Fired for refusing to draw blood without an order.

[deanzgurll]

FAIR WARNING Y'ALL...THIS IS BOOK LENGTH My first job out of school was as a burn nurse at a university hospital. When I started the unit put new staff through a kind of hazzing. I had a fairly compliant personality when I got there and I went home every night for six months, crying and rehearsing a speech about why I couldn't stay there. I ended up never giving it and I stayed there 13 years. The place transformed me. You either got tough, outspoken and assertive or were eaten alive. When the hospital started the application process to become MAGNATE...well, it was kind of an Emperors new clothes situation. Things changed, and not for the better in my opinion. Add to that a body that had been used and abused ( I am only five feet tall) and a new farmer husband 160 miles away. I went back and forth a couple of years and finally threw in the towel. Now I live in a rural agricultural heartland that hasn't heard there is a nursing shortage. The only sizable city is an hour and a half away and the county hospitals can't afforsd to hire. That leaves general practice clinics. I hired on PRN at at a system of clinics run by a professional management firm. It was diffrent, WAY diffrent. I was determined to keep a low, pleasant profile. But after awhile the place started getting to me. It was run by a "practice manager", read; desk jocky with no medical background. The "PROVIDERS" were refered to and treated like some race of demigod. The rest of the staff were expected to kowtow. Example: the large lunch room was for providers only, to entertain drug reps, unless they were at a meeting somewhere else. The staff ate in the clock room; 6x10 with lockers, time clock and message boxes, coat hooks, a small table and four chairs. At lunch time it was packed and some of us ended up sittiing on the floor. I will bypass most of the things I observed and fast forward to recently. They had just hired a new PA. The other PRN nurse and I had been taking turns working for her for about a month so she could "pick". One morning we came in to learn that the PA would be working with one of the full time nurses who wasn't getting along with her provider, and that provider would be interviewing outside the clinic staff. He wanted a hispanic nurse because we had a large hispanic patient population. OK. A week later his hispanic nurse arrived...blond, blue eyed, 23 and six months out of LPN school. He refered to her as his own little private playboy bunny. The man had passed over two experienced, clinic oriented RNs for THAT. We were told we were not to discuss the situation among ourselves. Fast forward again.. (a little back ground: since the clinic had started opening on saturdays, the pts. wanting appts. had snow balled. It was originally supposed to be acute care only, but had morphed into "WHATEVER". It had become a favorite time for pts to come in for labs. I volunteered to run the lab because none of the full time people wanted to take turns coming in on weekends. The pts. were allowed to walk in without an appt. A disaster waiting to happen. The problem was, more and more of them began showing up without an order...either in-hand or on file. The full time lab tech took a "stick now... resolve later" approach. It worked for her because all the providers were there. Not so on weekends. There were only one or two. I had been told by central office during a training session that , under no circumstances was I to stick a pt. without an order and I had discussed this with the manager. " In comes a pt. who is a frequent flyer. He wants labs drawn. He has no order. As soon as I told him that I might not be able to accomodate him, he started getting angry. I poured over his chart looking for something that I could construe as an order. He stomped out...I thought. I brought in my next pt. The manager comes into the lab and tells me I need to stop what I am doing and draw the previous pt . I told her he had no order, handed her the chart and went back to the pt. in my chair. She came back and said that, although there was no order, that SHE JUST KNEW THE PROVIDER WOULD WANT LABS AND IF ANYONE GOT IN TROUBLE IT WOULD BE HER. I told her that if she didn't back me up, this situation would never get any better. She gritted her teeth and said, "JUST DO IT... BECAUSE i SAID SO" I told her that it didn't work that way and before I could explain she said, "when i tell you to do something, you are not allowed to question me...you are fired. And so I left. I emailed the regional supervisor who had been fair and supportive before, but he ignored me. I emailed the Board of Nursing who said I had done the right thing, but they couldn't help me. The central part of this state is a very small world and I am afraid of being blackballed. If I just roll over and slink away I am encouraging them to treat us as though we were still living in our pink collar past. But I don't know what to do, short of spending thousands of dollars I don't have on a law suit. I WENT FROM A SITUATION WHERE NURSING WAS PUNISHED IF THEY DIDN'T GO ALONG WITH MANAGMENTS FANTASY THAT EVERYTHING WAS HUNKY DORY, TO COME HERE AND BE FIRED FOR REFUSING TO VIOLATE MY STANDARDS OF PRACTICE. I am so disallusioned that I am thinking of not renewing my license.

[llg, PhD, RN]

Talking to a lawyer does not cost thousands of dollars. Talk to one and see if you have a case or not for wrongful termination. I assume you kept a record of your communication with the state board of nursing. That would be great evidence to show the lawyer. There may also be other regulatory boards and/or state agencies who should be made of the situation in the clinic. I would think that whoever certifies them as eligible to receive payments would want to know that an unlicensed person was "ordering" lab tests with no assessment of medical need.

Someone should do something to change things. The question is whether or not you want to take on the challenge. If you don't, then it will continue and you may have to build a new career for yourself -- but that might be the right choice for you. Only you can say. But 1 meeting with a lawyer is not that expensive and may be worth it, if only to assure yourself that you are making your decisions based on the true facts.

Good luck,

llg

[steelcityrn, RN]

I guess this is a stupid question, but since the patient was there many times before, could you have collected his regular blood test and called for the order later, as you stated the tech does? Seems to me, there is a whole lot of blood drawing going on there. I myself, would not draw blood without an order, but then again I do not work in that type of setting. Seems like what you need to do now is just move on. Maybe you can try home health. Many agencies look for nurses who are in rural areas, and can mail in their paperwork from home. I would not have enjoyed the facility you were working in at all, seems just way too fast paced. Time for you to do something better in nursing. I would renew the license for sure! Good luck to you :)

[deanzgurll]

I guess this is a stupid question, but since the patient was there many times before, could you have collected his regular blood test and called for the order later, as you stated the tech does? Seems to me, there is a whole lot of blood drawing going on there. I myself, would not draw blood without an order, but then again I do not work in that type of setting. Seems like what you need to do now is just move on. Maybe you can try home health. Many agencies look for nurses who are in rural areas, and can mail in their paperwork from home. I would not have enjoyed the facility you were working in at all, seems just way too fast paced. Time for you to do something better in nursing. I would renew the license for sure! Good luck to you :)

i REALLY THANK YOU FOR YOUR REPLY. But the issue really isn't about knowing what to draw. It's about choosing to do an invasive procedure; even one as simple as phlebotomy without a doctors order. Although the chance of the patient suffering an injury from the procedure are miniscule, we can't go about picking and choosing among our standards of practice based on what is convenient in any particular work culture or the chances of there being a bad outcome. Let's say another frequent flyer came in requesting labs because his last INR was high. Lets say he only stopped his coumadin the day before and came in on a wild hair without an order ( this has actually happened ), lets say i stick him, he bleeds, he clots, he throws a clot...get the picture? Would the doctor or the clinic have my back? and when the judge says, "nurse did you believe that your manager had the appropriate knowlege and authority to order you to proceed against your own better judgement? No sir. Then WHY DID you proceed? Because she yelled at me?" A judge would say I should have known better..and he would be right. We all complain about not being treated as professionals. If I cower and move on what does that say?

[medsurgnurse, RN]

i REALLY THANK YOU FOR YOUR REPLY. But the issue really isn't about knowing what to draw. It's about choosing to do an invasive procedure; even one as simple as phlebotomy without a doctors order. Although the chance of the patient suffering an injury from the procedure are miniscule, we can't go about picking and choosing among our standards of practice based on what is convenient in any particular work culture or the chances of there being a bad outcome. Let's say another frequent flyer came in requesting labs because his last INR was high. Lets say he only stopped his coumadin the day before and came in on a wild hair without an order ( this has actually happened ), lets say i stick him, he bleeds, he clots, he throws a clot...get the picture? Would the doctor or the clinic have my back? and when the judge says, "nurse did you believe that your manager had the appropriate knowlege and authority to order you to proceed against your own better judgement? No sir. Then WHY DID you proceed? Because she yelled at me?" A judge would say I should have known better..and he would be right. We all complain about not being treated as professionals. If I cower and move on what does that say?

I back you up, you did the right thing. It's a shame how being a good nurse and following our nurse practice act often conflicts with "customer service". I would consider reporting to medicare, medicaid, DA for insurance fraud because they are doing things without a doctors order. The office workers have absolutely no idea about nursing practice. They should not be giving you orders, And while you're at report her for practicing medicine without a license.

[UM Review RN, ASN, RN]

I back you up, you did the right thing. It's a shame how being a good nurse and following our nurse practice act often conflicts with "customer service". I would consider reporting to medicare, medicaid, DA for insurance fraud because they are doing things without a doctors order. The office workers have absolutely no idea about nursing practice. They should not be giving you orders, And while you're at report her for practicing medicine without a license.

Now there's an idea....

[Tweety, BSN, RN]

Doing the right thing is never wrong. Good luck to you.

[vloho]

What happens when everything is said to be insubordination? Does it matter if your right ?

[Guest717236]

First, don't even think of not renewing your license.

You have worked hard all these years, the system is failing, not you.

This is the new Doc-in-a-box approach to patient care.

If they could set up a drive thru and have patients stick out

their arm for blood work, they would.

This new approach about money, not patients and not their care.

No unlicensed individual should be dictating to you, let alone nursing duties.

You have a license, and I am proud of you for refusing.

The boundries become pushed out further each year by people who do

give in. Nursing as a profession needs to find its voice and speak up

in a unified fashion. No amount of initials behind our name will be effective

unless we stop this type of practice of having business dictate.

Shame on the Board of Nursing not to refer this situation to

what ever state agency licenses that Doctors office and their lab.

I agree with the previous poster who suggested to report her for

practicing medicine without a license.

I wish you luck and hope you find an employer who is worthy of

an experienced patient advocate as you are. The patient was caught in the

middle of the problem, and reacted not realizing how important following

protocols is to his safety.

Best wishes...........

[Nurse Ratched, RN]

No unlicensed individual should be dictating to you, let alone nursing duties.

You have a license, and I am proud of you for refusing.

Ditto.

[santhony44, MSN, RN, NP]

What an awful place to work.

It is not typical of the clinics I've seen!

If they want "walk-in" labs, then they need standing orders to cover this.

I'm a provider. In our clinic, the nurse (licensed nurse) will order labs on the patients before the provider sees them, but this is based on a standing protocol and/or orders written previously (such as TSH next office visit). My nurse will also send patients with symptoms of a UTI, strep symptoms, and possible pregnancy to the lab, but she's been given verbal orders to do so. Patients can't just pop in and request labs without their provider, or some provider, giving an order.

No office manager I've ever worked with would have thought of "ordering" lab work herself or himself.

Further, while providers are treated with respect, we aren't treated as superior to everyone else- the only places I've seen separate lunchrooms is in hospitals.

And for the "own private little playboy bunny," well, that would not have been tolerated in any clinic I've ever worked in. That's outrageous! Any smart provider will choose a nurse who is sharp, williing to make your life easier, and can keep the patient flow going. Bilingual is also a bonus if your patient population has a large number of non-English speakers. I want one who has the sense and judgement to not let a patient having an asthma attack or chest pain sit out in the waiting room or in an exam room without my being aware, who will send a patient with UTI symptoms for a UA so that it's done by the time I get to the room, who will do the paperwork correctly, who doesn't have to be told the same thing a hundred times,etc etc. I don't care if the nurse is male or female, or looks like a model or Nurse Ratchett, I care about competence. Blonde, blue-eyed, and cute might be just fine, but add inexperience to the mix and you might find yourself in trouble.

And I would think that sort of remark is at least bordering on a hostile work environment.

[rnwaller]

I wish you all the best in your decisions. You complied with the nurse practice act but you have discovered that bad politics of HMO medicine.

I have to agree with other posts, IF you want to take this on you need to go to the insurance companies. But, you certainly run the risk of being blackballed in a rural community.

You can also ride the charting redirect road,"Per Ms Boss Lady pt has regular labwork, labs drawn at her request, to follow up with Dr. So-So."

In the end, maybe ask to work FOR the insurance company?

Remember, the rest of us love you......