opinion on this job please?

Editorial Team / Admin · Feb 3, 2009

Hello,

What did your contract state? Is this some type of QA they have implemented that may need to be revisited?

Have you asked them these questions/posed your concerns?

I feel a meeting may be necessary to see what they expect of you and if you are on some type of (in house) probation.

But, you will not get any answers to your questions as they apply to your situation until you confront your medical director and/or meet with the powers that be.

Hope it all works out and you can continue providing quality care to your patients.

lannisz · Feb 4, 2009

I still don't have a contract. I keep asking about it and keep getting told it's in the works.....?

prairienp · Feb 4, 2009

i still don't have a contract. i keep asking about it and keep getting told it's in the works.....?

when did you graduate? what specialty (pnp/fnp)? i sense there is more to the story you have not shared.

al dente · Feb 4, 2009

There is no need for this type of oversight, especially if you're in Oregon. I'm in Arizona and we also have full autonomy here. If I was working for a group and they treated me like this, I would attempt to clarify my role and scope of practice with them. If they were not receptive, I would be looking for another position, especially since they seem to have no problem letting the PAs practice without the scrutiny you're getting and the PAs are required by law to be supervised. It would seem that they are wasting their time (and yours) by being so big-brother. You'd think they would leave you to do your job thereby increasing the practice's productivity and enhancing their bottom line.

lannisz · Feb 4, 2009

when did you graduate? what specialty (pnp/fnp)? i sense there is more to the story you have not shared.

i am an fnp who graduated last june. as a nurse i worked in peds, nicu and ob/gyn.

prairienp · Feb 4, 2009

I am an FNP who graduated last June. As a nurse I worked in peds, NICU and OB/GYN.

Thus, you are a new grad and they are worried about your practice. A couple of things come to mind. They (MDs) have not worked with a NP before and may have a poor understanding of the NP role and ability. They may see you as a nurse not as a health care provider. They are used to controling the nurse, giving orders , co signing everything may also be a way they receive 100% reimbursement via incident to. I would want to talk the PA, how long before he was working alone? How often were his charts co signed.

I still think there is more to the story

lannisz · Feb 4, 2009

Thus, you are a new grad and they are worried about your practice. A couple of things come to mind. They (MDs) have not worked with a NP before and may have a poor understanding of the NP role and ability. They may see you as a nurse not as a health care provider. They are used to controling the nurse, giving orders , co signing everything may also be a way they receive 100% reimbursement via incident to. I would want to talk the PA, how long before he was working alone? How often were his charts co signed.
I still think there is more to the story

Yes, I am a new grad. However, I have been told there were other NP's who have worked there in the past and left because of this type of treatment. They didn't like feeling so controlled. Sometimes the hovering makes me feel more secure, but other times seems downright excessive. And I want to know there's an end in sight at some point? In terms of the PA, he is male and has worked there longer than any of the doctors! They seem to let him be. He does see tons of patients and seems to be very efficient. However, He was supposed to work with me this past month on the weekends so I could see how things are supposed to run....he would leave exactly at 5 pm even though there were still patients to see. He just left me alone to finish working. Also, he would disappear at random times for long periods during the day - only to be found watching football in the breakroom! Patients have lodged numerous complaints about him. Maybe that's why they are being so careful with me... because they have had some problems with him? It's just frustrating to be trying and working so hard to be really good at this. Maybe i am just too sensitive in feeling that the "feedback" is "criticism." Thanks everyone for listening

lannisz · Feb 4, 2009

There is no need for this type of oversight, especially if you're in Oregon. I'm in Arizona and we also have full autonomy here. If I was working for a group and they treated me like this, I would attempt to clarify my role and scope of practice with them. If they were not receptive, I would be looking for another position, especially since they seem to have no problem letting the PAs practice without the scrutiny you're getting and the PAs are required by law to be supervised. It would seem that they are wasting their time (and yours) by being so big-brother. You'd think they would leave you to do your job thereby increasing the practice's productivity and enhancing their bottom line.

Thank you. You are so right that I need to clarify my role and scope of practice with them. I'm just not sure where and who to start with. The practice seems to decide everything "as a team" and there is no "top dog" to go to. I had to have 7 separate interviews (1 with each doctor) before getting this job. They wanted everyones opinion on me. Guess that should have been a clue about how things worked around here, huh? :bugeyes:

Editorial Team / Admin · Feb 4, 2009

I still don't have a contract. I keep asking about it and keep getting told it's in the works.....?

I know hindsight is 20-20. In the future, you should never begin the job w/o a written contract. They are stalling...

It's just frustrating to be trying and working so hard to be really good at this. Maybe i am just too sensitive in feeling that the "feedback" is "criticism."

Yes, I'm sure it is quite frustrating especially since you have no written directives/contract outlining just what is expected of you and what you expect from them.

No, I do not think you are too sensitive. You must be proactive and upfront about this, respectfully, but indeed seeking clarification with your questions answered to your satisfaction.

prairienp · Feb 5, 2009

Yes, I am a new grad. However, I have been told there were other NP's who have worked there in the past and left because of this type of treatment. They didn't like feeling so controlled. Sometimes the hovering makes me feel more secure, but other times seems downright excessive. And I want to know there's an end in sight at some point? In terms of the PA, he is male and has worked there longer than any of the doctors! They seem to let him be. He does see tons of patients and seems to be very efficient. However, He was supposed to work with me this past month on the weekends so I could see how things are supposed to run....he would leave exactly at 5 pm even though there were still patients to see. He just left me alone to finish working. Also, he would disappear at random times for long periods during the day - only to be found watching football in the breakroom! Patients have lodged numerous complaints about him. Maybe that's why they are being so careful with me... because they have had some problems with him? It's just frustrating to be trying and working so hard to be really good at this. Maybe i am just too sensitive in feeling that the "feedback" is "criticism." Thanks everyone for listening

Based on your response if you know of another opportunity take it, I doubt it could be much worse and chances are a lot better. Sounds as if this current office does not deserve you.

emtneel · Feb 5, 2009

I just have to laugh because the "laws" are so inconspicuis.. or whatever...

YOu are working in a state without "supervision" and are being totally supervised... lol..

I am working temporarily in a state "with MD supervision" and am not really being supervised at all. i just think it is really ironic..

I am working nights/weekends and have MD on call, but basically work alone. In 3 mo. i think my "supervising MD" will review a few charts or so.. I'm only here on locums til end of May anyways..

I was told by the medical director that if i have any problems/questions he is the one to go to and that the "supervising MD" was basically a technicality and just needed to be on the prescriptions.

Anyways,

have you asked if they are concerned with your practice? Or if they feel you aren't practicing compotently? I would give them a statement in writing concerning the contract, and a deadline such as 1 week for the contract, and say you have requested multiple times, and will not be able to continue employment unless you have it. And if they don't do it, then don't show up for work until they do. They will have no reprecussions since there is no contract.. but then i guess you risk losing the job as well if they don't want to give you one.