SoundofMusic 11,629 Views
Joined Apr 7, '07.
Posts: 1,029 (55% Liked)
Wanted to post this, as a way to share my story, and help another practitioner avoid what I've gone through over the past few months. Many of you out there are probably too smart to land where I did, but then again, many out there who are new or who are cruising along just not thinking about it may benefit from my advice.
Earlier this year I was involved in a patient dispute, was terminated from my position, and the company reported me to the Board of Nursing.
There was no harm done to the patient -- more of a charting/billing issue in which I made an incredibly dumb mistake while working in a very pressured position in a retail setting and had zero administrative support to fall back on.
Anyway, a few lessons here I'd like to share:
1. FIRST AND FOREMOST -- get a malpractice policy and keep it current at all times, every minute while you are working. The malpractice policy will come in handy when you have to hire a lawyer to represent you in any dealings with the BON, even if you are innocent. Remember, ANYONE can report you to the BON -- a co-worker, a patient, a "friend," a doctor ....anyone.
2. Don't panic, and get a lawyer. There are lawyers out there who do this for a living and will counsel and advise you on how to present yourself in the best light to the investigators and/or board. Be prepared to fork out at least $2500 to start to retain them. It will go up from there if there are additional needs.
3. If you're in a bad job where you are not supported, or perhaps not really getting along with people you work with, or are unsure of their support, LEAVE as soon as possible and find a better job. Even if you are being paid well with outstanding benefits, etc. There is sometimes so much risk in what we do -- and patients are unpredictable and have the entitlement mentality going in many cases. Don't do patients any favors ...follow the policies of your employer at all times. Do not stay in a job where you feel you are being asked to do more than you can handle -- eventually something can and will happen. Call for help when you need it.
4. If you make an error, do NOT expect the company to come to your aid. They will throw you "under the bus" so to speak very quickly. And rightly so -- they have a company to uphold, and you are just not the priority to them. Thus, the malpractice policy, again -- very important.
5. Take care of yourself -- get counseling, get therapy -- whatever it takes. It's an intensely rough situation to go through -- you may be dealing with the loss of your income, the loss of your colleague support, the loss of your identity -- extremely rough thing. Was for me -- it just about killed me, literally. Luckily I had a wonderful medical provider (an NP who is fantastic) who recommended various steps for me to talk to get my equilibrium back, both mentally and professionally. Luckily I also have a wonderful spouse, family and friends who were there to support me. Luckily, my husband provides an income that we can get by on without my income. If this is not the case for you, you REALLY need to hear this.
6. Be truthful, and tell the story. Tell every detail, and don't try to cover up anything that you did. Yes, it will difficult and mortifying at times to admit what you did ...but this is what I did -- and in the end, the new doctor I will be working with knows the entire details of my story, and has been completely understanding. I had to go on many many interviews after being fired, however, and some of them were not pretty because I was just not ready to present myself properly. I also had to explain to the malpractice company what had happened to be cleared by them. I may receive a "reprimand" to my license soon, and it will follow me forever, unless I get it expunged from my record.
7. Know that you are in an extremely demanding profession and that you are held to an a very high standard -- higher than an RN. Go on the BON site and do a little CME for yourself -- look at the discipline process - look at the various types of discipline that can result from your errors. (for example, Getting a DUI is an instant LOSS of your license, etc.) Know that once you receive a public discipline, it will not only be reported to the state you worked in, but any other state in which you have a license. It will be public, and it will also be sent to a national data bank where anyone will be able to see it as long as you have it. It may make getting certain jobs very difficult.
8. While you may love and admire your colleagues, they are not your friends. They are sort of like that company you work for ....they'll help you to a degree, but when push comes to shove, everyone will have their own best interests in mind. You WILL stand alone to defend yourself. Be good, be friendly, but always keep that professional boundary with them.
9. Do the best job you can and do try to make a few contacts at your job who you may need to use later as references. I am thankful that I had a very good relationship with some of my colleagues and that they were absolutely there to support me through this ordeal. But that's because I always helped them when I could, and I tried to be a decent person at work.
Now that I have somewhat survived this ordeal and looking back, I'm not sure I'd change a thing -- I learned so much -- learned about the reality of the profession, learned about myself and who I am. Got knocked down from my very high horse (and I was on a high one -- I was a top clinician and producer for my organization and thought I could do no wrong). Learned how to handle a tough situation, learned the law, and learned that there are better jobs out there. Most of all, I learned that TRUTH is key ....be truthful in everything you do, even if it means letting a patient yell or get a little mad. Your license and your livelihood is at risk -- and really nothing is worth that, ever.
And lastly, do not affix your identity to this job. For me, I had to re-learn that my worth as a person is not defined by what I do, or how much money I make, etc. This is probably one of the hardest things I had to re-learn and face. Love your job, but love your God, your spouse, your family, your life that make life worth living ... these are the things that will ultimately sustain you in the end.
I feel, although I'm not even accepted into a program yet, that nursing is just about the toughest job in the hospital. At least as an NP, I may be able to sit and concentrate, perhaps, on one thing at a time -- or at least on one case at a time. I will not be interrupted with 1,000 tiny little things -- to fetch water, stop someone from falling, answer a tele call, check off 1,000 tiny little scribbled orders off a page -- I mean -- I want to study and think about one thing at a time! I also want to work a normal schedule! I don't care if, as a NP, that I EVER even hit the 6 figure mark -- I just want a normal schedule and the ability to study a patient, a case, and THINK about it, uninterrupted. I look forward, actually, to working part time as an NP. I don't care if my salary even goes UP -- I just want a different work pattern -- a different work lifetyle.
Also, if I am going to get treated like crap -- I'd rather it be by doctors who AT LEAST have more education and training than me -- whom I respect. I'm tired of being treated like crap by techs, by secretaries, by bosses w/ hardly any more education than I have -- simply because politically, they rank higher than me. It seems everyone can beat up the nurse and get away with it. I've had it with that. Money isn't everything -- it's not everything AT ALL.
I will honestly say, I strongly feel not all that much. I did 700 clinic hours, whereas my doc went to med school for 3 years, then did 3 years of solid residency ....that's what you NEED. I wish that's what I could have done. Now I'm out and expected to know and do what he does ...(well, not really), but sort of ...it puts you in a perpetual state of intellectual disarray and discomfort/risk ... even the PA's I work with were far better prepared. Now that I'm here, I wish I'd gone to PA school. A nurse turned PA is a nice combo -- you've got the nursing background, but get the medical training to prepare you more thoroughly. Just my .02.
I try at least to arm myself with enough knowledge about their case, their problems, what the treatments plans are, etc, so that I can discuss with them the plans. If I go in "blind," I ask them for time to review their case, explain to them that I just came on, dont' know their case, etc. MOST people will understand and give me time to get caught up. Then I can investigate, find out what's wrong, try to help, etc. With most reasonable people, it works.
I also don't get too friendly lately, EVER. I am professional, friendly, but not a "friend" to families. I am their nurse, try to be their advocate, but I'm not their friend. I have been burned from being too friendly with those who simply turned on me in a flash when things started not to go well.
With some who get unreasonable, I will try to politely reason, try to politely provide explanations, and often I can turn them around and get them to calm down. I will try to listen to them as much as possible, see their point of view, etc.
The ones that TOTALLY get me are the ones who complain about the food. I mean -- it's SO childish to me to complain about a hot meal -- who CARES if it's not restaurant quality -- most of it is edible, at least -- and if they are well enough to complain about it, IMO, they aren't even sick enough to be in the hospital in the first place. Just my opinon -- just grinds my gears to no end.
Just started in a primary care office in Maryland. Often, patients under 18 are coming in without parents, and without any sort of parental consent form on the charts.
Coming from the Minute Clinic environment, I always thought kids had to be accompanied by the parent. I realize this is not true for teenagers seeking birth control, pregnancy testing, STD testing, etc .....but for routine medical visits, shouldn't they be accompanied by a parent? We get a lot of the school physicals also being done without the parents of the older teenagers. To me this can be fraught with issues when kids are unreliable historians, uncooperative, clueless about their family history, etc.
Looking at our state consent laws, it's very confusing.
I'm finding lots of trouble with parents not present during these visits ...
Pale, you and me had the same day.
I've recently come back into a busy med/surg type tele unit from a six month hiatus. I've been working on my masters and taking care of kids ...but I knew I needed to work a bit and to keep up my skills.
I've been on my unit about six or seven weeks. I've been "on my own" for about a month now -- what do they do today? Slame me w/ a very impossible assignment w/ morbidly obese people, lung transplants, new admits, pain meds round the HOUR, gazillions of orders ... a tech who can't keep up, and just about anything that could go wrong did. I was at work until 9 p.m. last night, because I couldn't touch a chart all day.
I am just SICK because i truly felt for the first time that I could not adequately care for the people assigned to me ...there was simply a lack of ability on my part (mostly because, hell, I'm STILL new to the unit) and a total lack of time and support for all that was involved. I am up at 5 a.m., of course, today, unable to sleep, and just processing it all over and over.
I don't know the answer. Nursing jobs are just like this -- they are chronically short staffed, and it never changes. They refuse to hire enough techs to cover and the ones who have the jobs do whatever they feel like doing and seem to never get reprimanded for it. If they would just double the tech support and hire people who actually ran as fast as the nurses did ...well, it would be a lot different. Not a slam to all techs out there -- many are fine, but when you have a blistering lack of support like I did today, it really affects everything.
I am having thoughts of quitting already. I don't want to lose my license and I want to finish my degree. I hope this bad day was something rare ...i'm ok w/ being tested, but I also dont' want to lose a patient or my license.
Oh gosh -- I'm relatively new in the field, but still have not really seen one who seemed to have the ability to effectively really manage, and who just did not seem untrustworthy and smarmy. The one I have now does a lot to make my job easy, but also CONSTANTLY cracks the whip on us in terms of patient volume and a host of other things. She just seems to always be lurking . .... right around the corner, ready to pounce if she sees something out of line. And it is tough at times taking orders from someone you KNOW has likely half or a third the education you do and truly has no understanding of how hard your job is. That said, yes, it's their job to keep the office running at a profit so we can all get paid ...
The one I have now is already driving me crazy. She seems to draw you into her conflicts with others, which is ridiculous, because she doesn't seem to have the balls to stand up to the people whose behavior she wants to correct. She wants everyone to just keep their mouths shut, keep their heads down and do their job .... but it's just so unrealistic. There will always be a little bit of gossip in any office ...will always be a few moments here and there where people who are constantly hustling will sit back and slack a little. There will always be patients who take up a huge amount of time, and there will always be times where you just fail to perform perfectly. This one seems to look at us providers as if we are cattle ....she ALWAYS comes to talk to me during my lunch hour about SOMETHING ....which makes me mad ...I NEED A BREAK ...even just 15 mins to clear my head before the next session ... but she will never leave me alone during this time .... just wish they could view us providers as people/humans who need a little leeway ....but there is none. She's always digging and always saying things like, you need to remember who you work for .....ugh. (not necessarily to me, but says that about others ....actually, I think she's just a little off.) Also tough to see her relaxing, sitting at her desk with her manicured nails and cute outfits, all the while I'm sweaty, running from room to room, with my hands in various patient orifices, and me just trying to keep myself looking like an entirely disheveled mess.
My dream would be to have my own practice where I as the provider ran things .... and eliminate the NEED for this type of person. But not sure that's entirely feasible ....lol.
I don't know -- everyday I wonder if I should just hang it up ...I'm just four years into it, spent 3 in retail, and now during my first year in true primary care, I get easily overwhelmed and am often in a state of panic and/or sheer terror. However, it is pretty cool to write those orders and do that follow up, especially if your treatment helped that patient. Really nice when patients like you, want to come back to see YOU personally, and to see how much they believe in you.
Also nice to have nurses to help you, especially if they know what they're doing. Nice to not have to do the grunt work anymore .... nice to get a smidgeon more respect from patients than you did back in the days of nursing. Nice to work with a great doctor, which I do work for, and to collaborate and/or discuss cases with him. Nice to have weekends off finally. I'm still balking at having to wear street clothes, however -- just wish they'd let me wear scrubs and a lab coat ....which they won't.
And I guess the money is better ....but you sure work hard for it. I feel NP's should get paid far more, and I also think doctors, should also get paid far more than what THEY do. We're all so pitifully underpaid considering the work we do, and the responsibility we hold.
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