[santhony44]

What an awful place to work.

It is not typical of the clinics I've seen!

If they want "walk-in" labs, then they need standing orders to cover this.

I'm a provider. In our clinic, the nurse (licensed nurse) will order labs on the patients before the provider sees them, but this is based on a standing protocol and/or orders written previously (such as TSH next office visit). My nurse will also send patients with symptoms of a UTI, strep symptoms, and possible pregnancy to the lab, but she's been given verbal orders to do so. Patients can't just pop in and request labs without their provider, or some provider, giving an order.

No office manager I've ever worked with would have thought of "ordering" lab work herself or himself.

Further, while providers are treated with respect, we aren't treated as superior to everyone else- the only places I've seen separate lunchrooms is in hospitals.

And for the "own private little playboy bunny," well, that would not have been tolerated in any clinic I've ever worked in. That's outrageous! Any smart provider will choose a nurse who is sharp, williing to make your life easier, and can keep the patient flow going. Bilingual is also a bonus if your patient population has a large number of non-English speakers. I want one who has the sense and judgement to not let a patient having an asthma attack or chest pain sit out in the waiting room or in an exam room without my being aware, who will send a patient with UTI symptoms for a UA so that it's done by the time I get to the room, who will do the paperwork correctly, who doesn't have to be told the same thing a hundred times,etc etc. I don't care if the nurse is male or female, or looks like a model or Nurse Ratchett, I care about competence. Blonde, blue-eyed, and cute might be just fine, but add inexperience to the mix and you might find yourself in trouble.

And I would think that sort of remark is at least bordering on a hostile work environment.

[rnwaller]

I wish you all the best in your decisions. You complied with the nurse practice act but you have discovered that bad politics of HMO medicine.

I have to agree with other posts, IF you want to take this on you need to go to the insurance companies. But, you certainly run the risk of being blackballed in a rural community.

You can also ride the charting redirect road,"Per Ms Boss Lady pt has regular labwork, labs drawn at her request, to follow up with Dr. So-So."

In the end, maybe ask to work FOR the insurance company?

Remember, the rest of us love you......

[pgrsctrn2be]

I recently left a clinic job where the current and previous office managers tried to tell me my job, (I was the only nurse and only 1 doc). Didn't take me long to let them know how things worked. Not only would they tell me what to do for the pts but also who I could approve med refills for without consulting with the doc. I finially after monthes of trying got the doc to write out some standing order for me to use a guides for routine visits and a list of meds that could by authorized for refills depending on last exam of pt,etc.l Pts loved the shorter wait times to be seen and the dear doc loved being able to see more pts in a days time. Of course the office manager wasn't too happy, esp when I booked mark the BON site and often refered her to that when she demanded I do something out of my scope of practice. I hear she is back to bullying the poor soul that replaced me when I left that clinic. I did find out later that now the business office staff is now authorizing med refills, is that legal?

[deanzgurll]

Originally Posted by rnwaller

I wish you all the best in your decisions. You complied with the nurse practice act but you have discovered that bad politics of HMO medicine.

I have to agree with other posts, IF you want to take this on you need to go to the insurance companies. But, you certainly run the risk of being blackballed in a rural community.

You can also ride the charting redirect road,"Per Ms Boss Lady pt has regular labwork, labs drawn at her request, to follow up with Dr. So-So."

In the end, maybe ask to work FOR the insurance company?

Remember, the rest of us love you......

...that last line almost made me cry...thankyou. I am not really sure but I think the "redirect road" only works when ms boss has a license of her own.

[azhiker96]

I agree that you should take some action. You have a lot of options available.

1. Report the office manager for trying to order labs without a license.
2. Report the lab for routinely drawing labs without an order.
3. A lawyer may be able to help with a wrongful termination lawsuit.
4. If you are a member of INA, they would be happy to represent you. Even if you are not a member, they might be able to give you some good advice if you call them.

I'm proud of you that you didn't put your license at risk by performing an invasive procedure without an order.

[deanzgurll]

Originally Posted by azhiker96

I agree that you should take some action. You have a lot of options available.

1. Report the office manager for trying to order labs without a license.
2. Report the lab for routinely drawing labs without an order.
3. A lawyer may be able to help with a wrongful termination lawsuit.
4. If you are a member of INA, they would be happy to represent you. Even if you are not a member, they might be able to give you some good advice if you call them.

I'm proud of you that you didn't put your license at risk by performing an invasive procedure without an order.

Dear AZ>>>, report the office manager and the lab to who? I already tried going up the administrative ladder, and believe me, they don't want to know. To give her some kind of credit, she works her butt off for this system, 24/7. She didn't create this work culture. The Providers have a hand in this ( any good docs reading, sorry). They are also employees in a system dedicated exclusively to the bottom line. They are frustrated too I think. This shows up in getting testy about follow through, not wanting to be bothered by paper work details, trying to shuffle as many people as possible through in a day without too much concern about the quality of care (again, sorry good Docs) even ridiculing their pts. behind their backs, and taking out their neg feelings about themselves on the staff...kicking the dog. The lab tech has really never worked anywhere else and doesn't know any better. Lord knows I don't want the job back. I just want the staff to get some respect. I am grateful for you suggestions, could you elaborate.

[deanzgurll]

Originally Posted by Angie O'Plasty, RN

Now there's an idea....

...ANGIE O'PLASTY?...JOULE of an RN?...OOOHH MAAAN...LOL

[deanzgurll]

Originally Posted by pgrsctrn2be

I recently left a clinic job where the current and previous office managers tried to tell me my job, (I was the only nurse and only 1 doc). Didn't take me long to let them know how things worked. Not only would they tell me what to do for the pts but also who I could approve med refills for without consulting with the doc. I finially after monthes of trying got the doc to write out some standing order for me to use a guides for routine visits and a list of meds that could by authorized for refills depending on last exam of pt,etc.l Pts loved the shorter wait times to be seen and the dear doc loved being able to see more pts in a days time. Of course the office manager wasn't too happy, esp when I booked mark the BON site and often refered her to that when she demanded I do something out of my scope of practice. I hear she is back to bullying the poor soul that replaced me when I left that clinic. I did find out later that now the business office staff is now authorizing med refills, is that legal?

..YOU HAVE BEEN THERE..but tell me...how common IS it for clinics to have such convoluted, disfunctional , canniblistic work cultures?

[deanzgurll]

Originally Posted by vloho

What happens when everything is said to be insubordination? Does it matter if your right ?

...I suppose that depends on how you define "MATTERS". It matters to me that I am right (and believe me I stewed about this for weeks, all the time wondering what I had done to deserve this, what I could have done diffrently..we all do that I think; take on accountability for everything) It matters alot that, so far, everyone here thinks I was right, with a capital R. The support I have been given on these pages has gone a long way toward healing..I have been soooooo angry. It probably does not matter to them or anyone else locally unless I put my money where my mouth is. A couple of Nursing friends said, "SHE CAN"T DO THAT".. can't according to whom? she can, she DID..unless I am willing to push the envelope the rest is just opinion. We all talk big talk about not tolerating this behavior..but besides voting with your feet, what? WE ARE NOT AN AUTHORITY THEY ANSWER TO. Unless and until there is one .... I wish Nurses HAD an authority that wielded some power over medicine and or business.

[banditrn]

deanzgirl - you bet you're right!! Talk to a lawyer. Who regulates places like that, anyhow? Does the state have to approve them?

I HATE bullies - and I would have refused, too - tell HER to do it!