All Is Not Well In the Kingdom

Nurses General Nursing

Published

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

Specializes in M/S, Travel Nursing, Pulmonary.

"I need advice here y'all,"

Confucious say: "He who stand on toilet in stall is high on pot".

Oh, thats not advice.

Do what I did before a test. I went out to a movie and .............

Oh, nevermind, you posted that yesterday. Probably taking the test now.

Specializes in ER, IICU, PCU, PACU, EMS.

Best of luck to you today on your boards!!! Kick butt!

If all of these 'talks' are happening with your OM and you just started, then perhaps you should start looking around. Does the OM have issues with you? If she is the disciplinarian of the office (from what you wrote), she must have a lot of power in that practice.

Personally, I would look for another office that would be a better fit for me.

I hope it works out for you whatever you decide to do!

Specializes in Cardiac Telemetry, ED.

No advice, just good luck!

Specializes in Emergency & Trauma/Adult ICU.

Go kick butt on your boards, Angelfire ...

As for this particular job ... I agree with RNKittyKat who asked if this is an environment you can see yourself flourishing in. If not ... you know what to do.

Hmmmm, I'm reassessing... I would forget about work till you are done with the test. Then, I want to say make a date for lunch/coffee with the Doc... now is the time to do that. I feel that if I was playing you at the office, I'd about have had enuf sh*t. And I know, if it doesn't resolve you will find a better situation... you do seem like you're mentally ready to blow that place if it comes down to it. :no:

hope your test went well!

As for the whole thing happening again..wow..just, wow. I still maintain you've gotta talk to the doc. It doesn't seem like you're the type to just be able to smile and let this stuff pass. And if it comes to pass that the situation won't work out for either of you, well, in my mind it would've come to a head at some point anyway..at least if you approach it first you have a chance of kind of setting the tone for the conversation, and hopefully keeping it non-confrontational.

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

Well, boards did not go well, and that is all I have to say about that right now. I'll post more when I'm not ready to curl up and wither. Thank you for the well wishes.

Specializes in ER.

Hugs, let yourself hibernate for awhile.

think about all the NCLEX testers that come here swearing they failed, and then a few days later "I PASSED!!!" It could happen to you, and the future is still wide open.

After reading about the second incident, I am not so sure that the OM is not part of the problem and not just acting as a disinterested passer on of communications. I really wonder whether I would remain in such an environment. See what the doc has to say. Any doc who takes the word of one patient over that of their employee is probably not going to be able to keep any good employees around for long. At some point, you have to back up your employees. Good luck. Hope you passed your test.

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

Well, unlike NCLEX, you find out immediately on this test, so, unfortunately I know. It sucks. Missed passing by 20 points. Of course, having gastroenteritis and heaving during said test will tend to throw a wrench in your performance. Anyway, thanks again for the well wishes and advice. Do usually does not work on Fridays, but she made a trip out today to give me a hug, which was sweet.

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

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 nat 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.

I got the strange sensation reading this last post that your doc is manifesting behavior indicative of a "borderline personality disorder", and I'm not credentialed to make that call. I just hope you are able to put this behind you and gain another position. Good luck.

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