by Dr. Arif Nazir
Most of the time, I don’t get too focused on titles and labels. Instead, I try to focus on the effort and the impact people make. But I must confess, I never got comfortable with the “Physician Extender” title for our nurse practitioner (NP) and physician assistant (PA) colleagues. It’s no secret that we are short of the required physician force in our country. And when it comes to doctors who treat the oldest patients, the situation is much worse. A persistent shortage of geriatricians has led policymakers to engage other disciplines to create and deploy geriatric interventions. Formerly, as a faculty member at Indiana University Geriatrics, I was part of many federally funded initiatives focused on geriatricizing the healthcare system, which is to instill geriatric care principles in other disciplines among nurses, social workers, medical students, NPs, PAs, and others.
Geriatricizing does not require an all-knowing teacher in a cape, who can instruct others on how to provide evidence-based geriatric care. Rather, it relies on creating time and space for team members to come together for regular interprofessional collaborations and then, using foundational geriatric principles to assure person-centered care delivery. In such a model, learning happens through a focus on patient goals and a dialogue about how to achieve them. Each discipline is critical to this process and there is no hierarchy. Together the team extends the impact of the selected interventions. In my previous roles as medical director for various skilled nursing facilities, I was privileged to work in an interprofessional environment with the most compassionate team members, which included nurse aides, nurses, dieticians, therapists, and other staff. But most important was my partnership with the facility NPs.
The Importance of Partnership
Every morning, my clinical rounds started with a conversation with my partnering NP, and similarly, the day ended with a huddle about key clinical matters. As partners, we both made sure that we were available to each other for any medical and/or geriatric issue that was at hand. For example, where I was a resource on tedious medical concepts such as acid-base imbalances, or acute kidney failure, the NP did a tremendous job on untangling complex, daily social dilemmas, and functional barriers to discharge. With our collective and collaborative expertise, plus our areas of strength, we extended the impact each of us could have individually. I was as much of an NP-extender, as my NP was a physician-extender. Beyond enhancing the quality of care, this partnership also extended our job satisfaction. Being a high-quality clinician is not always about the number of years spent in school or subsequent years in practice. It is more about knowing one’s strengths and limitations, and about the mental awareness to ask for help and resources when needed. This applies to any discipline.
Collaborating with, and receiving assistance from colleagues, when needed, while providing care, is the best approach to professional development. As the President of a large NP and PA organization that is dedicated to the most evidence-based, and proactive geriatric care, I sincerely thank my NP and PA colleagues, across this country and beyond, who are doing their part in geriatricizing our country’s healthcare systems. Their hard work and commitment extend the impact of other team members, particularly the physicians with whom they collaborate.
Happy Nurse Practitioner Week!