no exclusions and without caving for "they told me that you'll do it for me". 

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15 minutes ago, KatieMI said:

It is bizarre but indeed quite common. 

In my experience, hiring "to help with the influx of patients" can mean literally whatever. If office personnel has no knowledge of what "NP" means and only hear the "Nurse" part, they very well can think that the person is "still just a nurse", with functions assigned accordingly. Random "helping here and there" just out of wish to be "friendly and helpful" only increases confusion. 

I would advise a meeting with practice owner/office manager and getting the job functions/expectations in written and in details. Explaining what you can do (prescribing, etc) can help. Then just act accordingly with no exclusions and without caving for "they told me that you'll do it for me". 

I'd say explaining what you *should* do is  part of it.  At the end of the day, you are a revenue generator and not support staff. Anything you do that doesn't involve seeing patients is revenue loss for the practice.

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22 hours ago, Neuro Guy NP said:

Don't do anything the docs wouldn't do. That is the only way you'll reinforce what your role is. Allow no gray areas. You have plenty of things of your own to do instead of helping the RN. Ever.

 

You have the next patient to see, labs to review, insurance appeals to review, refills to sign off on, etc etc. If someone has unfavorable testing results, you have to prepare your script on how to convey the information in a compassionate, honest, and non-alarmist fashion.

Not that being a team player is bad, but these folks sound like they will expect it to be habitual if you do their Nursing tasks. "Give an inch, and they'll take a mile". Always keep it professional. And of course if they still don't get the concept, go some place else. 

I agree with not doing anything the doctors don't do. I started saying no to the requests of giving injections, drawing blood etc. One of the doctors told me that my attitude is "bad" bc I'm expected to do whatever is asked of me. I don't think they see the consequences of that...I could just leave but I honestly thought these were growing pains that could get worked out😕

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