Welcome to my first blog on Clinician 1! As a Family Nurse Practitioner, I hope to share some of my thoughts about “life in the trenches” as an NP working in Internal Medicine. Hopefully, you will find some tidbits thought-provoking, amusing at times, and representative of our every-day world. I welcome your thoughts and comments!
Our professional titles are our downfall in some cases.
“You’re a … what are you, anyway?” the elderly woman peered at my lab coat title through her myopic lenses. I try to explain my role as a Nurse Practitioner to her in 20 words or less. “Oh, honey, you’re SO nice,” she intoned. “When do you finish medical school, anyway?”
Or I get the question, “are you an LPN?” Or the comment, “are you practicing to be a nurse?”
Or I hear the irritating words, often used by physicians and the medical and insurance world – “mid-level provider,” or my personal most-hated, “physician-extender.” Which sounds like an obscene phrase best left to the dark recesses of an adult bookstore.
Heck, my own hair stylist, whom I’ve gone to for 10 years, asked me last month if my office will close down when my collaborating physician is on a two-week vacation next month. I looked at her and said, slowly, “No, I will still see MY patients and cover the office while he’s gone.”
We have an image problem that, despite there being 125,000 Nurse Practitioners in this country, we are not a commonly-known medical provider in the public’s eye. Unless someone has seen one of us as a patient, he or she may not understand who we are...often, after MANY visits. Yes, I tell people, we are nurses with masters or doctoral degrees, who diagnose illness, prescribe medications, order and interpret tests, and best of all, use preventative measures to keep people healthy. Sure, there’s a lot more, but people won’t hear it. They just want to know they will be taken care of in THAT moment.
Speaking of titles...the “alphabet soup” BEHIND our names is enough to give ME a headache...much less our patients. Even I don’t know what all of our different initials mean. Then the ANCC accreditation changed our board certification initials...and my state of Pennsylvania does not use the same credentials that other states do (we are CRNPs). Is it any wonder patients are confused? Me too.
But the best comment was from a patient today. I have seen him for well over a year now. He is 84, distinguished-looking in a tie and shirt at every visit. He cares faithfully for his elderly wife, whose dementia has progressed to the point where she should be in a skilled nursing unit. However, he is determined to care for her “till I can’t take it anymore...those nursing homes are awful.” After spending 30 minutes discussing his diabetes, hyperlipidemia, depression, his frustration with his wife’s limitations, and the availability of home services to help him with respite care, I finished the visit by saying, “I’m going to have Dr. B. see you next time...Medicare requires that, from time-to-time, physicians see our patients as well for collaboration purposes.” (I try to make this a yearly occurrence, so any Medicare audit will clearly show that there is collaboration.)
His response? “You aren’t a doctor?” he asked, surprised. No; I explained my role. Thought I did a fairly good job without being too long-winded.
He thought a moment, then said, sounding disappointed, “Well...I guess you’re ALMOST as good as a doctor, then.”
Ouch. How, exactly, do you respond to a patient who says that to you...and doesn’t really mean it as an insult?
My physician boss told me after the fact, “You’re BETTER than a doctor.” And while that is nice to hear from him, the fact is, from the patient’s perspective...ALMOST is a dirty word. To some people, if you don’t have the almighty “doctor” title, it just doesn’t matter. And the education goes on…
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.
Your article was incredibly accurate, and very well written. I have been an RN for over 20 years, but an ARNP for only a few months. I had a vision that I would be much more respected as well as able to provide so much more for patients as a nurse practitioner, and this is partially true. I believe that NP's approach patient care in a more holistic, caring manner. But, we are not given the respect, autonomy or authority deserved---especially in Florida. I have had similar experiences in patients not knowing what an NP is or does,or asking to see a "real" doctor. Living in a university town with a huge teaching hospital, I have also had patients tell me that we are "better" than doctors as well. But it is difficult to come together as a profession when every state has different rules and laws for practice. My suggestion is that we continue to prove our value in the care we give, and advertise for ourselves. My hope that someday NP becomes synonymous with MD.....they're just letters, right???
Anna (Tampa, FL)
on 09 Mar 2010 at 7:31 pm
I frequently consider myself the Rodney Dangerfield of healthcare. I too have a doctorate, but don't use it so as not to confuse the patients. Those patients that know us, love us, but still don't understand what we are! Many of my patients say "well, you're MY doctor" I love my patients and know we offer them excellent, often superior care but find it to be a very frustrating business. Thanks for the blog that hits the nail on the head! In Florida, we don't have DEA numbers either so we are even lower class citizens in the neighborhood of health providers.
Laura (Jacksonville, FL)
on 09 Mar 2010 at 5:42 pm
I agree about the different credentials. It seems that everyone could agree on one thing whether it is ARNP, CRNP, whatever, and leave it at that, but I know that will never happen. The different certifications can be confusing also. I mostly do not use the certification part, just ARNP.
Jo Ann (Minneapolis, MN)
on 09 Mar 2010 at 5:30 pm
I have been a P.A. for 34 years and it is no different for us We call so many other professions doctor and no one seems to be confused. I think it is time that P.A.'s and N.P.'s become Physicians and can say I am Physician Smith or how about we are M.D. I and current M.D.'s become M.D.II. Our name is a huge problem for both professions and we need to merge to add strength to both causes.
Bob Blumm (LI.NY)
on 09 Mar 2010 at 2:26 pm
It's so nice to see you contributing to this article section of Advanced Practice Jobs. I have read your posts many times before on the ACC Circle and have thought that you could add so much more by putting your thoughts down in a blog from and sharing with both professions. You put a face on the "NP" and that's important. Your article was wonderful and we share the same sentiments on the slang titles. I loved the thought on an Adult store as I have been saying similair thing for years. And mid level? What are we up to when compared to a phytsician , their waist, their ubilicus their nipple line. what the hech is mid about us----nothing at all and they know it and our colleagues have got to know it and have greater confidence in who they are and what they do,
The comment by the elderly gentlemen was almost cute, after all, he has never heard the word NP or PA and has not the foggiest, that someone other than a doctor could diagnosis and prescribe. That's our fault as well as the fault of our organizations although the AANP has been doing a superb job in the past five years of getting the word out. Bob Blumm
Angel (Milton, FL)
on 09 Mar 2010 at 2:02 pm
BRAVO-------Our title does not impress anyone with our skills, capability or rightful regard. I am a Doctor of Education as well as an FNP-C (FL), but cannot use my well earned title of Dr because it "confuses" patients. So not only do we have "NURSE" be the operative word, few realize there are many other titles of DR that have nothing to do with medicine.
What should we call ourselves..................
Thanks for a great topic
Angel
ANN (GLENDALE, ARIZONA)
on 09 Mar 2010 at 11:26 am
A lot of the reactions to these situations refect super-sensitivity to the lack of knowledge by the general public. That is our own fault as NPs. A lot of misunderstanding can be avoided by having informational pamphlets available at the time of patient check-in so the patient can understand who their provider is and ask questions based on what is in the pamphlet if clarification is needed. We tend to blame the public for their lack of knowledge when our responsibility to educate is lacking.
