"That's not your job."

[AngelfireRN, MSN, RN, APRN]

This is getting to be a mantra of sorts in my house. I work in a very small clinic, and the staff is equally small. We have one gal that does our referrals, a medical assistant, a receptionist, an office manager, and me, the Nurse Prac.

The OM's brother works a few hours a day, doing scheduling. We have a lady that does our drug screens, but she is employed by the screening lab, not our clinic.

The medical assistant is training. She hasn't quite gotten to the point of drawing blood, but she's learning and she's a gem.

The office manager has a young child and sometimes can not work a whole day.

Therefore, I wind up wearing many hats. I answer the phone, I draw the blood, I triage, I post labs, I make patient phone calls, I call in meds, I sort charts, I file charts, and today, when the referral gal had to leave, I did referrals. Oh, and I saw 40-some odd patients.

My DH is of the opinion that I should go in, see my patients, and walk out. No blood, no phone, don't help out extra at all. His argument is the fact that my maternity leave replacement didn't do any of that, and she got away with it. Yep, she did, and she's also not there anymore.

I am of the opinion that whatever I can do to help, I'm gonna do it. If I don't draw the blood, it won't get drawn. If the referral gal has an emergency, the referrals won't get done. Doc gets ill, my patients don't get good care, etc.

I say it's a team effort...it's ALL a part of my job.

Thoughts?

[daviex]

As long as they aren't taking advantage of you I'm all for teamwork! I think your husband is concerned you do too much and that they are taking advantage. He's just being a good hubby and looking out for you.

[uRNmyway, ASN, RN]

Depends. Teamwork is great if it works the same all around. I realize that obviously a lot of your duties cannot be done by others, but if you fall behind on something that CAN be delegated, do the others help or huff and puff? Do they OFFER to help? Do you fall behind on your work because you are doing theirs? Do they sit playing solitaire, and that is why they fall behind?

I just ask because most of the places I worked had great teamwork, we all helped each other out and things went very well. But one place I went to for a few weeks had nurses who just did their own things, did not help when you needed it, but sure had no issues asking for your help when they were behind, even if it also put YOU behind. Just be careful not to be taken advantage of.

[TX RN]

Been there, done that.Don't do it.Burn out is real.If you're seeing 40pts daily, at 15min visits that's a 10 hour day with no break between visits.At 10 min that's an 8 hour day with no break between visits.I don't know how you fit 40 pts in one day without leaving some work undone and still have time to do someone else's.

[AngelfireRN, MSN, RN, APRN]

Most of my patients only need refills, we do yearly labwork and I've learned to prioritize fairly effectively.

I did burn out, before I had my son. I left this place and went elsewhere, for more money. I enjoyed the work, but the sporadic schedule and long hours did not jive with being a new Mama. I was eating supper at 10:00 most nights, and exhausted with trying to breastfeed AND work.

Finally, DH had it. That's the only time I have ever had him tell me to quit a job, usually he's on me for being lazy (IE: only working ONE job as opposed to two), and that was about the time that this job called me and asked me back. My replacement was hateful, she refused to help out, and she kept them here 3 hours past closing EVERY DAY.

The thing is...most of my folks don't want a long drawn-out visit. Just write my refills and let me go is quite the norm.

Oh, and you only think you couldn't do it. If there was no other choice, you'd adapt. I had to. We've been without a med assistant more than we've had one since I've been here, and the OM and I were the only other ones with phlebotomy experience.

It's not usual, for sure, but it works.

[Lovanurse]

I personally think it creates complacency. I'm all for teamwork as we were all nurses FIRST, before we became Advanced Practice Nurses. But you will eventually create a situation where the staff will not have a sense of urgency when it comes time to do their job. At first, they probably had a "real" life crisis where they absolutely had to call off. But eventually they will start thinking...hmmm, it'll be ok if I play hookey from work today because Angel can do my job. Don't encourage this behavior. It's not good for you and it deceases the quality of care you need to give your patients. Just my 2 cents...

[Psychcns]

I personally think it creates complacency. I'm all for teamwork as we were all nurses FIRST before we became Advanced Practice Nurses. But you will eventually create a situation where the staff will not have a sense of urgency when it comes time to do their job. At first, they probably had a "real" life crisis where they absolutely had to call off. But eventually they will start thinking...hmmm, it'll be ok if I play hookey from work today because Angel can do my job. Don't encourage this behavior. It's not good for you and it deceases the quality of care you need to give your patients. Just my 2 cents...[/quote']

I suggest you spend extra time you seem to have doing more for your patients as an APRN. They will benefit. Maybe pick a couple to follow more closely. Do pt education--follow up and see if they have questions, read about new research or new thinking about some of your diagnoses. Do an audit and prepare educational materials for common diagnoses. Get a student! Develop your job--that is why you are there!!

[Lovanurse]

I suggest you spend extra time you seem to have doing more for your patients as an APRN. They will benefit. Maybe pick a couple to follow more closely. Do pt education--follow up and see if they have questions, read about new research or new thinking about some of your diagnoses. Do an audit and prepare educational materials for common diagnoses. Get a student! Develop your job--that is why you are there!!

I'm not sure if this reply was to me or the OP? But I agree.

[nursel56]

I worked in a small clinic (as a nurse) for several years after working in a much larger one for several years. I loved our small clinic and we had very little "it's your job, it's my job" stuff going on. There were times when a doc would pitch in and see a walk-in the nurse was just about to make them an appointment for. Once the doctor I was with insisted on disimpacting a screaming 2-yr old himself (a few minutes after closing time) as the receptionist was in the process of telling the mother that "constipation isn't an emergency", most likely because she didn't want to cause our doc to get out late.

Next bit for people who agree with Angelfire's DH and refers to normal ebb and flow in clinic life and not chronic understaffing - I can't imagine what it would've been like if all of us refused to do anything other than strictly MD things or strictly nurse things etc. In small places conflicts loom large. Two people in a snit might be 1/3 of your staff! Suppose the place is jammed to the gills with people in the waiting room and empty rooms sitting there because there aren't enough people to call them in and take vitals. I'm quite sure that someone sitting in their office reading a journal won't last very long. Our doctors regularly called people in themselves when it was busy. Nobody became complacent, but perhaps that was the luck of the draw.

It really served as a model for a healthy culture, which helped me cope in subsequent jobs with absolute hell as a culture because now I don't take hell as a given in the healthcare world.

Anyway, I'd say let your emotional barometer be your guide. Most of us know when we are frazzled and being walked on, and that isn't what going above and beyond is all about in my opinion. Part of feeling OK about it is knowing your team will have your back too should they be in a position to be the decider about how that will go for you, and knowing your situation is during a transitional time (like when a new person is being trained). It is really so rare to feel positive about your team, especially the way you describe the other place -- if it were me there is no way I would leave unless the next job was near perfect.

(sorry for jumping into the NP domain - it's just I felt my experience in a similar environment might be helpful)

[NurseGuyBri]

I think that you need to look at the balance of teamwork and if they are taking advantage of you. I'm always leery when someone says "I am not going to do it because someone else didnt." That's not professional nor is it good work ethic. Now, before everyone jumps down my throat, it seems like you are doing way MORE than just helping out. You need to seriously sit down with the OM and get some clerical help. It's everyone's job to help and based on what you said, I'd love to work with someone like you, but I think you're being overused and abused....

[NPAlby]

Sounds like you're being taking advantaged of. They need to get more help. If your're drawing blood thats time away from seeing a pt, billing and making the practice money. Heck even as a kid working at McDonalds I realized I could take the order, make the burger, drop the fries and clean the dining area but for what???? Bottom line is this we are there to make the practice money and thats not happening if you're on hold with the pharm calling in a refill. Plus you are going to get burnt out and even make less money for them in the long run. Shoot get a second job at another location if you want to work that hard.

[AngelfireRN, MSN, RN, APRN]

I already have a second job, lol. Baby Boy can't get to Harvard Law if Mommy's a slacker!

We have our MA trained now... she's in love with venipuncture. Bless her heart, if she ever leaves, I may go with her.