Training New Providers

I talked about part of the reason I extended in Bradenton, Florida was to train a new nurse practitioner there. I have trained other nurse practitioners in the past, even as a locums, and I enjoy it. I know the first year working as a nurse practitioner is challenging so I like to be that mentor for other nurse practitioners. 

The new nurse practitioner at my current job is pretty laid back. This is good because she doesn’t get overwhelmed easily. She picked up on the EHR pretty quickly and the flow of things. Her greatest challenge was going to be clinical knowledge. Working at this managed care geriatric practice is challenging, and everyone goes through a huge learning curve working here. 

After she finished the 4 weeks orientation, she shadowed me for about a week. Then when she started seeing her own patients I shadowed her for a week. I tried to encourage her to study after hours because I witnessed some weaknesses in her clinical knowledge. Such as reading EKGs, pharmacology, and forming differential diagnoses. Sometimes she pawned it off that I just made her nervous when I was in the room with her. But if the patient asked her 5 times for an alternative medication and she couldn’t come up with one, I had to finally jump in myself.

As her schedule has become fuller, she is doing pretty well with time management. They have her sitting next to me for support. She bounces ideas off of me and I try to provide feedback on patient visits. I reassured her with time she will become more confident, and her clinical knowledge will improve with experience and exposure. So far she has 100% on patient experience surveys which is awesome!

On the other hand, there is a physician that started the same time as her. This is an experienced physician. Things haven’t gone well. This physician has a lot of anxiety and gets overwhelmed easily. She had a hard time ramping up her schedule beyond 5 patients per day. I’m like don’t you get bored?? Whenever staff approaches her about a walk-in she throws a tantrum. Then she is forever reliant on her medical assistant. So, if her medical assistant disappears for 5 minutes to help other patients, the physician goes crazy. 

Since the nurse practitioner I trained was doing really well, my supervisor approached me about shadowing the new physician for a day. He hoped I could give her some tips on how to finish documenting in the room while with the patient, and how to stay on time, so that she didn’t need to take work home. When I told the new physician I was going to be with her for the day, she literally said “do you have to? Is it required? Because I would rather you not. It would put me behind.” Everyone sort of gasped when she said that, and I merely answered “No you won’t be behind, in fact I will make sure you stay on schedule.”

While waiting for her first patient to be ready, I suggested she go over some of her work flow like lab results and phone messages. Then she literally when ballistic on me. She told me flat out she wanted to quit. That she doesn’t enjoy working here. That she was lied to, the patients are way more complex than she thought. That seeing one patient here is the equivalent of seeing 10 patients in a regular primary care office. That she has no work life balance and hasn’t been able to see her family since she started working here. 

I tried to reassure her that everything is hard in the beginning and it gets easier once you see the same patients over and over. Especially our patients come once a month so you don’t have to address everything at one visit. She didn’t take that as any help and instead barked at me that I don’t have any children so I wouldn’t understand. I told her I may not have children but I still finish work early every day and don’t bring any work home, and I can teach her how. She continued to say she is not in a good mental space to see any patients today and to let our supervisor know. 

Meanwhile, the other physicians were there holding their breath. Our supervisor pulled her aside and told me he planned on sending her home and asked if I could see her patients for the day. This ended up being a lot of work for me because I was seeing her follows up with only the allotted time for someone that knows the patients already. Of course, things worked out on my end, but I was in a bad mood considering all that I had to put up with. 

Apparently, she spent 2 hours talking with our supervisor, him providing her with therapy. At the end she felt better and was determined she would no longer quit but still needed the day off. -_- Leadership told us to continue offering her support and that they would limit her schedule so she can have more time to adjust. 

The other physicians approached me later and gave me props for staying calm when she went crazy on me. I laughed because I am used to being that way with patients all of the time. They were disappointed that leadership thought the situation would improve. She had been there for 2 months already and every day was a train wreck with her. We were tired of her outbursts. It also wasn’t fare that the new nurse practitioner was soaring and they started at the same time. 

Personally, I’d give it another 2 weeks before she decides to quit. I think leadership should just let her go instead of transitioning patients to her that likely will not last. 

The best part of the day were the other physicians approaching me and telling me how much they appreciate me. That they wouldn’t have been able to brush off the other PCP telling them off, nor would they have been able to accommodate seeing her entire patient schedule that day. They said since I have been there, they are able to focus on their patient panels instead of all of these outside noises. 

Also, during our monthly leadership rounding, I was told that the new nurse practitioner chose to celebrate me during her one on one. She said she wouldn’t be successful without my help, and leadership told her how lucky she is that I ended up being here at the right time. 

Despite that horrible day, I tried to focus on something my dad told me many years ago: “You never fail when you try to do something good.” No one feels good after someone yells at them. But I had to remind myself that she is going through something mentally, and I did my part in trying to help her. I just have to let that go continue focusing on helping people that want to be helped.