Hi all. I currently case manage for a small hospice with a plethora of issues I'm not going to get into right now. I've been a nurse for 18 years and have prior hospice experience. My question is this: the clinical manager quit right before I was hired. A field stna who is in nursing school was given her position. This person signs emails as "team supervisor" and delegates duties to me "you need to go do this admission, we need you to put an order in for so and so" and now I have to ask her or the clinical director if I am allowed to order DME for my patients before I order it. The clinical director was off work for a week and the STNA "team supervisor" was left in charge. This does not seem legal but I feel like they are skirting around that by saying that she is acting as the CD assistant. This has caused a plethora of issues, including me admitting a patient last week that we didn't even have an actual order to consult for. (I questioned this 3 times and was told they had gotten an order). Those of you who have done this job know that as a CM, I should not have to triple check these things. My part comes after the office has received all paperwork, made a determination that the patient is clinically appropriate based on diagnosis, labs and tests, etc, and gotten an order to consult. I feel the need to report this but I'm not sure who I would report it to. The company has no HR department. The clinical director is the end all be all. And yes, I am actively seeking employment elsewhere.