Developing the Relationship Between the Advance Practice Provider and the Physician

I am still a fairly new nurse practitioner. I have been in practice for almost four years. One of my highest points of anxiety upon graduation was what kind of relationship I would have with the physicians I would be working with. I think this is a common theme for advanced practice providers. It can be extremely intimidating coming into a professional setting where you will be practicing alongside someone who, by standards of time and experience, is more educated than you are. My own husband is a physician. At the beginning of our relationship I was hesitant and almost embarrassed to talk medicine with him because, let’s face it, no one wants to feel inferior.

I have been very fortunate to find a clinic that has built my confidence and allowed me to grow as a provider. From our first encounter the physicians felt like friends. I knew it was meant to be when our first meeting was at a bakery. Cookies always lighten the mood. Since that time, they have taken me under their wing, taught me what they know, and encouraged me through the entire process. I have not once felt like I was under them or not equal. It is truly a refreshing relationship! These women have trusted me with their patients, even their own children, judgement free. We also enjoy each other outside of work. We make it a point to invest in each other’s lives personally. Whether it is dinner, yoga, cooking classes, or kid’s birthday parties, we truly like being around one another!

I have spoken with several of my advanced practice provider colleagues, some of which I worked with in my nursing career prior to becoming a nurse practitioner. I asked for insight and thoughts on their relationship with physicians they work with. I was overwhelmed with all the positive responses. Everyone who responded mentioned having at least one physician who was willing to put in the effort to mentor them into becoming a better provider. The term “collaborative practice” was a collective theme. One of my favorite conversations was with a nurse practitioner who retired last year. Her statement resonated with me, “Be friendly, kind, and make sure you know what you don’t know. As long as you can put egos aside and work together, you will have a good relationship”.

There will always be some difficult situations when you are the middle person. We are in a group of our own; no longer practicing as nurses, but not physicians. I believe this is where there can be strain on the advanced practice provider and physician relationship. We are often performing similar jobs and functions with the same expectations, but at times with different levels of respect or notoriety. This can be mentally challenging for advanced practice providers. I have learned over the years to remind myself why I chose this path. I absolutely love what I do! I was able to go through nurse practitioner school while having children (two while in school, because I’m an overachiever) and working. These would be difficult tasks had I chosen the path of medical school.

In nursing school we are taught to put the physician on a pedestal. Everything they do and say goes. Nurses follow orders and only question if it seems to be life-threatening. Looking back, I am surprised that was so engrained. I think this is where we can come into relationship issues with physicians as advanced practice providers. We need to realize we are a healthcare team and we all have value. We have a common goal of treating and caring for our patients to the best of our abilities. Here are a few tips I have found that have helped me to strengthen the relationship and bond I have with the physicians I work with.

• Communicate frequently and clearly. Whether it is as simple as asking how your day is going or discussing office issues, communication is important to maintaining a good relationship.
• Define your role as an advanced practice provider early in the relationship. Expectations should be defined and possibly redefined over time.
• Know what you don’t know. Some of the best advice I’ve ever been given. It is important to put your pride aside when you’re unsure how to manage or help a patient. Sometimes my colleagues are unsure as well (hello, weird rash), but we work as a team to make a plan.
• Care about each other on a personal level. This has by far been the key to our success as an office. We are friends outside of work, and truly look out for everyone’s best interest.

In the end it’s not a “them” and “us” situation. We’re all people, not one better than another, doing our best to take care of our patients together!