Non clinical boss wants to sit in on pre-op visit with patients

[erica2117]

Hey everyone,

my boss is non-clinical and doesn't know a single thing about anything remotely medical related. She even tells us we are "grossing her out" when she hears us talking about medical issues. I work in an outpatient gynecologic oncology office. One of my jobs is to do pre-op visits and sign the consents, go over pre surgical testing, how to prepare for the surgery and what recovery is like. I have been at my job for over a year and have done hundreds of these visits. Suddenly my boss has decided today she wants to sit in on my pre op visits so she can "learn more about the procedures". Honestly it made me VERY uncomfortable because not only is this a very personal topic to be discussing with patients, I don't think she has any right to watch pre ops to "learn" in fact I find it nosey. She interrupted my preop several times today, her phone was vibrating, she was flipping through my paperwork and just being a huge distraction. What made it the worst for me was that she introduced herself as the office manager and she was "observing" me today. I felt like it broke the trust between the patient and the nurse because to me it looked like I was in trouble and I had to be watched. Mind you I have never had any complaints, my physicians are happy with my visits and explanations. She asked to sit in on more with me this week. This doesn't feel right. Is someone who is administrative even allowed to do that??? Something just doesn't seem right.

[Jolie, BSN]

If her presence there is truly to learn, she would ask patients for permission to attend their sessions, keep her phone and all other distractions in her own office, and merely observe without making a sound. She would save any questions to ask you in private after the patient has gone. And she would need to watch only 1 or 2 sessions to glean all the information she could possibly need.

Otherwise, I would question her motivation.

You can always speak to the patient confidentially, let her know that she has every right to refuse your supervisor's request, then show your boss the door when the patient expresses a desire for privacy.

[Here.I.Stand, BSN, RN]

What Jolie said. She could also read the clinic's pt education materials, or even Google the procedures, if she wants info. I like the idea of advising the pts that they can refuse her presence. Personally, I would be very uncomfortable with unnecessary personnel join my appt -- especially with an issue as sensitive as gyn onc.

[JKL33]

Well, as distasteful as it is, if she has some techical aspect of her job that requires her to learn about the finer aspects of pre-op visits, or if she actually means to evaluate you (although she didn't say that), then she may have a legit reason.

I have to say though, her own "excuse" for doing this is quite curious - - I'd be inclined to wonder what she's really up to. Think about it - if she doesn't need to observe any of this and is just doing it for "fun" then she is wasting a lot of time not doing her job. I very highly doubt that she is there because she wants to learn about the procedures. That is something that sounds so wacko that it has to be a cover for something else.

Why don't you just ask her? Say, "I know you're busy and there are quicker and more straightforward ways to learn about the procedures than this. I can get you information or even answer specific questions you may have. Or is there some other reason why you want to be involved specifically in the pre-op visits?"

[kp2016]

This is inappropriate and potentially a HIPPA violation. I don't thinks its fair to the patient to involve them in putting a stop to this. I think you should refresh on the dollar value for the individual and the institution of a HIPPA violation and go to this manger with your "concern" about the potential financial cost of her "sitting in" on interviews that have private patient information that is not relevant to her job role.

[Nascar nurse, ASN, RN]

This is inappropriate and potentially a HIPPA violation. I don't thinks its fair to the patient to involve them in putting a stop to this. I think you should refresh on the dollar value for the individual and the institution of a HIPPA violation and go to this manger with your "concern" about the potential financial cost of her "sitting in" on interviews that have private patient information that is not relevant to her job role.

My thoughts exactly!

[brownbook]

Do the patient's come to the clinic or do you go to their home? You post you do pre op visits? Either way IF your boss needs to understand so she can do her job better...maybe, but her boss and a doctor need to okay it in writing. It should only take a very few "sit ins" for her to understand what you do. And a form signed by the patient allowing her to sit in is absolutely necessary.

[sevensonnets]

Sounds like a HIPAA violation waiting to happen.

[Nurse SMS, MSN, RN]

Even in the hospital, if someone, such as a student or vendor rep, wants to observe then there is a form the patient has to sign that states they were made aware of this person's purpose in being there and that they agreed with it. Perhaps if you incorporate something like this and then have a little chat with your nonclinical manager about appropriate clinical behavior.

[TriciaJ, RN]

I agree with the others. This is a good time to involve the manager's boss to establish: 1. That this is an appropriate use of the manager's time 2. That there is a specific purpose for this 3. How many visits are required to meet that purpose 4. There are HIPAA regulations about the presence of extraneous personal and the patient absolutely needs to be asked and does have the right to withhold consent.

Once those factors are established, the manager needs to understand that this is a very stressful time for the patient. Her learning and retention may be much lower than her baseline. Therefore, there can be no distracting behaviours like cell phones buzzing or papers being flipped.

[MunoRN, RN]

I don't know where people are getting that this is a potential HIPAA violation, from the description it's the nurses direct supervisor, so whether she's a nurse or not her involvement in observing would clearly be allowed under HIPAA.

[pixierose, BSN, RN]

Oh no no no no no ...

I'll take this from a patients perspective ... or as a stressed out daughter of a mother who is a breast cancer patient (who just had a pre-op appt) -- I would probably fly over the table and lose my temper at that sense of entitlement.

I mean, for heavens sake -- silence your damn phone. At least make it seem like my mom means something.

I won't get further into it, there are just so many nopes ... the lack of professionalism and complete disrespect she exhibited toward that patient is just astounding.