deanzgurll

Insurance companies hmmm? what do I have for proof...just my own word. They can and do put orders in the charts retroactively. In the break room one day another nurse let drop that her provider was taking ss# out of charts to use in getting other pts. free drugs...illegals probably....and trying to force her to help. His heart was in the right place but sheesh, what bad judgment. That one just got hushed up.

...I suppose that depends on how you define "MATTERS". It matters to me that I am right (and believe me I stewed about this for weeks, all the time wondering what I had done to deserve this, what I could have done diffrently..we all do that I think; take on accountability for everything) It matters alot that, so far, everyone here thinks I was right, with a capital R. The support I have been given on these pages has gone a long way toward healing..I have been soooooo angry. It probably does not matter to them or anyone else locally unless I put my money where my mouth is. A couple of Nursing friends said, "SHE CAN"T DO THAT".. can't according to whom? she can, she DID..unless I am willing to push the envelope the rest is just opinion. We all talk big talk about not tolerating this behavior..but besides voting with your feet, what? WE ARE NOT AN AUTHORITY THEY ANSWER TO. Unless and until there is one .... I wish Nurses HAD an authority that wielded some power over medicine and or business.:angryfire

..YOU HAVE BEEN THERE..but tell me...how common IS it for clinics to have such convoluted, disfunctional , canniblistic work cultures?

...ANGIE O'PLASTY?...JOULE of an RN?...OOOHH MAAAN...LOL

Dear AZ>>>, report the office manager and the lab to who? I already tried going up the administrative ladder, and believe me, they don't want to know. To give her some kind of credit, she works her butt off for this system, 24/7. She didn't create this work culture. The Providers have a hand in this ( any good docs reading, sorry). They are also employees in a system dedicated exclusively to the bottom line. They are frustrated too I think. This shows up in getting testy about follow through, not wanting to be bothered by paper work details, trying to shuffle as many people as possible through in a day without too much concern about the quality of care (again, sorry good Docs) even ridiculing their pts. behind their backs, and taking out their neg feelings about themselves on the staff...kicking the dog. The lab tech has really never worked anywhere else and doesn't know any better. Lord knows I don't want the job back. I just want the staff to get some respect. I am grateful for you suggestions, could you elaborate.

...that last line almost made me cry...thankyou. I am not really sure but I think the "redirect road" only works when ms boss has a license of her own.

i REALLY THANK YOU FOR YOUR REPLY. But the issue really isn't about knowing what to draw. It's about choosing to do an invasive procedure; even one as simple as phlebotomy without a doctors order. Although the chance of the patient suffering an injury from the procedure are miniscule, we can't go about picking and choosing among our standards of practice based on what is convenient in any particular work culture or the chances of there being a bad outcome. Let's say another frequent flyer came in requesting labs because his last INR was high. Lets say he only stopped his coumadin the day before and came in on a wild hair without an order ( this has actually happened ), lets say i stick him, he bleeds, he clots, he throws a clot...get the picture? Would the doctor or the clinic have my back? and when the judge says, "nurse did you believe that your manager had the appropriate knowlege and authority to order you to proceed against your own better judgement? No sir. Then WHY DID you proceed? Because she yelled at me?" A judge would say I should have known better..and he would be right. We all complain about not being treated as professionals. If I cower and move on what does that say?

FAIR WARNING Y'ALL...THIS IS BOOK LENGTH My first job out of school was as a burn nurse at a university hospital. When I started the unit put new staff through a kind of hazzing. I had a fairly compliant personality when I got there and I went home every night for six months, crying and rehearsing a speech about why I couldn't stay there. I ended up never giving it and I stayed there 13 years. The place transformed me. You either got tough, outspoken and assertive or were eaten alive. When the hospital started the application process to become MAGNATE...well, it was kind of an Emperors new clothes situation. Things changed, and not for the better in my opinion. Add to that a body that had been used and abused ( I am only five feet tall) and a new farmer husband 160 miles away. I went back and forth a couple of years and finally threw in the towel. Now I live in a rural agricultural heartland that hasn't heard there is a nursing shortage. The only sizable city is an hour and a half away and the county hospitals can't afforsd to hire. That leaves general practice clinics. I hired on PRN at at a system of clinics run by a professional management firm. It was diffrent, WAY diffrent. I was determined to keep a low, pleasant profile. But after awhile the place started getting to me. It was run by a "practice manager", read; desk jocky with no medical background. The "PROVIDERS" were refered to and treated like some race of demigod. The rest of the staff were expected to kowtow. Example: the large lunch room was for providers only, to entertain drug reps, unless they were at a meeting somewhere else. The staff ate in the clock room; 6x10 with lockers, time clock and message boxes, coat hooks, a small table and four chairs. At lunch time it was packed and some of us ended up sittiing on the floor. I will bypass most of the things I observed and fast forward to recently. They had just hired a new PA. The other PRN nurse and I had been taking turns working for her for about a month so she could "pick". One morning we came in to learn that the PA would be working with one of the full time nurses who wasn't getting along with her provider, and that provider would be interviewing outside the clinic staff. He wanted a hispanic nurse because we had a large hispanic patient population. OK. A week later his hispanic nurse arrived...blond, blue eyed, 23 and six months out of LPN school. He refered to her as his own little private playboy bunny. The man had passed over two experienced, clinic oriented RNs for THAT. We were told we were not to discuss the situation among ourselves. Fast forward again.. (a little back ground: since the clinic had started opening on saturdays, the pts. wanting appts. had snow balled. It was originally supposed to be acute care only, but had morphed into "WHATEVER". It had become a favorite time for pts to come in for labs. I volunteered to run the lab because none of the full time people wanted to take turns coming in on weekends. The pts. were allowed to walk in without an appt. A disaster waiting to happen. The problem was, more and more of them began showing up without an order...either in-hand or on file. The full time lab tech took a "stick now... resolve later" approach. It worked for her because all the providers were there. Not so on weekends. There were only one or two. I had been told by central office during a training session that , under no circumstances was I to stick a pt. without an order and I had discussed this with the manager. " In comes a pt. who is a frequent flyer. He wants labs drawn. He has no order. As soon as I told him that I might not be able to accomodate him, he started getting angry. I poured over his chart looking for something that I could construe as an order. He stomped out...I thought. I brought in my next pt. The manager comes into the lab and tells me I need to stop what I am doing and draw the previous pt . I told her he had no order, handed her the chart and went back to the pt. in my chair. She came back and said that, although there was no order, that SHE JUST KNEW THE PROVIDER WOULD WANT LABS AND IF ANYONE GOT IN TROUBLE IT WOULD BE HER. I told her that if she didn't back me up, this situation would never get any better. She gritted her teeth and said, "JUST DO IT... BECAUSE i SAID SO" I told her that it didn't work that way and before I could explain she said, "when i tell you to do something, you are not allowed to question me...you are fired. And so I left. I emailed the regional supervisor who had been fair and supportive before, but he ignored me. I emailed the Board of Nursing who said I had done the right thing, but they couldn't help me. The central part of this state is a very small world and I am afraid of being blackballed. If I just roll over and slink away I am encouraging them to treat us as though we were still living in our pink collar past. But I don't know what to do, short of spending thousands of dollars I don't have on a law suit. I WENT FROM A SITUATION WHERE NURSING WAS PUNISHED IF THEY DIDN'T GO ALONG WITH MANAGMENTS FANTASY THAT EVERYTHING WAS HUNKY DORY, TO COME HERE AND BE FIRED FOR REFUSING TO VIOLATE MY STANDARDS OF PRACTICE. I am so disallusioned that I am thinking of not renewing my license.

I worked at a large MAGNET state teaching hospital for 15yrs and everytime I went to the NM with such a problem her response was, "sure, but nothing will be done anyway and they will make all our lives miserable." I think administrations job there was to make sure NO ONE said anything about the emperor (sp?) being naked...:angryfire

I tell them, IN DETAIL!!!