Culture Change Needed.
Over the past three years we have seen decreasing engagement from our Physician Assistants and Nurse Practitioners (PAs/NPs). There have certainly been times in the past where they stepped up to tackle a challenging issues that we faced. However, now it seems like they only want to clock in, do their work, and clock out. There have been many examples of this, but the most recent one had to do with the illness of a new PA’s child. When we hired the PA we knew that her son was battling cancer but her son seemed to be doing much better and headed to recovery. She started and two weeks later her son had to be taken to the hospital. Of course this meant that the PAs/NPs in our group had to step up and help cover or change shifts. When the PA returned to work, she was still having occasional days where she would have to run her son to the hospital. Our solution was to get the PAs/NPs together to discuss solutions and hopefully come up with a call schedule. The group’s response was that they did not want to do the call schedule and that our organization should get Locums PAs to be on call. Keep in mind that none of these PA/NPs work more than 120 hours per month and we offered to pay them $15 more per hour if they have to cover a shift in an emergency. Part of the reason that we have lower minimums for full time employment is so that we can flex up if/when one of the PAs/NPs has maternity leave or is injured.
There have been similar situations with our physicians, and the response was the exact opposite. Every one of the physicians supported setting up call schedules and taking extra shifts to help out when one of them went down. The physicians even jumped in to help take PA/NP shifts when the PAs/NPs in our group did not step up.
The senior leadership in our organization recognizes that the culture that has formed with the PAs/NPs in our group is not what we would like or expect. We have offered for them to nominate a PA/NP to join the leadership team but the response from the group was minimal and they mostly wanted to know if this position would pay more and/or reduce their clinical shifts. We had meetings with all of them to hear their suggestions on how the organization could better engage with them and mostly the said that they just wanted to work their minimum number of shifts, not be asked to pick up any extra, and get paid more.
Have any of you had similar experiences with your PAs & NPs? Do you have any suggestion on how our organization can move in the right direction?
Participant comments on PA/NP Engagement
It seems you have a unique situation. In our institution, the PA/NP step up if physician like our hospitalist get sick or injured.
May sure you that they arE not burned out or under payed. Both make human whatever they are depressed, not happy to come to work, inefficient and break tea spirit.
I think make one of the PA/NP as a team leader (Director of PA/NPs). Once you do that(for a small cost probably), have the leader set up team meetings with other PAs or NPs to come up with solutions for themselves. Once you designate one of them as a leader, their motivation changes and I would suspect, that they would engagement of all. Once they come up with a solution, recognizing and rewarding them might help as well.
My 2 cents.
In todays world, compassion and willing to go extra mile for somebody else is just too much to ask for / expect for.Its just pure RAW ECONOMICS AT WORK everywhere.
Obviously a BETTER / ATTRACTIVE monetary compensation for the person doing the extra shift, will work wonders .
The second or concomitant option is to compensate them with an extra off duty on a day of their choice.
The Third option is the cash equivalent of some freebies / coupons / etc.
Appears to me that you have some that haven’t adopted the culture of your organization. Clearly there is a dichotomy in cultures where you have some that are willing to chip in at all costs while others are in it for themselves.
I suggest first try to understand what is holding some not to be part of the culture that exists in your organization? Have the expectations not been clearly defined? Is this not a good fit for them? Is this a system issue (recall one of the cases we discussed in class)?
Second, make sure the midlevels are engaged in the governance of the organization. In our institution, midlevels have a seat on the medical executive committee and are to a great extent viewed as a valuable part of the team.
Lastly, transparency in compensation should be apparent.
And if all else fails, maybe your organization’s culture is not meant for them.
Culture of your organization is very important. expectations should be presented upfront upon hire. In our organization the midlevels (NP’s/PA’s) are the most reliable group. Many of them are cross trained to cover different departments to fill gaps. We also utilize perdiem and part time staff to fill gaps as well. We do have a chief Midlevel provider that is responsible for the coordination of all the midlevel providers including scheduling. This position makes a world of difference and is worth its weight in gold.
Most of our staff is seasoned and experienced which also makes a big difference. Newer grads tend not to have the commitment and work ethic that our more experienced staff have.
We do not have PAs, and there are only a very few NPs. Having said that, I think we have all experienced a situation where a team/individuals do not appear committed nor engaged.
Like the above comments, culture is really important, but rather than just focussing on the PA/NP team, I think it is worth investigating the behaviours of the ‘line managers’ for the NP/PA team. The times I have seen this kind of blatant lack of engagement, the line managers asking for volunteers to work the extra shifts have been renowned for their poor communication, lack of tact, grumpiness and general poor leadership skills. Thus, when a fvaour is asked, people are less likely to respond positively.
There have been trends of this occurring through some parts of the country lately. I believe with Physician shortages, the push to have more PA/NPs to fill voids has increased. What I have noticed, with more Advance Practice Providers (APP), most organizations have not included their representation at the leadership levels. Most organizations have more or less dictated the type of work, where to work, schedules, and how to perform their duties without including this group in decision making. We had a similar problem a few years ago. Our institution began making the change by adding one PA/NP to each of the medical executive committees with voting rights. Within the medical groups, each designated a leader that was either an NP or PA. In addition, we started APP grand rounds at the hospital which gave the APPs a chance to get CME, lunch, and discuss issues collectively as a group. Over time, the engagement began to change and the APPs took “ownership” of many issues. We aren’t perfect, however, we have noticed changes within the organization.