All Is Not Well In the Kingdom

[AngelfireRN, MSN, RN, APRN]

Hi again, all.

I just graduated as an NP in December. Right before I did, I got a phone call from a local doc with a job offer. This clinic is about 10-15 minutes from my house, and is a family practice/internal med clinic. I had known the doc for a while, so I took the job. It started out great. Then all heck broke loose.

I am an ACNP, or will be as soon as I sit my test. I'm training, trying to get "un-ERed", which was where I did the bulk of my precepting. ACNPs can't do women's health or see kiddos. This was explained and agreed upon at the interview. There was a second NP there that could see these, so no problem. Then she wasn't there anymore.

Now I am back in school, getting my FNP certificate, waiting to sit my test, training, and feeling a bit like I have landed in Bedlam. Don't get me wrong, I LOVE what I'm doing, but I am so on tenterhooks I can't think straight. My boss is paying my tuition, since the FNP certification is for the benefit of the clinic, so that I can run it when she is away. That generosity is not lost on me.

I got called into the office manager's office the other night before I left, who had a list of complaints that the doc had about me. (Doc will not say much to you herself, she lets the OM handle it). One was the fact that I am too loud. Yes, my voice carries. I sing, I have trained it to project, and there is NO insulation in the office, so you can hear a whisper in the next room.

Another was the fact that I spend too long with patients. Well, I'm sorry, I'm new at this, and when you have a patient who's on enough B/P meds to kill an ox, 300+ pounds, and whose B/P is still sky-high, it takes a while to calm him down. The suggested approach of "You're too fat, you need to lose some weight" is something I have not hardened myself to yet. I may never. I can't think I'd take it too well coming from my 130-pound self.

And then there was the issue of me cherry-picking the patients, taking the easy ones and leaving the hard ones for her. On this, I have no clue. The only reasoning I could come up with is perhaps she meant the times that I will clear 2 rooms who just need refills before I go to an illness, because the illness will take a bit longer, and while I am in there, 2 more patients can be brought back. I though that was time management, and with no idea who got where when, I did not realize there was a certain order. The rooms are not numbered. I have never left a harder case for her just because I did not want it. She will refuse to see certain troublesome ones, but she is the boss, and that is her right.

I am expected to see 20 patients a day, which is fine. I always see 15 or more, but I guess she felt I was slacking.

For obvious reasons, this bothered me, as I thought, for 2 months in, I was doing well. Th OM told me not to let it bother me, which begged the question, how can it not? I have begun keeping track of how many I see in a day, for my defense, should that be brought up again. I am now quiet to the point that the billing girl asked if I was sick. Nothing else has been said yet, but I have this niggling feeling like the other shoe will drop any time.

The clinic has a high turnover, yes, but I do not want to quit. I had thought that we had a good rapport until that OM convo. Doc hugged my neck before she left last week and said that I saved her butt on a particularly busy day. I appreciate the notice, but at the same time I wonder if I should check my back. According to OM, she "was just having one of her days" and "I got on her nerves".

What do y'all think? I LOVE what I do. I really like it, it's close to home, I like the people, it's where I grew up. Would you let it ride, say something, let it go? I'm new at this aspect, and were I not, my outspoken self would probably already be fired. Thanks for reading and for advice.

Angelfire

[DeepFriedRN]

Could you maybe have a discussion with the Doc herself? Not confrontationally, by any means, but just to kinda air it out..Let her know that you have heard her concerns, and would just like to address them with her, so that you are both on the same page in terms of number of patients seen, in which order, etc. As far as the whole "she's too loud" thing, I don't even know what to think about that?!? Gotta say that she sounds a touch....difficult, maybe? IDK, just seems a little strange that she didn't just speak to you herself..Anyway, I guess that's what I'd do. I hope it all works out for you!!

[AngelfireRN, MSN, RN, APRN]

I'd try it, but I don't know how it'll work. If I do, I'll post how it goes, it just may be from the ranks of the unemployed. :nuke: Thanks!

[nurseeB]

I would let it go for now. We all have bad days and open our mouths and complain about things that normally would roll off our backs. Maybe that is the case with this doc. I would continue to cover your backside by tracking the number of patients you saw etc., but I wouldn't say anything to her yet. Now if the OM gives you another "talking to" then I would have a discussion with the doc. That's just my nonconfrontational opinion.

[scribblerpnp]

I also would agree to let it go for now. It can be very stressful to deal with a new grad. I had a similar experience with my doc when I started working. If your doc has never helped to break in a new grad before (and we do need breaking in), it probably didn't help the situation. You are both still adjusting to the new routine, and it has only been a few months. Give yourself some more time, and try to improve in the areas that you feel are valid concerns.

The doc I worked for went through the office manager as well with the complains. I've been with them for over four years now and love them both. But my doc is one of those people who hates confrontation and would rather someone else do it for her. It is just the way she is, so I roll with it. She is a wonderful employer otherwise, and I'm glad I stuck it out through the early months, as frustrating as it was sometimes.

Maybe the office manager can help with the ordering of the patients. The MA's (or whomever bring back the pts) could easily stick a post-it-note on the door with numbers 1, 2, or 3 indicating who should be seen next.

I can see where a poorly sound-proofed office could be an issue. It would be frustrating being in one room trying to examine/ question a patient and hearing a full conversation in the next.

Hang in there. It is just an adjustment period. Everyone has their quirks, and in a small office it can be more grating since there are less people around to water it down. I

[tencat]

Ummm....why is the OM playing messenger? I think you and the doc need to sit down and discuss issues face to face and not rely on a third party to transfer information. It's too easy for information to get distorted when the 'telephone' game gets played. I'm not suggesting you confront the doc. I'm suggesting just sitting down and telling her how it's going for you, and asking her what she feels you still need to work on. I think that's completely reasonable and could go a long way toward making you feel more secure. Now, if she's hesitant to do this, then my little voices in my head (the rational ones...:) ) would be saying this is not a good place to be and maybe I should be looking elsewhere.....

[Valerie Salva, BSN, RN]

Ummm....why is the OM playing messenger? I think you and the doc need to sit down and discuss issues face to face and not rely on a third party to transfer information. It's too easy for information to get distorted when the 'telephone' game gets played. I'm not suggesting you confront the doc. I'm suggesting just sitting down and telling her how it's going for you, and asking her what she feels you still need to work on. I think that's completely reasonable and could go a long way toward making you feel more secure. Now, if she's hesitant to do this, then my little voices in my head (the rational ones...:) ) would be saying this is not a good place to be and maybe I should be looking elsewhere.....

I agree!

[SuesquatchRN, BSN, RN]

I respectfully disagree that the OP should approach her boss directly since the boss has made it very plain, by using a third party, that she doesn't want to do that.

Ride it out and believe the OM when she says things are okay.

:)

[Whispera, MSN, RN]

We don't know if the doc asked the office manager to talk to you about the complaints or if the office manager took it on herself to talk to you in response to simple venting by the doc. I'd want to get the middleman out of the loop here if it continues.

[wonderbee, BSN, RN]

Reading between the lines, I wonder AngelFire if you can settle into a practice where communication goes between third parties. Is this your working style? Can you get comfortable enough to enjoy your work or will you always be watching your back? Is this what you want or envsion for yourself?

Confrontation is simply a means of communication. It doesn't have to be nasty. This doc is clearly uncomfortable with it. That may mean you will never be able to gel with her. Cohesiveness and the ability to communicate is at the heart of any successful unit or practice. What are your options?

[caliotter3]

Do you see this situation working itself out over the next few months or do you see the undercurrent, side panel communication, and slight distrust continuing to be the way things operate? If this has not been discussed and worked out soon, I would suggest you think about finding a place where you will fit in better.

[leslie :-D]

oh gawd angel....i sooooo understand...

especially about the loud voice.

my voice carries and echos.

in other words, i do have a big mouth.

and working inpatient hospice, they have all this harpy therapeutic wanna-kill-myself music going.

one of my coping mechanisms in stressful situations, is to sing.

i am always singing.

well one day when one of my pts died, i 'guess' i was singing "and another one bites the dust" by queen.

never even knew what i was doing until my arm was physically dragged off the floor by the med'l dir.

evidentally, that was their final straw and they let me have it, lock, stock and barrel.

these days, my voice is a lot softer and i still have to bite my lips r/t the urge to sing.

as for md c/o you taking the easy pts, i can see where she'd expect you to have seen more.

once you get your groove going, i'm sure you'll be faster.

and i too, talk and talk and talk.

thankfully, it's appreciated by my pts, coworkers and mgmt.

i just have to remember to use my quieter voice.

and not to sing insensitive songs.

leslie