Moderator LT_Oneal_PAC Posted October 1, 2019 Author Moderator Share Posted October 1, 2019 6 hours ago, mcclane said: Having a hard time wrapping my head around why an ex-ICU RN would be unable to formulate a handful of reasons for difficulties between RNs and PAs/NPs and a few effective strategies for managing this conflict. Emphasis upon effective, because while your ideas so far might work for some providers, it sounds like your execution has been so terrible that you've doomed yourself to failure. And how exactly are you going to receive reasonable advice on a PA forum, especially this PA forum, especially with the attitudes that you are projecting here? Seriously, I think they can smell you a mile away. They're onto you, dude. Do you have a suggestion? Also, may I ask what they are smelling and are onto? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 1, 2019 Moderator Share Posted October 1, 2019 I have had a few jobs like that in the past. They either learn to trust you or they don't. If you can work with it, you stay. If you can't you leave. I left a few and made a few work. When they see something like low dose ketamine turn a CHF pt on bipap around and prevent an intubation you get some street cred as a smart guy. In WA I don't have to a have backup doc to cover the ED or chart review. My CP knows how I practice and knows I do a better job than most and leaves me alone. Took me 15 years to find this job and I am not leaving unless they drag me out kicking and screaming. 4 1 Link to comment Share on other sites More sharing options...
RadMan87 Posted October 3, 2019 Share Posted October 3, 2019 Light speed, --------------------------------------- deleted due to being inflammatory and personal attack 1 Link to comment Share on other sites More sharing options...
cinntsp Posted October 3, 2019 Share Posted October 3, 2019 Welcome to rural medicine, my friend. You will face issues like these wherever you go. Most rural facilities care little for best practice, EBM, updating/maintaining sound practice policies, or trying something new. It's all about status quo. You have to be careful not to push too hard or else you will continue to deal with the types of situations you posted about. It won't be just the nurses, but administration, pharmacy, other providers, and so on. Small town folks tend to become very offended when you tell them that their outdated way of practice that has served them just fine for the past million years is sub-par. Any changes that you want to implement will have to be done slowly. 1 Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 3, 2019 Author Moderator Share Posted October 3, 2019 On 9/30/2019 at 10:58 PM, EMEDPA said: I have had a few jobs like that in the past. They either learn to trust you or they don't. If you can work with it, you stay. If you can't you leave. I left a few and made a few work. When they see something like low dose ketamine turn a CHF pt on bipap around and prevent an intubation you get some street cred as a smart guy. In WA I don't have to a have backup doc to cover the ED or chart review. My CP knows how I practice and knows I do a better job than most and leaves me alone. Took me 15 years to find this job and I am not leaving unless they drag me out kicking and screaming. Yeah, I would have thought they would have been happy with me doing US guided IVs when they have failed multiple times. But it seems they are finally turning around. I’ve continued to kill with kindness, but do what is best for patients. I’m continuing to use ultrasound, but haven’t gotten any more emails. In fact, tonight one of the docs asked me to give a demonstration of all the EM uses for ultrasound for ultrasound awareness month, which is apparently a real thing. I’m still not sure about staying. I’ve just felt I’ve gotten a look at the character of some people here and despite their change of attitude, I feel apprehensive and wondering what is the next thing they won’t like. Will it all just happen again if I drain a peritonsillar abscess or inject priapism? Before someone asks, I made sure these procedures were included in my credentialing. 3 hours ago, cinntsp said: Welcome to rural medicine, my friend. You will face issues like these wherever you go. Most rural facilities care little for best practice, EBM, updating/maintaining sound practice policies, or trying something new. It's all about status quo. You have to be careful not to push too hard or else you will continue to deal with the types of situations you posted about. It won't be just the nurses, but administration, pharmacy, other providers, and so on. Small town folks tend to become very offended when you tell them that their outdated way of practice that has served them just fine for the past million years is sub-par. Any changes that you want to implement will have to be done slowly. Both glad and sad to hear it’s pretty common. I appreciate the advice to take it slow. I’m not trying to revolutionize the hospital or change the way others practice. I think that they actually do a great job on the inpatient service here. The outpatient clinic is pretty great too with the exception that I see the occasional prescribing high dose opioids and benzos together. Link to comment Share on other sites More sharing options...
kargiver Posted October 3, 2019 Share Posted October 3, 2019 Agree with others working in rural EDs... this is common until they learn to trust you. I'd even go so far as to say they are testing you, as they know what normally comes through their doors routinely and knows what works for them. Deviation from this makes them pucker a little... until they get to know YOU. Then what you know becomes what they know, they'll grow with it, and in time, it works. All politics is local... and this is what it sounds like. Sounds like the "lead" PA spoke up when needed. They'll either agree with you in time or you'll leave, validating any of their complaints (just how they will perceive your leaving, not that there is any validity to them). If you like the environment, ride it out. If not, move on. But, be like a reed in the wind... resist when you have to, bend, don't break. It generally works out. G 2 1 Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted October 3, 2019 Share Posted October 3, 2019 What Kargiver said matches my experience in my critical access hospital. Once they've seen your techniques work, they'll have faith in you and you'll become one of their own. There's been lots of talk in the thread about the interpersonal aspect of being the new person in a small operation. I'm not going to presume whether any of that is a factor or not in your situation, but I have seen and experienced myself. So, try to give it time. Try to find someone who knows the players who is willing to talk to you about what they see as the underlying dynamics. Don't give up too soon. 1 1 Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 3, 2019 Moderator Share Posted October 3, 2019 I have run into the same thing in IR when I was breaking new ground it is hard, it tests your patience, but it is worth pushing for if the location and job is good. Nurses who are your worst enemy might well turn into your biggest supporters once they learn you. Remember this is all new to them and you are not even a Doc, (GASP) and yet out perform the FP doc's (double gasp and turf battle with the FP's) So just keep holding steady, doing what is right, being a professional at every step and forge on. it will get better (on a side note - some posters believe this is due to our dependent status, totally untrue - I saw a boarded IR doc coming from a top fellowship get raked over the coals by the battle axe nurses in the department - one even flatly refused to push am med during a procedure because they had no knowledge of it) the doc just rolled with it for a few months till people realized he was right and that was it- it has very very little to do with our status and most to do with being the new guy/gal doing new things) good luck - keep us posted 1 Link to comment Share on other sites More sharing options...
Marinejiujitsu Posted October 4, 2019 Share Posted October 4, 2019 Sigh...... Direct quote from LT_Oneal_PAC in his third comment on the thread he himself created... before I even posted anything: "they absolutely would not do this to the docs. They treat them with deity reverence." So maybe there's the poster that you are talking about that believes this is due to your profession's dependent status... I really don't think dependent status would matter. And i think most people will have a hard time sometimes transitioning to a toxic environment. Alot dont even give the NPs respect.Sent from my SM-N975U using Tapatalk Link to comment Share on other sites More sharing options...
Marinejiujitsu Posted October 4, 2019 Share Posted October 4, 2019 Its easy to let nurses dictate your care unless you put the foot down though.Sent from my SM-N975U using Tapatalk 1 Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 4, 2019 Author Moderator Share Posted October 4, 2019 The thread has run its course and is no longer productive. Locking to prevent future conflict. I have deleted my last 2 posts so others can have the last word. 1 2 Link to comment Share on other sites More sharing options...
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