Is it an ethical violation to quit a job before you start?

[myoglobin, ASN, BSN, MSN]

I will try to be as succinct as possible:

a. I accepted a once per week job doing PRN disability exams on Sunday's. I signed a contract as a 1099 worker that did not specify any damages for breech, but said I could be terminated if my exams were not up to industry standard. It takes up to six weeks to get paid.

b. My "main job" was to pay me a 10K bonus which they concluded I was not in fact eligible for and will not be paid. Since I was "counting" on this income until my PMHNP practice was built up I am forced into the position of finding "part time" work. Thus, I was offered a Psych RN position on Friday, Saturday, and Sunday at $57.00 per hour. This would more than "pay the basic bills" until my practice on Monday, Tuesday and Thursday filled up.

c. I wrote the "disability exam" place and stated that I would not be able to start next Sunday week for the above reason (I need to earn money to pay my bills I need cash flow). I literally only have money for one more month's rent. They said I didn't have "an emergency" I pointed out that not only was I going to go late on my credit cards (for the first time in over a decade), but that I literally faced being homeless if I did not generate cash flow.

d. They stated they would pay me 50% of the $110 per exam when the exams were performed (the rest later), but that they considered me under an "ethical/legal" obligation" to perform all shifts signed up for (through the end of May) unless they could find a replacement (these exams are located all around the state of Washington). Furthermore, they said since patients have been scheduled for these appointments that failure to perform the exam would result both in civil litigation (for damages without regard to what the contract says which does not specify damages) and direct action against my license. They said that "unlike being an RN your obligation starts when you agree to do the exam" since I pointed out that as an RN the obligation started once you had accepted report.

e. I said that while I disagreed with their perspective (specific performance to perform work is generally considered to be a 13th Amendment violation which is why you can force someone into a Chap Seven, but not a Chapter 13 bankruptcy, basically you would be requiring them to work to pay their debts and this had been found to be unconstitutional in most cases-child support being a noted exception). Still, I pointed out that I had moved from Florida to Washington and did not even have the resources for an attorney so I would "go along" as they don't seem to be giving me a choice. I re-read my contract and there is nothing about damages for non performance. But that doesn't mean they couldn't take action against me anyway or with the Washington State Board (especially since they are a contractor to do disability exams for the state of Washington).

f. What if someone became ill or their spouse or child suffered a situation or they found they just couldn't do the job? Would they face sanction against their NP licenses? If someone can be held on the hook for disability exams three months down the line it seems a bit like involuntary servitude. Part of me just wants to "shut up and take what's due me for a poor decision", but the other part finds it difficult to take. Still, there is a point that people are expecting to show up starting next Sunday and see someone for their disability exams.

[djmatte, ADN, MSN, RN, NP]

I would consult a lawyer for sure. But imo If the contract doesn’t obligated you to set days for a predetermined period, then you’re not obligated to that company. But ethically they are working with you to some degree when offering to pay half up front. Might want to consider dropping the Sunday on the other gig and maybe remove one day over into your personal practice to finish the transition.

[myoglobin, ASN, BSN, MSN]

The challenge is that the $57.00 job is mainly nights (I haven’t established they have need for days). Thus it is not possible to work a 7pm to 7 am job on Fri, and Sat and still do the disability exams on Sunday from 0800 until around 1800 with up to a two hour drive each way. Also, actually writing up the exams will take about one hour each (this could be done on Wed which I have off). My main issue is that the cash flow isn’t enough. Had I got the bonus from the first “commission job” it would have been perfect as a supplement however by itself it isn’t sufficient and will likely mean losing the RN job that would maintain me indefinitely.

[umbdude, MSN, APRN]

I don't see how they can sue you, and I don't think it's unethical. All they have to do is cancel the clients' appointments. The clients are not looking for "healthcare" services, but an exam for disability checks. It's not like you're quitting on existing patients who need your prescriptions to survive.

If you have malpractice insurance, start there. Insurance companies usually have attorneys.

[FullGlass, BSN, MSN, NP]

Personally, I would do the disability exams and cancel one day of psych RN work. I also do the disability exams on the side and it is a big pain to get those scheduled. In addition, some vets have waited for a long time and may have to travel long distances for their exam. You are giving less than one week notice to reschedule and I can understand why they are upset. They are willing to meet you halfway and the pay is almost the same as your RN gig.

Can they sue you? Perhaps - they can say damages were their income lost due to you not doing the exams, but that isn't a large amount. It is not in your interest to get into a legal mess now. Talk to an attorney - the first consult is generally free.

I don't understand why you are taking such a labyrinthine path to becoming a PMHNP, but that seems to be typical for you. There are plenty of mental health clinics, FQHCs, and Native American Health clinics, not to mention the VA, that would happily hire you as a PMHNP full time, with benefits. At least in California, the pay would be at least $160K to start, and if you do a good job, there would be rapid yearly increases. Once you have at least 2 years experience as a PMHNP, you could easily set up your own practice in an FPA state. You should focus on being a PMHNP and nothing else for at least 1 year, because you have a boatload to learn.

[myoglobin, ASN, BSN, MSN]

Keep in mind they are holding me to the end of May not just this week. I gave up 175k with benefits in upstate NY to come to Wash ( perhaps a poor choice). Many of the NP’s at Mindful earn well over 200k, it’s just that in my case I am both cash and credit poor.

[Daisy4RN]

I would check with the board to see if there is anything they could report if you quit (or check state practice act etc), I dont see that there is but I am not familiar with the Wash board. There is a big difference between legal and ethical. I dont think it is unethical, peoples situations change all the time and you have to do what you have to do to live. You were hired 1099, which means not an employee so legally I dont see a problem for you and esp if it is not in your contract, although I would check with a lawyer.

Good luck!

[FullGlass, BSN, MSN, NP]

On 2/18/2020 at 5:02 PM, myoglobin said:

Keep in mind they are holding me to the end of May not just this week. I gave up 175k with benefits in upstate NY to come to Wash ( perhaps a poor choice). Many of the NP’s at Mindful earn well over 200k, it’s just that in my case I am both cash and credit poor.

Why would you turn down $175K in upstate NY? That is generally a very affordable area, and it is easier to fly home to Florida from there.

In California, there are places hiring non-PMHNPs and training them in psych, that start at $150K to $160K per year. I'd imagine an actual PMHNP would get at least $170K to start.

After you get through this temporary cash crunch, think seriously about just getting a full-time PMHNP job. That will give you a lot more cash and a lot better training and experience. Honestly, you could get a job in California in about one week! I'd imagine there are plenty of jobs in Washington state, too. Get a full time PMHNP job and save up as much as you can and then in 2 years go start a private practice if that is what you want. It takes at least a year to build up a reasonable practice and 2 or 3 years to build a full practice, minimum.

[FullGlass, BSN, MSN, NP]

2 hours ago, myoglobin said:

Keep in mind they are holding me to the end of May not just this week. I gave up 175k with benefits in upstate NY to come to Wash ( perhaps a poor choice). Many of the NP’s at Mindful earn well over 200k, it’s just that in my case I am both cash and credit poor.

Holding you to the end of May is just ridiculous. They are blowing smoke up your a**. Go talk to an employment attorney - the first meeting is free. However, I do understand they are upset about this Sunday. As I said, I would do this Sunday and then that is it.

As for paying rent, just explain to your landlord that you will be a little late. You could pay 2 weeks rent and then pay the rest when you get paid.

[myoglobin, ASN, BSN, MSN]

5 hours ago, FullGlass said:

Holding you to the end of May is just ridiculous. They are blowing smoke up your a**. Go talk to an employment attorney - the first meeting is free. However, I do understand they are upset about this Sunday. As I said, I would do this Sunday and then that is it.

As for paying rent, just explain to your landlord that you will be a little late. You could pay 2 weeks rent and then pay the rest when you get paid.

When my current Seattle job called last December (I had already tentatively accepted a 100/hr job in Flagstaff Arizona that would have let me work 45 hours per week at a place called Phoenix mental health (they are a great company if anyone is looking for a PMHNP job and it is a nice place to like if you life the out-doors). Anyway, my current "Monday, Tuesday, Thur" gig seduced me with their insurance reimbursement rates (about $150.00 for 30 minute med management) and their 70% split (less about $600 in monthly fees), oh and the 10 K bonus (which their attorney's later told them would violate the 1099 relationship in Washington). I didn't realize that the credentialing process would take so long, and they had planned to have me credentialed when I started today (I'm still cash only until March 01 and then I should gradually pick up insurance companies over the next several months). The whole selling point of their "being the biggest company in the Seattle market" and having 1000's of referrals per month was seductive (Oh and the fact that most of their NP's were earning 175-250K per year working four days per week). Anyway, it may have been a poor decision. As for the New York gig they flew me up in early Nov and didn't make an offer until early Jan, By then I had already paid for a Washington State DEA and many other fees in the licensing process. As it is I'm licensed in Florida Colorado, Arizona and Washington. I need to work, work, work rather than obtain more licenses. As for California it would probably take me a solid six months to get through the RN, NP, furnishing, DEA process and I would probably be living in homeless shelters by then (as for the landlord I'm strictly living in AirBnb extra rooms for about 1K per month, there is no such thing as mercy or late rent with AirBnb).

[FullGlass, BSN, MSN, NP]

On 2/19/2020 at 1:26 AM, myoglobin said:

When my current Seattle job called last December (I had already tentatively accepted a 100/hr job in Flagstaff Arizona that would have let me work 45 hours per week at a place called Phoenix mental health (they are a great company if anyone is looking for a PMHNP job and it is a nice place to like if you life the out-doors). Anyway, my current "Monday, Tuesday, Thur" gig seduced me with their insurance reimbursement rates (about $150.00 for 30 minute med management) and their 70% split (less about $600 in monthly fees), oh and the 10 K bonus (which their attorney's later told them would violate the 1099 relationship in Washington). I didn't realize that the credentialing process would take so long, and they had planned to have me credentialed when I started today (I'm still cash only until March 01 and then I should gradually pick up insurance companies over the next several months). The whole selling point of their "being the biggest company in the Seattle market" and having 1000's of referrals per month was seductive (Oh and the fact that most of their NP's were earning 175-250K per year working four days per week). Anyway, it may have been a poor decision. As for the New York gig they flew me up in early Nov and didn't make an offer until early Jan, By then I had already paid for a Washington State DEA and many other fees in the licensing process. As it is I'm licensed in Florida Colorado, Arizona and Washington. I need to work, work, work rather than obtain more licenses. As for California it would probably take me a solid six months to get through the RN, NP, furnishing, DEA process and I would probably be living in homeless shelters by then (as for the landlord I'm strictly living in AirBnb extra rooms for about 1K per month, there is no such thing as mercy or late rent with AirBnb).

Honestly, I think you are trying to do too much. Starting out as a new PMHNP requires you to focus on that. The first year is the hardest. I'm not trying to make you feel bad, but offering some practical advice.

1. You are already in Washington, so look for a full-time salaried position in Washington. I'm sure there are loads and loads of PMHNP jobs in Washington. I know Washington state also has a program to help get providers out to rural areas. (I plan to move to Washington myself in the future).

2. Seattle is expensive. The rest of Washington state is not. So you might be as well off, or better off, making less in a more affordable area. Look at Olympia, Moses Lake, Spokane, Wenatchee, Yakima, the Richland area, and other smaller cities and towns.

3. Having a reliable salary is the best way to go now. Even if you settled for $150K a year, that is more than you are making now, and without all the hassle, plus you will have a reliable income until you get more established.

4. So, if I were you, I would immediately start looking for a full-time PMHNP job in Washington state. Look up every FQHC and Indian Health Center. Also research and find large mental health clinics. Send your resume in, even if they don't have a PMHNP job listing.

5. Housing - I just moved to Sacramento and the rents there are high. I googled "housing for traveling nurses" and got a bunch of reasonably priced places (for that area). For example, I am in Elk Grove, a very nice and safe area, in a fully furnished 3 BR 2BA house for $1450 a month. Normally, a place like that would go for $3000 in that area (because it is fully furnished).

6. You could also look to just be a roommate - a lot cheaper and often no credit check, especially if you provide proof of a job and income.

7. For your first job, you want to be paid fairly, but maximizing your income should not be your priority. A job with a positive and supportive environment for a new grad that is a great learning experience is what you should focus on obtaining. Once you have 2 years experience, you will be golden and can go for the big bucks.

[FullGlass, BSN, MSN, NP]

One more thing - California has the worst shortage of mental health providers and is the highest-paying state for NPs. Once you get settled, go ahead and get your California license, so this will be an option for you in the future. If you live outside of SF, LA, and San Diego, the state is quite affordable.

https://www.beckershospitalreview.com/rankings-and-ratings/states-ranked-by-shortage-of-mental-health-professionals.html