Question from the dark side (NP wanting to hear more from you Docs)
I have 2 discussion questions I feel compelled to ask after months of being a fly on the wall in this sub:
in the acute care hospital setting, do you see any value in having specialized nurse practitioners in areas such as general surgery post call coverage or 24/7 Sicu coverage? With residents constantly rotating in and out of the unit as an intern or pgy2, and many not giving their full effort due to lack of interest etc, I have had attendings pull us aside and say “watch this patient and don’t let (insert resident name) kill them.”
I have always been pro-resident and I am happy to participate/modify my day to day responsibilities in order to further their orientation and education, including promptly taking a backseat so they get their procedure reps in, etc.. The residents and attendings are always very appreciative and I have never worked in an academic center where this mentality of “F all Np’s” existed or where it was in any way outwardly anti-NP. If anything, the mentality is we (team of NPs and PAs) are responsible for going behind resident teams, cleaning up orders, dc-ing benzos on Geri trauma patients, addressing a BG of 350+ when no SSI or glucose checks were ordered, not resuming home cardiac meds on preop trauma patients, etc. TBH, what I have witnessed more and more frequently is off service interns handling consults and Trauma activations nearly independently with absentee supervising physicians and uppers. Which brings me to question two:
- setting aside hate for mid-level providers, what is your honest experience and opinion about academic centers’ day to day culture of supervision and involvement in resident care of patients? Some of the stuff that falls through the cracks by the hands of residents on a daily basis without any conversation or repercussion blows my mind.
As an Np, I will never pretend to be something I am not, but I am proud to have 9 years of trauma and critical care experience under my belt and feel that I can be utilized in a manner that is highly beneficial to patients and attendings/residents. To add further context, I am constantly adding to my list of “oh I need to research this further and get a better understanding of \_\_\_\_” and following thru with growing upon my own education. I also never hesitate to ask questions and have great closed loop communication while caring for patients to ensure we as a team are all on the same page while treating critical patients.
I have always been able to recognize the value of each member of the care team and do not ever try to out throw my coverage while caring for patients, but I can’t help but recognize (even with bad apples in any and every profession, NP/MD alike) there are some serious systemic flaws I have witnessed day in and day out as an Np regarding physician and resident education and supervision. And lastly, I just don’t know how physicians would function in the high acuity environment that I have been immersed in for nine years without the help of Np’s writing notes, seeing consults, admitting patients, and being the 24/7 labor that is required to keep many of these sick patients alive 🤷🏼♀️. Notice I didn’t say how would they “survive“ because I know it can be done, but is that really what yall want?
For context: I am a SICU RN of 6 years turned Trauma/SICU NP since 2023 (9 years experience total) I have never called myself a doctor nor would I ever be comfortable allowing that misconception without correction before continuing the conversation with any patient/family or otherwise. I have consistently worked with surgical residents, ortho residents, and EM residents (especially rotating their month in SICU) my entire nursing and NP career.