Like it or not, in many states nurse practitioners must work with a collaborating physician. Even if your state does not require that NPs practice with physician supervision, the hierarchical nature of many medical practices and health systems has nurse practitioners reporting to MDs. These professional relationships can make or break your experience working as a nurse practitioner. Here are a six tips for navigating the NP-MD relationship.
1. Know how success in your role is measured
Measuring success as a nurse practitioner seems simple, right? Treat patients safely and appropriately and you’re in the clear. While this is certainly a part of success as an NP, your employer and collaborating physician are likely rating your performance on other measures. Speed, efficiency and productivity may be important in your role. Managerial responsibilities may fall on your shoulders as a nurse practitioner. Ask a collaborating physician how success is being measured in your position as a nurse practitioner to get an idea as to what metrics are important to your employer. This will let you know how to best allocate your time and energy.
2. Adjust to each other’s practice styles
Working in the emergency department, I have nine or so physicians with whom I work, reporting to each on a rotating basis. Each MD has his or her own practice style. Some order more diagnostic testing than others, others are quicker to consult a specialist than their counterparts. Some MDs thrive on multitasking where others work in a more linear fashion. It took me a long time to learn how to best work with each of my physician coworkers based on their practice styles.
Knowing and adjusting to each other’s practice styles is a must. Get an idea as to which of your MD collaborators prefers to be consulted on each and every patient you treat and which are comfortable with NPs treating patients independently. Understand how you both prefer to work with patients so you can use collaboration to your advantage.
3. Be aware of each other’s workflow
In a similar vein, both you and your collaborating physician should work to respect one another’s workflow. There have been times in the ER when an MD coworker is completely overwhelmed with high acuity patients only to have me, the NP, walk by tossing a few patient charts to the ever growing stack on his or her desk. A better move may have been to hold onto these patients myself until the ER slowed down, before passing them along.
Be aware of your collaborating physician’s workflow and workload. What processes will help you best work together? Are either of you bearing more of the patient care burden? If too many responsibilities fall on either party, resentment can develop. Go above and beyond to help your collaborating MD out when he/she is overworked or overwhelmed and he/she will do the same for you.
4. Ask questions
Asking questions of your collaborating physician may seem annoying or, in some cases, not be well received, but it is essential for patient safety and a working relationship. If you need assistance managing a patient, ask for help. This is particularly important for new NP grads. Even if your physician coworkers seem unapproachable or disinterested in helping you grow, safe practice is a top priority. Ask away.
5. Know your state’s scope of practice laws
At the very core of your nurse practitioner role are your state’s scope of practice laws. What are you permitted to do as an NP in your state? Which guidelines must you follow? Many of these laws dictate how you and your collaborating physician must work together. In some cases these laws stipulate that the MD must work on location while you practice. In other cases, the MD must simply be available for phone consultation. Know the scope of practice laws in your state and abide by them closely. Stay up to date with any legislative changes that could affect your collaborative agreement.
6. Give and receive feedback regularly
Set a recurring meeting with your collaborating physician. During this meeting, check in as to your performance. Discuss how you are working together to manage patients. Is your practice running smoothly? Is your communication effective? Do any of your practice protocols or processes need to be adjusted? These meetings may take no more than five minutes and a quick “Yep, everything’s great!”, but they leave the door open for feedback from both parties as needed.
How is your working relationship with your collaborating physician?
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