Warningsign

Funny this was posted because in my ER in AZ there's a huge storm brewing with the FNPs. We have an FNP who is incredibly arrogant and acts like she knows everything and did an online program. She sees a crazy number of patients and brags about it - even hypoxic and hypotensive and septic patients, chest pains, DKA. She doesn't staff her cases with physicians. Many physicians have complained about her and went on a huge rampage trying to prove she is working beyond her scope of practice. Which she is. The laws clearly state that if she wants to work with complex or unstable patients she needs an acute care NP certification. Which she doesn't have. It's sad because she's ruining things for the other FNPs in the ER who are quite good and thoughtful in their work. However, good or not it doesn't seem like it's in an FNP scope to work ER unless they're just working fast track.

My attendings do agree with most of my work ups, actually, and that is what can be hard about all of this nurse frustration.

Oh my GOD, I love you guys! Thank you for your thoughtful responses. I appreciate the perspective of the nurses wanting to take care of the sicker patients. I have been viewing nurses NEGATIVELY for wanting to push my patients out of the department so fast but now I realize it is because they want to keep up the efficiency and make room for the sicker patients that walk through the door. I hate to admit this but when I have patients I solely focus on them - I am not concerned about who is out in the lobby because I figure the real sick ones will be brought back to a physician's zone. It helped me to hear this perspective because now I will know that when a nurse is impatient with my delayed discharges it may be coming from a positive place. It also helps me to realize that I need to also be more focused on those patients out in the lobby and what I can do to get them back. Sometimes I do forget that I did not order something and order it 45 minutes later. I assumed that the nurses are too busy to even notice that, but you are probably right that it is an annoying trait. I like the suggestion about ordering all the pain meds at once. Sometimes I will order an ibuprofen...then a Lidoderm patch...then Percocet because I keep reassessing my patients and realizing their pain isn't controlled. I think it is a good thing I am reassessing but it might also be best for me to order as much as I can up front. Another thing I realized is I don't make time for small talk with the nurses. I don't make time for small talk with anyone. I keep myself so busy that every single minute is valuable. I somehow need to learn to slow down. What other tips do you guys have for us providers? Anything else?

I am a PA working in the ER. Relatively new PA, doing this for about two years. perhaps I need thicker skin but some days I come home defeated as on certain days, especially busy days, I feel like I am annoying or frustrating the nurses I work with. One thing I do is I really do thorough work ups and I have overheard that some of the nurses feel what I do is over the top (ie too many tests). Other nurses have gotten annoyed at me for not discharging patients fast enough. Last week I had an old lady with low back pain who couldn't walk at discharge due to pain so I asked to hold off on discharge until more paid meds were ordered. I feel what I am saying is reasonable but it doesn't take away the sting of feeling as though the nurses are frustrated with me. what kinds of things do providers do that upset or annoy you as nurses? What kind of providers do you love to work with? I could use some tips.