Why It's OK to Want a Supervising Physician

There's a movement in the nurse practitioner community to eliminate existing state requirements that NPs be supervised by or collaborate with physicians. Nurse practitioner organizations are engaged in the fight for nurse practitioner independence. While there is merit to the argument for expanding the scope of practice for NPs practicing in many states, working alongside a supervising or collaborating physician isn't always a negative. 

Throughout my nurse practitioner career, I have always worked closely with physicians given the nature of my practice environment. Overall, my experience with the hierarchical healthcare system hasn't been a bad one. I am thankful for the assistance providers of all kinds with more education and experience than I have provided me as I have grown as a nurse practitioner. My value as an individual and a professional is not diminished given the fact that state laws and my employer require NPs to have physician oversight. Rather, in my personal experience, collaboration with MD coworkers has been as asset to my career. Here's why. 

Decreased Day-to-Day Stress

Acting as the ultimate decision maker when it comes to caring for patients is no easy task. Healthcare inevitably involves a significant amount of background knowledge, weighing positives and negatives, and making serious, sometimes life-altering decisions for others. While I am able to care for patients in these scenarios independently 90 percent of the time, it's a stress reliever to have a designated point-person to go to for a second opinion or to ask questions as needed. 

Sharing of Managerial and Operational Responsibilities

Working as an urgent care nurse practitioner, I was employed by a physician owned practice. Now, as an emergency department NP, I am employed by a physician owned ED staffing company. As a nurse practitioner in my state I could similarly open my own practice. But, this simply isn't appealing to me. The associated managerial and operational tasks of owning a clinic aren't something I enjoy. So, employment by a physician practice owner and collaborating MD is appealing. The arrangement allows me to focus on patient care rather than staffing, billing and accounting. 

Continued Learning Opportunities

As nurse practitioners, most of us graduate from an NP program with significantly more on the job learning necessary compared to newly graduated MDs. This is simply a reflection of the disparity between the length of medical school compared with the length of a nurse practitioner program. Working alongside a collaborating physician gives nurse practitioners, particularly those newer to the profession, an opportunity to increase clinical knowledge and skills. 

Laws regulating nurse practitioner's scope of practice certainly have their downsides. Often, they accomplish little more than paper pushing and increasing practice overhead. But, if you do find yourself required to work with a supervising or collaborating physician, you may find that the professional relationship is an asset

Do you prefer to go solo or work with a collaborating physician?

 

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Comments

This article is offensive!

Supervision & Collaboration are very different. Collaboration is something that happens between the entire medical team (or is supposed to). I suppose physicians should have practice agreements with pharmacists, physical therapists and dietitians as well?

I work with some great physicians, and I am very thankful for the contribution they have added to my knowledge. I however am responsible for the outcomes of my clinical decisions, ultimately I should be making those decisions on my own.

I once worked at a diner; the cooks even trusted me to deliver food to tables on my own (no contract required!). When I had a question, I was never lost on who I should turn to. If I messed up an order I took full responsibility, I never blamed it on someone "above me".

Working in collaboration with physicians, nurse practitioners, therapists, nurses and social workers is something taught day one in any nursing program. Apparently medical programs don't cover this, and that's why physicians feel they need laws and contracts to enforce their control over healthcare.

Respectfully,
ARNPjoey twitter- @ARNPjoey
MSN, ARNP, A-GNP-C, Patient Advocate

Joey

This article just reeks of the 1960's submissive behavior of nurses to physicians. Of course we collaborate. We collaborate daily as no clinician is an island. Mandatory "supervision" is laughable at best. I was a mild fan of your site but this is a joke.

Josh

I agree with Lynn. Just because you are comfortable with a supervising physician shouldn't have any bearing on the states that require supervision or collaboration with physicians. A wise practitioner will build a network of providers from all disciplines to collaborate and refer to. Many NP's have never met their "supervisor" and there is a clear lack of understanding amongst the public of what that role even looks like. There is no physician authorizing every treatment plan for every patient, or pushing the button on the electronic prescription. There are physicians who could probably use a supervising provider! The constraints both logistically and financially that supervising physicians hold over NPs is out of date and not appropriate.

TR

Yes, clearly collaboration is good, and I'm sure that all of those MANY NPs in the 22 states that already have full practice authority DO collaborate- with other colleagues, be it MD, NP, PA, etc. That does not mean that they can't work without some nebulous and often invisible "supervising MD." You are clearly misunderstanding what the goal is with "full practice" for NPs. And yes. I am an NP- not a "mid-level" anything. You set the profession (all Advanced Practice Providers) back with this kind of thinking. Shame on you.

Lynn

Any professional should be open to collaboration, MD, NP, PA, PT, Teachers. One does not need to be supervised to collaborate. Advanced Practice Providers, as I chose to be classified as I am NOT Mid anything and practice at a top level, need someone in in a role of leadership to provide other professionals knowledge of our scope of practice. Too often healthcare institutions are unaware of our legal scope of practice and make arbitrary decisions on what we can and cannot do based on assumptions. Additionally, MD leadership has the mentality, as perpetuated by things such a website that would title itself MidlevelU, that we are incapable of functioning without oversight. Language often states collaboration but the intent is supervision. So yes, collaboration in ANY field is excellent, but does not need to be mandated.

Melissa

Supervision is very different than collaboration.

Jenny AC PNP, PC PNP

Isn't collaboration a hallmark of a good clinician? We don't know it all and must occasionally collaborate with peers to provide sound patient care. Working in isolation is a dangerous approach even for a primary care MD. If we are in agreement with this, why the mandate for NPs?

Toni Kiangi

I agree with the article. I work as a Hospitalist Nocturnist. I have worked in independent practice states and now work in a state that requires physician oversite. While I can handle most of the issues that come up during my shift, there are situations where I require assistance. I welcome it as a collaboration and it contributes immensely to my knowledge base and increasing my clinical skills.

April Donovan