I work bedside in the NICU for about 8 months. I hate it. Management sucks, completely understaffed so I've found myself in unsafe situations and so, on. I have a contract with them that I knew I would break eventually because I knew I wouldn't end up there for even a year.
I applied to a plastic surgery clinic position (cosmetic - Brazilian butt lifts, breast implants, tummy tucks, etc.) This plastic surgery is all over TV in my city even though he's just starting practice and he's pretty popular on social media. I had to do an online test, a phone interview, interview with the doctor and manager and finally an interview with his business advisor today (which I've never heard of having to do before). They all absolutely loved me. However, are these red flags?
1)I would be the only registered nurse working in the entire clinic. Surgeries are Tuesdays and Fridays and the doctor would be in another clinic Mondays, Wednesdays and Fridays doing other surgeries. On M, W, F, I would be the one seeing every post-op patient from Tuesday and Friday by myself without having the doctor to consult. I would do patient education, dressing changes, and other stuff that for right now I don't know..
2) I would have to write his progress notes. They use Nextech, which I'm not familiar with but I'm really good with computers. However, writing his progress notes? That seems weird? He said it's because since he's only there Tuesdays and Thursdays, he wouldn't have a chance.
3) No insurance and no 401k. The business advisor told me they're in the process of getting it for the employees. My current job has both. Because of this, when we spoke about pay, I told them I would want the highest they're offering because it almost matches my current job. Surprisingly, they agreed and said I could be looking toward raises in the future.
4) They have another building they plan on moving to, that's bigger and owned since they're currently renting out. It's already built according to everyone, so the business advisor was trying to assure me that this is a real thing and that if I'm part of the team as they grow, it would be a huge learning experience for me. But how do I know that's really happening?
5) I would be with him Tuesdays and Thursdays as his scrub nurse I guess. He has 1 medical assistant currently and hiring 2 more. Do they help during procedures? What would be my role? I guess this isn't a red flag but I'm just confused.
6) He only wants a brand new RN. Isn't that weird for something so big like surgeries? He said he doesn't want nurses with bad habits and that he wants someone young because he's young and wants someone with him that's in the long-term. He told me his extremely strict, demanding but nice. He says he just wants his clients to get the best work, but how does he expect this with a brand new nurse?
7) Last but not least (sorry) - the staff briefly mentioned (like VERY briefly) that their only RN left. They have been in practice for less than a year, so I don't know what may have led her to leave beforehand? I might be looking into it too much but I feel like that's a major red flag?
Anyway, thanks so much guys. EVERY single comment means the world to me. My parents and other family members have been telling me I'm crazy for leaving my current job which has good pay, insurance, 401k and room for growth but I'm so depressed in that job. Breaking my contract is also something that will be big because of the money and the fact I'd be burning bridges with this hospital franchise but I don't mind, as long as I'm not making the wrong decision. But I'm not sure if I'm getting red flags. ?
Specializes in ER, ICU, Infusion, peds, informatics.
Writing his progress notes in itself isn't an issue for me as long as it is his assessment that he relays to you -- that is a lot like he's using you as a scribe which is very common.
Writing progress notes based on your assessment that reflect that it is your assessment is OK.
Writing progress notes based on your assessment that he signs as his assessment is not OK.
Doing the next day post op visit is OK (but questionable) if he's available and upfront with his patients that they will be seeing you 24hrs post op. He has some leeway here since he probably isn't billing insurance. If you had more (and relevant) experience it would bother me less.
Are you sure that you will be his scrub nurse? Usually there is a scrub tech for that. Some docs do use RNs but that isn't very common anymore. I'm not an OR nurse, but I wouldn't be comfortable with there only being me, him, and anesthesia in the OR -- there should be another licensed person who isn't sterile.
Who is doing the anesthesia and who is in PACU recovering the patient? If it is a CRNA doing the anesthesia, are they supervised as require by your state (and that might be no supervision -- some states don't require it)?
The insurance/401k stuff makes sense, though I'd nail him down on the timeline.
The business partner thing I think is a plus -- most doctors are terrible at the business end of things. Hiring someone to focus on that for him indicates that he wants to grow a successful business and isn't just interested in Cash Now.
Have you done any research on this? Google reviews, yelp, glass door, etc? Are his patients happy? Does he have any pending complaints/lawsuits? Is he board certified (in plastic surgery)? Consider asking if you can shadow for a day or at least a few hours at the other clinic.
Is that other clinic run the same way? Will they all be moving to the new location once it is ready?
The lack of insurance involvement (on the part of the patient) does mean that some of the practices that we consider to be standard don't necessarily apply. Insurance billing requirements dictate a lot of that. Plastic surgery is generally a cash business. If he does accept insurance at times, it is important to find out if he follows their requirements for those patients.
Overall I would lean towards "pass," but if he has good reviews, his patients are happy, he has decent staffing, his overall staff is happy and you have a reassuring experience at the other clinic I think you could possibly make it work.
All of that definitely sounds suspect. From working solo, specifically seeking out a new nurse, the lack of benefits... Definitely seems off. Trust your instincts... if you’re seeing these red flags before working there, imagine what you would see once hired! Protect yourself and your license!
I don't have much time to write all the wrongs with this situation. Is this man from a different country? Reason I ask, it has been the theme of new emerging plastic surgery clinics in my area. Usually a foreign doctor looking for a pretty new grad to make face and do underground shady work.
Do yourself a favor and don't walk, but instead run far away. You will regret this decision for the rest of your life. You can be sued and stripped of your license if you risk this.
Forget the red flags, this is a far worse deal than your current situation in the NICU. As both a previous NICU nurse and now an OR nurse, I can't even begin to entertain the fact you will be his first assist. It is a joke, and a disservice to any patient. Please don't do that. You have no idea how long and hard it takes to master that skill, not to mention all the other crap you will be expected to do as the ONLY RN in the building.
I hope you are not seriously still entertaining this job. If so, I have nothing more to say other than good luck!
Plenty of money for TV promotions and not enough for insurance or a 401k for you? Empty promises about future raises? What does that tell you.
Yeah you know I was promised a substantial pay raise when hired. We’re talking two years approaching. Even with strong inquiries, do you think I have seen that raise? Looking for the weather report for freezing hail, sleet, or blizzard conditions in hell first. Never believe verbal promises regarding pay. Some won’t even honor written or contractual promises.
Your contract for the NICU is only 1 year? Let’s focus on being an employable adult and stick with it for the remaining four months. It is not worth burning bridges (especially for this new short term gig) and paying penalties when all that you have left in the contract is a few more months.
Perhaps NICU is not for you or perhaps you’re going through new grad sorrows/realization that this career is not fun & games. Do your year. Speak with management about trialing a different unit. Find your niche. They have invested this much time in you so far and will be willing to relocate you to a new department rather than lose you and that investment.
I completely agree. I have worked surgery before. This is not right at all. Don't ever put your license on the line, its not worth it. We work way to hard for those! Best of luck to you. Keep on looking......
Specializes in Former NP now Internal medicine PGY-3.
It’s prob not as bad as it sounds in an online forum post but I wouldn’t do it with no benefits. Also if you want a hospital job in the future the narrow spectrum of this job won’t look good on applications
the interview process itself seemed normal. But I’d still pass
It’s prob not as bad as it sounds in an online forum post but I wouldn’t do it with no benefits. Also if you want a hospital job in the future the narrow spectrum of this job won’t look good on applications
the interview process itself seemed normal. But I’d still pass
I want to respond to everyone in this post, it’s crazy. Didn’t expect to get so many responses. But reading yours was comforting because yes, I really don’t think this job sounds as bad as I probably made it seem on this post but I just wanted to highlight things since I’m still a new nurse. Thanks for your input. I’m still deciding but I guess I’m leaning towards a no since everyone is advising me to do so :/ The manager said I can call her today to ask any questions so I’ll address stuff but still.
Specializes in Former NP now Internal medicine PGY-3.
16 minutes ago, Puppylover0213 said:
I want to respond to everyone in this post, it’s crazy. Didn’t expect to get so many responses. But reading yours was comforting because yes, I really don’t think this job sounds as bad as I probably made it seem on this post but I just wanted to highlight things since I’m still a new nurse. Thanks for your input. I’m still deciding but I guess I’m leaning towards a no since everyone is advising me to do so ? The manager said I can call her today to ask any questions so I’ll address stuff but still.
It seems most people are objecting basing it off seeing follow ups. To play devils advocate here:
if the surgeon only does a couple surges it’s not hard for an RN to pick up (after being trained) on what to look for to go wrong. They aren’t operating on critically ill patients and no body cavity is being entered. Low risk. Just as long as aseptic technique and good product being used is maintained.
Most patients coming in for this type of stuff are young, healthy (relatively) unless he does post BC tx implants) and unlikely to have any significant issues from the surgery. just have to again, look for infection.
Progress notes for this type of thing wouldn’t be any different than a simple wound assessment and a general wound care nurses job would likely be more difficult than assessing a simple suture line or a drain or two in these patients. progress notes aren’t super complex for focal issues such as outpatient surg follow up. It may just be foreign to most here since they haven’t written them.
I still wouldn’t do it though. And if I was a patient I’d rather be seen f/you by the doc but in this day and age it just doesn’t happen all the time. It’s hard to judge the competency of cosmetic surgeons and the patient population is usually of the worst variety.
It seems most people are objecting basing it off seeing follow ups. To play devils advocate here:
if the surgeon only does a couple surges it’s not hard for an RN to pick up (after being trained) on what to look for to go wrong. They aren’t operating on critically ill patients and no body cavity is being entered. Low risk. Just as long as aseptic technique and good product being used is maintained.
Most patients coming in for this type of stuff are young, healthy (relatively) unless he does post BC tx implants) and unlikely to have any significant issues from the surgery. just have to again, look for infection.
Progress notes for this type of thing wouldn’t be any different than a simple wound assessment and a general wound care nurses job would likely be more difficult than assessing a simple suture line or a drain or two in these patients. progress notes aren’t super complex for focal issues such as outpatient surg follow up. It may just be foreign to most here since they haven’t written them.
I still wouldn’t do it though. And if I was a patient I’d rather be seen f/you by the doc but in this day and age it just doesn’t happen all the time. It’s hard to judge the competency of cosmetic surgeons and the patient population is usually of the worst variety.
Yes, he specified that he only performs surgery on completely healthy individuals. No diabetics, BMIs greater than 32, patients who don’t exercise, so on.
CritterLover, BSN, RN
929 Posts
Writing his progress notes in itself isn't an issue for me as long as it is his assessment that he relays to you -- that is a lot like he's using you as a scribe which is very common.
Writing progress notes based on your assessment that reflect that it is your assessment is OK.
Writing progress notes based on your assessment that he signs as his assessment is not OK.
Doing the next day post op visit is OK (but questionable) if he's available and upfront with his patients that they will be seeing you 24hrs post op. He has some leeway here since he probably isn't billing insurance. If you had more (and relevant) experience it would bother me less.
Are you sure that you will be his scrub nurse? Usually there is a scrub tech for that. Some docs do use RNs but that isn't very common anymore. I'm not an OR nurse, but I wouldn't be comfortable with there only being me, him, and anesthesia in the OR -- there should be another licensed person who isn't sterile.
Who is doing the anesthesia and who is in PACU recovering the patient? If it is a CRNA doing the anesthesia, are they supervised as require by your state (and that might be no supervision -- some states don't require it)?
The insurance/401k stuff makes sense, though I'd nail him down on the timeline.
The business partner thing I think is a plus -- most doctors are terrible at the business end of things. Hiring someone to focus on that for him indicates that he wants to grow a successful business and isn't just interested in Cash Now.
Have you done any research on this? Google reviews, yelp, glass door, etc? Are his patients happy? Does he have any pending complaints/lawsuits? Is he board certified (in plastic surgery)? Consider asking if you can shadow for a day or at least a few hours at the other clinic.
Is that other clinic run the same way? Will they all be moving to the new location once it is ready?
The lack of insurance involvement (on the part of the patient) does mean that some of the practices that we consider to be standard don't necessarily apply. Insurance billing requirements dictate a lot of that. Plastic surgery is generally a cash business. If he does accept insurance at times, it is important to find out if he follows their requirements for those patients.
Overall I would lean towards "pass," but if he has good reviews, his patients are happy, he has decent staffing, his overall staff is happy and you have a reassuring experience at the other clinic I think you could possibly make it work.