6 Tips for Working Effectively with Collaborating Physicians

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?

 

You Might Also Like: Confessions of a Former New Grad Nurse Practitioner

 

Comments

I wanted some advice, I have been practicing for 18 years and I was trained differently from the newer younger nps, I was working in a small town hospital that initially hired me full time for an np role in a clinic. When I started orientation I found out I was actually going to work two days out of the week alternating with another np but I was given the option to shadow an emergency physician in order to get familiar with how they do their routine. The emergency doctor was helpful and eager in shadowing me and answered all the questions I asked. While I was still in the early orientation phase I was introduced to my collaborating physician who did not seem very social and even seemed distant. I orientated with two other mid- levels who did an excellent job of showing me their routine but when I stopped to introduce myself to my collaborating physician a female she did not seem receptive at all. I started asking her if she was expecting as far as working together, did she want me to do nursing home rounds, follow her to the medical floor during rounds to become familiar with her style of ordering and admitting patients and so forth, the first thing that she said was "did they give you the job duties?" Mid-levels are only required to work in the clinic and emergency room and stated you can ask I'll call her Mindy if you can shadow her!!! Wow! Fast forward, I finished shadowing the ER physician and start the ER by myself for the first time. In the past when I trained with my past collaborating physician I discussed my case with him and relay to him what medication I were going to treat the patient with, wether it be IV medication or oral meds he was comfortable with me talking to him about it. The physician who was my backup during my first hours working in ER was very helpful and mentoring, I mentioned to him that I usually talk to the collaborating physician and asked him if for example a case of atrial fib with rapid ventricular response he used cardizem IV because having worked with an older doctor, he used digoxin IV push, he stated cardizem and I monitored the heart rate and told him that the patient would be admitted. This went well, now during a weekend I worked in the ER and with my training I called my collaborating physician who is on call for admitting patients, the distant female and informed her I will have the admit written history and physical since I had no access to the electronic charting computer in the hospital. Unbeknownst to me this apparently infuriated her and she came to the emergency room and yelled. Later I was called to the administrators office stating I was terminated because I asked too may questions and two physicians felt I did not have the confidence to do the emergency room! Earlier they stated I could train in the ER and if I did not like it to remain working in the clinic as originally planned! I would like someone's opinion regarding this situation.

Jan c.

Having worked for many years with physicians, there are definitely good ones and bad ones, as we all know. The majority of physicians simply want you to help them with their case loads, period! How I medically managed patients was of no real concern to my fellow colleagues. Don't misunderstand, I was more than committed, in my career, to the patients I have treated, affording them every opportunity to be evaluated by those more knowledgeable; family practice and other specialties. I certainly would rather another provider criticize me for referring a patient for nothing than hurting an individual because I wanted to appear the expert. Now retired, thankfully, looking back and seeing how often I was disrespected by my fellow "supervising" providers, I can only hope that the NPs now are having experiences unlike the ones I had. I did, occasionally, meet a specialist who appropriately considered my medical expertise. Sad that those within my family practice group did not follow suit. In my State, the regulations require that an NP have an MD supervisor, but the gap between the two disciplines is widening, almost to the point of total independent practice for the NP. The practice of medicine requires extensive knowledge and training, but it also requires common sense and practicality, and for the best practitioners, intuition and respect. The last two characteristics, especially, are common to NPs. Without those you can only achieve mediocrity at best. If the physician with whom you work is lacking those, then, unfortunately, the "6 Tips for Working Effectively with Collaborating Physicians" may or may not even scratch the surface.

Jean Black

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