Marketer Conflict as a DON

[HeyHeyitsMaay]

I work for a small hospice with a census of 30. We have a marketer with no clinical background who's pretty difficult to deal with. She tells me patients/families/everyone said or did things that never happened at all. For example telling me that doctors are angry over how long an admission is taking to start or lying and saying the fax machine at a LTC where a referral resides isn't working for her to send me clinical documentation from the pt. Chart for clinical review prior to accepting as a patient and telling me "they're going to be a COPD dx just tell the nurse to get the clinicals from the patient chart when they get there to admit".

Our owner and administrator regularly admit that she's a problem and it's so bad that we've lost so many good nurses because of her. But because of politics they aren't getting rid of her yet. Or at all...not sure anymore.

The patient who she demanded that I accept for admit the other day has a long hx in our community of severe drug seeking behavior so bad that nurses have quit the facility he resides in over his behavior. I finally got the marketer to send me his h&p, etc so I could review and accept and we got him admitted. But as the admission was still in process she called me to tell me that the patient had called HER to tell her our nurse denied him pain medication and said he couldn't have anything at all for pain.

I called the nurse who explained that she never told then patient that...she told the patient that she had to count his narcotics with the facility nurse before she could give anything and that some meds were still on a schedule and he wasn't due for most of them but she'd give the prn morphine once it was checked in per facility protocol.

Called the marketer back...explained the situation and she verbalized that she understood. "Makes sense got it thank you for following up" was her response.

Next thing I know the admit nurse is calling me back saying that the marketer is texting and calling her demanding that she give the patient something for pain immediately after I just told her that the meds hadn't been counted with the facility nurse yet. She's additionally telling me that the facility medical director told her that the current nurse working at the facility is a "problem" who has labeled the patient a seeker and regularly denies him meds when the doctor said no such thing and ALL of the nurses at the facility are wary of the patient's constant demands for opiate analgesics to the point that he's abusive if he doesn't get them when he wants them. She just completely lied and said the doctor said something that never came out of his mouth.

My response was to tell the marketer that it isn't the nurses job to determine if the patient is being truthful about their pain but for us to assess and report our findings to the MD and let them choose the appropriate intervention. I assured her that we would do just that, and she finally left us alone for the night.

But she's constantly lying, demanding immediate admissions for referrals without any clinical review...interrupting the IDT process and demanding to lead IDT and refusing to take no for an answer until people finally scream at her....I could go on forever.

It doesn't sound bad when I type it out but I'm just wondering how to diplomatically deal with her because she's extremely disruptive and creates so much chaos. I'm trying to learn how to speak her language to improve the work environment but she's the worst marketer I've ever worked with.

Any advice? We did have a meeting to delineate the referral process responsibilities with my boss clearly telling her where she ends and nursing begins but she completely ignored it. My boss says when she's held accountable she yells..blames everyone else and just generally act like a child. Any and all advice on dealing with her in a way that minimizes the chaos until she's gone is much appreciated.

[Aunt Slappy]

The problem is not the marketer. The problem is the leadership that refuses to get rid of her.

Clearly, they don't give a fig about losing nurses in order to keep her. You need to decide if you're willing to work under those terms, or not, because they're clearly not going to change. They may "admit" to you that she's a problem, but they obviously like the money she brings in just fine, and that's why they keep a tantruming child in their company.

[caliotter3]

The problem is not the marketer. The problem is the leadership that refuses to get rid of her.

Clearly, they don't give a fig about losing nurses in order to keep her. You need to decide if you're willing to work under those terms, or not, because they're clearly not going to change. They may "admit" to you that she's a problem, but they obviously like the money she brings in just fine, and that's why they keep a tantruming child in their company.

My thoughts exactly. Time after time, I've seen negative employees of varying degrees flourish, while hardworking workers with high ethical standards can't get to square one. All one can do is to learn to keep one's observations to oneself, or else one will suffer the consequences. As they say, no good deed goes unpunished. No good employee goes unpunished either, only eventually unemployed.

[Neats, BSN]

I would just tell her to send in the request in writing so everyone is on the same sheet of music. Anything she asks for I would say I am so very busy can you fax it in so then we all can understand what is going on. If she wants someone to have medication I would say I thank you for your input, we will speak with the prescribing physician since it has to come from that provider anyway. I appreciate what you are saying but I need physician orders...When she goes on about what someone said I would listen and say I thank you but I need a licensed clinician documentation as these are the legal documentation with all the information we need to make sure this patient gets great care. I want to protect our licenses and protect your position too. Get everything in writing. Lastly I would come up with a short list of what is needed (not more than say 7 items) for an admission that is "Urgent" from her perspective, like orders, current H&P, medications, POLST. If the market person texts I would save all those texts, just ensure her interference does not place your nursing responsibility in jeopardy for if it does no one will back you up, you are on your own.

I will not let anyone push me around like this and if management thinks she is the best thing since apple pie then they will lose a lot of people. Sounds like she is practicing out of the scope of her practice, and once admitted why does she have involvement in direct patient care?

[Katillac, RN]

"What? What? Can you hear me? We have a bad con. . . ."

Sorry, I couldn't resist.

You're right OP, it doesn't sound bad. It sounds horrible!

My suggestions involve a mindset change on your part. On your part because until your leadership decides she's a liability and gets rid of her, you're subject to her behaviors. Unlikely you can change her, only your response to her. Put your nursing hat on here and ask what the motivation for changing her behavior would be. What can you appeal to?

You can't do anything about her being disruptive and creating chaos. You can only decide that her judgments and orders don't concern you, they're just the rantings of a deranged pitch woman.

Following is some language you might find useful. None of it's designed to change her or change her mind, just designed to create boundaries between you. I'm not sure I'd work too hard on learning to speak her language. The problem here isn't, as they say, a "failure to communicate", it's her bullying and lies and other unethical tactics. So I wouldn't spend much time trying to educate her about how it needs to work. It sounds like she just gives you lip service and goes on the next target, so its a waste of your time to try to explain.

"Thanks for your input, I'll keep it in mind. I really need to get back to patient care now."

"That makes total sense from a marketing perspective. Unfortunately, I need to follow good nursing practice so as case manager I'll be implementing _______."

"You and I see this differently. I need to refer you to (insert boss') name here."

"We remember this differently. What I'm going to do going forward is. . . "

"Speaking just for myself, I need to practice within the Conditions of Participation. So as soon as I am provided with ____ , I can do _____ ."

"I feel the urgency of your request, however right now my priority must be ____"

"What I can do here is ______ . Regrettably _________ isn't an option."

There's nothing you can do about her lying to you or about you. Your leadership knows about it and is banking that she can bring in enough dollars to justify the harm she's doing to your agency and its reputation as well as staff, patients and families. There's nothing you can do about her screaming at IDG, or bullying your colleagues. But you may be able to carve a tiny island of sanity out for yourself in the middle of this mess.

Good luck, you make me really glad I don't need to contend with one like her!

[zoeyzoe]

I have been in your shoes. I have worked with overzealous nonclinical marketers before. I've even had some administrators like that as well. You have to let them know; You're not going to lose your license, and most definitely are not going to jail for anyone! If they want the person admitted, or to be given meds that bad. THEY BETTER DO IT THEMSELVES ! I have no problem not admitting someone I don't see hospice appropriate. Or, if I don't have H&P.

[broughden]

I dont get the problem? Is the Marketing Director your boss? If not....

Marketing Director calls: Start to complain or direct nursing staff...

Nurse: "Stay in your lane", hangs up phone on them.

The end.