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Ethical dilemma

Posted

Specializes in Foot care. Has 12 years experience.

I don't know if this is even appropriate for Allnurses, but here goes. I'm working in a one-doctor office. Though I am an RN, I was hired to fulfill a medical assistant role, which was ok with me as a means to an end beyond this particular job. I thought I'd work there for a year, learn what I could and then move on. I've come 2/3rds of the way.

Long story short, I am the only one left in the office besides the doc and because of this I have had to do the front office tasks, i.e., answer the phone, re/schedule patients, check in/out, take payments, all the administrative tasks associated with a doctor's office. Plus I room patients and do some minor documentation in the charts.

There is more work than I can do, and it is of such an intensity that I am exhausted. The doctor massively mismanages the business, and I regularly field calls from patients who do not get their tests or prescriptions called in as requested, who do not get test results once the tests are done, who are confused and angry because there is no follow up, or from creditors who shut off accounts for nonpayment. On top of this the paycheck does not come regularly: I am paid biweekly, am 1 paycheck behind, and the latest check is late.

The doctor was totally unprepared for ICD-10 adoption on October 1, and we are now unable to bill. It is a setting of utter chaos. I also happen to know that the doctor is now under warning from the local hospital professional organization for not paying dues and not charting within the required time frame.

I am currently training a medical receptionist. I'm very organized, have kept the front desk "together," and feel like a complete and utter fraud with this woman, a very nice woman who needs her paycheck to be regular. She likes me, and I evidently put on a good show of having it all under control. I am not telling her that she should run away now, though that is what I think she should do.

I got into this mess because I wanted the job, I wanted it for a year, and I was willing (and able) to put up with alot of nonsense. Then things happened and I ended up being the last employee on staff. I'm not sure what I'm going to do, but I'm miserable right now and having a tough time sleeping.

I'd love to read your thoughts. Opinions, please.

Farawyn

Has 25 years experience.

I clicked on this because of your name.

Quit. You are an RN and shouldn't be working (read: paid) as an MA.

Apply to everything. Work as an RN.

Good luck.

If you feel like telling another employee to run away, I think it is time to start your job search. Not worth it.

I thrive in situations where the workload exceeds all resources, but I think even I would have to concede that this one is not for me. I would do the best you can until you have your new job lined up. That is probably more professional courtesy than is warranted. For day to day operations, I would prioritize and give each function only so much of your workday, no more, no less. If the doctor wants more, he can hire another employee.

Time to bail. Take the receptionist with you.

ixchel

Specializes in critical care.

Time to bail. Take the receptionist with you.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

There is no dilemma there, whatsoever, in my opinion.

hotflashion, BSN, RN

Specializes in Foot care. Has 12 years experience.

Saying not to work below my level does not help. The fact is, I have almost no experience as an RN in the 6 years after graduation, and the experience I have had is piecemeal at places where you wouldn't want to work. The current job has just about served its function, which is springboard to my next endeavor, an independent RN-based endeavor in a specialty area of practice. This job provides money and relevant background experience, so it has been valuable. The ethical dissonance I feel is in not being upfront with the new employee. I feel like I am using her as a stepping stone out of the alligator-filled pond, all the while saying the alligators are rocks and logs and the water is just fine. I also don't like to run out on people, even when they do not uphold their end of the relationship. So, I have my issues in that regard.

RNperdiem, RN

Has 14 years experience.

Why be overworked and underpaid if you don't have to be? It sounds like this job is doing nothing to enhance your RN career and you are having to put up with issues that you shouldn't be.

Do you really owe a year? Did you sign a contract for a year?

No?

Then time for a job search. Leave on good terms, be professional and don't look back.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

Quitting your job to take a different job is not running out on someone.

imintrouble, BSN, RN

Specializes in LTC Rehab Med/Surg. Has 16 years experience.

You owe the new employee your honesty. Period.

I don't see how she wouldn't figure it out after a week or two anyway.

Since I'm being honest, after you give the new employee the cold hard facts, she's probably going to ask the MD if that's true. At least that's what new employees do in my experience.

They'll even say "Suzy said"....

It can make an unpleasant situation for you even worse.

Maybe I wouldn't volunteer all the ugly details unless I was asked.

I wouldn't hide my frustration with the paycheck situation.

I wouldn't pretend I was altogether, when I was obviously falling apart.

Edited by imintrouble

Sounds like you have issues with letting go and with valuing yourself.

You are worth more.

There is no need for you to be loyal to a train wreck. All that will happen is that you will get burned in the crash.

Farawyn

Has 25 years experience.

Saying not to work below my level does not help. The fact is, I have almost no experience as an RN in the 6 years after graduation, and the experience I have had is piecemeal at places where you wouldn't want to work. The current job has just about served its function, which is springboard to my next endeavor, an independent RN-based endeavor in a specialty area of practice. This job provides money and relevant background experience, so it has been valuable. The ethical dissonance I feel is in not being upfront with the new employee. I feel like I am using her as a stepping stone out of the alligator-filled pond, all the while saying the alligators are rocks and logs and the water is just fine. I also don't like to run out on people, even when they do not uphold their end of the relationship. So, I have my issues in that regard.

Okay, then stay and have 7, 8, 9, 10 years as no experience as an RN.

Wave Watcher

Specializes in Community Health/School Nursing. Has 7 years experience.

Okay, then stay and have 7, 8, 9, 10 years as no experience as an RN.

My thoughts also. People gave their opinions/advise and the OP is defending her reasons for staying. So stay. Good luck.

Mavrick, BSN, RN

Specializes in 15 years in ICU, 22 years in PACU. Has 30 years experience.

This doctor is allowing his practice to fail and you are the only one left holding it together?

Something is wrong here. Could it be substance abuse on the doctors part? Just speculating.

If he can't bill, there is NO money coming in to pay anybody. If you don't bail while you can, you will go down with the ship.

RNNPICU, BSN, RN

Specializes in PICU. Has 13 years experience.

I admire your desire to "do the right thing", however, you really need to get out. Loyalty will only get you so far, and you have been far beyond loyal. This is no the time to think of yourself. Get out and move on. You have learned a lot of skills and good time management. If things are mismanaged from the MDs end and something happens you may also get in trouble. It sounds like you have to now start thinking about your future and not worrying about the loyalty. There are plenty of better places to be that would love your loyalty and actually pay you and give you a better working environment

ixchel

Specializes in critical care.

This person is a receptionist, will view this job through the eyes of a receptionist, and will be functioning in the role they are trained to do. It is possible this person won't mind as much the things you do, and yes, I believe working below your license and training IS a factor here. Every single other employee has quit. You are going to quit. If this isn't a wake up call for the MD, nothing will be.

Some MDs can pull off private practice, others can't. This guy can't. If you REALLY want to do the ethical thing, you could tell him that, since he hasn't figured it out yet. And genuinely, I don't believe that's his fault. Other people require college degrees in business management and leadership to pull off what this guy thinks he can do only studying medicine. I recently had a chat with our newest GI surgical attending who said he came here because he tried his luck at private practice and it was horrible.

There is a LOT involved in it, more than a typical business. You've seen that. And this doc of yours may not realize just how much you save him on a day to day basis.

EmRN14

Has 2 years experience.

Definitely time for a new career and not a job. Find your passion. Don't work as an MA. Work as an RN like you are credentialed. Working as an MA will not help with your skills and it sounds like where you are working, you are underpaid and under appreciated. I would get out of there if that is really what is occuring.