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

[moonchild20002000]

Your Doctor reminded me of someone I worked for for1MONTH! I was the one to leave.

Sounds like your Doc has got issues. The frequent staff turnover is a give away.

I think you not working there is the best thing for you. This incident will not affect any

future employment.......sounds like she is well known in your community.

[AngelfireRN, MSN, RN, APRN]

I was just sitting here thinking that I could write a book about all this. Trouble is, EVERYONE'd know who it was, even if I changed the names, and then Lord knows what would happen.

[classicdame, MSN, EdD]

Try to focus on testing just now. That way if you lose your job you will still have your license. Later, ask for feedback from the MD. Every new job has a specific culture to learn. BTW, I went from MD office to hospital and can tell you the whole vibe is different. Part of your pain is UNLEARNING the hospital culture. This takes time but you are smart enough to do it or would not be where you are now.

[AngelfireRN, MSN, RN, APRN]

Just had another view weigh in, my Aunt. She works at a local restaurant and goes to a competing doctor who used to work partners with Dr. Wonderful. She said that they did not part well, that she basically ran him off because the patients liked him and requested him. When I was so excited about patients requesting me, I had no idea I had a bounty on my head.

I called again today to ask about the school papers being signed, and was told again that the NP was to sign. I again reiterated that the doc HAS TO SIGN at least part of the hours, as she was listed as the lead preceptor. OM said she'd "have to talk to her and call me back" and hung up on me. That's OK. I can out-stubborn anybody. My Mama raised me right.

[lamazeteacher]

This sounds like a case of jealousy, and when that green eyed OM has a new NP, she gets off seeing her/him squirm. It may be best to ignore her and communicate directly with the physician upon whose knowledge you depend.

It seems the boundary between OM and NP was breached, as the OM cannot supervise a NP. I also project my voice, having done many public presentations, but have never been approached as you were. It's good that you've lowered your decibels, but raise them for the "hard of hearing".

While the OM is out of her element, don't take offense longer than is warranted. It will come through and taint your relationship with her. I strongly suspect that a physician wouldn't use an OM to communicate, so the criticism may be only hers.

[Saifudin]

I'm an adult NP and my first job was in a busy inner city Bronx ER. I was the first ANP in the ER and frankly, I had to wing it on many days but I made it, and learned a tremendous amount. I transferred to the primary care clinics 2 years later and stayed there for 10 years. Tremendous docs, NPs and nurses! Again, learned so much. As a city hospital we had time to spend with the patients but, of course, we often paid for it by getting backed-up and an HIV+ pt. walk-in could come in at anytime with a horrible cough and fever or the 300 pound, 80+, multiple problems, meds and non-English, first time patient, etc., etc.. but we could take our time.

Anyway, that was a bit of nostalgia. With your doc, I suggest when she gets back you ask for a meeting or some time for a coffee, with no appointments waiting, phones, etc., and discuss the OM comments. Ask her directly for her evaluation and let her know that it's OK and that you welcome feedback, criticism, etc., about your practice, especially since you are new. She might be a person who finds confrontation difficult. Its an art, not an attack.

If you take the 'high-road' so-to-speak, she may open up which will hopefully lead to ongoing open evaluation of your work and she may feel more relaxed about the small issues like your voice.

On an intellectual level she likely understands your new and will improve but on a busy, stressful day, emotions may take over and she loses sight of that.

Communication is usually the key and some people are better at it then others so work on that. I think she will appreciate you even more.

[AngelfireRN, MSN, RN, APRN]

Update:

Doc had OM call and say that she WOULD sign my school papers. Thank GOD.

On a different note, an source told me a few things. I was told that doc has ben having to come in at 0400 EVERY DAY to try and catch up from the day before. The source said that the day she saw her, she looked awful. Another source told me that they have been slammed every day since I left. To which I said "Good." She laughed and said "No bitterness, no bitterness." I'm not bitter, I'm just mean enough to be glad.

First source said that two NPs have been interviewed since I left, and neither was hired, one because doc did not like the way she shook hands. Ugh.

And, lastly, first source said that doc is apparently having an attack of conscience, as she kept coming in to tell source that she did not care to sign my papers, that she had no ill will towards me, no hard feelings, and would source tell me that. Source apparently told doc to tell me herself. Sourse also said that doc said I had had 3 complaints in one week, then later she said in one day! She even said that they wrote letters.

Now, nothing was said to me about this. Ever. I never was shown a letter, and no complaint was ever brought to my attention, save the "not smiling at Cathy" hoopla. Now, as a business owner, if what she said happened happened, would you not use THAT as a reason to fire someone, rather than "you ask too many questions" or "you're not helping". I was never even written up! This makes me think it's a crock.

Gotta say though, seems like the chickens are coming home to roost, and they're clucking all the way.

She has been known to try to hire back people she fires, and I'm wondering if that will be the case this time as well. Thanks for all the support.

[lamazeteacher]

Qhote from "Angelfire"

"She has been known to try to hire back people she fires, and I'm wondering if that will be the case this time as well. Thanks for all the support."

It seems like "what goes around, comes around" worked again, and while that may even things out for those who deserve it, patients get messed up by all the negative stuff flying around.

Now that it's over (and you may have to repeat that to yourself a dozen or so times to really register it), take this time to excel in your exams, your next job, and leave it behind you (but not too close). You'll look back and wonder why it upset you so much........

Best of luck to you (although it's not luck, just hard work and ultimately, satisfaction).

Lois

[megjrn]

Here's what I think... I think the Office Manager may be the problem in this place. You said there is a rapid turnove in employees there. Wonder why? Yes, she manages the office--keeps it running smoothly, probably interviews prospective employees, ensures office policy and procedure is followed, etc., some even oversee billing. That is what an OM does. From what you're saying, it sounds like your OM is a bit full of herself and maybe she's just a b.... who thinks she's all that. Sounds like the doc wanted her to discuss issues with you that she felt needed addressing, and again, that is the OM's job for other office employees, but it is inappropriate for her to discuss job perfermance with the NP. HOWEVER... I'm wondering if the OM carries her job too far and is just plain bossy and goes around addressing things as she sees fit without actually having the authority to do so? Sounds like she may be one of those "wanna-be's", you know the kind--she's not a nurse, really wants to be, won't go to school to be one so she tries to be superior to those who went to the trouble to become nurses. I'm wondering if those people who suddenly quit their jobs at your office did so because she upset them?

As far as the patient who overheard your kidding around with that Cathy person...I hate when stuff like that happens!! And WHAT I hate about it is the WAY IT IS HANDLED by the person to whom the incident is reported. Why do they always blow these things way out of proportion??? It's as if they purposely want to make these incidences much more than they are just to stir up doodoo and be bossy. They live for that stuff. They weren't there, so they don't know what really happened, but yet they don't take your side nor give you the benefit of the doubt. After the nosey-busy-body patient finished telling the OM what she THOUGHT she heard, the OM should have said, "OK", then smiled and told the patient it was nice to see her again and walked or turned away and pretended to carry on with her business. She should never have even said anything about it to you at all. But she WANTED to say something to you because it made her feel superior. The OM is not your boss, but she wants to think she is.

Definitely discuss this with doc. I would make my own *******' list and tell (don't ask) the doc you need to have a meeting with her ASAP about some concerns you have. If she asks what kind of concerns, tell her you will discuss them in the meeting, not now (put yourself in control of this situation). Be polite and professional, not angry. In the meeting tell her you were confused by the things the OM spoke with you about and explain to the doc your rationale for seeing the patients in the order you had been originally seeing them (getting med check patients done and out of the way first, etc.) Ask her, point blank, why she thought you were dumping the hard cases on her? See what she says. Tell her that addressing the quality of your speaking voice is simply insulting to you and who you are as a person. Tell her it is as inappropriate as addressing the voice of someone who has an non-regional accent. It is bordeline discriminatory. Then tell her at the end of the conversation that in the future you want the doc to address any issues she has with you HERSELF, not the OM. Be absolutely clear about that. Having the OM, a non-nurse, discuss your job performance is unacceptable to you. And stick to that. You are the doc's right hand person. You are the next practitioner, second to the doctor only. You expect the respect your education and positon garners you. You are not the same as the other employees in that office and therefore you should only be subject to direct review with the doctor. The OM doesn't tell the doc what to do, neither should she be telling you what to do. Assert yourself on this issue. And...tell the doc you expect her to make this clear to the OM. Do not be apologetic in any way about any of your "deemed" problems. If the doc doesn't like the amount of time you spend with your patients, tell you think that is the whole problem with health care these days--it's become assembly line and you see the need to take the time to assess, diagnose, educate, and treat your patients appropriately. Tell her you will try to find ways to cut down on some of the time you spend with each patient in order to speed things up and see 20 patients/day (it can be done), but not to the point of compromising care and CARING.

As far as you getting fired? PPffft! I don't think they fire anyone at your office. Nobody stays there long enough to get fired, they all quit!! BTW, you said there was another NP there who was supposed see the pediatric patients, but when you came on board, suddenly s/he was no longer there. Well, what happened to that one??? Up and quit? You know...like the PA who quit after two days? You're not going to get fired. And don't quit---you need to stay there just to p..s off the OM!! You go girl! Good luck! You sound like someone I'd love to work with any day.

[AngelfireRN, MSN, RN, APRN]

Well, it just keeps coming. Since termination, I have heard inklings that doc was telling everyone that I "quit", presumably to save face. Of course, when they asked me about it, I'd tell them the truth. I'm not going to lie for her. I have nothing to hide.

I was visiting a friend at a local LTC the other day, and an aide came in, who just happened to be a former patient. Her Mama was a patient as well. She asked how I was doing and then said "So, how are you liking your new job?"

"Come again?"

"Dr. said you got a great new job, that paid a lot more, and that you were so happy, she could not make you stay. How's it going? Is it better? We sure do miss you." All this in front of my Daddy.

After I explained what happened, her tone changed. One of the "questions" I had had was in regards to this lady's Mom. She had had sx, and her incision was infected. Doc told me it was MRSA, without final culture results, and to put her on Bactrim. I looked in the chart, and she had already been on it a week, and was worse, not better. She refused to change the script, and since I was unlicensed, there was nothing I could do.

The aide told me that her Mom had had to have sx again, that there was a problem with the mesh, and the infection got worse. The surgeon told them that it was NOT MRSA, and placed her on a different antibiotic. She's doing much better now, praise God. The aide said she remembered the argument between me and Doc after I challenged the abx order, and she did not blame me.

I filed for unemployment, since I cannot find a job, and I was hesitant, since Doc is reportedly suing the last NP to do so, for "not following proper firing procedure". I was under the impression that firing procedure burden fell on the firer, not the firee. About a week after I filed, the OM called. Remember when I said that I had been precepting at the satellite clinic owned by Doc? She was phoning to tell me that, since my unemployment was pending they would be "unable to accomodate me for the next semester".

OMG, the gall. She really thought I'd come back there after all that, the firing AND the act of Congress to get my hours signed? Please! I wanted to rip into OM so badly I had to bite my lip, but I settled for nicely telling her that I appreciated the notice, but that I had already made other arrangements for my clinical.

Any suggestions for this? It steams my clams. There's nothing that I hate worse than a liar, unlss it's a liar that lies to make herself look like less of a troll. Thanks again!

[moonchild20002000]

Your anger is justified. You worked in a dysfunctional office. Things are not going to change there.

Actually,being terminated was to your advantage. Had you stayed there the drama would continue.

Most likely you would have been very unhappy there. I think the OM functions just like the doc wants.

I know you don't have a job,focus on preparing for your exam.You are going to be fine in your next job!

[scribblerpnp]

On the upside, your next job will seem like a dream after this nightmare. I've had the toxic/crazy doc as a first NP job, and the second job was GREAT in comparison.

You aren't alone in this experience. Sometimes I feel that EVERY doc has a crazy gene and it just depends on if you end up working with a doc with a crazy gene you can deal with.