Physician Hostility

Specialties NP

Published

Why are so many physicians threatened and hostile toward NPs? What are the strategies in dealing with these types of professionals,and in what ways can we make it easier to practice together?

I'm so tired of these debates and arguments--why can't all the doctors just go back to their sandbox (bulletin boards), and get out of this one? I welcome input on clinical issues where useful knowledge is shared, but this is getting ridiculous. I think I'm just tired and cranky tonight, so I'll just hush and go to sleep on that note. :rolleyes:

A little cut and paste of 3 messages from the studentdoctors.net message board of 3 of PACtoDoc's postings (just search by author or look in the PA forum), who was posting in this thread as PA-C,DO. When all many seek is discusion and peace, this is certainly a sad commentary.

#1

"NP's are scary!!

Holy crap guys, if you want to see a group of crazy renegades, take a stroll over to allnurses.com and peruse their NP forum!! These people truly have no clue about medicine and scare the living sh%% out of me! These people really do think they are the equivilant to physicians, and they think PA's are sub-par. I even tried to have an intelligent conversation with them but its like fighting a group of illiterate inmates!! They have power in numbers and it is truly scary that with one sign of the pen, the nursing boards can dictate practice however they like it!!!"

#2

"Holy triple sow cow!! I went incognito over to the allnurses.com web forums and hung out in the NP forum for awhile. You want to talk about a group of people who hate the world, most especially doctors and PA's!!! Go check it out in a stealth way. I was the guy posting as PA-C, DO, and read what I wrote. I wasn't even being rude, but I got banned from posting further responses. These women are locked and loaded and ready to take aim at anyone not bowing down to their profession. Go check it out!!!

http://www.allnurses.com

then choose the discussion board. It is amazing how they think!! They must think under the nursing model even in their daily lives"

#3

"Funny thing is MDterminator wrote me a private message telling me that he was going to be going to medical school because he just realized after my post that an FP can do OB and minor surgery in the rural areas. What an epiphany!! He told me not to tell anyone he had written me because he would get banished from the NP forum forever!! So I better not tell anyone"

I am a lowly ADN RN. However, I often have to care for pts without physician involvment or input, and I've had to do so for most of my 12 year nursing career.

Simply put, most docs just do not want to be bothered with their pts needs and concerns.

I resent having to act alone, and yes, write orders that the docs sign weeks later, without even looking at them.

It is very unfortunate that many docs yell at nurses, hang up on them, or just talk over them without listening to what is going on with the pt.

If only we could work together, collaborate for the benefit of our pts.

I think it would be very beneficial to everyone involved if medical school curricula included classes on nursing- what it is that nurses actually know and do- as well as classes on promoting positive nurse-physician working relations and collaboration. Lectures on the "nursing shortage" and the physicians' role in creating the pseudo shortage would be wonderful.

I am a lowly ADN RN. However, I often have to care for pts without physician involvment or input, and I've had to do so for most of my 12 year nursing career.

Simply put, most docs just do not want to be bothered with their pts needs and concerns.

I resent having to act alone, and yes, write orders that the docs sign weeks later, without even looking at them.

It is very unfortunate that many docs yell at nurses, hang up on them, or just talk over them without listening to what is going on with the pt.

If only we could work together, collaborate for the benefit of our pts.

I think it would be very beneficial to everyone involved if medical school curricula included classes on nursing- what it is that nurses actually know and do- as well as classes on promoting positive nurse-physician working relations and collaboration. Lectures on the "nursing shortage" and the physicians' role in creating the pseudo shortage would be wonderful.

i was just wondering what you mean by "the physicians' role in creating the pseudo shortage"

"i was just wondering what you mean by "the physicians' role in creating the pseudo shortage"

http://www.expresshealthcaremgmt.com/20020715/international1.shtml

Study says 'disruptive physician behavior' has contributed to nurse shortage

As healthcare staffing studies continue to paper the industry with startling statistics, yet another one is highlighting what could be a big problem for nurse retention: doctors.

Despite relying on nurses for important caregiving functions, physicians may be driving them away from the profession, according to a new study by healthcare alliance VHA. And if Irving, Texas-based VHA is right, the exodus of dissatisfied nurses comes as a healthcare workforce shortage reportedly grows.

Citing as one of the factors that contributes to low morale among nurses, the study said 30 per cent of nurse respondents reported knowing of a nurse who had quit because of poor treatment by a physician. '

Like the American Hospital Association and other groups that have addressed the staffing problem with studies and strategic recommendations, the VHA believes its study on the physician-nurse relationship helps to identify root causes of the nurse shortage that are often difficult to discuss or even recognize. Rosenstein said he had trouble finding information on the possible link between physician behavior and nurse satisfaction. Seeking answers, he launched the study in part to ''develop policies to deal with it.''

The VHA report reflects responses from 1,200 nurses, physicians and healthcare executives at VHA hospitals. Rosenstein said 92 per cent of respondents said they had witnessed disruptive physician behavior, such as inappropriate conflict involving verbal or even physical abuse of nurses. All the respondents identified a direct link between such behavior and nurse recruitment and retention challenges. Yelling and ''condescending behavior'' constituted the vast majority of the abuse doctors inflict on their nurse colleagues, Rosenstein told Modern Healthcare. Nurses who have seen such behavior in their daily work weren't surprised to hear that it can affect nurses' satisfaction with their jobs, and even whether they decide to stay. ''Nurses aren't (physicians') subordinates (who) they can treat with disregard when they're having a bad day,'' said Erin Murphy, executive director of the 16,000-member Minnesota Nurses Association. ''Once nurses say this is not right, I think the physicians will change.'' Murphy, a former practicing nurse, said ''degrading and insensitive'' behavior is all too common among physicians, who tend to ''view themselves as the leader of the healthcare team and think other team members should be able to deal with their outbursts.''

The study also cited a disconnect between nurses and physicians, saying that when physicians think their behavior is acceptable or improving, nurses don't necessarily view it that way. Long-held habits, healthcare team. ''It is a team, but it's hard for some of the older physicians to adapt to that because they're used to just giving orders and leading the floor,'' said Peter Halford, M.D., chief of staff at Queen's Medical Center in Honolulu.

Halford, who reviewed the VHA study, said the collaboration necessary to prevent disruptive behavior is much easier said than done. The relationship between doctors and nurses is ''like a marriage,'' Halford said. ''You have to continually look at what you can do to promote communication, which translates into safer, better, more efficient care.'' Halford cautioned that although the VHA study highlights an important problem, physicians' treatment of nurses is not the only factor in their diminishing morale. Nursing, he said, ''doesn't pay what it should given the amount of work and stress involved, and the physical and mental demands. It's a tough job. You have to be on your toes.''

With nationwide staff shortages haunting health system executives, VHA earlier this year released another study suggesting the workforce shortage is unlike any before it, and that hospitals must address the problem to prevent sinking morale from negatively affecting financial performance, quality of care, customer satisfaction and market position. The study is similar to one conducted earlier this year by the AHA, which found 84 per cent of hospitals were experiencing a registered nurse shortage. VHA's report characterizes the healthcare workforce shortage as ''not a short-term blip, but a long-term crisis.''

(Source: Modern Healthcare Magazine)

http://www.nursingworld.org/AJN/2003/march/health.htm

Health & Safety

American Journal of Nursing - March, 2003 - Volume 103, Issue 3

Verbal Abuse in the Workplace

How to protect yourself and help solve the problem.

By Vicki Carroll, MSN, RN

A few doctors at my facility verbally abuse the nurses. As a result, some nurses suffer from stress-related illnesses and find it difficult to come to work. How can we address this problem and protect ourselves from more abuse?

Verbal abuse in the workplace must not be tolerated. Violence often begins with verbal abuse and escalates to physical abuse. In surveys over the past several years, nurses have said that patients, physicians, and other health care workers yell, swear, intimidate, demean, publicly scold, and sexually harass them. In addition, 82% to 90% of 1,000 nurses surveyed in at least seven states included verbal abuse in their definition of workplace violence.

Alan Rosenstein's report on the nurse-physician relationship (AJN, June 2002) indicated that daily interactions with physicians strongly influenced nurses' morale. Carol Farina, a Denver psychiatric clinical specialist who has facilitated communication for health care teams, states, "When nurses experience abusive treatment by physicians and feel unsupported by administration . . . they are left feeling powerless to respond appropriately. Staff members may harbor resentments for being treated disrespectfully, which can manifest as any one of a number of psychological symptoms, including anxiety and depression, as well as somatic complaints such as GI symptoms and headaches."

Verbal abuse can lead to staff turnover. An analysis of the first 1,200 responses from nurses, physicians, and hospital administrators in the Rosenstein study indicated that all respondents directly linked disruptive physician behavior and nurse satisfaction and retention. Verbal abuse can also affect the quality of patient care. Research since the 1980s has indicated that when collaboration between nurses and physicians is promoted, patient care improves, often with fewer costs.

What can you do? Try not to react emotionally to arrogant, hostile, or condescending behavior. Remain courteous and professional, and concentrate on the issue. One helpful question to ask is: "If we were looking for a solution to this issue, what would we be doing?"

Report the incident in writing as soon as possible to your immediate supervisor. If the incident is not addressed satisfactorily, consider filing a formal complaint with the peer review committee. In 2001 the ANA released its Bill of Rights for Registered Nurses, which states: "Nurses have the right to a work environment that is safe for themselves and their patients." Cite these rights when asking your administrators to address the issue of verbal abuse. Ask them to offer training in the management of aggressive be*havior; institute a conflict resolution program; and develop a disruptive conduct policy, which should have a formalized peer review system and outline clear consequences for unacceptable behavior. Consider eliminating "zero tolerance," which translates as arbitrary, unfair, and without the opportunity for reasonable and careful decisions. Instead, consider posting policies or "no violence" signs.

Nurses and physicians must be able to relate to each other with respect and professionalism. To be part of the solution, nurses must not excuse or tolerate abuse. Use these and other strategies to make your workplace safer and healthier and to enhance patient outcomes and professional satisfaction.

Resources

See Issues Update on page 65 to learn how the ANA's Commission on Workplace Advocacy and nurses are addressing verbal abuse. To order the ANA Bill of Rights for Registered Nurses poster and user guide, go to http://www.nursesbooks.org or call (800) 637-0323.

Vicki Carroll is a clinical instructor at the University of Northern Colorado School of Nursing, a consultant in the area of health care workplace violence, and a member of the Colorado Nurses Association and the ANA Commission on Workplace Advocacy.

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http://www.nursingworld.org/AJN/2003/march/health.htm

Health & Safety

American Journal of Nursing - March, 2003 - Volume 103, Issue 3

Verbal Abuse in the Workplace

How to protect yourself and help solve the problem.

By Vicki Carroll, MSN, RN

A few doctors at my facility verbally abuse the nurses. As a result, some nurses suffer from stress-related illnesses and find it difficult to come to work. How can we address this problem and protect ourselves from more abuse?

Verbal abuse in the workplace must not be tolerated. Violence often begins with verbal abuse and escalates to physical abuse. In surveys over the past several years, nurses have said that patients, physicians, and other health care workers yell, swear, intimidate, demean, publicly scold, and sexually harass them. In addition, 82% to 90% of 1,000 nurses surveyed in at least seven states included verbal abuse in their definition of workplace violence.

Alan Rosenstein's report on the nurse-physician relationship (AJN, June 2002) indicated that daily interactions with physicians strongly influenced nurses' morale. Carol Farina, a Denver psychiatric clinical specialist who has facilitated communication for health care teams, states, "When nurses experience abusive treatment by physicians and feel unsupported by administration . . . they are left feeling powerless to respond appropriately. Staff members may harbor resentments for being treated disrespectfully, which can manifest as any one of a number of psychological symptoms, including anxiety and depression, as well as somatic complaints such as GI symptoms and headaches."

Verbal abuse can lead to staff turnover. An analysis of the first 1,200 responses from nurses, physicians, and hospital administrators in the Rosenstein study indicated that all respondents directly linked disruptive physician behavior and nurse satisfaction and retention. Verbal abuse can also affect the quality of patient care. Research since the 1980s has indicated that when collaboration between nurses and physicians is promoted, patient care improves, often with fewer costs.

What can you do? Try not to react emotionally to arrogant, hostile, or condescending behavior. Remain courteous and professional, and concentrate on the issue. One helpful question to ask is: "If we were looking for a solution to this issue, what would we be doing?"

Report the incident in writing as soon as possible to your immediate supervisor. If the incident is not addressed satisfactorily, consider filing a formal complaint with the peer review committee. In 2001 the ANA released its Bill of Rights for Registered Nurses, which states: "Nurses have the right to a work environment that is safe for themselves and their patients." Cite these rights when asking your administrators to address the issue of verbal abuse. Ask them to offer training in the management of aggressive be*havior; institute a conflict resolution program; and develop a disruptive conduct policy, which should have a formalized peer review system and outline clear consequences for unacceptable behavior. Consider eliminating "zero tolerance," which translates as arbitrary, unfair, and without the opportunity for reasonable and careful decisions. Instead, consider posting policies or "no violence" signs.

Nurses and physicians must be able to relate to each other with respect and professionalism. To be part of the solution, nurses must not excuse or tolerate abuse. Use these and other strategies to make your workplace safer and healthier and to enhance patient outcomes and professional satisfaction.

Resources

See Issues Update on page 65 to learn how the ANA's Commission on Workplace Advocacy and nurses are addressing verbal abuse. To order the ANA Bill of Rights for Registered Nurses poster and user guide, go to www.nursesbooks.org or call (800) 637-0323.

Vicki Carroll is a clinical instructor at the University of Northern Colorado School of Nursing, a consultant in the area of health care workplace violence, and a member of the Colorado Nurses Association and the ANA Commission on Workplace Advocacy.

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very interesting and rather disturbing....i think i would be looking for a job somewhere else if i was in an environemnt like that....

our best friends are both physicians and they would never do anything like that.....and my spouse has never been in a situation like that and she has been practicing awhile...

Posted by tjjs: In our nursing class, not NP but RN, we had a man who was a DR, who taught A&P, Patho, etc at the university who wanted to be an RN.

Reminds me of Wilfried Rappenecker, a German M.D. who now primarily practices Zen Shiatsu which we all know is preferred over allopathic medicine and nursing!

Reminds me of Wilfried Rappenecker, a German M.D. who now primarily practices Zen Shiatsu which we all know is preferred over allopathic medicine and nursing!

Hi all. I came over here to this board because I wanted to try and foster a better image of PA's and medicine in general with some of the nurses. I honestly never knew that there was this much hostility between nursing and medicine before I attended a state NP meeting and heard all of the vitriolic garbage about the conflict between the two groups. It seems that this also goes on in medical circles judging from some of the posts in this forum from other boards. Honestly, it had never occurred to me that there was so much conflict because I have NEVER experienced it in my years of school or practice.

I never denigrate the education of NP's because I believe they have an important role in health care. However, I often hear PA education referred to in a way that conjures up images of driving up to DeVry Institute and having them throw a diploma in the back end of your pick-up truck. That is neither fair nor accurate. In Texas, the length of PA curriculum exceeds that of NP students by an average of three months. In addition, the average amount of clinical time exceeds that of Texas NP programs sometimes as much as four-fold. This is not to say that NP's have lesser education. They are almost all RN's before they attend a master's degree program, and so the longer PA program is used to compensate for that even though almost all persons accepted into PA programs are either paramedics, respiratory therapists, nurses, or something related.

I do not have the knowledge base of a physician and neither do any NP's that I have ever known. Does that make our skills less valuable? No, but I am not so bold to believe that I can ever replace the physician as the ultimate authority in medicine. I feel I could practice independently (I pretty much do anyway) and do just fine, but I am not so eager to abandon the physician/mid-level relationship as some of you are. Many of you speak of physician hostility, but I am curious whether MSN programs foment this hostility on the nursing side. If you look at an M.D. or D.O. as someone who is holding you back, it is easy to create tension and anger, but if you look at them as a resource who probably is more informed than you are, and treat them with the respect that you wish to receive, productive relationships can evolve.

I chose medicine because I believe in the medical model. Some of that is probably a function of working in emergency medicine before becoming a PA. Feeling someone's pain really does not help them when they are in asystole due to hyperkalemia and you are trying to set up an emergency hemodialysis, but patient education is something that physicians don't usually do very well.

For all of you who claim physicians are holding you back or are rude, etc., remember that when they look at you, they see someone who wants to play the same game but not do the time, and the situation is never going to improve if the 'holier than thou' attitude continues on both sides. I will diagnose and treat pneumonia just the same as the rest of you, but for some reason, we choose to focus on distinctions rather than commonalities.

Aloha PA-C. Your comments, while valid, do not go with my quote. I was making the point that both you guys(NPs and PAs) are not the only game in town! I'm not a doctor nor a NP/PA and I have no idea why there is so much hostility among the groups. As I've said before (in jest) "I'm not racist, I hate everybody!" The medical model is another story alltogether...well our entire healthcare system...and one that really needs reworking. I'm now more interested in Eastern modalities and their focus; the Western model is just too boring for me after 30+ years. Of course, I've had the scapel applied to me several times and that is why I think both systems need to work together. If I need cutting on I prefer the Western model; for keeping myself in shape and avoiding the need for the Western model or for chronic conditions I prefer the Eastern model. Maybe now would be a good time for you NPs and PAs to discuss how you are similar and how you look at a patient. Then when you are stumped or your patient does not get better...just call me...Dr. (Hon) Feelgood!

Aloha PA-C. Your comments, while valid, do not go with my quote. I was making the point that both you guys(NPs and PAs) are not the only game in town! I'm not a doctor nor a NP/PA and I have no idea why there is so much hostility among the groups. As I've said before (in jest) "I'm not racist, I hate everybody!" The medical model is another story alltogether...well our entire healthcare system...and one that really needs reworking. I'm now more interested in Eastern modalities and their focus; the Western model is just too boring for me after 30+ years. Of course, I've had the scapel applied to me several times and that is why I think both systems need to work together. If I need cutting on I prefer the Western model; for keeping myself in shape and avoiding the need for the Western model or for chronic conditions I prefer the Eastern model. Maybe now would be a good time for you NPs and PAs to discuss how you are similar and how you look at a patient. Then when you are stumped or your patient does not get better...just call me...Dr. (Hon) Feelgood!

Sorry. You are right. I just hit that little reply button in the bottom right hand corner and it quotes the last post.

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