NP vs MA vs MD power struggle

Published

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?

On 6/29/2019 at 3:56 PM, LibraSunCNM said:

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

I see patients with the doctors for now...which is why I say no to these other requests. There is so much more involved in my actual role that I could use that time for. Smh...just kinda mad at myself that I ended up in this situation. I know I have a lot to offer this office, but not if they're giving me other tasks that the up my time

Up Vote Up Vote ×
5 hours 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".

Thanks For the advice! I agree that helping here and there adds confusion. There really is no one person to talk to...i expressed my thoughts in a meeting but to no avail. I will try again this week, but I'm starting to conclude that this place was just not ready to receive an NP and just doesn't want to adjust.

Up Vote Up Vote ×
Specializes in ICU, LTACH, Internal Medicine.
2 hours ago, Ria21 said:

Thanks For the advice! I agree that helping here and there adds confusion. There really is no one person to talk to...i expressed my thoughts in a meeting but to no avail. I will try again this week, but I'm starting to conclude that this place was just not ready to receive an NP and just doesn't want to adjust.

I see amazing number of job advertisements for urgent care and the like settings which openly state that the NP candidate they seek will be treated as "all tasks' maid". Rooming, taking vitas, venipuncture, all other tasks as assigned, then provider's job, then calling on scripts, case management, insurance business, etc., etc.

What is interesting, most of them want NP, not PA. I wonder why - probably, because PAs will not put up with it.

And I do not even mention this example of greed level 80.01:

https://www.practicelink.com/jobs/676574/physician/hospitalist/Michigan/Rural Physicians Group MI

(7 on/7 off round the clock - yes, 168 hours in a row, no interruption, no chance to leave, not seeing your family, eating cafeteria junk for your own $$, responsible for anything and everything - for LESS than local standard salary. New grads, please pay attention).

They were looking for an MD for over a year, found no fools, now fishing for PA or NP to do two people's job for one salary.

1
Up Vote Up Vote ×
19 minutes ago, KatieMI said:

I see amazing number of job advertisements for urgent care and the like settings which openly state that the NP candidate they seek will be treated as "all tasks' maid". Rooming, taking vitas, venipuncture, all other tasks as assigned, then provider's job, then calling on scripts, case management, insurance business, etc., etc.

What is interesting, most of them want NP, not PA. I wonder why - probably, because PAs will not put up with it.

And I do not even mention this example of greed level 80.01:

https://www.practicelink.com/jobs/676574/physician/hospitalist/Michigan/Rural Physicians Group MI

(7 on/7 off round the clock - yes, 168 hours in a row, no interruption, no chance to leave, not seeing your family, eating cafeteria junk for your own $$, responsible for anything and everything - for LESS than local standard salary. New grads, please pay attention).

They were looking for an MD for over a year, found no fools, now fishing for PA or NP to do two people's job for one salary.

I believe it! I do agree that they are seemingly looking for someone to do the role of nurse and NP. it's definitely not what we discussed on interview so my impression of the role was different. And yes, people hear "NURSE practitioner" and they just think nurse. It's such an ugly battle.

Up Vote Up Vote ×
Specializes in Mental Health Nursing.
On 6/29/2019 at 2:30 PM, 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?

This is common. I was the first NP at the practice I currently work at and the MDs had no clue what I could and couldn't do. They also didn't know what required close supervision and what didn't. There are still forms (psych evals, HRAs, labs, treatment plans) that are co-signed by an MD because the MDs aren't comfortable with those tasks being completed by NPs "unsupervised."

1
Up Vote Up Vote ×
4 hours ago, Ria21 said:

I see patients with the doctors for now...which is why I say no to these other requests. There is so much more involved in my actual role that I could use that time for. Smh...just kinda mad at myself that I ended up in this situation. I know I have a lot to offer this office, but not if they're giving me other tasks that the up my time

When you say "see patients with the doctors", what exactly do you mean? Are you seeing the same patients in conjunction with them or are you seeing and charting your own case load?

3
Up Vote Up Vote ×
Specializes in FNP.

I skimmed the responses but agree with not doing anything that the MD's don't do. And keep reinforcing the boundaries. I was in a similar situation and just kept being persistent. I'm sure that you're invited to the provider only meetings. There, I'd ask for the other MD's to help to remind the staff of your role. Additionally, the staffs immediate supervisor needs to be clear as well.

1
Up Vote Up Vote ×

Maybe you need to type up a list of duties for an NP and pass it around. Giving them the benefit of the doubt, maybe some of them at least really don't understand the role of NP.

1
Up Vote Up Vote ×
17 hours ago, Ria21 said:

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?

I think that having a discussion with the doctors is important to clarify what they expect, and perhaps educate about what you can do.

PP suggested pointing out the financial aspect of this. As a provider, you are a revenue generator for the practice - or CAN be, if they let you get on with the provider tasks rather than getting bogged down with the nurse tasks.

If you still get push back, you might be polite but firm in pointing out that they (the MDs) do not give injections, draw blood, etc., not because they are incapable of doing so but because their time is better spent doing the things the MAs and RN cannot do. It's kind of blunt, but point out to them that if they want someone to do support staff functions, it would be much cheaper to hire another RN (or LPN or phlebotomist who doubles as an MA) than to pay your NP salary. Remind them that you were hired to replace an MD, not replace an RN, so your duties should be replacing the MD's duties. If a task is something the MDs aren't doing on a regular basis, it shouldn't be something you are expected to do on a regular basis. There are lots of people who actually prefer to see NPs rather than MDs, and you have an opportunity to build up rapport with established patients and attract new clients to the practice.

If the doctors still aren't supportive, then this job might not be a good fit for you. Some MDs are great when it comes to working with PAs and NPs, and really value their ability to work as providers. Others just can't get past the Nurse part of NP, and will never see you as more than an RN with a little more schooling. Best to know sooner rather than later which type of doctors you're working with.

6
Up Vote Up Vote ×

Can you put together a brief in-service to share with the providers and staff outlining your education and scope of practice, and clarifying that while you want to be a team player, your team is now licensed providers? If you are alotted 20 minute slots to see patients, you don't have 5-10 to spend on rooming, waiting while someone provides a urine sample, vitals, and whatever basic intake is done before the patient is provider-ready. (But I don't need to tell you that!) I think clear communication about your role is the way to go, and sooner than later before your current struggle has turned into a you vs everyone situation.

1
Up Vote Up Vote ×

I don't understand how you are bringing the practice any revenue at all if you are seeing the pt with the MD? Who bills?

Is this one of those scams where the physician puts their face in the door for 5 seconds to increase the RVU's? And you are really doing all the work?

OK, maybe for a week or two, but you should be fairly independent, and fairly quickly.

1
Up Vote Up Vote ×

Oh wow. What a situation!

First - as an RN myself, I can not comprehend another Nurse thinking that a Nurse Practitioner is on the same level. You have earned a higher ranking and are on a different rung of responsibility.

Second - what MD doesn’t understand where an NP falls? “Practitioner” is literally in the title.

Third - and I truly don’t mean to offend the good MA’s that stay in their lane, but MA’s are notorious for falsely claiming to be “Nurses”. This creates a power struggle that does nothing good. And frankly, they should be held accountable for working outside their scope of practice, but also for fraudulently claiming to be a Nurse. (And I get some say “I work in the Nursing departmen”, etc - but when they say “I’m a Nurse”, that should be grounds for dismissal and board review).

It would seem you have 3 choices: live with it the way it is, find another job, or find away to directly address the situations to find resolution.

Good luck!

3
Up Vote Up Vote ×
+ Join the Discussion