1st nursing job in a doctor's office - a little wierded out

  1. hello to you all fellow nurses!

    I was super excited when I was finally offered an RN job, but I was extremely nervous too. I always thought i would start in a hospital setting, but instead i was offered a job at a doc's office (internal med) where the staff is split right in the middle - 1/2 are vietnamese, 1/2 are spanish-speakers (me = spanish speaker And right off the first day, i was majorly weirded out.

    Ok, so tell me why all the people that give the shots and draw labs and collect samples are called NURSES? I'm the only RN there, the other 2 are Med. assistants, 1 is a phlebotomist, 1 is a CNA working part time here, and 1 doesn't even have a degree in anything related to health care. And get this - that last one - the one with no health care degree - is the one in charge.... what the FLIP!?!?!? Here's the thing - He is the one that is orienting me, when he introduces himself, he says "I am one of the nurses", he draws blood, starts IV's (!!!!!!!), gives meds (almost all are IM injections).....

    Am I delusional? While I was in nursing school (and please feel free to chime in on this one), it was expressed to me in VERY STRONG words that I should NEVER introduce myself as "I'm one of the nurses" but rather "I'm a STUDENT nurse". Every time I charted something, it had to be signes ",SN" not "RN" - why? I thought it was b/c it was illegal to be representing myself as a nurse when in fact I was only a student nurse. Even on this Allnurses forum, I specifically remember that when I chose my username at first, I chose "Sakura_SN" b/c it was in the guidelines that I could not represent myself as an RN until I got the title.

    So why is it that in this doc's office it is ok for this gentleman, as well as the other ppl, to represent themselves as nurses???

    and most importantly - I am worried that by me, as an RN, being there might put my license in jeopardy. I know that certain advice can't be posted in here, but maybe i can be directed as to where to find info about this.

    ...... the other less important thing that weirded me out was the Point system. Apparently, when you do something wrong, you get a "point". This point is then sent out to EVERYONE in the office, for example, "Jane doe has received a point b/c she did not key in the right code for the CBC machine". Well now everyone knows what you did wrong. So I asked, well what happens when you get a point? This was the explanation: "You don't want to accumulate too many points, you may get a verbal warning. If you want the point taken away, it may be docked from your pay or YOU MAY BUY THE DOCTOR LUNCH"


    Why is it that that explanation made a big siren go off in my head???

    ugh... I already hate my job and I've only been there a week. I have no idea how I am supposed to stick it out for a year (that's my goal - I want to be able to put my experience in a piece of paper and write my ticket elsewhere)

    sorry for the long entry

    p.s - please don't close my thread - I really do want feed back
  2. Visit sakura_RN profile page

    About sakura_RN

    Joined: Sep '08; Posts: 38; Likes: 29
    med/surg; from US
    Specialty: Med. Surg, physician's office


  3. by   Mike A. Fungin RN
    Can you please share with us what state this is in?

    I believe that in most if not all states the titles "Registered Nurse" and "Licensed Vocational Nurse" are protected titles. That means it is a crime to use either of those titles if you do not have the education and licensure to practice as such.

    Here in California, they've gone one step further, and "Nurse" itself is a protected title. Only Registered Nurses and Licensed Vocational Nurses can use the title "Nurse."

    The Board of Registered Nursing takes offenses very seriously, taking action up to and including prosecution. A CNA or MA who misrepresents themself as a nurse can face stiff penalties including losing their certification.

    If these employees are misrepresenting themselves, it stands to reason that they may be practicing out of their scope as well. That would be a patient safety issue, and if I were you I would go up my chain of command and make sure they stopped. If they didn't, I wouldn't hesitate to report it to the state.
  4. by   NotReady4PrimeTime
    Good advice from Mike. This place has some serious issues and you're totally right to be twitchy about it. Were I you, I'd be looking for something else, and right now! (Don't worry we're not going to close your thread... unless somebody pops off in a really inapporporiate manner!)
  5. by   sakura_RN
    Quote from Mike A. Fungin RN
    Can you please share with us what state this is in?
    North carolina ....

    I will look into it. I know they don't say "I'm a registered nurse" but they do say "one of the nurses". But I wonder.... as far as giving IM injections or starting IV's - who can do that? Only nurses?

    And I would want to go to another job, it's just that as a new grad, in this economy, or at least in this state, this was the only option that came up - I have had no other phone calls
  6. by   chicookie
    Yeah I would keep looking. It just sounds fishy.
    A CNA can do technical tasks such as vital signs, weights, blood pressures, EKG's once trained, but they may not administer medications nor vaccines. They can even draw blood if the doctors train them and collect specimens too.
    I want to say for medical assistants its the same. But I am unsure of this.
    Also I have seen offices where the people have been there so long they can do everything and the other people let them because they have been there forever. ITS STILL ILLEGAL!
    But I also know that private offices have their own rules. Even then that point system is whack. Buy the doctor lunch? Seriously? yeah right.
  7. by   llg
    Leaving a job after only a VERY short time is not the same thing (and doesn't look nearly as bad) as staying several months and then leaving. When you leave after only a couple of weeks, it is easy to explain that this job was a total misfit.

    For example, you could say that when you took the job ... "I didn't realize that I would be the only nurse on duty. When I interviewed an people introduced themselves as nurses, I thought they were really nurses and that I would be one of a team of nurses." Employers will understand why you left and probably not hold it against you. With this economy, many people are being forced to take jobs that they would not otherwise have taken. If you explain that you were looking for a hospital job ... but no one was hiring ... you took the office job thinking there were other nurses there ... etc. etc. .... I believe most decent employers will understand why you left quickly and not hold it against you.

    Good luck!

    Edit: Upon further reflection ... that thing about buying lunch for the doctors or paying for points out of your paycheck intrigues me. My first reaction was as negatve and "weireded out" as yours was. But when you think about it, they have a point. They are running a business -- a medical business. The only money they take home to their families is the money that is left after all the expenses are deducted from the money that comes in. When people make mistakes, those mistakes take dollars out of their families' incomes. Staff mistakes cause their incomes to be reduced. So, they want the staff to pay them back in the form of money. It's equivalent to asking store cashiers to make up difference when their cash drawers do not match the register tape. I don't necessarily like it ... but it's interesting to think of it from that perspective. As the daughter of a small town physician who only brought home what was left after he paid all his expenses, I appreciate the doctor's side of that situation as well as the staff's.
    Last edit by llg on Jul 3, '09
  8. by   LadyEJ BSN, RN
    I'm sorry...but this is one of the most bizarre posts that I have read on this site. RUN don't walk away from this job. Nothing good can come of this.
  9. by   nkara
    I would definitely look into this. Hopefully they are not working under you license to perform these task's.
  10. by   Valerie Salva

    What is going on at this doc's office is so illegal, so wrong, and so insulting to REAL nurses- I am so angry, I wish I never read the post.
  11. by   nursel56
    It sounds like the doctor is a weirdo with a very large practice and an underlying distrust of his employees. Usually results in mass neurosis of the staff.
  12. by   FindmyNiche
    I am intrigued with this post as well. I am an LPN who mostly worked in nursing homes and didnt do a whole lot of IVs, EKGs and the like. I am also working toward a degree in DMS. I was recently offered a position in a doctors office and think it would be a great learning experience for when Im through with my studies. I too am verrrry nervous as I have never worked in this sort of environment and not sure what to expect or what is expected of me. I am scared to death that I will look stupid and flop! I am frantically skimming the web to refresh myself on different procedured we covered in practical nursing clinicals, but I hardly ever used. Any advice is appreciated.
  13. by   DolceVita
    I would leave. Immediately. Frankly, I would leave and report the whole thing to your BON.

    I had a "nurse" perform procedures etc. on me until I found out later that she was a med asst. Now I know that med asst. can perform these procedures but the woman said she was a nurse.

    Not OK......

    Good luck.
  14. by   jamieslovingmom

    In Washington State, an MA can administer injections, including immunizations. I believe CNA's are also authorized to do this. As far as starting IV's, I would have some objections to having a CNA or MA doing that. I would check your state's DOH for scope of practice laws and investigate this yourself before reporting the activity at your clinic, just to be sure. I also work in a doctor's office (fam practice) as an LPN and the MA at our clinic does pretty much everything that the LPN's do, but we don't draw blood or start IV's there. (Thank God!)
    That being said, I would be cautious about staying in that environment. As you stated in a previous post, you should worry about your licence since, technically, the CNA is working under your supervision. An MA would not be, I believe, since they are technically working under the physician's supervision.