Ethical dilemma

Nurses General Nursing

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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.

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.

Specializes in Community Health/School Nursing.
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.

Specializes in 15 years in ICU, 22 years in PACU.

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.

1 Votes
Specializes in PICU.

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

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.

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.

OP, I think ixchel is right; the woman may view things somewhat differently since she is a receptionist as opposed to a medical assistant or nurse.

You have been more than loyal to this MD, and it is good that you have been able to find value in your work experience in that office. But maybe it's time to follow that old bit of advice, "Take what you need, and leave the rest."

Best of luck to you in the future.

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.

Then what are you expecting us to tell you? If it's just a vent, that's one thing. But you've gotten the advice we have. It's not the advice you want, but really? What else can we advise?

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.

You do not need to feel like you should gush your every emotion (hatred) for your employer to this new employee. She was hired as the front desk to fill the obvious need, you will train her, things will(may) be somewhat better with the added help and then you will move on to your next endeavor when it's time.

I have many unpleasant (mean) things to say abt the current company I work for, including frequently bouncing paychecks, physicians openly yelling at other workers etc. However, I still train new employees and do not feel guilty about what they are getting themselves into. You need the help, they are there to help!

And, dont feel guilty about leaving (bailing) when u have found a new job! I am sure they had many RNs/MAs before you, and they will find ones after you. Plus, its not your job to care about the physicians improperly ran business, especially after you give notice and leave :)

Specializes in Psych, Addictions, SOL (Student of Life).
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.

IMHO you are not running out. The minute your paychecks fell behind is the minute you should have been looking for another job.

One thing I learned about working for a doctor in new private practice, is that some of them will use you only to get the practice stable, once it's stable financially they have no problem replacing people who were there the whole time helping to get the office up and running smoothly. I once worked for a doctor at a hospital for two years when he decided to go into private practice and asked several of his staff to quit the hospital with him and join his private practice, telling us when he profits, we will all profit financially. Well that profit for the employees never happened after he became successful. A year later when the staff that went with him to private practice asked him about the raise he promised us at one year in new practice. His response " If any one of you don't like what you make on your paycheck you can leave because I got many people who want your jobs and you can be replaced. Long story short, he used the staff who worked for the hospital with him to help him get his private practice started, once it was successful, he said we were replaceable. So in my opinion if your doctor don't care enough about his bills etc then trust your instincts or else you will probably end up jobless soon with no resources of income until someone else hires you. That's what happened to me, after a total of seven and a half years dedicated years altogether of working my butt off for him, he terminated my employment when I told him to not yell at me in front of patients, that was something that should be done in private. When I left there was only one girl that remained still employed out of the 5 girls that quit the better paying job at the hospital to join him in private practice.

If you are not being paid on time, you owe this workplace no loyalty. Run, don't walk, away.

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