Question regarding where I stand with my job (long, but with paragraphs!)

[Alisonisayoshi]

I am a nurse in an ambulatory care hospital associated specialty clinic. I'm very new to this position and a fairly new nurse. We do in office invasive procedures regularly. I am in a quandary as to where I stand/did I do the right thing/what's going to happen on Monday.

Situation: pt sent to us by PCP for an issue that was rather urgent, a possibly cancerous mass. In office my provider choose to send pt for diagnostic imaging. Pt returned, MD waiting, needed an invasive procedure for dx purposes post imaging (pt may need surgery, the procedure will tell us). Prepped pt for invasive procedure. For this procedure pt is draped from the waist down. Doctor was over time for the day, due for a holiday party with spouse. Provider was happy to stay/concerned for pt.

Pt begins procedure with provider, as per protocol, I wait outside the door in case I'm needed, but give privacy for the procedure. The receptionist comes back with the providers spouse, who's trying to retrieve a holiday card for the party from the providers office. Spouse can't find it. I'm asked to pop into the procedure and ask where the card is. I refuse. The procedure is in process, the pt is in a vulnerable position and I feel it's inappropriate.

The providers spouse keeps clock watching/asking how long the procedure will take, spouse is going to be late ect ect. Receptionist says she will just crack the door and ask. I say no, please wait until the procedure is done. She does it anyway.

I wait until the pt is gone, and go to the receptionist and ask her how she would have felt if that had been her, naked on a table, in pain, and scared about having cancer, and someone popped in a room. She said that it was not a big deal and that's how things are done in that office. I'm making a mountain out of a molehill. I don't understand their clinic ect ect. Continually argued the point until I simply walked away in sheer frustration.

I'm not familiar with ambulatory care. I'm not used to what goes on. I felt it was wrong. I felt doing that violated the privacy and dignity of my pt. I felt an obligation to protect my pt, and correct the receptionist to protect future pts. I'm not rude or mean, and I wasn't in this situation but the receptionist was very confrontational with me about the issue. I felt in the moment very right, but now, I'm unsure. Really unsure.

So, was I wrong, and am I getting fired/in trouble/chewed out for telling the receptionist not to do that? What should I have done or what could I have done better?

[klone, MSN, RN]

Agree with everything Nursel said

[KelRN215, BSN, RN]

As a patient, there are a few situations where I'd be ok with someone interrupting my time with my doctor. This isn't one of them.

If I'm with my oncologist looking at scans and someone were to come in and say "Dr. we need you for an emergency" or "your wife is on the phone, it's urgent about your kid", I'd be fine with that. If someone came in and said "Dr. your wife is looking for a holiday card for that party you're late to", I'd be pissed. And I'd be more apt to fill out the survey I'm sent after this appointment in the second scenario.

[OCNRN63, RN]

I agree with the above poster. As someone with cancer, I would be livid if I were in the middle of getting a pelvic and someone poked his/her head in the room asking about a stupid holiday card. When I'm with my oncologist, I expect her to be present, not thinking about the party she will be attending later or being interrupted for something that's not urgent. A party is not urgent...I don't care what the spouse says.

[Alisonisayoshi, LVN]

I agree with the above poster. As someone with cancer, I would be livid if I were in the middle of getting a pelvic and someone poked his/her head in the room asking about a stupid holiday card. When I'm with my oncologist, I expect her to be present, not thinking about the party she will be attending later or being interrupted for something that's not urgent. A party is not urgent...I don't care what the spouse says.

That was kind of how I felt, that it wasn't just about dignity, it was about how that moment appeared to the pt, who had not met my provider before today, and now was being rushed through a series of life changing imaging and procedures.

[Alisonisayoshi, LVN]

I don't see why you would be fired in this situation but neither do I regard the issue as "right way, wrong way". Every office has it's informal rules and regulations. Ask the provider to tell you under what circumstances you should interrupt. A common ground rule could be when a call for a phone consult is returned by a specialist.

If you knock softly on the door and crack the door, say "excuse me" and keep it short and sweet I don't think the dignity issue is a major concern. You're in a hallway, and there is no need to walk all the way into the room.

I figure if it's the type of place in which "Where is the Christmas card?" is acceptable established patients are often familiar with the provider's style and either don't care or find some other quality in that provider that keeps them coming back. If they're not, and you don't violate the ground rules already given, it's between the provider and the patient at that point.

Best wishes to you!

This wasn't an established patient, but the provider is known to be the absolute best in the specialty you can find. Pts feel lucky to see him. He is awesome. Kind of doctor that still calls you back when your upset or scared or concerned.

Thank you, I think what it comes down to for me is the last thing you said, in an office I'm very confused about my role, where does my responsibility to the pt stop and to the provider take over type questions. I've always worked under the understanding that I'm the pts nurse, not the doctors, but this feels different. Like I'm some mix of both that I don't have a good feel for yet.

[dudette10, MSN, RN]

If it was a communication from the spouse's wife, I'm not sure I would have had a problem with it. The way you're presenting things makes it sound like the door would be flung open in front of a large crowd and the patient would be cowering, in tears, naked. In reality, things were probably much less dramatic.

What was the patient's reaction to the situation?

In any case, your heart was probably in the right place. I don't see this as a fireable type of "offense", but not getting along with others could very well turn out to be. Was there conflict with this receptionist before this incident?

no, it was a communication from the PROVIDER'S spouse, not the patient's.

As a patient, I would also be very ticked off if, in the middle of a procedure, someone walked in asking about something so insignificant. I don't care about the "culture" of an office or whatever.

[Pangea Reunited, ASN, RN]

no, it was a communication from the PROVIDER'S spouse, not the patient's.

As a patient, I would also be very ticked off if, in the middle of a procedure, someone walked in asking about something so insignificant. I don't care about the "culture" of an office or whatever.

I misunderstood and thought it was the patient's spouse ...I agree 100% that the provider's spouse can and should wait. I have to stop responding to these things half asleep.

[Emergent, RN]

You may be right, but as a new member of this group, and a new grad, you will be viewed as a pushy young upstart by your behavior in this incident.

And never forget, a unit secretary can make or break you in nursing. I've crossed swords with them before, and lost. They may be less 'educated' and make less money, but their social clout is enormous. Tread carefully!

[BuckyBadgerRN, ASN, RN]

My MD would NEVER allow any kind of interruption during a procedure (if the light is on, your need/question/request WILL wait until the light goes off and everyone in our clinic knows it.

[Alisonisayoshi, LVN]

You may be right, but as a new member of this group, and a new grad, you will be viewed as a pushy young upstart by your behavior in this incident.

And never forget, a unit secretary can make or break you in nursing. I've crossed swords with them before, and lost. They may be less 'educated' and make less money, but their social clout is enormous. Tread carefully!

This is at the heart of my concern here. I don't want to be viewed in a way that I'm not. I don't want this incident to be a blemish on my career with this hospital system. I feel lucky to have been hired by them. I don't want this woman to effect that.

[Alisonisayoshi, LVN]

My MD would NEVER allow any kind of interruption during a procedure (if the light is on, your need/question/request WILL wait until the light goes off and everyone in our clinic knows it.

That's what the nurse training me said, that it doesn't go on elsewhere. She's very unhappy in this position, and happy to be going back where she was floated from to cover until I was hired.

[caliotter3]

That's what the nurse training me said, that it doesn't go on elsewhere. She's very unhappy in this position, and happy to be going back where she was floated from to cover until I was hired.

Think about this nurse's reaction and file it away for future reference. Although you were 100% correct in this matter, it seems that this receptionist is throwing a lot of weight around this office. The doctor should have put her in her place. Since that didn't happen, you can bet that incidents of this nature will recur, to your detriment. Start considering an exit strategy.