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?

[nursel56]

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.

Your responsibility is to the patient but if you ignore the personalities around you there is a risk of the "not a good fit". There are a number of other factors to consider. In the situation you describe, a new patient with a new diagnosis of cancer, I would have communicated with that patient and tried to provide a reassuring atmosphere with my first contact with them.

An example of that would be a young mother who had a mole removed that come back as malignant melanoma. I would treat that person with an abundance of support from the beginning and tell them to let me know if they have any problems navigating the scary world of what happens after that.

If at all possible I would want to be in the room standing next to the terrified patient getting the invasive procedure to talk them through it if necessary and explain what is happening at each stage of the process.

Sometimes nurses in ambulatory care can counter-balance the personality of the provider. An example of that would be if they are disorganized and mumble when they convey information. You would make sure the patient understood what they needed to understand. If the provider runs out the door forgetting to call a patient who expects a call I would call them myself to see if they are cool with waiting a day or freaking out-- if they are freaking out I page the provider and deal with their annoyance.

There are lots of ways nurses can advocate for patients in ambulatory care. With returning patients many times there is the patient's relationship with the provider on one track and their relationship with you on the other.

I'm using paragraphs in my over-long reply and appreciate that you did the same!

[Been there,done that, ASN, RN]

Looking at all sides of the issue, I don't think the patient would even realize it as an intrusion. Nurses interrupt doctors all the time.

The receptionist has a better feel as to what the doctor would prefer in this case. You need to clarify with the doctor as to what to do in a future situation.

Being concerned about being fired in this situation does indicate you are hypersensitive.

Being the newbie is tough. In this case, I would have gone with the experienced person in the office, "lowly" receptionist or not.

[ProgressiveActivist, BSN, RN]

Ask the doctor if the receptionist is allowed to interrupt him during a procedure or an exam.

If he says no, and she tries to intrude on an appointment again, you can tell her to step away from that door, he is with a patient.

If he is allowing her to be disruptive and run amok, resign.

[FolksBtrippin, BSN, RN]

Thank you for doing the right thing for the patient. Have confidence in yourself on this issue, you were 100% correct.

[NightOwl0624]

Ask the doctor if the receptionist is allowed to interrupt him during a procedure or an exam.

If he says no, and she tries to intrude on an appointment again, you can tell her to step away from that door, he is with a patient.

If he is allowing her to be disruptive and run amok, resign.

i agree!!

As a patient, I would have been upset if my procedure was interrupted for something so trivial. Hopefully the patient didn't hear the reason for the interruption.

i would think the doctor would set the tone for appropriate interruptions. If HE thinks this behavior is ok, that's a problem in my opinion. If he can't control the behavior of the clerk or is afraid of offending his wife, that's a problem too.

I would be interested to know how the doctor felt about this. I would also like to hear more from the nurse who trained you!

[Oedgar]

I don't think you are going to be fired! In my former ob/gyn office where we often did procedures... I can't imagine interrupting the doctor to ask about a holiday card. And, if the procedure had not gone well, it would have looked doubly 'off' to the patient to have that interruption... a potential liability? I also have to add that in my office, neither of the spouses would have insisted on interrupting the doctor.

[springchick1, ADN, RN]

I'm surprised you didn't have to stay in the room wi the doctor. At my OB/GYN, there is ALWAYS a nurse present any time there is any sort of examination.

[Dany102]

I will be the first one to admit I do not have much experience yet but I can't help to feel this receptionist was in the wrong. And, to be honest, "wrong" here is to be taken as a euphemism. What I have in mind are words a gentleman should never use in public. You reacted the right way, Alisonisayoshi. I'm only surprised that this [insert very derogatory word] of a woman ignored you and went ahead.

Putting myself in this patient's shoes, I imagine I would have a very curt discussion with said provider just so we were both clear on just how displeased I was with this interruption. And I might even have a go at the receptionist as well on my way out, for good measure. Privacy is something patients hold on to very dearly and are not usually willing to have it taken away from them for frivolous or trivial reasons.

However, I can understand you not having a clear idea of the lay of the land and not wanting to "rock the boat" too much. I can only suggest you engage the provider on this and seek to understand his/her opinion, clinic policies and also, because it matters as well, bring up your own concerns about this. This is were you can shine as a patient advocate.

Dany

[Lunah, MSN, RN]

I think you were in the right, OP. Something similar the other day: we had a patient come in who had expressed some suicidal ideation related to a personal incident/screw up that had potential career/life implications after a long exemplary and spotless record. One of our nurses was having a birthday and our nurse manager brought a cake out to the team center, right next to where this patient's room was, in preparation to sing happy birthday. I asked them to take it to the break room, away from the team center. I just didn't think it was appropriate to loudly celebrate right outside of a room where a patient is dealing with a huge life upset, it would seem like a big kick in the gut to someone who is already in a emotionally charged state. My nurse manager took me at my word without question, and understood completely when I explained it later. Some things just aren't appropriate around all patients. I didn't care if anyone got annoyed with me, either — the patient comes first.

[Alisonisayoshi, LVN]

I feel really reassured by all these posts. Being a new grad is really hard, and I took a big leap of faith dropping to per diem at my SNF where I was getting really confident in my job and moving to ambulatory care where I know nothing. I was trying to advocate for my pt and future pts. I'm used to the way my instructions work with CNA staff, they are simply followed. To say don't do that please, and be ignored was disconcerting to sat the least.

I'm also not used to office politics. In my former career, there was very little of that. I worked as a supervisor where my word was the law, and before I had that job, when I was the underling I listened to the supervisor regardless of personal opinion on the decision or outcome. Nobody ever threw weight around in that job, it made little sense in the context of the job we did. So now, navigating that kind of enviroment at 30+ is hard for me.

[not2bblue]

I agree with those who say to speak with the provider, asking which situations are ok for interruption. Tell him your concerns about offending the patient's privacy and also that it may startle him causing an error. I'm concerned that he is still practicing by performing invasive procedures alone, so that if any thing comes up, he has no witness to rebuff complaints of any abuse. I don't think you will get fired for standing up for a patient's rights, but seriously if you even get in trouble for this, you need to start looking for another job because this won't be the only time this happens.

[Alisonisayoshi, LVN]

I agree with those who say to speak with the provider, asking which situations are ok for interruption. Tell him your concerns about offending the patient's privacy and also that it may startle him causing an error. I'm concerned that he is still practicing by performing invasive procedures alone, so that if any thing comes up, he has no witness to rebuff complaints of any abuse. I don't think you will get fired for standing up for a patient's rights, but seriously if you even get in trouble for this, you need to start looking for another job because this won't be the only time this happens.

Most of our pts are male, which is why I think he chooses privacy versus a nurse on hand. With female pts undergoing this specific procedure and a few others, he has me there, to "hold the scope". Then again, other procedures with women that are rather painful at times, I'm not in the room. I'm confused on this as well. During my clinical rotation in an OBGYN office, the precepting nurse said we are always in the room to ensure protection against abuse allegations. But this is a different specialty with different procedures so I've been just going with it.