Career move advice please!!

Daytonite, BSN, RN · Aug 11, 2005

The LPN in my internist's office takes one day off a week to go to school. She is working on getting her RN. It is an arrangement she made with the doctor. On the day this nurse is off, my doctor does all the things she would do. The office nurses or the office staff are the buffer between the doctor and all kinds of people who call the office with questions and problems. The duties you would have would be up to the individual doctors, but you need to make it clear before you hire on what your school needs are going to be. Unlike a hospital, there is no one to replace you when you take a day off, call in sick, or have a sick child at home when you work for one doctor. Your attendance will be expected to be exceptional. Office nursing involves more than just patient care. You really become a right hand to the doctor and the other office staff, so if you are not prepared to kind of cater to the doc, office nursing is not for you. You will be screening labwork and test results and making sure that the doctor is seeing the ones that are abnormal, setting up tests and hospital admissions for the doctor's patients as well as performing a number of office procedures such as drawing blood and giving injections. Most offices have a pretty well-oiled plan in place for setting up appointments and dealing with people who call in with emergencies. Depending on the size of the office and the number of other staff you may also be called upon to file charts and even get involved in some of the billing.

Before you burn your bridge with the hospital you now work in, make sure you have a backup plan in case the office job doesn't work out for you either. One way you can keep the hospital "on the hook" so to speak is to try to get a leave of absence so you can come back. However, it would involve some deception on your part because they would never grant a leave of absence to someone for the reason of trying out another job. And, if there is only one hospital in town it is very likely that it will eventually get back to the people at the hospital that you are working for a doctor. Another possibility would be to change your status at the hospital to PRN where you would only be obligated to work for them once every two weeks or so. Of course, with PRN status you usually don't get any of the benefits that full-time employees get. Another option for you as an LVN is to consider working in a nursing home where you would be a charge nurse.

One of the problems of working a Monday - Friday 9 to 5 job is that it is difficult to find time to do doctor's appointments for yourself and a host of other business you need to carry out with the retail stores and other professionals that are only open Monday through Friday 9 to 5. When I worked Mon-Fri 8 to 4 I found the supermarkets really, really crowded every evening and on the weekends. So make sure you have some kind of agreement with the doctor that you will be able to get some time off for these kinds of things you have to attend to in your life. Some offices close down for a couple of hours for lunch, but in reality part of that lunch time is catch up time or the only time you will have to run your own errands. In some areas, doctors still take Wednesdays off and they either close the office entirely or only keep one or two staff on. FYI: most offices will turn the phones over to the answering service at times when, in fact, the staff is actually in the office and working (catching up on the paperwork). My internist's office has the answering service taking all their calls on Wednesdays with the answering service telling callers that the office is closed when, in fact, it is open and the doctor is seeing patients. I've had to go to their office on Wednesdays with a problem I needed addressed because of this.

And, finally, most hospitals are reluctant to hire nurses who have been working in another setting for the very reason that you are thinking of leaving. So, it is not as easy as you would think to go back to a hospital to work. RNs particularly have to take a refresher course to get back into hospital work. Don't go into another part of nursing without looking at what the pros and cons are for you. Hospital nurses are held in great esteem because of their ability to keep up with the stress and pace of their jobs. They, in general, run from room to room stamping out little fires that constantly flare up. Over time you learn to organize and manage your time to get things done more efficiently, but the pace generally doesn't slow down very often.

I'm sorry you are finding yourself in a stressful situation. Is there anyone at your job who you feel you can trust enough to discuss your feelings about your performance with? Perhaps, one of the nurse educators?