Life and Career Coaching for NPs and PAs— Negotiating Success for Advanced Practice Practitioners: Strategies for Dealing with a Challenging Boss

by Kasey D’Amato, PA-C, MPAP

Ms. D’Amato is President of Certified PA Consulting in Ft. Lauderdale, Florida.

J Clin Aesthet Dermatol. 2023;17(1–2 Suppl 1):S42–S43.

FUNDING: No funding was provided for this article.

DISCLOSURES: All authors are employees of Certified PA Consulting.

Negotiation is a crucial skill for professionals in advanced practice, particularly when dealing with challenging bosses. Advanced practice practitioners (APPs), including nurse practitioners, physician assistants, and other healthcare professionals, often find themselves in positions where effective negotiation can significantly impact their careers. However, there are strategies that can be tailored to the unique challenges faced by APPs when negotiating with difficult superiors.

Negotiating as an APP requires a nuanced approach due to the complex nature of healthcare environments. APPs operate at the intersection of patient care, collaboration with other healthcare professionals, and managing the expectations of patients, staff, and superiors. When faced with a challenging boss, it becomes imperative to navigate these complexities while maintaining a focus on the ultimate goal, delivering quality healthcare, and doing so in an environment that is aligned with professional and personal goals.

1. Building Strong Foundations

Successful negotiations begin with a foundation of trust and respect. Before entering into any negotiation, take the time to understand your boss’s perspective, priorities, and concerns. Establish open lines of communication to foster a positive working relationship wherein you support each other. This foundation will serve as the bedrock for future negotiations and can ease tensions when facing challenging discussions.

2. Leveraging Data and Performance Metrics

APPs can strengthen their negotiating position by leveraging data and performance metrics. Collect and present tangible evidence of your contributions to patient outcomes, team collaboration, operational efficiency, or collections. Numbers and statistics can provide a clear picture of your value within the healthcare setting, making it more challenging for a challenging boss to dispute your contributions.

3. Emphasizing Patient-Centric Approaches

Highlighting your commitment to patient care can be a powerful negotiating strategy with employers who place a high emphasis on patient feedback. Emphasize how your proposed initiatives or changes align with improving patient outcomes. By framing your proposals in a patient-centric context, you appeal not only to your boss’s professional concerns, but also to their commitment to providing high-quality healthcare.

4. Effective Communication Skills without Emotion

Effective communication is pivotal in negotiations. APPs should hone the ability to clearly articulate ideas, concerns, and proposals. This should be accomplished using objectivity and compassion without an emotional undertone. Additionally, active listening skills play a crucial role in understanding your boss’s perspective. By fostering open and transparent communication, you can create an environment conducive to a successful, win-win negotiation outcome.

5. Negotiating Work-Life Balance

Negotiating success extends beyond professional matters; it encompasses work-life balance. APPs often face demanding schedules and high-stress environments. When negotiating with a challenging boss, consider addressing aspects of your work environment that contribute to burnout or stress. Negotiating for a balanced workload and realistic expectations can lead to a healthier and more sustainable professional life. Keep in mind that negotiating to reduce patient hours or go part-time will likely result in reduced salary or salary percentage, as the collections will be impacted.

6. Seeking Mentorship

In the healthcare field, mentorship and advocacy are invaluable. When faced with a challenging boss, seek mentorship from experienced colleagues or experts who have navigated similar challenges or have unique experiences. A coach or consultant can provide guidance, share industry trend insights, and offer customized strategy and support during negotiations.

7. Understanding Organizational Dynamics

Negotiating success involves understanding the broader organizational dynamics at play. Consider the organizational culture, hierarchies, power structures, and target vision or goals of the organization. Being aware of these factors can help you tailor your negotiation strategies to align with the person in the organization who has the ultimate decision-making power.

8. Utilizing Conflict Resolution Strategies

Challenging bosses may lead to conflicts that require resolution. Familiarize yourself with effective conflict resolution strategies, including controlling your emotional state and rational compromise. Rather than viewing conflicts as obstacles, challenges, or conflicts, see them as opportunities to strengthen relationships and focus on finding common ground that can lead to a win for both parties.

9. Know When it is Time to Plan an Exit

There is a difference between a challenging boss and a toxic or unstable personality. If you are in danger or are simply emotionally exhausted working alongside your boss, it might be time to consider planning an exit rather than pursuing negotiation.


Negotiating success for APPs facing challenging bosses can be a complicated, multifaceted endeavor. By building strong foundations, leveraging data, emphasizing patient-centric approaches, honing communication skills, negotiating work-life balance, seeking expert guidance, understanding organizational dynamics, and utilizing conflict resolution strategies, APPs can navigate challenging situations with resilience and effectiveness and experience successful outcomes.

Ultimately, successful negotiations empower APPs to contribute meaningfully to their healthcare teams, enhance patient care, and cultivate fulfilling and sustainable careers in the dynamic field of healthcare. APPs who navigate how to create truly successful outcomes that benefit both the facility and themselves have some of the most fulfilling careers in medicine today.