Collegial Relationships: Extending Otolaryngology Practice with Other Professional Providers

As with PAs, nurse practitioners are educated against a backdrop of family practice or internal medicine. Although there is no formal educational program to certify otolaryngology nurse practitioners, they can become certified in otolaryngology and head-neck nursing once they meet certain criteria.

Ms. Lynch would advise prospective physician employers to educate themselves on NPs’ advanced practice and clinical training. “Physicians often think that nurse practitioners are meant to come in and do basic office procedures such as histories and blood pressures and they don’t recognize it as its own specialty. I’m here to bring my own brand of expertise.” She has been employed in two ENT practices and they have both allowed her the independence to work at a collegial and optimal level. She hesitates to recommend any specialty as an initial clinical setting for beginning practitioners. “The more conventional style of nurse practitioner work is far better because you learn basic assessment skills and build confidence in yourself,” she said.

Linda Miller Calandra, MSN, RN, CRNP, CORLN, past president of both SOHN and the Society for Ear, Nose and Throat Advances in Children (SENTAC), is one of 16 nurse practitioners working with 10 physicians in a practice associated with Children’s Hospital of Philadelphia. In her practice, nurse practitioners assess and evaluate patients before the physician sees the patient, reviews the plan of care, and makes the disposition. NPs also do presurgical evaluations and workups so that the families do not have to return to the hospital before the day of surgery for an anesthesia evaluation. Outside of a surgical practice, however, she said, “globally nurse practitioners can address issues that patients have, such as the need for education, setting up home care, and identifying issues that could be problems postsurgically. This can save physicians a lot of time and frees the physicians to do what they were trained to do.”

What is the general difference between what PAs and NPs can do in a practice? “I think in practice, there’s very little difference,” said Ms. Calandra. “In theory, the difference is that we’re trained in the nursing model, with more of a holistic approach, and PAs are trained in the medical model. For instance, I’ll go in [to an exam room] and look at a child for breathing problems and a PA will go in and specifically look at big tonsils.” But Ms. Gilbert disagreed. “No [PA working] in ENT would just look at tonsils and not consider the whole patient,” she said, and thought this might be an often-held misconception NPs have about PAs.