Managing Ancillary Staff

[Babyboss 19, MSN, APRN]

sorry this is long...

Need some POV on how to manage ancillary staff in private practice. Which, is usually not a problem for me.  Have been part time, 3 years now, as a PNP in private practice. 3 MDs and myself.  We have 2 MAs, no nurses on staff. The senior MA (23yrs in) is often assigned to triage and room my patients.  She is great, nice, mostly professional. The practice would be a mess without her as she has many front and back office duties. That being said, she often takes liberty when triaging my patients, ordering labs incorrectly or what the patient requests. Remember this is all in my name. I have addressed this before with the office manager, only to get passive aggressive retribution from the MA.  This made my work day hard.

Recently, she added a covid antibody test to a well check patient's STI labs, at patient request. I was not aware of this until I signing off my chart the next day- blood was gone to lab.  Now, how do I justify the order, in MY NAME, if the insurance does not pay? I heard it can be upwards of > $1000 for this test. They are not recommended by CDC. I would never order blood for a previously covid + patient who is 3 months recovered, without issues.  How can I make her accountable, stop this behavior, without retribution?  I am so angry that this even goes on and the docs make excuses for her because she is overwhelmed with responsibilities. I'm always respectful, but I am being taken advantage of. 

[DizzyJ DHSc PA-C]

I would sit her down with the office manager and tell her directly that her ordering tests without your direct order to do so can be considered practicing medicine/nursing without a license and this ends now.  

[Babyboss 19, MSN, APRN]

I have approached her directly, and the manager, in the past, which is my usual MO.  I agree that is often the best approach.  Just doesn't seem to stick for long.  Then I was asked "so, you want YOUR labs a, b, c  to be fasting, etc." implying that I am being fussy or practicing differently than the MDs.  And afterward then the MA is asking for me to enter every single lab requisition on my patients, like routine labs, out of spite.  Guess I can have a sit down and write out how I want labs done for me. Although this did not work in the past either.  The other MA, I have no issues with. Labs are always spot on. 

[DYS NP]

She's entering the labs, but I assume you still need to cosign? If not, you could request adding that level of control in the EMR, or limit the types of tests she can order to standard panels. Also, you might try approaching it with her as preventing financial harm to patients, a shared goal. No one wants to think their error cost a patient 1k. (I hope.) Good luck!