I started at an OBGYN office as an NP a month ago, was hired to replace an MD and help with influx of patients. There are 6 medical assistants, 1 RN and 6 MDs. This office has never had an NP, so it's new role to the office and to the patients. I can deal with patients not wanting to see me, etc. But the most frustrating thing is the way I'm being treated by the staff. I feel like the role of an NP is not understood and at times disrespected
1. The MDs think I'm just their assistant, expecting me to "help" with the duties of the RN and the Medical assistants. Or they ask me questions like "can you prescribe?", "do u know how to give IM injections", "do you want to draw the bloodwork?"
2. The Medical assistants think they can tell me what to do bc they've been there for years and also in an effort to alleviate some of their tasks (bp weight, blood work etc). They don't recognize me as a provider.
3. The RN is also expecting me to alleviate her tasks by giving injections and returning phone calls. She said she was told that I would help her and her tasks.
When I interviewed, it was conveyed to me that I'd be a provider. I am super helpful and not typically the type to say "that's not my job". But it seems they misled me bc they want someone who will do all the tasks of RN and MA and also have a full panel.
I've been vocal about it and it has proven problematic. But I'm not a pushover?Any thoughts on how to navigate this?
I don't understand how you are bringing the practice any revenue at all if you are seeing the pt with the MD? Who bills?
Is this one of those scams where the physician puts their face in the door for 5 seconds to increase the RVU's? And you are really doing all the work?
OK, maybe for a week or two, but you should be fairly independent, and fairly quickly.
That's where my confusion lies---they hired an NP, are paying you NP wages, but are not allowing you to see patients on your own and bring in more revenue (unless I'm misunderstanding the situation). Why wouldn't they just hire another nurse if all they want is someone to help with nurse tasks?
I agree with not doing anything the doctors don't do. I started saying no to the requests of giving injections, drawing blood etc. One of the doctors told me that my attitude is "bad" bc I'm expected to do whatever is asked of me. I don't think they see the consequences of that...I could just leave but I honestly thought these were growing pains that could get worked out?
This is an interesting topic. I work with a PA who does generate considerable revenue for her practice, however also does assigned tasks that the docs don’t want to do including injections, H&Ps, post surgical rounds, ER consults, and closing at the end of a case while the doc heads out to the golf course. Maybe there is a reason the surgical groups don’t hire NPs? The PAs I work with definitely do “whatever” is asked of them. It is expected.
This is an interesting topic. I work with a PA who does generate considerable revenue for her practice, however also does assigned tasks that the docs don’t want to do including injections, H&Ps, post surgical rounds, ER consults, and closing at the end of a case while the doc heads out to the golf course. Maybe there is a reason the surgical groups don’t hire NPs? The PAs I work with definitely do “whatever” is asked of them. It is expected.
All of those are tasks that fall under a mid-levels (or MDs) purview. Those are tasks an RN really can't do. Those are specific tasks that you can bill for. But the things noted here are ancillary office tasks that are handled by office staff. IM injections (vaccinations, toradol, etc) are best handled by them as the bill for the procedure is on the lower side. Joint injections or a range of other higher value procedures require and justify the mid level option.
All of those are tasks that fall under a mid-levels (or MDs) purview. Those are tasks an RN really can't do. Those are specific tasks that you can bill for. But the things noted here are ancillary office tasks that are handled by office staff. IM injections (vaccinations, toradol, etc) are best handled by them as the bill for the procedure is on the lower side. Joint injections or a range of other higher value procedures require and justify the mid level option.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I'm curious as to who hired you and why. Surely they understand why they shouldn't be paying an NP to be doing non-revenue-producing tasks. Can they not have a general staff meeting and let everyone know exactly what you were hired to do? It would be better than you having to constantly jockey for position and deal with disrespect on all sides.
I believe that some of it may come down to the state where you practice. I would expect this in say Alabama, Florida, or Mississippi. However, I would not expect it in Arizona, Oregon, Washington, or Nevada where IP is long established. In any case if I were "paying your checks" it would primarily be to increase my revenue, which means seeing patients (and hopefully providing excellent care so they come back). Anything, that doesn't involve billing patients/insurance means that you may be less than fully optimizing the money I'm spending on your salary.
I see amazing number of job advertisements for urgent care and the like settings which openly state that the NP candidate they seek will be treated as "all tasks' maid". Rooming, taking vitas, venipuncture, all other tasks as assigned, then provider's job, then calling on scripts, case management, insurance business, etc., etc.
What is interesting, most of them want NP, not PA. I wonder why - probably, because PAs will not put up with it.
And I do not even mention this example of greed level 80.01:
(7 on/7 off round the clock - yes, 168 hours in a row, no interruption, no chance to leave, not seeing your family, eating cafeteria junk for your own $$, responsible for anything and everything - for LESS than local standard salary. New grads, please pay attention).
They were looking for an MD for over a year, found no fools, now fishing for PA or NP to do two people's job for one salary.
I agree. Employers want the 3 for 1 special hoping to work you like a dog doing the work of 3 people. Being that nursing is female dominated. most women naturally want to assist where they can, but it's a proven disadvantage that results in job dissatisfaction and high turnover .
I see patients with the doctors for now...which is why I say no to these other requests. There is so much more involved in my actual role that I could use that time for. Smh...just kinda mad at myself that I ended up in this situation. I know I have a lot to offer this office, but not if they're giving me other tasks that the up my time
What do you mean by "see them with the doc"? Like, you both are physically with the patient at the same time? What is your role when you guys are in the exam room together? I mean the whole idea behind "saving money" with an APRN is paying you less than an MD but still making loads of money off your billable services. You aren't generating revenue if you are seeing patients with your doc.
I am the first to jump up and help my MAs or LPN if I magically happen to be done with my own work. But I would feel very unsatisfied and undervalued, if that was a defined part of my role. I don't enjoy working as a nurse or an MA. It is not the career I chose.
You should meet with your office manager. Express your confusion over your role, and ask them what they had in mind when they hired you. If they TRULY want an NP then get your responsibilities outlined on paper, in specifics.
If it becomes clear they dont plan to utilize you as a provider, definitely time to seek greener pastures.
Specializes in ICU, Telemetry, Cardiac/Renal, Ortho,FNP.
Well, I can't speak to your case specifically but my view is if the paycheck clears then I do whatever it takes to clock out at 5:00. If that means doing my job, the physicians job, and the MA then so be it...other days just the patient care. Personally, I don't care...I look at it like they rent my time and credentials for $$$/yr or hr and ego aside, I'm going to do whatever it takes to get the job done and go home. However, your case....office mgr (if they have authority) meeting and get things clarified according to your contract...in writing or it ain't real.
Just a quick update! I ended up resigning from the position. I was fighting too many battles and outing too many fires. It was exhausting! It really put a bad taste in my mouth for clinic work in a private office. Hoping I will be able to find a group that practices differently and actually do as they say?
LibraSunCNM, BSN, MSN, CNM
1,656 Posts
That's where my confusion lies---they hired an NP, are paying you NP wages, but are not allowing you to see patients on your own and bring in more revenue (unless I'm misunderstanding the situation). Why wouldn't they just hire another nurse if all they want is someone to help with nurse tasks?