I’ve had a number of supervising physicians throughout my years as a nurse practitioner. Some I’ve looked up to. Others not so much. Some physicians have served to add bricks of clinical knowledge to my ever-growing medical foundation. Others have dodged my questions. Even if you practice in a state without a supervisory or collaborative practice requirement, as a nurse practitioner you’re going to do a lot of on-the-job learning and physicians are a natural go-to in this quest to grow your knowledge.

So, aside from putting in your two-weeks notice, what steps can you take if you don’t feel like you’ve got a very supportive, helpful, [insert whatever positive characteristic you seek here] supervising physician?

Many nurse practitioners I talk with seem to go nuclear when they don’t feel supported in their roles or perceive some other offense from the MD in charge. As NPs, managerial and business skills aren’t necessarily what we’re trained to do. I for one have been tempted to quit a job for lack of support before seeking to understand the issue in greater detail. The good news? It’s entirely probable your supervisory relationship with the physician you work for or to whom you’ve been assigned can be salvaged. You may even gain some professional cred in the process. How do you go about this?

1. Recognize what the role means 

‘Supervision’ and ‘collaboration’ are very broad terms. In some healthcare institutions, these roles imply management responsibilities. In others they deem the ‘supervisor’ or ‘collaborator’ a mentor. Yet, in other facilities, supervising or collaborating physicians are essentially assigned as paper pushers for the sole purpose of fulfilling state regulations and are primarily devoid of a NP-MD relationship. So, if you as a nurse practitioner believe that a supervising physician should be one way and the MD in question sees his or her role differently, this leads to disappointment and unmet expectations.

The first thing to do if you feel like your supervising MD isn’t living up to the role you envision is to write down the things you need from him or her. Then, jot down characteristics of the role he/she is filling. Finally, note what seems to be the standard in your workplace. Are these behaviors and roles typical for your employment setting?

2. Have a conversation to delineate roles 

Once you’ve figured out where the gap in what you need as a nurse practitioner and the role your supervising physician is actually filling lies, you’ll need to discuss it. More than likely you’ll feel awkward initiating this conversation. But, consider it a moment for professional growth. If you don’t speak up, the problem won’t get solved. Avoid being defensive. Rather, approach the conversation constructively as one where you seek to understand where your supervising MD is coming from. It’s entirely possible that your supervising MD will have some feedback for you as well. Listen.

3. Get a plan of action 

Open conversations are great. Developing an action plan is even better. Identify two or three things each of you can do to improve the relationship. One action point, for example, could be you proposing the what you think the next step should be for your patient when asking a question to show that you’ve taken initiative. One example for your supervising MD might be responding promptly to texts about patient care when he/she is out of the office and you’re practicing solo. Plan a follow-up conversation in a couple of weeks to touch base about progress and see what’s working and what’s not.

How is your relationship with your supervising/collaborating physician?


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