Wednesday, May 23, 2007

Relationship issues

When you work with someone every day, you have a relationship with them - like it or not. NewFNP is very picky about her relationships, although she has made some questionable decisions in the past. Let's just say that newFNP is a wiser woman for them!

She is now in a relationship with a new OB/GYN at work. This OB/GYN has been in our clinic for a little under a month. NewFNP was out last week so the relationship is still a fledgling one. This relationship, however, is very unlike the honeymoon phase in other relationships during which all you want to do is make out, eat dinner and make out again. NewFNP thinks that under non-clinical circumstances, she and this OB/GYN may be friendly. Under work circumstances, newFNP is ready to snap.

In newFNP's clinic, the prenatal population cannot support a full time provider. On the other hand, the uncontrolled diabetics, depressed patients and kids with URI's provide a never-fucking-ending stream of work for newFNP while the OB/GYN leisurely sees her 10 patients per day. This pace leaves OB/GYN plenty of time to point out the flaws in care she sees in the charts, the flaws with our clinic's MA's and the flaws in systemic issues, and man alive, does she ever take advantage of all this free time. Unfortunately, the maelstrom is all directed toward newFNP while she is in the midst of charting, writing letters, filling out forms, helping MAs, etc.

Does OB/GYN think that newFNP has a fucking shred of control over any of this? Patient care notwithstanding, newFNP believes it safe to say that any input she may have into overall administrative issues is placed directly into the "whatever" file. NewFNP may exude the cool professionalism of upper management, but in her clinic, she is nothing but a worker bee.

OB/GYN's complaints struck a chord when she noted that a prenatal patient disclosed that her husband had been beating her throughout her pregnancy and it hadn't been addressed and it's our responsibility, yada yada yada. NewFNP looked through the chart. This patient had been screened for IPV at every visit, admitted to it once and was sent to the appropriate resource. Does OB/GYN want newFNP and the other providers, all of whom see full patient loads, to go Guantanamo-style on the patients in order to get information from them? NewFNP wants OB/GYN to work for a month before she starts pointing out all of our flaws. And even then, she should learn a little tact or keep her trap shut.

As newFNP was walking out the door, OB/GYN asked her to contact a patient for her. NewFNP encouraged her to ask our LVN to do that as he would be in the clinic a full hour after newFNP left. No, OB/GYN left it for newFNP. Unacceptable, but newFNP was too pissy to deal with it in an appropriate manner.

NewFNP is admittedly a little low on emotional reserves this week as her cousin died last Monday. But even when newFNP is at full reserve, she takes it very personally when other providers point out what they deem mismanagement when it is done in a mean-spirited fashion. NewFNP isn't even responsible for some of the visits about which OB/GYN is complaining, but she still takes it personally. All of the providers in newFNP's clinic strive to deliver care that rivals private practice standards given our resources. NewFNP is open to teaching and constructive criticism, but assholery will not be tolerated.


Anonymous said...

Hindsight is 20/20. When multiple providers working in the same clinic are seeing the same patients, isn't it wonderful to be asked "Why didn't you do that???" It is in the way of asking though - can be constructive or even (wow this a concept) collaborative - but others can be just maddening. Chances are OB/GYN moves on.

BostonFNP said...

While it wasn't so long ago that we were that idealistic, thank god we had the good manners to keep our mouths shut about it! Give her another month, honey. She'll either start putting it together or not... hang in there, honey. I feel your pain ;).

Anonymous said...

Dear new FNP,
You are an absolute RIOT!! I enjoy every word of your blog! I am a nursing student--used to be an English teacher--right, I know, from the frying pan into the fire--but on I go. I so appreciate your brutal honesty. As a middle-aged curmudgeon who sniffs out bullshit a mile away, I too, am prone to cynicism and a "bad attitude." Actually, I embrace this quality in myself and others, though politcal correctness requires its supression. Work is often a lonely propositition when professionalism, i.e., keeping the analytical part of your brain (the part the establishment tells you is crucial to becoming a successful practitioner) under wraps, is so disproportionately valued. Thanks for telling the truth. People often spew: "Oh, you should become a nurse practitioner!" No thanks! Way too old for that! I found a gem in your blog, though, and I will continue to take solace in reading honesty peppered with righteous indignation while LMAO along the way.

Anonymous said...

How have you been. I am a little concerned. Miss you posts. ttt

Anonymous said...

I too am a newer NP working in an urban CHC, and our Midwife is the same.

Thank you for writing this blog. It has been a very long and lonely first year of practice.