CMA Is it me.

[Slipping CMA]

After being fire from 2 jobs before the 90 day mark I need some honest opinions here, what am I doing wrong so I can stop making the same mistakes and be successful at what I enjoy doing.

The first job had a rocky start, at my one month review I was told I wasn't rooming patients fast enough, which was true I was new and very nervous. By the second month I was much better but I went to them because no one was showing me the paperwork side of things like prior othorizations. I was set up with a very smart CMA for 2 weeks to teach me what I needed to know and felt much better about how to do the paperwork.

Then right before my 90 day review they had some thing which certified CMA's went threw, it had nothing to do with our real certification but everyone had someone following them around. No big deal to me I thought since I do everything how I was taught and by the book. We only deal with adults so when taking heights new patients get there hight taken and anyone with osteo... will always get a height check. All others the height shouldn't change so I just take it from the previous height check.

I was was fired for committing fraud. So they say, they think every adult should have a height check every time they come in or its fraud. I asked my teacher and 2 of my doctors about this they all called bs on this.

On to job number two. A small family owned business with family members working there. Everything seems to start out ok expect for the daughter at first all she does at first is give me the cold shoulder. I try to start a friendly conversation with her since I found out she is studying to be a CMA but I get nothing.

Ok ok so I get to my one month and I go to the doctor and ask him how I'm doing. He gives me lots of praise the only thing he says I need to change is the way I document. I document the way I want to and I need to remember to document the way he wants it documented. Ok no big deal good thing for him to point out and I change and I'm happy with life.

Meanwhile things with the daughter get worse really bad. I tried to talk to her one day and it was like talking to a two year old she would not let me get a word out. It was insane.

Things got wose from there, one time I was waiting for the doctor to leave the room because I needed a quick ok from him this was all rush rush. So while I'm waiting because I didn't want to knock on the door the daughter walks by and says to me " Just standing around doing f****** nothing". Another time I was using the copier and she took

all my copies threw them on the floor so she could use the copier.

Anyway it just so happens the day I was fired I made the mistake of using company email to email my husband because of something she had done again. At this point I was keeping a journal of the insudents and happened to mention it in the email.

The reason I was given that I was fired had to do with lab errors. One I remember and I could still kick myself for this mistake. One of the tests this patient was getting was a PT/INR and a grabbed a violet tube instead of the blue tube. Agh don't ask me why I don't know I remember doing it and everything. The second one I'm not sure it was me that made this mistake just because of the way i mark my tubes, I always double check, but I guess it could be. They claim I put the wrong year on one tube for a patient DOB.

What do you think I need to work on so that I can be successful at my next job or at least make it past my 90 days. I really love being a CMA but being fired twice I feel like I have to change something.

Thanks.

[BuckyBadgerRN, ASN, RN]

Accuracy in documentation would be a great start.

[Slipping CMA]

Thanks it wasn't my accuracy it was me not being detailed enough for him. Instead of just stating "I told pt to see us in 6 months", he wanted "I told pt to see us in 6 months and pt understood he would make an appointment".

It's something I would make sure and clarify with any new Dr how they like there documenting done. Lesson learned there before I was fired.

[elkpark]

Whether or not every adult needs a height check at every office visit isn't really the issue; what got you in trouble is that the office's policy is to check the height every visit, and you were documenting in the medical record that you had checked the height when you hadn't. That is fraud. (I think that might be what Bucky was referring to.) It isn't your prerogative to decide that adults' height "shouldn't" change so you don't need to check. If the office policy is to do something every visit, you do it every visit. Or, if you don't, don't document that you did (you'll still eventually get in trouble for that, of course :), but at least it won't be fraud, which is serious).

In the second case, you were screwed as soon as the daughter decided she didn't like you. It was all going to be downhill from there (it's unfortunate, but it happens). If I were you, I would be cautious about working for offices in the future that have physician's family members working in the office.

It sounds like you are learning from your mistakes as you go and willing to take direction, which is good. My advice would be to stay away from small, "family" practices going forward, and to be more careful and consistent about documentation and double-checking your work as you go (like mixing up lab tubes). It sounds like maybe you are a little too casual and careless about what you're doing. Best wishes!

[Slipping CMA]

Thank you guys for your advice. Now I understand.

[OCNRN63, RN]

1. Make sure you use the right tubes for labs.

2. Documentation: You may think it's not a problem, but there was a perceived issue regarding documentation of height on charts and DOB on lab vials. You said "I document the way I want to, and I need to remember to document the way he wants it." That isn't just incidental to just one job...that's how it will be no matter where you go. Also, part of documentation is using proper spelling and grammar. While we tend to relax a bit when we post here, in order to be considered a professional, it's important to be able to write clearly and accurately.

3. NEVER, ever, ever, ever send personal emails on the company computer. Esp. if you are going to denigrate a co-worker, or, even worse, a family member of the owner of the practice. No, no, no.

It sounds like you had jobs with some dysfunctional family dynamics going on. Perhaps the next time you look for a job, look for one that isn't run by a Mom & Pop organization.

Good luck.

[Slipping CMA]

While shadowing for a job yesterday I noticed you are all corrected when it comes to documenting height. The person I shadowed mostly didn't take height or put it down, but one patient had osteoporosis so she took her height and marked that one down even though there was no change in height.

I like this job, and think I may have a good chance. I'm already familiar with the EMR they use but they ask more questions in the software than I am used to doing at my other job. They already know this. I will need to work on those questions with accuracy and speed. I wish there was a way I could practice at home, that is if I do get the job, because with this job I really need to room PT fast. The quicker I can get used to all the new questions and placement in the software the quicker I can get rooming done.

OCNRN63 sorry about the grammar/spelling mistakes, I still get very emotional when I think of what I've been through with the daughter. Thank you for telling me what I needed to hear, you are right. As for grammar and spelling when documenting I am very careful and have my words already thought out before I start, I'm much more careful. If I have to use a scratch paper first then I do. I make sure my documenting is much more thought out and professional.

[OCNRN63, RN]

While shadowing for a job yesterday I noticed you are all corrected when it comes to documenting height. The person I shadowed mostly didn't take height or put it down, but one patient had osteoporosis so she took her height and marked that one down even though there was no change in height.

I like this job, and think I may have a good chance. I'm already familiar with the EMR they use but they ask more questions in the software than I am used to doing at my other job. They already know this. I will need to work on those questions with accuracy and speed. I wish there was a way I could practice at home, that is if I do get the job, because with this job I really need to room PT fast. The quicker I can get used to all the new questions and placement in the software the quicker I can get rooming done.

OCNRN63 sorry about the grammar/spelling mistakes, I still get very emotional when I think of what I've been through with the daughter. Thank you for telling me what I needed to hear, you are right. As for grammar and spelling when documenting I am very careful and have my words already thought out before I start, I'm much more careful. If I have to use a scratch paper first then I do. I make sure my documenting is much more thought out and professional.

If you're hired, depending on the type of EMR the practice uses there may be a "practice patient" function so you can do just that. That's what we did when we went live with our computer system.

I'm sorry you've had such a hard time and wish you the best in finding a job that's the right fit for you.

[Slipping CMA]

If you're hired, depending on the type of EMR the practice uses there may be a "practice patient" function so you can do just that. That's what we did when we went live with our computer system.

I'm sorry you've had such a hard time and wish you the best in finding a job that's the right fit for you.

thank you for the suggestion, I was offered the job and I mentioned I'd like extra practice or study time at home she offered me more hours to sit in a private room and do like you said practice on practice patients which should really help. I still may see if I can take a few screen shots of the practice patients for at home studying because I'm kind anal but also really scared of this being job loss number 3. I really want to bring them my best A game I can.

[elkpark]

thank you for the suggestion, I was offered the job and I mentioned I'd like extra practice or study time at home she offered me more hours to sit in a private room and do like you said practice on practice patients which should really help. I still may see if I can take a few screen shots of the practice patients for at home studying because I'm kind anal but also really scared of this being job loss number 3. I really want to bring them my best A game I can.

Best wishes for the new job! :balloons:

[Spidey's mom, ADN, BSN, RN]

We only deal with adults so when taking heights new patients get there hight taken and anyone with osteo... will always get a height check. All others the height shouldn't change so I just take it from the previous height check.

I was was fired for committing fraud. So they say, they think every adult should have a height check every time they come in or its fraud.

Technically, as others have said, it could be considered fraud.

However, I am not a fan of EMR as many of my fellow AN members know.

The new program our hospital uses didn't have outpatient wound care as part of the program so we had to jerry-rig the program for our use. One of the things the entire program doesn't allow is a way to bring information forward like an adult's height. I have to chart height and weight every time I see the patient. That means 3 days a week for me. There is no way height changes in two days. Redundancy drives me crazy.

Did you take a class in how to do medical charting? That was part of my pre-reqs for the nursing program and then it was also covered during the program. (As an example, we never say "I did this for the patient" . . .it is "this nurse" did this for the patient).

I agree that the daughter was a huge red flag. She sounds like she might have some mental issues.

I wish you luck with your future endeavors. And yes, practice and maybe take a class in how to chart.

[Slipping CMA]

Technically, as others have said, it could be considered fraud.

However, I am not a fan of EMR as many of my fellow AN members know.

The new program our hospital uses didn't have outpatient wound care as part of the program so we had to jerry-rig the program for our use. One of the things the entire program doesn't allow is a way to bring information forward like an adult's height. I have to chart height and weight every time I see the patient. That means 3 days a week for me. There is no way height changes in two days. Redundancy drives me crazy.

Did you take a class in how to do medical charting? That was part of my pre-reqs for the nursing program and then it was also covered during the program. (As an example, we never say "I did this for the patient" . . .it is "this nurse" did this for the patient).

I agree that the daughter was a huge red flag. She sounds like she might have some mental issues.

I wish you luck with your future endeavors. And yes, practice and maybe take a class in how to chart.

i did get a class in medical charting but we mostly used paper charts for the class. The teacher basically said there are to many EMR's to choose one to teach. I was introduced to Epic during my Externship.

Not that I'm try to make an excuse, but the company used Epic and the person who trained me said to bring up the last known height for the BMI. I know now that it was wrong and understand how it constitutes fraud. I would never do it again. Thankfully the new job uses a program that shows all past vital signs. Making everything much easier for the Dr to look at changes in bp or weight, ect.

Thank you