Question about office job vs. hospital job

[ShiphrahPuah]

I have been working as an RN in a hospital for 2 years and have an interview at a doctor's office this week. From all the posts I have read under ambulatory care, I think I would really prefer to work in an office even with a cut in pay. While the occupational outlook guide (http://www.bls.gov/oco/ocos083.htm#outlook) from the government states that RN jobs in offices of physicians are expected to grow more rapidly than RN jobs in hospitals due to a lot more procedures being done in offices or outpatient centers, I also know that a lot of MD offices are using medical assistants instead of RNs to save money.

My problem is that this economy is just so unpredictable. I graduated from nursing school in 2008 (second career), and all through school all we heard about was the nursing shortage and how easy it was to move around to different employers or specialties. Sadly that is no longer the case. Since my hospital is having financial problems, I started looking for jobs in offices or other hospitals. So many hospitals near me have hiring freezes. I have applied for about 15 jobs, and this is the only job for which I have been called in for an interview.

I am excited because I have always thought that I eventually I want to be in an office setting. However, I am nervous because I have read about so many offices using MAs instead of RNs, and I don't want to find myself squeezed out of a job and then have a hard time getting back into a hospital. I obviously don't have an offer yet and cannot assume I will, but I am remaining optimistic at least until after the interview.

I would love some input from those of you who work in offices. If I were to get this job, I don't necessarily ever want to go back to a hospital, but what is your take on the way office jobs are headed? Are you concerned at all that you will be replaced by less expensive medical assistants? Any great advice? Thanks much.

[Ayvah, RN]

You are correct that many offices are moving towards more and more MAs/MOAs to save money. But if I remember my scopes of practice correctly you still need RNs to do certain things like medication education, and taking verbal doctor's orders, so some practices are required to staff with at least some RNs. And if it is a practice with multiple specialties(such as a clinic that's attached to a hospital), if they do decide to restaff with ma's/moa's they could transfer you to another area. I wouldn't really worry though that you job would be eliminated any time soon, though.

I'm currently in a specialty office and don't worry about job elimination at all... and I am loving how different it is from the hospital! While the scheduling changes and less stress are obvious, I didn't realize all the little changes until I was there, like how you could go to the bathroom in peace, without having a phone on your hip ringing while you are in there!

Good luck!

[ShiphrahPuah]

Thanks Ayvah,

Yes, the idea of having a minute in the bathroom without the portable phone ringing sounds wonderful. Also, the opportunity to GO to the bathroom! I can't believe the number of 12 hour shifts I have worked without EVER going! (or eating). I know plenty of people say it's time management, but there are occasional days in the hospital where everything is a crisis and there really is no time for even a few minutes of a break. That doesn't happen on most of my shifts, but the times it does happen, I think "this is NOT a healthy job!"

Thanks for taking the time to respond! I had my first interview and am still optimistic!

[tewdles, RN]

I found that the physicians I worked with in Community Health appreciated that I was a professional partner with them in care of our patients...unlike the MAs who were skilled employees.

Development of nursing diagnosis on ambulatory care setting patients helps the care team to focus efforts and interventions during visits which ultimately improve health behaviors, outcomes, and patient satisfaction. This, of course, is not something that an MA can provide.

I am not dissing MAs, I have worked with some good ones and some bad ones, just like nurses. However, there are very real differences in what skills each discipline brings to the table and even the best, most skilled MAs are not able to function as a nurse.

IMHO, nurses that practice like MAs will find themselves replaced by MAs. Nurses who practice like professionals are unlikely to be replaced by nonprofessionals.

[*LadyJane*]

I was hired in an office not too long ago. I was hired specifically because of my nursing education, because my doc wanted someone she could bounce ideas for care off of, and because I could do patient teaching, education on drugs, look for interactions, explain lab tests and other medical tests, explain the recommendations to patients, triage patients, and take care of psych patients. The MA's can do office procedures that they have been taught, but don't know all that you do. I am reminded of this almost daily.

In the office, I have a one hour lunch each and every day. We get weekends and holidays off. We get to develop relationships with patients, and the ones that come in frequently, we can see how they are doing when they walk in the door. Depending upon the group that you work with, your days can be pleasant or nasty. You can still get stressful days, if your schedule is packed, and then you get walk-ins who are "really sick" and still need to be seen. For some reason, people figure out that they need an RX filled on Friday, and then you have to run around, check on this and that to see if they are due for a refill, and get the doc to sign a scrip, and call it in, or e-fax, or whatever. You have people that come in and after some initial checking, need to go to the ER. It's pretty tame for the most part at the office, but you still get a splash of the unexpected to make it interesting.

I really hadn't expected to like the office so much, but my doc is wonderful, and I can only see her practice growing alot in the future. Working for a wonderful doc can be a great career....