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.
