Your BOSS is the DOCTOR....oh boy!

[Annor]

Ok..here is the deal...

I work for a plastic surgeon.....I love my job. :) This is my first time working for a phyisican in his office....great boss, great office staff...I am his only nurse..we work side by side in the offfice.

I have worked in hosptials and home care....a good part of nursing is advocating for the pt.

BUT....sometimes I feel like , I am pressured at times to side with the doctor...and not speak,up for the pt. Do you get what I am saying?

There have been times I want to speak for the pt...regarding whatever ,but feel , I am stepping on the doc's toes, if I do. He is my BOSS....get what I mean? He does write out my paycheck....hmmm.

Example...writing pain meds...sometimes he holds back on prescribing, another one, removing a JP drain...too soon. Not a good idea....

Then another time he was doing laser on a pt's arms..and he burnt her...hey it can happened...she keeps coming back to the office for him to follow her case..she is very angry and I dont blame her...he did burn her...he is talking all around the reasoning of why it happened...but WE all know it happened. I stand at his side...while he talks to this pt....and I just feel I want to speak up and side with this pt and her concerns...Can you understand what I am trying to express...??

I am not afraid to speak up for what, is right for any pt....just when does the nurse ,whose boss is the doc,know not to.... ,so,she does not get "dismissed" from her job,...I get along very well with the Boss..... :)

Does anyone else feel this way,working one on one with the doctor in his office?

He is a very good doctor...just sometimes, i think my nursing judgement over rules his regard for the pt.

Thanks for reading this...I appreciate your thoughts on this matter.

Annor

[Daytonite, BSN, RN]

This is one of the problems of working for one person. Domestic servants (maids, house staff, personal assistants) are in the same situation. It sounds like you are having problems dealing with the docs way of doing things. Your choice is to look the other way or leave. He is your boss and you owe him your allegiance. All you can do for the patients is be sympathetic and listen to them. In the situation you are in you really don't have the kind of autonomy than a nurse working in a hospital has. It is very hard to stand by and not be able to practice the way you were taught.

Private duty nurses have similar problems. Some of their wealthy clients will tell them what they want them to do for the patient and its not always good nursing practice. If the nurse has trouble with that she gets out of that kind of nursing. I worked in a hospital where we had a lot of celebrity patients and you had to be careful how you spoke to them, especially when they started playing the "money buys anything" attitude. The hospital wanted us to cater to them and it was really hard when they were wanting to call the shots and it conflicted with good nursing practice.

It takes a special attitude to be a servant to another and requires a feeling of devotion to stay in that kind of situation.

[SusanJean]

Are you able to speak to him about your concerns privately, not in front of the patient? I would think that, as a professional, as part of a medical team, he would value your input. Perhaps you can talk to him in general terms, first, to gauge his response for future (advocating for the patients.) If he is favorable, then do so on later patients.

You may decide that this is just not the right place for you. I do not think I could work there if the doc would not value my input.

Good luck.

SJ

[Nurse Ratched, RN]

My docs and NPs are great. All I have to do is ask them to educate me about a particular technique, rationale or school of thought. It's good to know where your provider is coming from. Example: "I've also seen x done y way. How have you found that z method is better?" Another phrase: "Is there any reason not to consider x in this case?" (I also am very fortunate to be able to be more blunt with them: "I really think so and so would benefit from more agressive treatment of such and such. Is there something we can do for her?") This is rarely needed.

Pain med stuff is another animal altogether. You can advocate for your patient but ultimately it's the provider's license and level of comfort with a particular narcotic.

I hope you are able to develop a relationship with your doc that lets you interject your professional experience where appropriate. Sometimes the answer will still be no, and you need to be comfortable with why that is, and allow the provider to explain things directly to a patient where appropriate if you aren't able to fully support/understand that decision.

Best of luck to you :).