He Says/ She says, Who's in Charge?

Specialties NP

Published

I have a question, guys, and I want brutal honesty...I don't want to quit my job. I love it. But I will leave if this mess continues.

As I have mentioned, I work in a clinic that dispenses controlled substances. As such, we do frequent and random drug screens. We operate on a three-strike policy. You fail 3 screens (except in the event of an illegal drug), you're out.

Last week, it was brought to our attention that one patient in particular had multiple failures, and notations were made in the chart that stated that this patient was reporting the unprescribed meds as being from the ER. The decision was made to screen again and to inform the patient that meds would be held until we saw what the screen showed.

When the patient arrived, we did the screen, and I phoned my OM with the results. She said to tell the patient that we would not be prescribing a certain med, but to dispense the others. The patient became irate and stated that they knew where they could obtain meds and that they would get them from there. I excused myself and explained the situation to my doc, who said the patient was not to receive any meds at all.

I arrived at clinic today, and was met with OM, who told me that the patient was in before my arrival, accompanied by a family member who apparently was a local LEO. The patient was apparently in a state and said that I completely ignored their complaints and that I accused them of being a drug addict. I was told that I should have dispensed the meds, regardless of what my doc said. Basically, I was told, "You do what I say, don't listen to Doc."

SO, end result, the patient came in a whined to the doc, got pacified and got her refills. They even went so far as to close me in a room so that the patient 'would not have to lay eyes on me".

The kicker? The WHOLE LOBBY heard this tirade that went down. Every last one of my morning patients made it a point to tell me. And every last one hugged my neck and told me they had my back.

I'm so flipping mad right now I can barely eat. I had witness to the fact that I was not dismissive to the patient, a staff member was within earshot (as always happens with discussions about med misuse/failed drug screens) and backed me up. I didn't raise my voice, I was not mean. I don't candy-coat, and I am pretty straightforward, but this patient apparently is of the opinion that I sit at the right hand of Satan himself now.

My documentation saved my butt. I documented every discussion about every failed screen and about the statement regarding getting meds elsewhere.

My OM is Doc's daughter. Lately, the push is on to keep patients for revenue, which I get. But I feel that we're excusing way more than we used to in the name of money, and I feel that people will get the impression that , if they throw a big enough fit and get law enforcement involved, that we'll cave. I don't want to be a party to that.

It fries my bacon that they catered to this person that way. I feel devalued as an employee and as a professional, especially since the whole conversation was at their instruction. And the whole closing me in a room thing just capped it. That, and the fact that I overheard OM and Doc discussing the 'need to keep patrons'. I get that part, but where is the line drawn?

So, what would y'all do? I truly don't want to quit, but I also am not sure who is running the show anymore. Thanks for reading my tirade.

Specializes in med-surg, psych, ER, school nurse-CRNP.

Update...

Today, I feel vindication like none other I have ever felt in my life. The patient's outsourced drug screen came back, and was lit up like a Christmas tree. Multiple things, including illegal drugs. The OM interrupted me with a patient to show me, then had me come with her to Doc's office, where I received an apology.

My OM is absolutely beside herself. She is so mad about having been made to feel that we had to cater and kowtow, only for this to show up, that she literally could not think of what to say. When this patient shows up to challenge the letter we send in the event of dismissals, as we feel they will, I have been told that not only am I allowed to be present for the discussion, I will be allowed to express my feelings about the situation, to the degree I see fit.

I feel like I have lost 20 pounds. The fact that I overheard OM telling Doc "When I think how they came in here and threw Angelfire under the bus, and then us...Oh, I am so mad."

It was the LEO that did it. Scared her to the point she caved.

So for now, I'm going to go day by day. I don't think they will do anything like this again. OM got wind of the fact I was talking to my other job. I was overheard by another employee...they warned her, hey, Angelfire's UPSET.

But, boy, what a day.

Good for you!

Specializes in family nurse practitioner.

Well I am glad you got an apology. I would start looking if nothing else. I literally just quit my job because of nonsense like this. Everyone in the office needs refills on vicodin and xanax. Been on the mess for years with no hope in sight of them coming off of them. Its a group practice so when I don't give them the meds, they come back in a few days and see Dr. so and so and get it. Mind you, positive UDS for cocaine and marijuana and negative for opiates and benzos.....really? WHERE DO THEY DO THAT AT! Its all about a dollar. They get these pts to come back month after month and it generates volume. I told my OM that I would rather starve than to partake in crime. Because at the end of the day its wrong as two left shoes to give ppl narcotics just for the sake of making money. No objective data to support the need to be on narcotics at all. It was ridiculous!

I get that you love what you do, that's great! But this behavior is not going to get any better. Practices are being closed left and right for things like this and providers are going to jail. Its not worth it. Im proud that you did the right thing in the first place and I encourage you to keep practicing within the guidelines...not just doing whatever the OM says to do. What? Really right now. She sounds insane! Its your license and not hers. We have the duty to do what's right for our pts regardless of who agrees with it.

She's an OM why was she part of this decision making process at all. Im glad you got some vindication but I dont see the culture of that clinic changing. I would look around and start freshening up on my negotiating, interviewing skills. Somehow I dont think this is going to be the last post we see from a ****** off (and rightly so) Angelfire

Specializes in FNP, ONP.

NPAlby is right. The problem isn't this incident (which isn't singular, you post these issues about once a month), the problem is an unhealthy workplace culture and inappropriate relationships. None of the rest of what you posted is your problem and they will all be just fine without you. We all like to think our patients and colleagues would be lost without us, but let's be honest, they did fine before we got here and they will do fine when we are gone. None of us is irreplaceable. Save yourself. Get out.

Specializes in Emergency.

Glad this incident worked out for the best, but I have to concur with Blue and NPAlby, this is going to happen again and again and again until you decide to change jobs. Make a plan, you decide if it's find another job, go FT at the PRN, or whatever and move on. This is no way for a professional to be treated and irregardless of what is going to happen at this clinic, you need to protect yourself first.

NPAlby is right. The problem isn't this incident (which isn't singular, you post these issues about once a month), the problem is an unhealthy workplace culture and inappropriate relationships. None of the rest of what you posted is your problem and they will all be just fine without you. We all like to think our patients and colleagues would be lost without us, but let's be honest, they did fine before we got here and they will do fine when we are gone. None of us is irreplaceable. Save yourself. Get out.

This is such an important point. You are not a martyr and a job is a job. Get out and save your license.

Specializes in ED, Tele, Psych.

Strongly recommend you seek a place to practice elsewhere. If policy says x and practice does y then you are in a very bad position should there be a negative outcome, audit, or legal action taken. Get out now.

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