Why do we love “home?” Why is home, despite the worn sofa with the faint but persistent odor of hound dog and the kitchen table with the varnish worn off from gazillions of spilled glasses of milk the place of satisfaction and ease?
I started thinking about this concept when recently given re-credentialing forms. At my hospital, these forms were absolutely developed and deployed for physician providers. These forms are, dare I say it, a symbolic representation of the lack of our “home” in the hospital! So often hospital or hospitalist group leaders do not know where to put us. I mean, as I have already said, I’m not a nurse; I do not perform any nursing type activities so I shouldn’t be placed under nursing per se. I’m more like a physician in my duties and my administrative needs, but so much of the language given to me in re-credentialing, orienting, communication and education is tailored specifically to physicians. We NP/PA providers just get wedged in somewhere. It can be kind of disheartening really. Aren’t we important? I mean our numbers are growing.
We are going to be here. We aren’t going away. We aren’t the most important piece, of course. But we are an important cog in the massive, slow moving behemoth of health care. So I feel there are a couple of choices. Either medical staff offices or administrations are going to have to adopt an attitude and a language of “radical inclusivity” with the word “provider” being substituted for “doctor,” or there is going to have to be an administrative home for NP/PA providers that is seperate but equal, a little home just for us. Many hospital organizations are having the foresight to do just that.
This is not just a question of language and inconvenience. I think it is hard sometimes for physicians to understand. I mean the day you graduate medical school you are a member of the “MD club.” You know who you are, you know who the club members are, you have built-in community. Also, most physicians work with other physicians; there is built in support.
An NP/PA often has a completely different experience. We are often a lone ranger. We may have other NP/PA colleagues, but often we don’t. We are embedded somewhere between nursing and medicine. It’s hard to know, when an interaction goes badly, is it just because it was a bad interaction? Or is it because we are an NP/PA? Our retention, our performance, our motivation and our self esteem suffer on this wobbly ground. We need the sounding board and support of our fellow sufferers! We long for community! We want to be acknowledged! We long for a home! Even if it smells like hound dog.
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.