I’m no shrinking violet. When I get an idea in my head, I’m like a dog with a bone, I don’t let go. And I have been crowing like a rooster forever about NPs and PAs and how life affirming and awesome we are; how we bring the party to the party; how anyone’s practice could be smoothed out, enhanced, lifted, tightened, tucked made more glamorous and younger simply by our appearance. All we had to do was show up and the practice would instantly be blinded by our supreme fabulousness! I berated countless numbers of hapless physicians about hiring an NP/PA to the point of boring those poor sweet people to death! Every time I heard of one our kind being hired I would feel a little thrill, do a little happy dance, hear all the little Who’s down in Whoville scream out, “We are here! we are here! we are here!” Another blow against the Empire. Vive la resistance!
Ok maybe that is a slight exaggeration.
But only slightly.
Because it truly didn’t matter to me, at least it didn’t used to, how we were utilized or analyzed or evaluated. It just mattered that we finally had a ticket into the room. Forget the damn table, I will just stand in the back of the room!
But obviously that is just not the case. And to quote Ron Greeno’s blog post: If you don’t have a seat at the table, then you are on the menu.
Right now, we, as NP/PAs are on the precipice of change. We really are. You don’t even have to consult your Magic 8 ball to know “it is decidedly so”. We can no longer just show up to the room and expect that to be enough. No we cannot.
We have to be part of the newer design and system that supports quality outcomes. We need to actually know how to best utilize our skills to maximize our efficiency and reduce our costs. We need to understand where that optimization occurs, where skill set meets patient population in a very thoughtful and efficient way. We have to get on board with demonstrating that our outcomes in readmission, length of stay, CAUTI, etc are, dare I say it? Superior! We need to learn the culture of ownership. We need to get away from the idea of just showing up and exiting; we need to OWN our responsibilities and our privileges; we need to OWN our impact and make changes where they are needed.
The Affordable Care Act (ACA) is a great chance for us to implement systems that let us truly show our worth and capabilities in a corporeal way. The American Academy of Nurse Practitioners is helping NPs understand what the roll-out of the ACA will look like and how we can help through the changes. On a different level, we need to help hospital medicine group leaders understand why they should hire us and how we will impact the quality, cost, efficiency and outcomes of their programs. At Hospital Medicine 2014, I presented a precourse entitled, “NP/PA Playbook in Hospital Medicine” which is designed to help group leaders and others develop a framework to determine how to approach these issues when hiring NP/PA team members.
Note the paradigm shift: The room is not enough; now we want to sit at the table.
Or maybe at the head of the table.
May the force be with you!
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.