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Discussion

Help Work Issue

I have been a nurse practitioner for almost 3 years. I currently work for an internal medicine practice with 2 physicians. One of the physicians is the "president" and oversees everything. I have worked in the practice for a little over a year now but am all of a sudden getting all these chart corrections. First I started getting messages that said "see me" in the EHR which means to come to his office to discuss a case. I would have to go to the MDs office multiple times throughout the day to try to catch him between seeing patients to find out what he wanted. When I get there most of the time it is about something small like "you charted the patient is 64 when they recently turned 65. I would correct the corrections. Then he moved from see me's on the patient chart to sending me messages through the EHR stating what the corrections were instead of having me come to his office which worked better for me. Now he is going into my charts prior to me finishing my chart, making changes to my chart as if he saw the patient and stating that I am missing information on my document, then he signs off of the chart which closes it and makes me have to add an addendum. I am really fed up with this person and wanting some advice from seasoned NPs. I feel like I am underappreciated and being bullied. I don't know what I can do, besides look for another job. I love what I do, I love my patients but I forgot to mention that I am the first NP that they have every had. I don't get corrections about treatment plans or diagnoses, I get corrections about minute things. Now he is signing my charts off before I finish my documentation. What should I do?

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    • Expert

    I would have a sit down discussion like two professionals and ask him what the issue is.

    As APRNs we are professionals that sometimes have to have "tough" discussions with our colleagues.

    1. Make an appt so that his and your time is blocked out.

    2. Come to the meeting prepared with details: what chart was changed, when it was changed, and most importantly why did HE change it if he hadn't seen the pt.

    3. Also come to the meeting with a plan of action: if he says your charting lacks something, have a ready answer as to how to correct the issue. If he can't come up with a concrete reason as to why he is doing this, then I would also point out the legalities of changing another provider's documentation.

    No one should be changing another's charting. If necessary, our EMR allows us to add addendums if we need to. However, none of the physicians in my practice would ever change my charting - they might add something but never change MY charting. If I make a mistake there is a mechanism in the chart to correct it.

    Does your MD HAVE to sign off on your charts? That seems to be a waste of time to me. When I see pts in the office, I do the charting as I see the pt and then close that encounter out. If I need to send something to the MD, I just attach it to the chart of off it goes to their dashboard of the chart.

    Are there other APRNs in the practice - does he do the same thing to them?

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    • Author

    I am the only NP. He is not seeing my patients. My EHR works the same way as yours. When he would tell me the correction I would do an addendum. Because he was riding me about simple mistakes I have slowed down on my charting so that I take the time to comb over them to avoid the small errors. I do the most I can do within the visit but I don't sign it because im not done with it, I close them out during lunch or by the end of the day.

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    • Expert

    Got it - how about sitting down and having a discussion with him?

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    • Author

    So I sat down with him after lunch because he was already closing my charts from patients I had seen in the morning. I asked if there was a particular reason why he was closing my charts which causes me to have to do an addendum when my chart is incomplete. At first he said what's the big deal about doing an addendum, then he said my charts are basically his charts aND he wanted to go in there to do quality management things so he could get his part done. For some reason his PQRS stuff is linked to me etc etc. There are some tasks that he is to see in the chart, that I cannot see under my login.

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    • Expert

    Hmmm....thats weird. My docs and I see the same things.

    Do you get a bad feeling from this situation? I do just from what you wrote. Can you consult privately with another APRN who is familiar with him to get their take on it?

    On one hand, maybe he has been burned with a quality assurance issue, on the other hand if this isn't the issue, why all of a sudden this is occurring?

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    • Author

    Yea. I don't don't trust him. It is my understanding that they are not billing incident to but maybe they are now. If so that is a problem.

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    • Expert

    I rarely advise leaving a practice but when I was a new APN, I got into a situation with an unethical MD that spiraled out of control so I'm more cautious now.

    The red flag for me would be that I don't trust him.

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    • Author

    Thank you

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    • Expert

    You are very welcome - let us know what you decide

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