All Is Not Well In the Kingdom

[AngelfireRN]

Hi again, all.

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. 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 is paying my tuition, since the FNP certification is for the benefit of the clinic, so that I can run it when she is away. That generosity is not lost on me.

I got called into the office manager's office the other 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 though 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.

For obvious reasons, this bothered me, as I thought, for 2 months in, I was doing well. Th 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 last week 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".

What do y'all think? I LOVE what I do. I really like it, it's close to home, I like the people, it's where I grew up. Would you let it ride, say something, let it go? I'm new at this aspect, and were I not, my outspoken self would probably already be fired. Thanks for reading and for advice.

Angelfire

[AngelfireRN, MSN, RN, APRN]

About the OM taking it on herself, nope, she had a LIST, in doc's handwriting, of my transgressions. I don't know if I see it working out, but she IS paying for school. That may be a mixed blessing, and if it gets worse, I may let her have it and pay back the tuition.

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.

[Whispera, MSN, RN]

I'd talk with the doctor about it before it builds. It's not fair to the office manager or to you to have the office manager telling you these things.

[leslie :-D]

I'd talk with the doctor about it before it builds. It's not fair to the office manager or to you to have the office manager telling you these things.

agree w/whispera...

and if you feel uncomfortable talking, no harm in leaving a letter in her office.

leslie

[tencat]

Even a list in her writing isn't sitting face to face and talking it out. It needs to be done. Sounds like the doc needs some skills in dealing with employees.

Not to change the subject, but Leslie, you crack me up! Yes, a bit inappropriate (another one bites the dust...) but oh so funny........:)

[netglow, ASN, RN]

My . I am (just a student) but I am always watchful... and am listening.... I also have much corporate and some medical office exp. My take... maybe this is not so bad. You are very experienced and can be trusted which is why she has hired you. This she knows. Hey you can do her job. But, I think there might be a little bit of checking that you know she is boss going on here (her little insecurities). Many docs always need to be sure that people are aware of the pecking order. This is insulting, of course, as you know your place (duh). But let it diffuse... don't try to meet with her right at this time, just biz as usual, tone it down a bit... (I am also very vocal :rotfl:) You probably are very personable, and remember she's a she... maybe she is a little worried that pts. will loooooove you, better than they love her. You know that might be all it is, right?!

[VivaRN]

Hmmm, if my boss took time to make a list about me I'd want to talk about it.

She hired you and is paying for your education because she wants to keep you, I doubt her aim was to hurt your feelings or try to drive you away.

But still, making a list and going through a third party strikes me as passive-aggressive. I would rather meet it head-on and communicate than start this pattern of playing games. It's hard to judge without knowing more about her temperment.

Good luck with this doc. She sounds like a tough nut to crack.

[SuesquatchRN, BSN, RN]

they have all this harpy therapeutic wanna-kill-myself music going.

one of my coping mechanisms in stressful situations, is to sing.

i am always singing.

well one day when one of my pts died, i 'guess' i was singing "and another one bites the dust" by queen.

never even knew what i was doing until my arm was physically dragged off the floor by the med'l dir.

I'm laughing so hard I'm snorting like Chrissy on "Three's COmpany." Scared the cat.

[ANnot4me]

Hi Angelfire, just remember you are a very qualified and sought after professional. While your doc may be paying your tuition, remember it is for the benefit of her practice. Many people prefer NPs over physicians and in the long run, she will benefit. Don't feel beholden.

It would appear you are working in a difficult and stressful situation. Not everyone is able or willing to do that (as evidenced by the two people who left). I know I would not be very willing to have an office manager read me a list of my "defects." There are things about me that are me and I am not in a position to change (or to change would take some time and work). I , too, have a voice that projects; my personality is also quite big.

You are new and deserve some time to learn. You are also not a doc but a nurse and you bring your own experience and talents (don't excuse that). This woman should be looking out for you and kissing your back side to keep you happy in my opinion.

Good luck!

[Virgo_RN, BSN, RN]

I agree with Suesquatch.

[wonderbee, BSN, RN]

Years ago I had a boss who kept a list. He had invited my husband and I to his house for parties and was cordial. One day I had to go into his desk for something and there it was right on top in the drawer. It was a list of transgressions he kept against me. Never once did he give a hint that there was a problem. I was stunned, hurt and angry. I did confront him with the list. It meant the end of that job (fired that day and got that news third hand too) but there were others out there and I did not want to work for him anymore anyway.

It's a personality thing. You won't be able to change her. If it were me, I'd start collecting letters of reference from other pros you work with. It never hurts to have them in hand. I don't trust anyone who keeps lists.

[rngolfer53]

Ummm....why is the OM playing messenger? I think you and the doc need to sit down and discuss issues face to face and not rely on a third party to transfer information. It's too easy for information to get distorted when the 'telephone' game gets played. I'm not suggesting you confront the doc. I'm suggesting just sitting down and telling her how it's going for you, and asking her what she feels you still need to work on. I think that's completely reasonable and could go a long way toward making you feel more secure. Now, if she's hesitant to do this, then my little voices in my head (the rational ones...:) ) would be saying this is not a good place to be and maybe I should be looking elsewhere.....

Actually, the doc is well within normal bounds in delegating supervisory tasks to the Office Manager. At least presumably, the OM is qualified to manage people, which includes performance review.

The big boss rarely likes to play the heavy, which is why the military uses the XO as the disciplinarian. This can work to the employee's benefit. The boss can back down, or rethink something w/o losing face. And in some cases, the OM might be saving you a real hiding if the boss has a temper, for instance.

As always, I'd be very hesitant before stepping outside the established chain of command in the organization structure.

[AngelfireRN, MSN, RN, APRN]

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 am taking my NP boards tomorrow, I did NOT need that today.

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 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?

Any thoughts? Am I overreacting? SHOULD that have been addressed, or WOULD it have been at your facility. I'm just so over this at this point that I don't know what I think I should do. Thanks.