I just got hired in a plastic surgery clinic. Are these red flags?

[Puppylover0213]

Hi everyone!

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?

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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. ?

[JKL33]

21 minutes ago, DextersDisciple said:

Exactly why I said he shouldn’t be OPPOSED to experienced nurses. The Dr I worked for did not do that.

Yes that is the vibe I was getting too.

I hear you and I didn't overlook that, but there are a lot of things people aren't opposed to if/when their options are limited or they have no other choice, so their saying that they aren't opposed isn't exactly a very hearty declaration.

[CritterLover, BSN, RN]

58 minutes ago, DextersDisciple said:

Exactly why I said he shouldn’t be OPPOSED to experienced nurses. The Dr I worked for did not do that.

Yes that is the vibe I was getting too.

I don't know that any of us (other than the OP) can really get a vibe from this situation -- we weren't there. We don't know what question/comment/part of the conversation prompted that comment. It is pretty much being taken out of context -- which is not a knock against the OP at all. It just means that we weren't there and didn't exactly get a transcript of the conversation.

I agree that it is possible that he wants someone who doesn't know any better as far as best practice, shortcuts he might be taking, that sort of thing. But we don't know that.

Lets face it -- new grads are cheaper. By *a lot* if you compare their salary to that of an experienced OR nurse. Given that he agreed to give her the top of his range, which still did not match what she is making in the hospital as a new grad, money probably has a lot to do with wanting a less experienced nurse. He probably didn't want to say that. He probably thought what he said would sound better and reassure her. He very well might not have any idea how sketchy that sounds.

[CritterLover, BSN, RN]

4 hours ago, Mergirlc said:

Your post reminds me of the stories shown on the shows, "El Rojo Vivo" and "Primer Impacto." These are televised on the Univision and Telemundo networks in Spanish. I watched these shows with my mom all the time.

It seems every week there was some story about some woman going to a plastic surgeon's office (insert any Latin American city name here OR Miami) and how they ended up either maimed, disfigured, or dead. Of course, the surgeons run off and hide and then the employees get picked up by the authorities and have to fend for themselves.

Stay far away. Don't be that nurse led off in cuffs!

This is why it is really important to find out if he is board certified -- or at least eligible. Any physician can take a weekend course and call themselves a "trained" plastic surgeon. If that is the case -- then I would run far far away.

If he's board certified or at least had a surgical residency/plastics fellowship and has worked as a plastic surgeon for a while and just needs a certain number of additional cases in order to be eligible to become board certified, then this sort of thing becomes less of a possibility.

[DextersDisciple, BSN, RN]

31 minutes ago, JKL33 said:

I hear you and I didn't overlook that, but there are a lot of things people aren't opposed to if/when their options are limited or they have no other choice, so their saying that they aren't opposed isn't exactly a very hearty declaration.

I feel like you are getting caught up in the semantics of my anecdote. Did not meant to stir up anything . I was simply sharing my own personal experience.

[Puppylover0213]

44 minutes ago, CritterLover said:

This is why it is really important to find out if he is board certified -- or at least eligible. Any physician can take a weekend course and call themselves a "trained" plastic surgeon. If that is the case -- then I would run far far away.

If he's board certified or at least had a surgical residency/plastics fellowship and has worked as a plastic surgeon for a while and just needs a certain number of additional cases in order to be eligible to become board certified, then this sort of thing becomes less of a possibility.

He’s board certified, has done fellowship and is a professor at a great university in my area. He is really qualified (not trying to kiss his butt though)!

[Puppylover0213]

51 minutes ago, CritterLover said:

I don't know that any of us (other than the OP) can really get a vibe from this situation -- we weren't there. We don't know what question/comment/part of the conversation prompted that comment. It is pretty much being taken out of context -- which is not a knock against the OP at all. It just means that we weren't there and didn't exactly get a transcript of the conversation.

I agree that it is possible that he wants someone who doesn't know any better as far as best practice, shortcuts he might be taking, that sort of thing. But we don't know that.

Lets face it -- new grads are cheaper. By *a lot* if you compare their salary to that of an experienced OR nurse. Given that he agreed to give her the top of his range, which still did not match what she is making in the hospital as a new grad, money probably has a lot to do with wanting a less experienced nurse. He probably didn't want to say that. He probably thought what he said would sound better and reassure her. He very well might not have any idea how sketchy that sounds.

You saying stuff could be taken out of context is not offensive to me at all. I actually appreciate you saying that it’s hard to tell the vibe from reading the post. Reading back, I think I posted pretty emotionally and dramatically just because I was really nervous about the idea. I ended up speaking to the manager and clarifying the role and they even raised my pay to be above my current hospital pay, but I still haven’t given a response to them. Mostly because I have 40 responses from everyone telling me to run ? It’s definitely not as sketchy as I made it sound, I guess, but I absolutely trust all of you who definitely have more experience than me and aren’t bias.

People have recommended I either stick it out for a year here, which I really don’t want to because I’m depressed here but if I have to, then I guess I would. Others have recommended me to transfer to another unit already but I’m not allowed to do that, until a year. I just want to do outpatient, but I also know I can’t just run to any job opportunity like this one. It just doesn’t seem so bad to me after I spoke to the manager but again, I don’t know.

Anyway, a sincere thank you to EVERY single person who has responded. Never in my life do I expect to even get more than like a couple replies but everyone has been so helpful. Thank you.

[CritterLover, BSN, RN]

3 minutes ago, Puppylover0213 said:

He’s board certified, has done fellowship and is a professor at a great university in my area. He is really qualified (not trying to kiss his butt though)!

So that makes a lot of this more palatable. He has a license to protect, too after all. Someone with those kinds of accomplishments isn't likely to risk it all.

I'd still check Google reviews, yelp, glassdoor, etc. Google his name (hopefully it isn't common). Ask about shadowing, tell him you want to make sure that you are a good fit before you quit the job you have.

Many plastic surgeons are looking for a certain image in their staff, for better or worse. It's another reason why they like "younger" nurses. They have an image they want to promote. Feels kind of icky but they do have a business to run.

[Puppylover0213]

9 minutes ago, CritterLover said:

So that makes a lot of this more palatable. He has a license to protect, too after all. Someone with those kinds of accomplishments isn't likely to risk it all.

I'd still check Google reviews, yelp, glassdoor, etc. Google his name (hopefully it isn't common). Ask about shadowing, tell him you want to make sure that you are a good fit before you quit the job you have.

Many plastic surgeons are looking for a certain image in their staff, for better or worse. It's another reason why they like "younger" nurses. They have an image they want to promote. Feels kind of icky but they do have a business to run.

He has amazing reviews in his own clinic. The one where he would only do surgeries Tuesdays and Thursdays and the nurse would do the consults. He has over 500 reviews with images and everything, of everyone saying he has great bedside manner and that they love their results.

Then the other clinic that isn’t his has good reviews to but everyone talks bad about the office staff like the secretaries. There’s about three surgeons there and they all specifically mention mine and say he’s amazing though. Then I can easily Google his name and find so many great things about him, it’s crazy.

[CritterLover, BSN, RN]

2 minutes ago, Puppylover0213 said:

You saying stuff could be taken out of context is not offensive to me at all. I actually appreciate you saying that it’s hard to tell the vibe from reading the post. Reading back, I think I posted pretty emotionally and dramatically just because I was really nervous about the idea. I ended up speaking to the manager and clarifying the role and they even raised my pay to be above my current hospital pay, but I still haven’t given a response to them. Mostly because I have 40 responses from everyone telling me to run ? It’s definitely not as sketchy as I made it sound, I guess, but I absolutely trust all of you who definitely have more experience than me and aren’t bias.

People have recommended I either stick it out for a year here, which I really don’t want to because I’m depressed here but if I have to, then I guess I would. Others have recommended me to transfer to another unit already but I’m not allowed to do that, until a year. I just want to do outpatient, but I also know I can’t just run to any job opportunity like this one. It just doesn’t seem so bad to me after I spoke to the manager but again, I don’t know.

Anyway, a sincere thank you to EVERY single person who has responded. Never in my life do I expect to even get more than like a couple replies but everyone has been so helpful. Thank you.

Yeah, I'm in the minority in that I don't see this as the great dumpster fire that many see it as.

I've ready everyone's responses too, and I do see where they are coming from. However, I think many are reacting from the "prefers new grads" part as that can be a huge red flag but can also be code for "don't want to pay for experience."

Most nurses are also very very conditioned to what insurance companies require/expect, and those aren't necessarily the standards in a cash business. For example, an insurance company might require, as part of their reimbursement practices, that the post op visit be done by the surgeon or a midlevel. Keep in mind that in general surgical services are bundled -- insurance pays one fee for the surgery and typical post surgical care, so they can dictate who does the post op visit. In general, a 24 hr post op visit is pretty basic, but for a surgeon to let an RN do it but still be reimbursed for the full fee is insurance fraud (depending on what the agreement says).

If you want to do outpatient, this might not be a horrible option. It *is* a risk though, and you'll need to weigh that. Honestly, though, the fact that he is board certified has alleviated 90% of my concerns. That is pretty huge - it isn't easy to become board certified in plastics.

I would, however, draw the line at truly being the only RN in the building - at least on surgery days. There needs to be an RN in recovery, unless for some strange reason anesthesia stays while the patient is in recovery and monitors the patient. I guess that is possible? That would require that there be more than one person doing anesthesia. There also needs to be someone responsible for OR set up, etc. That is usually the scrub tech. It could become you in time, but that is a lot of training and not something to just jump into.

[Tegridy]

I think he just wants a younger staff for aesthetic purposes. A lot of those body shops do. I’m not here to say if it’s right or wrong just a fact of life.

he isn’t really wrong in saying he wants a newer nurse. Unless someone has worked in surgery before or in a very similar job situation experience probly won’t be helpful. The old myth that more experience is always better is just not true and especially not true for unrelated job descriptions.

Reminds me of one of the silliest things I ever heard. Some older nurse when I was in school overheard I wanted to work in icu. She said everyone should work on the floor first. Nonsense! If you want to get good at something you do that one thing not something else....

[CritterLover, BSN, RN]

1 minute ago, Puppylover0213 said:

He has amazing reviews in his own clinic. The one where he would only do surgeries Tuesdays and Thursdays and the nurse would do the consults. He has over 500 reviews with images and everything, of everyone saying he has great bedside manner and that they love their results.

Then the other clinic that isn’t his has good reviews to but everyone talks bad about the office staff like the secretaries. There’s about three surgeons there and they all specifically mention mine and say he’s amazing though. Then I can easily Google his name and find so many great things about him, it’s crazy.

So it sounds like he is fed up with the way his patients are treated at the other clinic and so wants to open his own. That isn't such a bad thing.

There are a lot of logistics involved in opening a surgical clinic. It will take him a while to figure it all out.

I ... don't think this is such a horrible option. Necessarily.

Check on what is going on with PACU.

Check on anesthesia.

Clarify who will be the author for the post op notes.

You'll need ACLS, which I'm sure you don't have as a NICU nurse unless you had it before you became a NICU nurse.

In other words, do your best to make sure he isn't cutting corners. From your last few posts though, he doesn't sound like someone who would put his patient's safety at risk. His talk about wanting to grow this practice with you sounds real, though a bit idealistic. Again, hiring a business manager is a good sign.

I'd investigate more, though. Just because he is acting above-board with respect to medical ethics does not mean that he understands nursing responsibilities.

[Puppylover0213]

21 minutes ago, Tegridy said:

I think he just wants a younger staff for aesthetic purposes. A lot of those body shops do. I’m not here to say if it’s right or wrong just a fact of life.

he isn’t really wrong in saying he wants a newer nurse. Unless someone has worked in surgery before or in a very similar job situation experience probly won’t be helpful. The old myth that more experience is always better is just not true and especially not true for unrelated job descriptions.

Reminds me of one of the silliest things I ever heard. Some older nurse when I was in school overheard I wanted to work in icu. She said everyone should work on the floor first. Nonsense! If you want to get good at something you do that one thing not something else....

All his staff is beautiful ??