Are NPs staff or providers?

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I work in a private practice outpatient clinic where the owner is an MD and assured me that in his practice, NPs are providers (mid level) yet his office manager goes around and announces to the MAs and technicians that no it's not true, I am staff as she calls it. She's been doing this for the last two years. sometimes, I make suggestions on how to make the office more efficient and when that happens, I am met with a face palm (figuratively). The vibe that I'm getting is that as an NP, I only see patients anything else doesn't concern me but I beg to differ. It does concern me. When things aren't running smoothly in the clinic, my work and patient care is affected. i am beginning to wonder if there are other clinics or healthcare settings that have more delineated roles for mid level providers because it seems like this current workplace doesn't appreciate or maybe they just don't what to do with a mid level provider. I'm a quite frustrated right now because I put so much effort in my work and I just want to do a good job.

Ummm...wait lemme guess. Is the office manager related to him?

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Ummm...wait lemme guess. Is the office manager related to him?

No hehe. She's just got hired one year ahead of me. He's really supposedly impressed by her since she knows a lot about billing. She claims of 15+ years of being a biller and this is the first time she got promoted to a managerial position and he's really anal about billing. When he mentioned that to me, my reaction was then make her supervisor of the billing department hehehe but I'm at a point where I'm just fed up and I notice that she starts making up gossip about me and last week it reached the MD that I work for and I got reprimanded for it. This is the 2nd or 3rd time I believe that she started gossiping about me.

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Oh my. Sounds like a classic secretary or MA problem where someone with not a whole lot of formal education gets a little too much power. You are not going to instantly be able to command the same respect as the Dr who actually owns the practice. It has been my experience (and from listening to NP friends who have all seemed to experience this in the past few years) that this is usually a female/workplace jealousy type of issue, sometimes race and age play into the female thing to make it a combination of the two. Men in general are NOT confrontational and will hide and play in the back of the office seeing patients and pretend these type of issues do not exist.

You need to flat up call her on it.

Get your big girl panties on and request a meeting with your boss (the MD) and the "office manager." Have your script in writing. I would honestly avoid going into past grievances, but you can lay out your expectations and come up with a plan for the future such as "I occasionally have ideas for how something in the office should be done...in our monthly team meetings I will propose them to X and we can decide together to do things." i.e. "look, woman...you are NOT going to snake my ideas and pass them off as yours!"

I would also lay out a process for her to voice any grievances in where she comes to both of you as a team and not behind your back, etc.

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Orangepink,

your situation sounds like a huge headache, perhaps, if you have thought about leaving....its probably time for you to get another job. One thing I have learned from my professional practice is that everyone is out to look for themselves. Nobody has the best interest for you, other than yourself. It is obvious that the MD has not given you your bonuses and the staff do not respect you and gives you attitude. So i guess if I were to put myself in your situation, I would start looking for other jobs on the sly and not tell anyone about it; keep in good terms with the MD and the staff as much as I can until you get the next job and boot out of there. I always tell myself when people give me bad attitude especially my staff and I had brought it up to the owner and things have not improved or resolved that "I get paid to take care of my patients, not to deal with bad attitudes." There's just no excuse for it. If I have to deal with bad attitudes and disrespect then I should get paid extra for that (not that I would put up with it anyway). For now, I'm just turned off by having a permanent job so I am currently a Travel Nurse Practitioner...I just finished my first assignment and I am quite happy knowing that I can go travel to other places and work.

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Specializes in Psychiatric and Substance Abuse Nursing.
Thanks for the support! @psychguy i do agree that it's just a label but the younger MAs and technicians do seem to not respect me as much as the physicians and I've wondered why until a couple of them came up to me and admitted to me about it. In fact when I started working there, the MAs expected me to see patients and do THEIR JOB too! I had to stand my ground as one member here said but I'm just sick and tired that I have to stand my ground every single time with every new MA. I mean I have a lot more things to worry about than disciplining an impetuous staff. I did ask the MD about that and he stresses out that I am a provider and he'll speak to the manager about it but the thing is he lets her run the office as she sees fit. When I make suggestions, the next thing I knew she runs up to the MD and claims its her idea. Which might be petty but annoying.

This clinic is my first job out of grad school. I've always been grateful to the MD who hired me and trained me and gave me a chance. But right now I'm at a crossroads. He's been making me see more and more and more patients without asking my opinion about it and he hasn't increased my salary. I'm supposed to have a bonus which I have yet to see materialize and it's been two years. If I ask for vacation time it's like pulling teeth and if I get sick, he gets upset. All that with the sh1tty attitude I get from the office manager and staff, I want to leave. I just feel guilty since he gave me a chance right out of school. Another PA I knew advised me to be cautious because most MD/owners will try to trick u etc. I wonder if this is part of the trick. I'm really at a crossroads and want to leave but I feel guilty if I do. I do need your advice and input.

Did you ever get anything in writing when you first started regarding the bonuses and vacation time? Being able to point to written terms that you both agreed upon would give you a leg to stand on in actually obtaining the bonus & vacation time.

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@carachel: you are so right! She's 50-something divorced single mom of three who is a high school graduate and started working front desk in medical clinics until she learned billing then for the first time in her life, she was promoted to a managerial position.

@aprnkate: I think you're right. Before I would gently air out my grievances to the MD/owner, he'd nod and say yes but he doesn't put emphasis on it just enough to show that he did his part but he doesn't care if my grievances are followed through. I put too much trust in him since he showed me kindness but in the end, you're right. He's only using me and looking out for his business. I'd still like to leave on good terms though. This is my first job as NP. He's my only reference.

I'd appreciate any ideas on how to approach that conversation.

@xeno: my contract is very vague and that's my fault. I was naive back then and was all too happy that someone was willing to hire me and train me fresh out of MP school. I discussed it with a more seasoned PA and she said that it's a classic trick MDs pull on new graduates. Make the bonus clause so vague that I don't have much chance to negotiate. Quite frankly i don't even care about the bonus anymore. I just want to get out on good terms.

What I really want to tell him is --- don't give me my bonus but just be my reference hehe oh and btw your manager is a b1tch hahahaha jk

Seriously I just want to be at peace.

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@carachel: you are so right! She's 50-something divorced single mom of three who is a high school graduate and started working front desk in medical clinics until she learned billing then for the first time in her life, she was promoted to a managerial position.

Ah...then definitely one of two scenarios or possibly a combination of both: 1. she *truly* does not know better as far as what your education entails and/or 2. she is pulling a power play because you outrank her in education and pay but not in age. She is using her age for some muscle.

Tell the MD you want a meeting with both of them present. Lay it out there that you will not tolerate rumors, you treat them very seriously i.e. professional slander and you are not to be treated as another office "staff" since you are indeed a healthcare provider. Be cook, clear and calm and professional, don't attack but let her know (in front of a witness!) that things need to be change.

I know of at least four colleagues who have had to change jobs, are in search of new jobs or almost got fired from jobs all because of an MA or secretary who liked to stir up the drama!

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Thank you! She recently pulled a fast one on me last week. Started some ugly gossip that I'm the reason why one of the younger technicians is mentally unstable! What the!!!! The worst part was when he believed her over me!

I know I'm venting mostly in the thread but I do appreciate all your inputs! I always thought for the longest time i was alone in this situation! That this was my fault and all.

Anyway I'll definitely use your strategy when I hand over my resignation!

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I agree with prior comments that if you work for the clinic (in whatever entity) you are staff. And as an NP you are a provider and often referred to as a mid-level provider. Sounds to me you have an office manager problem and those can be sticky - for some reason people who answer the phones or make appointments often act as though they have earned a medical degree.

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I am currently working on pre req's so I can get into nursing school. With that, I have been a medical secretary for over 14 years. If the office manager is calling you staff, she needs to be reminded that she is also only staff. I have never worked in an office where any NP is considered just staff. All of the NP's I have been so lucky to work with are always on the same level as the MD. Most of the patients would rather see the NP. The NP's are always and have always been the first line of defense to help out patients. Seems like the office manager should be reminded of that.

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Specializes in Outpatient Psychiatry.
Thanks for the support! @psychguy i do agree that it's just a label but the younger MAs and technicians do seem to not respect me as much as the physicians and I've wondered why until a couple of them came up to me and admitted to me about it. In fact when I started working there, the MAs expected me to see patients and do THEIR JOB too! I had to stand my ground as one member here said but I'm just sick and tired that I have to stand my ground every single time with every new MA. I mean I have a lot more things to worry about than disciplining an impetuous staff. I did ask the MD about that and he stresses out that I am a provider and he'll speak to the manager about it but the thing is he lets her run the office as she sees fit. When I make suggestions, the next thing I knew she runs up to the MD and claims its her idea. Which might be petty but annoying.

This clinic is my first job out of grad school. I've always been grateful to the MD who hired me and trained me and gave me a chance. But right now I'm at a crossroads. He's been making me see more and more and more patients without asking my opinion about it and he hasn't increased my salary. I'm supposed to have a bonus which I have yet to see materialize and it's been two years. If I ask for vacation time it's like pulling teeth and if I get sick, he gets upset. All that with the sh1tty attitude I get from the office manager and staff, I want to leave. I just feel guilty since he gave me a chance right out of school. Another PA I knew advised me to be cautious because most MD/owners will try to trick u etc. I wonder if this is part of the trick. I'm really at a crossroads and want to leave but I feel guilty if I do. I do need your advice and input.

This speaks volumes actually. You're not supported by the physician/owner. If you're a partner or even associate then you should have some direct input in how much you work, when you work, and how much you make. If you're seeing more patients then you need to be seeing more zero's on your check. You should also have the professional courtesy of telling him when you'll be off and then actually being off. Taking a day off work, for whatever reason, shouldn't evoke anxiety.

With respect to the MAs, with education not working, it's time to pull weight and become a task master.

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Specializes in Psychiatric Nursing.

I think you should start looking around and see what else is out there. The reference part is a bit problematic- it would be nice if he would give you a good reference but he doesn't sound like a nice person. The situation is too annoying to continue. I wouldn't bother asking about the bonus etc. In interviews give your reason for leaving that you want a change. Don't say anything negative. If you can do per diem or locum tenens it could be a way to build up references.

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