“… it’s not about me being a learned and skilled NP. It’s not about my abilities and knowledge. It’s about the patient.” – Sean Dent
When the patient asks to speak to the doctor – a nurse practitioner’s dilemma
Nurse Practitioners (NP)are an integral part of the healthcare team. They serve a primary role in the care decisions for patients throughout the nation. Unfortunately, the role and function of the NP is still evolving within the health care system and in the public’s eye. Many have never heard the term, let alone understand what they do. NPs are fulfilling the role of primary care provider in many areas of the world, while others are managing complex high acuity patient cases. Most NPs will tell you; they often are mistaken for another member of the healthcare team and not a primary decision maker that makes life and death decisions for patients on a daily basis.
You don’t have to look too far these days for an NP. Unfortunately, they’re still not enough for many, even after they save your life.
Let’s go through a situation I experienced…
Situation
Bedside nurse: “Hey Sean, the family in bed 3 wants to talk to Critical Care Medicine. They have some questions, and they’d like some updates.”
Me (NP): “Sure, I’m on my way.”
[For HIPAA compliance, we’ll refer to the patient as “Bed 3” with their first name being John]
Background
“Bed 3” was a patient I was caring for who was admitted to my ICU several days prior. They arrived knocking on death’s door from acute respiratory failure, multi-system shock, poly-traumatic injuries, post-cardiac arrest and acute renal failure. In the world of critical care, the day they arrived, they were “circling the drain.” There were many moments during the past several days when I didn’t think the patient was going to survive my shift, let alone be there the next day I reported to work. While I was responsible for many other patients during that time, this patient required most of my attention. There were many shifts when I didn’t leave the bedside because they were so fragile.
Under the direct supervision of my attending physician, I was the medical provider responsible for their overall care. While I worked collaboratively with other members of the medical team, including the bedside nurse, the pharmacist, multiple specialty services, and ancillary staff I was the one who chose the medical therapies.
I chose the ventilator strategies. I adjusted our team’s approach every step of the way. I constantly communicated with the other specialty services to coordinate the patient care. I ordered the labs. I ordered the radiologic exams. I ordered the tests. I read, evaluated and treated the patient’s medical diagnoses. Was I the sole entity that dictated this patient’s care?
Absolutely not.
But as a rough analogy, I was driving the bus for most of the trip. And with the help of such an amazing medical team, “Bed 3” pulled through their brush with death and was now recovering.
Assessment
I enter the room greeted by a number of anxious visitors surrounding the patient’s bed. There is a pause, then a moment of silence. I infer the visitors are family and friends, many of which I have never seen before during my time with the patient. Remember, I saw this patient every day since their admission to my ICU.
“Hi, my name is Sean, I’m one of the Nurse Practitioners that works with the Critical Care Medicine team. I’ve been helping take care of your loved one. I understand you have some questions? What is everyone’s relationship to John?”
I begin all my family conversations this way to establish roles, responsibilities and baseline knowledge about the patient’s condition and care. I then proceed to review the current course, highlight all challenges, discuss diagnoses and prognoses in language that is understandable for all parties. I usually end my conversation with a closing question,
“That was a lot of information in a short amount of time, does anyone have any questions. Anything that I can clarify or review?”
Now, most of the time this is met with great appreciation. The visitors thank me for my transparency, my honesty and my direct language that they could understand. But every so often…
Visitor: “What was your name again?”
Me: “Sean”
Visitor: “And you’re one of the doctors…?
Me: “No sir/ma’am. I’m one of the Nurse Practitioners that works with the Critical Care Medicine team, helping manage their care”
[Long, painful pause]
Visitor: “I’m sorry, can I talk to the doctor?”
Recommendations
When I first started working as an NP, this response would anger me greatly. I would spend an absurd amount of time explaining who I was, my background, my training, my participation within their care, how much time I’ve spent with the patient and how the attending physician trusts me to make these difficult decisions. I would exhaust my efforts to defend my role. I wanted to “prove” to my patient, their family, and visitors that I was important, that I mattered, that they were mistaken. They needed to appreciate my hard work, my unwavering effort and my relentless dedication. They needed to know I saved the patient!
Boy, I was wrong.
That feeling lingered with me for quite a while, in fact for several years, until I had an “ah-ha” moment one day mentoring another nurse.
I had a fellow male nurse confide in me their anger towards a patient when a patient refused their care and requested a ‘female’ nurse. An experience I had many times over.
I too used to get angry when a patient would refuse my care, and request one of my female colleagues care for them. I would get spiteful, jaded and defensive. Just like me, this nurse wanted to “prove” themselves to the patient. Prove that they are worth it. Prove they can provide congruent care. That being a male nurse is just as good as being a female nurse.
I offered my personal experiences with this nurse. I explained that it wasn’t about them at all. It wasn’t about their care. No one was questioning the quality of their care or their abilities. It wasn’t about them at all. It was about the patient.
It was about the patient and their comfort. We have to remember that the patient is feeling unprotected, vulnerable and down-right scared. They could very well be going through one of the most difficult times of their life, and they need to have some semblance of comfort whenever possible. And if their nurse being a man, makes them uncomfortable, isn’t it our responsibility to help meet their needs?
It’s not about you. It’s not about your abilities. It’s not about the outcome. It’s about the patient.
I realized at that moment that it’s not about me being a learned and skilled NP. It’s not about my abilities and knowledge.
It’s about the patient.
