NP supervising residents in the ICU

[apex1212]

The rotation at this hospital has NPs supervising multiple residents on the ICU team. We have attendings but they’re always busy and the NPs take charge. When the attending is not around, residents, sometimes second year and even third year residents would check out to the nps and the nps would tell them to what orders to give and basically act as a supervising fellow over reaidents. They also have fellows but the nps basically act as the critical care fellows and give orders to the residents. Also for procedure, if residents need supervision, the nps count as the supervising person for the procedure over the resident. I understand that they have been there for a long time and residents switch out but I think this is just wrong. Does an md mean nothing and if an np is on the same level as a critical care fellow then what am I doing wasting all this time when I could have just went to get an np degree. The nps also act like they’re on the same level as the fellows and call them by first name and also call attendings by first names even when the residents address the same attendings as doctors do and so. Is this ACGME violation? And if so can someone link me to the page where it stipulates this bc I would like to somehow let this hospital know annoynymously with a source they can link to and inform themselves. Thank you.

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[Gastrapathy]

It’s BS. But they will be able to say they are following the letter of the law and you are really supervised by the fellows.

 

[Raryn]

Except in the context of supervising for bedside procedures where the NP has hospital priveleges and the resident doesn't (yet)- this shouldn't happen. At all. Completely inappropriate.

Not much you can do about it though unfortunately.

 

[rokshana]

Are the NPs Co signing orders and notes? That is against ACGME policies, at least in IM. If so, you can report to the ACGME as a violation.
Also there is a question on the ACGME survey about other people interfering/restricting your education.

 

[CCM-MD]

The rotation at this hospital has NPs supervising multiple residents on the ICU team. We have attendings but they’re always busy and the NPs take charge. When the attending is not around, residents, sometimes second year and even third year residents would check out to the nps and the nps would tell them to what orders to give and basically act as a supervising fellow over reaidents. They also have fellows but the nps basically act as the critical care fellows and give orders to the residents. Also for procedure, if residents need supervision, the nps count as the supervising person for the procedure over the resident. I understand that they have been there for a long time and residents switch out but I think this is just wrong. Does an md mean nothing and if an np is on the same level as a critical care fellow then what am I doing wasting all this time when I could have just went to get an np degree. The nps also act like they’re on the same level as the fellows and call them by first name and also call attendings by first names even when the residents address the same attendings as doctors do and so. Is this ACGME violation? And if so can someone link me to the page where it stipulates this bc I would like to somehow let this hospital know annoynymously with a source they can link to and inform themselves. Thank you.

This is terrible and should not be happening.

My first question to you is, does your program director know this is happening? It wouldn't surprise me if they didn't know, especially if you are in a large residency program. Your PD might not know the day-to-day issues occurring in every rotation. If there is someone approachable in your program leadership, it might be worth bringing it up to them. I would like to think that most reasonable physicians would not want their physicians in training supervised by midlevels. If for some reason your program leadership seems to be fine with this, which is crazy, I don't think it is unreasonable to anonymously inform other leadership in your institution including head of GME, DIO, others, and the ACGME.

I also agree with mentioning this on your annual ACGME survey. This survey is important to programs and comments on this could have an impact on how the program does things.

 

[Chemist0157]

Sounds like that hospital has no business participating in resident training if the attendings are just calling it in effectively and letting NPs teach MDs.

 

[Splenda88]

No wonder NP are saying in social media they are teaching residents... You should report this program to ACGME.

 

[FutureInternist]

Sounds like that hospital has no business participating in resident training if the attendings are just calling it in effectively and letting NPs teach MDs.

“teach”