collaboration--your help is needed

I am planning to spend most of this weekend writing a chapter on NP/physician collaboration for a resource book by and for nurse practitioners. I would love to hear from my readers any insights, impressions, beliefs, concerns about the collaborative nature of practices that involve NPs.

If you are an NP,

I would love to read how you have found your relationships with various physicians with whom you have worked. Are they interested in collaboration or do they have other reasons for working with an NP? What are the barriers you have found to NP/doc collaboration? How have you worked to overcome those barriers?

If you are a doc,

what are your impressions of how docs and NPs collaborate? Is this something that you believe to be advantageous to your patients, or does it interfere with your independent practice of medicine? Do you have NPs in your practice? If so or if not, I would love to know why. Are there barriers to collaboration, and if so, do you have suggestions for how to overcome them?

If you are a patient/or the parent of a patient who receives care (in-patient or out-patient) from a system or group that includes NPs

tell me your impressions of whether and how the NP and the doc work together. Do you feel that there is collaboration or do each of the members of the health care team work in isolation?

I realize that these responses will not constitute a scientific sample and that I will not be able to draw conclusions from them. But I want to be able to understand how some perceptions might differ from what is in the literature. I believe that perceptions, attitudes and behaviors have changed over time, but if I don't have input from my readers I won't necessarily know by how much, or if we are truly making progress.

If you have something you want to say, but not in a public forum, please sign in and leave me a message to contact you, which I will do by email (no one can see your email address except for me).

Thanks, every one for your help.

Recent Comments

I think it depends on the situation too though...for example (in the outpatient situation I described to you by email) would a doctor work better as a team in a hospital setting where they are rounding as a team? In the outpatient setting, the doctor was likely not even there or was possibly with another patient.

In our experience, the NPs and Docs have worked well together. In pediatrics in particular, my personal opinion (and not necessarily scientific at all) is that the NPs are often women and more sympathetic to peds patients and their families. But we've had some great docs too. :)

Thanks for the comment and insights, Lauren. One hopes that physicians can be as sympathetic and empathetic as their Nurse Practitioner counterparts. I am glad you have had good experiences. Thanks again.

From my perspective, it is completely dependant upon the doc. Those docs that are collaborative with other docs in their and other specialties are also collaborative w/ NPs. Those that are not, are not. It is in the make-up of the personality of the physician. They are either independant minded or collaborative by nature. It can probably be learned, but the motivation needs to be there, and backsliding is common. I'm sure the same can be said for NPs, but I bet you a nickel, it is less of an issue.

Yes, personality has a lot to do with it. But somehow that is never addressed in any of the literature I have read. It all talks about educational background and lack of knowledge about the role, as well a communication and respect. But I guess the docs who tend to not respect their NP (or PA) colleagues may also not respect other docs, etc.
Thanks for coming by and for taking the time to leave a comment.

In my personal experience as an NP I believe that it is not only individual (and thus personality) driven, but I also feel that the willingness for collaboration is driven by the environment as well. I have worked as an NP in 2 different environments, both of which utilize NP's. The first of which was in the ED where I was met with both "collaborator's" and "non-collaborator's" of working with an NP/PA. Those who were not privy to collaboration were those described above as the more independent type person (again, personality likely). They were those who were usually traditionalists and didn't conform to change well and simply felt they practiced better alone. I did find however that many MD's who at first may have been a little hesitant with working with an NP began to realize the value in which they can be and soon began to embrace it! As NP's become more numerous and advanced in education (DNP)in the future, I can only hope that more and more MD's will come to favor the value an NP can provide in the care they offer their patients... collaboratively.

Thanks, Vanessa. So you think that some docs can actually learn to be more collaborative. You also mention the NP asserting her or his added value. I think that is very important. As an NP you yourself have to understand the value you bring to healthcare and how your role is different but complementary to the role of the doc. You can both work toward the same goal but use different skill sets and talents.

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About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

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