VENT! I Could Absolutely Scream!---long, sorry

[AngelfireRN, MSN, RN, APRN]

Hi guys, I had this posted in the General forum, but as I am a new grad NP, I want some APN feedback as well, if y'all don't mind. I apologize for the length.

I just graduated as an NP in December. Right before I did, I got a phone call from a local doc with a job offer. This clinic is about 10-15 minutes from my house, and is a family practice/internal med clinic. I had known the doc for a while, so I took the job. She agreed to train me until I could pass boards. It started out great. Then all heck broke loose.

I am an ACNP, or will be as soon as I sit my test. I'm training, trying to get "un-ERed", which was where I did the bulk of my precepting. ACNPs can't do women's health or see kiddos. This was explained and agreed upon at the interview. There was a second NP there that could see these, so no problem. Then she wasn't there anymore.

Now I am back in school, getting my FNP certificate, waiting to sit my test, training, and feeling a bit like I have landed in Bedlam. Don't get me wrong, I LOVE what I'm doing, but I am so on tenterhooks I can't think straight. My boss initially agreed to pay my tuition, since the FNP certification is for the benefit of the clinic, so that I can run it when she is away. Then she saw the bill and reneged, and said that she would pay half up front, and stipend the rest. I have the half, but have yet to see a stipend.

I got called into the office manager's office one night before I left, who had a list of complaints that the doc had about me. (Doc will not say much to you herself, she lets the OM handle it). One was the fact that I am too loud. Yes, my voice carries. I sing, I have trained it to project, and there is NO insulation in the office, so you can hear a whisper in the next room.

Another was the fact that I spend too long with patients. Well, I'm sorry, I'm new at this, and when you have a patient who's on enough B/P meds to kill an ox, 300+ pounds, and whose B/P is still sky-high, it takes a while to calm him down. The suggested approach of "You're too fat, you need to lose some weight" is something I have not hardened myself to yet. I may never. I can't think I'd take it too well coming from my 130-pound self.

And then there was the issue of me cherry-picking the patients, taking the easy ones and leaving the hard ones for her. On this, I have no clue. The only reasoning I could come up with is perhaps she meant the times that I will clear 2 rooms who just need refills before I go to an illness, because the illness will take a bit longer, and while I am in there, 2 more patients can be brought back. I thought that was time management, and with no idea who got where when, I did not realize there was a certain order. The rooms are not numbered. I have never left a harder case for her just because I did not want it. She will refuse to see certain troublesome ones, but she is the boss, and that is her right.

I am expected to see 20 patients a day, which is fine. I always see 15 or more, but I guess she felt I was slacking. By now (the first sentence in the paragraph was part of the original post), I am seeing 20 and then some.

For obvious reasons, this bothered me, as I thought, for 2 months in, I was doing well. The OM told me not to let it bother me, which begged the question, how can it not? I have begun keeping track of how many I see in a day, for my defense, should that be brought up again. I am now quiet to the point that the billing girl asked if I was sick. Nothing else has been said yet, but I have this niggling feeling like the other shoe will drop any time.

The clinic has a high turnover, yes, but I do not want to quit. I had thought that we had a good rapport until that OM convo. Doc hugged my neck before she left a few weeks and said that I saved her butt on a particularly busy day. I appreciate the notice, but at the same time I wonder if I should check my back. According to OM, she "was just having one of her days" and "I got on her nerves".

Our last PA quit after 2 days. I have never seen such a rumpus of trying to find another NP or PA. Then, to add insult to injury, one of our med techs quit, via text message of all things.

I genuinely like this lady, and as I said, I LOVE what I'm doing. What I DON'T like is being blindsided by what I think is a little bit petty. I mean, if I'd been there 2 years, and could not see 20 patients in one day, sure, that's an issue, but in not even 2 months? And when I never see less than 15 a day. I know, I know it is not 20, but I'm also not twiddling my thumbs. I never leave without having my dictation done, I usually beat her there in the mornings, and I thought I was doing well. I guess my feelings are hurt.

And later...

OMG, happened again today! And this was so UNBELIEVABLE that I'm considering putting in my notice.

Doc had left for the day, and one of the med techs and I were in the back kidding around. We had one patient left, and they were done, I had not seen them, doc had. I have no idea why they were even still there.

Med tech comes up to me and asks "Do you know where we keep strips?" , meaning glucose strips for the office monitor, as it needed refilling. I did not, and told her so, as I knew where the ones for patients were, not office stock. She said "Well, I can't find them, and you don't know where they are, what are we going to do?"

To which I replied, "I don't know, I left my map at home today, and I didn't stamp one on my forehead, either." She laughed, I laughed, and we eventually found the strips.

You can imagine my surprise when OM stops me as I am leaving and says that I need to "watch myself". Apparently, the old biddy in the room had called and told her about mine and Cathy's convo, and had said that she did not think I was joking. I was stunned, but moreso by what came next....

"She said you didn't smile when you talked to Cathy."

Oh, my FREAKIN LORD!

At no time was this lady involved in the convo, nor was it directed at her, nor was she even acknowledged while we were talking. Had nothing to do with her, but yet here I stand getting raked over the coals because of some perception because I was not wearing an ear-to-ear grin.

I did tell the OM what happened, and stressed that Cathy and I both knew the other was joking, to which she said, "It has nothing to do with Cathy".

It had everything to do with Cathy and nothing to do with that busybody, who number one should have minded her business. Number 2, OM should have handled it, and number 3, I really feel that I should not have even been made to listen to that based on sheer ridiculousness. (I had my NP boards scheduled for the next day, I did NOT need that.)

I need advice here y'all, biding time is not helping. If I am going to get picked on for petty little things like that, then I'm ready to pay her back my half tuition and walk. I have quieted down, am seeing 20 a day, and am seeing them as they come, all what was discussed at my last powwow. But this kills it.

I have a good mind to, after I pass boards, have a meeting with doc and let her know that, should this sort of thing continue, I will be tendering my notice. I mean, really, what next, I did not point my toe and make a graceful enough exit as I left a room? Where's it going to stop?

I missed passing boards by 20 points, and I had to wonder if stress did not play a role. I had had gastroenteritis earlier that week, which did not help, but this added into it, I don't know.

Well, today was it. I knew it was coming, but it did not make it any easier. I have made mention of the fact that I have been called in the office for various and sundry petty transgressions, but yesterday kinda did it in for me, and today was apparently the final straw.

You know, with 3 months experience, no one can be expected to know everything, but I suppose I was expected to be the exception to the rule. I was told I was too loud, I quieted down. I was told that I spent too long with patients, so I shortened my visit times. I was accused of cherry-picking charts, so I went to the extreme of, when there were 2 to pick from, asking doc "Which one do you want, and I'll see the other?". I posted on here about my being called in about joking with staff and a patient phoning in and saying that I was not smiling, even though NO ONE WAS TALKING TO HER! (This was still being brought up as of yesterday).

So, yesterday, I get "spoken to" yet again, after I get railroaded by a patient who literally would grab me by the back of my lab coat and PULL me back into the room. No help from Doc, just another "you're spending too long with the patients". Also "when you change a dose of meds for elderly, write it down". No sweat, I WAS doing that, and asked who I missed. She could not tell me. The thing is, if you go back and look at my dictation, I put changes in my treatment notes, as well as refills, medication names, dosages, and when they are to return. All I can figure is she was referring to the woman who had not been in to have her PT/INR checked in 2 months and it was 5.2. Had she bothered to look at my last note, the lady was told to come in 3 weeks after her last check, and was given an appointment card. Where it fell apart after that, I have no idea.

It's like no matter what I did, every time I fixed or improved what she told me to, she would just LOOK for something else to pick at.

It came to a head today. On Wednesdays, we have a bus come out and do stress tests, and she schedules a full complement of those AND a full patient load for the day as well. I am a new grad, and she has told me numerous times that "You have to learn to think like I do so they will trust you." Fine and dandy, when I can nail her down. On a good minute, I can get one question in, and ZOOM, she's gone. I do not want to flub up, so I try to track her down again. So, today, she tells me that she is tired of having to do her job and my job too. By the end of the day, I was offering to quit and she told me not to come back, or rather she had her mouthpiece to do it. Poor OM was nearly crying. Said that Doc said I was supposed to be helping, and that I was not helping. I really would like to know how seeing those 24 patients today did not fall into that category, but I did not ask.

So, now what? I agreed to go back to school because she asked me to, she said she would pay for my tuition, then reneged when she saw the cost and only paid half up front, said that she would stipend the rest. I have yet to see a stipend. I would not be in school now if not for her, and she has yet to sign my clinical hours. Those are things I intend to address tomorrow. Doc left for the day before all hell broke loose. I actually stayed and finished my charts.

So, do I demand my money for tuition? And another thing, I was never written up, do I have recourse for firing if I live in a fire-at-will state? I was not made to sign termination papers. I worked 91 days, from November 26- today. I want what is mine by right, but then I worry about retaliation. I would not put it past her to make something up. Any advice of the non legal sort would be appreciated. Thanks.