As a nurse practitioner in hospital medicine I have multiple opportunities to interact with all sorts of physician hospitalist colleagues, hospital medicine group leaders, quality officers etc. Often their interactions with me take on a certain wary curiosity, like I am some exotic monkey or another creature that is unfamiliar to them. If I am speaking with someone who has had the benefit of successful collaboration with an NP or PA in hospital medicine that same interaction may take on a particular respectful reverence. Or if the physician hospitalist has had a less than stellar experience with a NP or PA in hospital medicine there may be regret, or reluctance to connect.
I often wonder, after these interactions, when I and my other NP/PA colleagues will be seen as we wish to be seen: as highly valued and productive members of the hospital medicine team. I have been taking care of inpatients literally for a quarter of a century. I am a member of SHM and have been for seven years. I am chair of the NP/PA committee at SHM. I feel more supported and included at SHM than at any other professional organizations with which I have been involved. SHM has the wherewithal and future vision to espouse the values of the “big tent” philosophy. They know that the future includes us. It must. Yet my interactions often leave me somewhat frustrated and bemused.
When I attempt to analyze this frustration I believe the foundation of migration is simply this: language. Language is powerful. I am not a nurse. I am a nurse practitioner. I am not a “physician extender” anymore than a cornerback on the football team is a “quarterback extender.” I am not a non-physician anymore than a catcher is a “non-pitcher.” I am not a “mid level.” What the heck does that mean anyway? I am a professional, seasoned, experienced, hard-working, intelligent, energetic member of the hospitalist team engaged in the sacred and sometimes profane mission of caring for the poor and down trod, the sick and infirm, the sad and scared, just as my physician colleagues are.
Over time I have utilized many methods to heal my tiny wounds from the perceived slights. Chief of all these methods is the simple understanding that these minor cuts and bruises are rarely, if ever, intentional. I am sure my physician colleagues would be horrified at the idea they would ever intentionally cause me consternation. When these “cringe worthy” moments occur, and if I have felt a bit of sting from them, I just press the pause button, as Stephen Covey so eloquently describes, and then I think about the interaction. If time goes by and it’s still bothering me, I may find a non-stressful time to bring it up, giving the other party “the sandwich.” The dialogue might go something like this: “Hey great call on that patient the other day! Truly! Listen, I’ve been meaning to talk with you about something that was bothering me. When you were talking to that patient the other day, you referred to me as “your nurse.” I would really, really prefer that you refer to me as the nurse practitioner. I know you didn’t mean any offense by this and of course I value your support and love working with you.”
I do find it difficult to express my frustration with these flaws in language. I don’t want to be militant and strident, calling people out amongst their peers in a demeaning way. I also don’t want to let these breaches blow past as I believe these changes are the cornerstone to a larger and more definitive change in the way my NP/PA colleagues are treated and perceived. I think this issue too, is complicated by my own NP/PA colleagues who often refer to themselves as “mid-levels” without acrimony or dismay. But I feel strongly that we must identify ourselves with accurate reflection. I guess the best option is for all of us, gently, professionally and one on one to demand and expect, from ourselves as well as others, to be named for what we are: Nurse Practitioners and Physician Assistants in hospital medicine.
Tracy Cardin, ACNP-BC, SFHM is the Associate Director of Clinical Integration at Adfinitas Health and also serves on SHM’s Board of Directors. Prior to this, she was the Director of NP/PA Services for the University of Chicago and worked in private practice for a group of excellent pulmonologists/intensivists for over a decade. She has been a member of SHM for over ten years and has over twenty years of inpatient experience, which seems incredible as she cannot possibly be that old! Her interests include integration of NP/PA providers into hospital medicine groups and communication in difficult situations.
In her free time, she likes to run and lift, read and write and hang out on the front porch of her semi-restored Victorian house with her dear family and friends while drinking a fine glass of red wine and listening to whatever music suits her whimsy.