Locating and Working Effectively with a Supervising Physician/Nurse Practitioner

Linda Ebner Erceg, RN, MS, PHN
November 2017

Camp professionals are well aware of the critical need to have a medical professional associated with the camp's health services. This professional typically provides direction when questions arise and collaborates with camp leaders regarding routine health policies and practices. But finding that medical supervisor can be challenging. Some physicians (MD) and nurse practitioners (NP) have no personal camp experience. Often these professionals don't understand the scope of camp health even if they are former campers or staff members. Most are employed by entities (e.g., hospitals, clinics) that provide their malpractice insurance, something that may not transfer to cover work for a camp. This makes the medical professional hesitant to take on a camp. The hesitancy is compounded when we, as camp professionals, do not articulate or are unclear about the agreement we'd like with that professional.

Following are tips and strategies to improve your working relationship with this key person and some background information to help you more clearly understand "pain points" from the physician/nurse practitioner's perspective. Note that the focus is on work with medical professionals who are not living at camp, although camps with in-residence physicians/NPs will also find helpful tips.

First Clarify What You Need

Before talking with a medical professional, write a list of tasks and responsibilities you need your medical supervisor to provide. This list typically varies from camp to camp. For example, the level of support needed by a camp serving health-compromised campers is different from that needed by a camp for the general population. Resident camps have a different health risk profile than day camps. Some camps want their medical professional to talk with camper parents; others don't need this support. A camp with only a camp nurse (RN) on-site has different needs than a camp with a team of providers holding various credentials. Some camps want their medical professional to have office hours at camp while others don't. Some want to meet with their supervising physician/NP prior to and after camp to review and update policies or address emerging or identified "hot spots." This meeting often includes addressing items in ACA Standards HW.11 and HW.12.

The list goes on. The point is to clarify — in writing — needed services. Then look at that list and separate wants from needs. Your camp needs must be met, whereas wants are nice but not critical. Once this is done, consider ways in which the medical professional might meet those needs. For example, you may need medical protocols signed. Will the camp provide a suggested protocol, or do you want the medical professional to generate them?

Consider what you are willing to pay or provide the professional in exchange for their services. The individual will be using their professional skills to benefit camp; how might you value that? A monetary value is one option, but also consider things like a campership for a child of their choice, membership in ACA and/or the Association of Camp Nursing (non-nurses are ACN associate members), and/or placing an article in the local paper about the physician/NP's community service. Some camps pay an honorarium that covers known services (e.g., reviewing and signing medical protocols, ordering prescription meds) and then extra for things that may occur (e.g., phone consultation, responding to a communicable disease outbreak).

Talk with your liability insurance representative and legal counsel. These two individuals represent services that should know the scope of your agreement with a medical professional. Indeed, each may provide comment to strengthen and/or clarify that relationship, so loop them into the conversation before making a final commitment with the medical professional.

Consider the unique aspects of your camp program, campers, and staff. Might there be something about that profile that needs attention from your medical supervisor? For example, having your physician/NP order a vial of epinephrine for the camp nurse saves money, but you may also need your MD/NP to order automatic devices (e.g., EpiPen, Auvi-Q, AdrenaClick) for tripping staff.

Finally, develop a flier or infographic that captures this information. You want something about the role that can be placed in the hands of interested people. That "something" should include your name and contact information. The point is to consider aspects about the role ahead of time and have information in written form ready when a person expresses interest.

Finding Prospective Candidates

With a firm grasp of the content already described, one is in a good position to lay things out to prospective candidates. In general, physicians and nurse practitioners with family or pediatric backgrounds do well handling the medical needs of most campers and staff. If the camp serves a special population, then familiarity with that specialty should be considered. In the process, don't neglect consideration of epidemiology and communicable disease management as well as the professional's familiarity with local emergency management plans. While these last three skills are often not needed, they're extremely valuable when need does arise.

Where does one find prospective candidates? In short, anywhere. Sometimes there's a board member one could approach. Often there are camper parents with an appropriate credential who may be interested. These folks are especially attractive because they know camp from their parent perspective and, as a result, may be more cognizant of parent concerns. Sometimes physicians/ NPs associated with the local clinic or hospital are interested — or know someone who is. Camps have also found their medical supervisor by asking other camps who they use and then approaching that same individual. Another potential source is university programs for physicians/NPs. These programs will certainly have graduates looking for work, but the faculty may also appreciate the opportunity to use their clinical skills. Finally, capitalize on word of mouth.

Get others to talk about the need for qualified candidates and take advantage of social media. The more that need gets mentioned by others, the more likely one is to find an interested individual.

In particular, take note of people who may initially show interest but don't act on that. This is your nonverbal cue to action. Follow up with an invitation to coffee or lunch. Today's busy world means that people often are intrigued by something but then the next thing grabs their attention and they don't circle back. You want to keep your need in their frame of reference and, in so doing, provide additional information. Doing so over coffee or lunch is perfect for this. As the individual's interest increases, provide more information, especially information that feeds their professional spirit or engages their curiosity. Bring the interested candidate to camp at this point so the individual sees the context in which camper and staff health is impacted. Talk about how your medical supervisor has been helpful in the past and invite the individual to consider how their involvement can make a difference.

The Care and Feeding of Interested Medical Supervisors

Just as with any member of your camp community, once an individual expresses interest, move from recruitment strategies to your hiring process. This might be where talking through the handout mentioned in the first section comes into play. Its content may already be familiar to the candidate, but talking through it helps both you and the candidate more fully grasp the role's responsibilities and ask clarifying questions of one another.

I strongly recommend putting the agreement in writing and having it signed and dated by both parties. The written elements should include language that covers needed services from the supervising physician and the benefits camp will provide in exchange for those services. To improve clarity for both parties, even "in kind" remuneration and/or donated services should be acknowledged in writing. Remember to include a statement that covers "other services as agreed to by both parties" if that's germane to your camp situation.

Provide needed orientation and set a start date for the position. Some professionals benefit from talking with the previous medical supervisor or an experienced person from another camp. Discuss how the medical supervisor interfaces with people working in the camp's health center, the credentials of those individuals, and their experience. Determine a convenient time for these professionals to meet one another. Pass along the camp's medical protocols for review and request a returned, updated copy with the medical supervisor's dated signature. Determine how the health center's prescription medications (e.g., epinephrine, albuterol) will be procured. Provide copies of the camp's health history form(s) so the professional can see what information about prospective clients is gathered. Explain your parent policies pertaining to healthcare and health services. Provide the camp's calendar; note dates when the medical supervisor might visit camp to talk with staff and/or see the program in full swing. Exchange critical contact information (including cell phone numbers) and discuss the circumstances under which the camp director or nurse may directly call the MD/NP. Talk about records you want your medical supervisor to maintain and explain how those records will be used.

Also consider how the two of you will address concerns that arise. While most things go well, challenges eventually surface. These may be as simple as clarifying the best time for the camp's RN to call the clinic for advice, or they may be more critical (e.g., talking with an irate parent). Here's where having one another's cell phone number can really be handy coupled with a commitment to straightforwardly address concerns using classic conflict-reducing skills (e.g., "I" statements, restating what one thinks one heard).

Talk about the camp's professional practice insurance for the medical supervisor, how a claim might be handled, and any special considerations associated with making this insurance work effectively for both the camp and the medical supervisor. Let the supervisor know that the camp's legal counsel has been informed about the scope of service to be provided. Information like this can be delivered in a way that helps everyone feel comfortable and secure or in a way that inflames the situation, so consider how the message might be phrased.

Remember to periodically reinforce your medical supervisor's passion for your camp. Some camps invite their supervising MD/NP for special events, some have a mid-summer meeting to check in with one another, and many seek the opinion of their medical supervisor when addressing the "pain points" of the camp's health services. When information germane to camp health services comes across your desk, share it with your medical supervisor. Actions like these reinforce the professional's commitment to your program and help build a relationship that can stretch into the future.

Act Now; Don't Wait until Spring!

Winter months are good for building or firming up the relationship with your medical supervisor. Do not wait for late spring, a time when camp health services need to be in full swing and when your attention may be strained by other matters. Build — and reinforce — the relationship now. Finally, remember to share successful strategies with other camp professionals. Helping one another makes everyone that much better.

Note: Prospective medical supervisors have a genuine concern about malpractice coverage. In today's world, this insurance is often provided by the entity for which the physician/NP works and, typically, is not transferable to other work locations. Can your camp provide this insurance? Here's where a conversation with your insurance carrier may be needed. If the camp policy provides malpractice coverage, understand the parameters of provided coverage so you can appropriately communicate that to candidates interested in helping your camp.

The Nurse Practitioner: A Professional Who May Be Perfect for Camp

A Nurse Practitioner (NP) is a registered nurse with advanced practice training and credentialing. The person is first educated as a nurse and then adds a medical component via post-baccalaureate education.

Depending on the state, an NP may have independent prescriptive authority. Some states may limit the kind of prescriptions an NP can prescribe; some may require the NP to be affiliated with a physician in order to practice.

The bottom line is that an NP may be a great medical supervisor for your camp, so check into this. Talk with NPs licensed by the state in which your camp is located. Become familiar with the parameters under which they function. If the scope of their practice seems like a good match, consider NPs when you look for your camp's medical supervisor.

Want to talk with someone about NPs at camp? Contact Tracey Gaslin, executive director of the Association of Camp Nursing. In addition to being an RN, Tracey is also a nurse practitioner credentialed in both pediatrics and adult health. She currently serves as the medical director for her camp. Call ACN's phone number to connect with her (502- 744-6803) or email gaslin@acn.org.


Linda Ebner Erceg, RN, MS, PHN, is the program coordinator for Bemidji State University's Certicate in Camp Nursing (MN). Her experience includes over 30 years as a year-round camp nurse for Concordia Language Villages and deep experience in working with camp professionals to address camp health needs. She currently chairs ACA's Healthy Camps committee where her time at camp as well as her former role as executive director for the Association of Camp Nursing now contributes to her educational and research activities.