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. ?

[FlyGirl4Eva]

Oh hale NO! I ❤️ plastics,

one of my fav OR service lines but would never subject my license to ANYTHING that would jeopardize that PERIOD! Years ago Ioriented for a few days with a pediatric dentist who was double licensed in anesthesiology as well.....his RN was dosing the Propofol....I RAN. Signed a Legal Nurse Consultant. ?

[Wlaurie, RN]

I've found that if you have to ask the question you already know the answer.

[dirtyhippiegirl, BSN, RN]

I hope you are going to be hourly and not salary because I can see this job eating up all of your time once he has a patient base. Who is going to back you up should you want a vacation or be sick? Are you going to be expected to take call to answer after-hours questions? Who is going to teach you wound and drain care?

[Horseshoe, BSN, RN]

On 2/27/2020 at 7:05 AM, CritterLover said:

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.

I work in a plastic surgery OR and there are four of us in the OR working cases:

Surgeon

Scrub RN (very experienced RNFA)

Anesthesiologist (MD)

me (circulating RN)

We meet all AAAA requirements and provide very safe care with those numbers. We are also in an adjoining professional bldg attached to a hospital. Help isn’t far away.

[Horseshoe, BSN, RN]

This sounds like a very bad fit for you. You are going to scrub without extensive training???????

You have no experience but you are doing follow up appts without the surgeon on site?????

You are writing progress notes for a physician? Who hasn’t seen the patient at follow up??????

I could go on and on why most of what you have described horrifies me.

I’ve worked as a circulating RN in a plastic surgery OR for the past 9 years and no way would I accept this position!

[Rosie_one]

DoNot Take This Job!!

OK, first of all it's not uncommon for a plastic surgery office to have one RN. The RN that's hired by a plastic surgeon that I've seen are always youthful. After all you're representing the clinic. They wouldn't generally hire a 50 something nurse.

Not uncommon for surgeons to work in multiple hospitals or clinics, particularly when trying to build up a reputation for themselves.

What I find very disturbing is as an ICU that works closely with plastic surgeons and someone that has had plastic surgery themselves, it's absolutely unheard of for the surgeon not to see their patients post operatively.

After all, they are really only the one that knows what work they did, possible complications associated with that work as it's often different techniques used for different cases.

How are you going to identify these problems, other than just the general issues. I'd be worried that since you take down their dressings and seeing them post op that it's your registration on the line.

For instance breast surgery, are you going to identify a nipple losing blood supply for instance?

I'd run, not walkway from this if I were you.

The surgeon I went to who's very well known in Sydney has an RN managing his clinic. You see the nurse to finalise paperwork once you've consulted with the Dr. Gives you all the written info on procedures, rings up patients to tell them surgical times, rings post op patients and if they have issues, run it by the surgeon and organise with hospital the surgery and times etc, never consulting.

[NurseNikki=)]

I say no. I was in a similar situation and ultimately left because I felt like I would be the one thrown under the bus if anything went wrong. Doctors have the money, power, and more respect, and if it came to the nurse’s word against theirs, I felt I wouldn’t have the support (with no other RNs onsite), so I left the job similar to what you’re describing for those reasons. Also, I anticipate patients who are particular about their procedure expectations and results who will demand to be seen by the doctor. He really needs to hire a nurse practitioner in addition the RN, if that is his expectation of the nursing role.

[Mergirlc, MSN, APRN, NP]

13 hours ago, Horseshoe said:

This sounds like a very bad fit for you. You are going to scrub without extensive training???????

You have no experience but you are doing follow up appts without the surgeon on site?????

You are writing progress notes for a physician? Who hasn’t seen the patient at follow up??????

I could go on and on why most of what you have described horrifies me.

I’ve worked as a circulating RN in a plastic surgery OR for the past 9 years and no way would I accept this position!

^^^^^^ Listen to the voice of experience! She knows!

[LPN Retired, LPN]

Just my thoughts, as a new grad do,you have enough confidence to,be writing his progress notes? Seems to me you wouldn't have anywhere enough experience to do someyhing like that . I'm only a retired old LPN, but that sounds fishy to me . I wouldn't want that responsibility.

[klone, MSN, RN]

On 2/27/2020 at 4:28 PM, DextersDisciple said:

Older/experienced (I’m talking 1+ years) nurses In general can be “set in their ways”. I know for me Something as simple as the order/route/length of infusion is taught differently from facility to facility. Even though both ways were safe/acceptable I still liked to do it the way I was taught and used to.

A good nurse can adapt her practice, it doesn't matter how many years she's worked.

[DextersDisciple, BSN, RN]

8 hours ago, klone said:

A good nurse can adapt her practice, it doesn't matter how many years she's worked.

Agreed. That’s why I said “can be”.

[VivaLasViejas, ASN, RN]

I'm late to the party, and I admit I haven't read the entire thread, but I'm going to throw a few words in anyway:

Oh HELL no.

This stinks to high heaven. There are so many things that can go sideways. You should run far, far away from this "opportunity". Keep looking for another job, but don't quit your current one until you're gainfully employed elsewhere. Life is too short for risky jobs and license revocations; you worked too hard for your career to let yourself be treated like a mushroom (kept in the dark and fed BS like that doctor is doing). Listen to your gut! It's unlikely to steer you wrong.

Good luck.