 Provided by Clinician 1
Every day, I come across some new tidbit of knowledge. OK, some days, it’s more than a mere “bite” of information. If I don’t know something, I research the information...through the variety of internet resources, and even my decades-old textbooks that I still page through (while marveling at the fact that I actually read and highlighted most of them).
So with this in mind, it bugs the HECK out of me when I come across a provider who will not do the same. Who can honestly say that he or she knows everything? Guidelines don’t change? Research doesn’t show that there are better, newer treatment options? We are held accountable to the standards by which a “prudent” practitioner (insert NP, PA, or MD/DO) would practice. Therefore, I think it goes without saying that our education continues long after we hang our diploma on the wall. Or throw it in a musty closet.
We also fight continuously against the common public misconception that “only your doctor” can treat/prescribe/diagnose conditions A through Z. Anyone who has read my prior blogs knows that I spend a fair amount of time educating patients on my role. In my current practice, I also have spent a good amount of time, particularly my first six months, UNDOING the damage that my predecessor did. Not that I have anything against her...she was a new graduate, feeling her way among a high-acuity internal medicine practice. It is a huge mountain for anyone to climb, including THIS seasoned NP after many years of practice.
However, I take umbrage against any provider who refuses to do the right thing, including order the correct tests, because she says, “I don’t know how to interpret them.” ESPECIALLY when said provider SAYS IT TO THE PATIENT.
Case in point: my optometrist husband has practiced for 16 years. I will say this—and NOT because I have been with him for two decades—he is extremely astute, very accurate, and careful to look at the “big picture” when treating eye ailments. So when a woman with a unilateral uveitis turned into a bilateral presentation that was difficult to treat...he started looking for a possible systemic reason why she had the problem.
After MULTIPLE visits, he sent her back to her PCP, with a prescription in hand, stating her diagnosis and noting which tests should be ordered to look for a systemic cause. Three separate times, she came back to see him for follow-up. Her primary care doctor had been away, and according to the patient, the nurse practitioner in the office “wouldn’t order the tests, because she didn’t know how to interpret them.”
WHAT?! My husband and I were stunned.
Um...where was her collaborating physician...or back-up? Did she not know how to open a lab manual? Did she not know how to refer to a specialist if the rheumatology or other labs were abnormal? Who was this NP who was acting like a student, instead of a professional?
While the patient’s uveitis is improving (SLOWLY, after 4 weeks), she is so frustrated with how she has been treated by the NP that she plans to leave the practice.
In hearing about this, I, too, am disgusted. And angry. Not only because it’s the PCP’s responsibility to order these tests (because in Pennsylvania, it is difficult for optometrists to follow-up with testing)...but because it is a classic example of Nurse Practitioners can look like blathering idiots if they don’t act or know what they are doing (or look things up)...and appear unwilling to help. And that makes ALL of us look bad.
Not once did the NP bother to call my husband for any consultation or clarification. Oh, yes, doctors do this too, but in my humble opinion, we need to go the extra mile in situations like this. I’ll bet that the patient will remember it was the “mid-level” (still hate that term) that didn’t know what to do...and if her doctor had been around, things would have been handled.
So now, the patient now has a dim view of what we nurse practitioners offer to our patients. How many other family members and friends did she talk to? Bad news always travels farther than good news. I told my husband to have her come to our office if she wants to transfer.
Then I thought about it, and I changed my mind. I told him, no, please don’t send her to us. Because, want to bet she won’t want to see me? Then I’ll have to work twice as hard to “prove myself.” Again.
 Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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