Physician assistant in the er

offlabel · Apr 7, 2017

What I used to see, in my time as an MICN/trauma nurse, was staff RN's that were resentful of advanced practitioners, PA's in our case, doing their jobs. They were very nice, competent people that had a job to do and a lot of us had a chip on our shoulder and could not possibly know all of the details about the backstory behind why they were ordering what they were ordering. That didn't stop the sniping though. I really regret that now.

jeshelby · Apr 7, 2017

That is an excellent point, I am certainly not speaking on their character.

JKL33 · Apr 7, 2017

Don't know how popular my opinion will be, but from my observations I believe it is directly linked to our increasing reliance on protocols and the de-emphasis of a solid exam and history - all of us, not just PAs. I see the same thing amongst nursing staff. Too many don't really focus on what's going on with this particular patient, and instead become entrapped by the pressure to initiate an order set or perform protocolized tasks in the required time frame. Need an EKG within X minutes because the patient mentioned some chest discomfort (when asked), nevermind the fact that s/he is an otherwise healthy 30-yr old with a fever and brown sputum. In everyone's defense, we have been told over and over how faulty our (collective) critical thinking is, that people the world over are dropping like flies due to all of our errors, and that the only way to improve the situation is to cut out as much human decision-making as possible. I suppose that's one way to mitigate the problem of human error, but it comes with risk for error just as you describe, and other (sometimes terrible) consequences that are simply not up for discussion.

The only thing I've found that has had any effect on my day-to-day frustration with this is communication with the provider...another thing we have become lax about. Size and layout of the department can make this difficult, but I make it a priority to touch base as early as possible regarding 'what we're thinking' about my patient. This is good for patient care, but over time also helps develop trust between nurse and provider. Don't wage battle over small things - I guess my general mantra is 'go along to get along' whenever it is reasonable to do so, saving my protestations mostly for things that have a likelihood of causing harm or making things worse or that require an unnecessary and inordinate amount of nursing time for no benefit.

Editorial Team / Moderator · Apr 7, 2017

The PAs I have worked with in the ED setting have been fabulous, I adore them! Highly individualized, I suspect, much like the skills/clinical acumen of nurses. :)

Kooky Korky, BSN, RN · Apr 9, 2017

Hi everyone,
Not trying to be negative, I have worked in several different emergency rooms, and seems that the Pa s will often over order or miss diagnosis in this setting. I don't know if maybe because they are younger and have less time in emergency room setting or something else, but it is becoming frustrating to question so many of the orders. Just wondering does anyone else see this?

The older you get, the younger newcomers will seem to you.

Or if they are new and you aren't, their ways might strike you as odd or wrong. Just try to keep the lines of communication open. Continue to advocate for the patient.