Working for Alternative physician - need advice

[Charslight]

Hello,

I left my 16 year nursing position in a critical care environment in the hospital, after a couple of surgeries made the physical work of standing, lifting etc not a good fit for me anymore.

I was hired by an 'integrative physician' I was very excited, the position was in a gorgeous resort, with his office in the Spa and healing arts center. I was his first nurse. This is a 24 hour position. I have been there 3 months.

From the beginning this has been fraught with problems. I was hired to case manage patients - by coordinating care between therapists, trainers, doctors, and various services. I was supposed to meet with the doctor twice a week to discuss patients.

The doctor is never on time for his appointments with me sometimes showing up 5 hours late - when it is time for me to leave - then I end up leaving late. He said he would pay my mileage - but so far I have not seen a check. We have yet to sit down and discuss a pt in depth.

1. Our offices despite being in a great location, are miserable - with dirty carpets and floors, no space for supplies. He doesn't have a sink in his office - and I do not even have a table to centrifuge and pipette specimens into containers. I do this at my desk.

2. Stress testing - he wanted stress testing - but has a resting EKG machine that is a dinosaur - and a BP cuff that doesn't do ambulatory BP's. I refused to do stress testing until we had state of the art equipment.

3. He wants me to do all of his documentation and spend hours re-typing information that is already in the EMR into another section of the EMR - because this saves him time.

4.I do inventory, order supplies, call in prescriptions, create logs, make appointments and communicate with patients about their appointments and V02 testing.

5.I do complicated blood draws and Glucose tolerance tests - these require centrifuging and pipetting serum into containers, then separating by temperature - I do not have an appropriate lab area to do this; no table - and specimens have been rejected if they are not centrifuged and pipetted in a timely manner.

6. I have created spreadsheet, vaccine information sheets for patients, consent forms for V02 testing and vaccinations - which he never had before-

7. Since this is a concierge practice - the patients are wealthy. I have dealt with all types of people in the past and treat everyone with respect. I am chastised for saying things like: "please let me know when would be a good time for you to have an appointment so I can fit you in" Fit you in is deemed inappropriate -

8. Last week I was asked to order 'mole removal equipment' I did not see such a thing, but knowing how this is generally done, I ordered sterile supplies - the doctor doesn't have a sink in his office to even wash his hands prior to doing a sterile procedure, or in between patients.

8. Most of the appointments on the Dr's schedule are book deals, talks on nutrition and lifestyle, book writing workshops, guitar lessons, etc with him seeing about 8 patients a week and supposedly checking in with 10 by phone.

9. He now wants to stock narcotics. Since he is so bad at documenting - I am afraid this will have repercussions... I am putting everything in a locked box, and have created inventory sheets with 2 person counts and I have ordered rx in unit doses when possible.

I do not feel like a nurse - I feel like a glorified secretary who is not given respect. I am an RN with lots of experience and I am not using my critical thinking nursing skills

I would love to have a job doing hospice care and wish I hadn't left the umbrella of the larger organization where one has protection of the protocols and the union. I feel like I thought I could make a difference - but am getting a huge wake up call. Has anyone else experienced working for a doctor like this who beats to his own drum? What are the liability issues? What are the laws of accountability ? He isn't accredited by any organization like JCAHO. Does not comply with meaningful use criteria.

[HouTx, BSN, MSN, EdD]

Oh my goodness. I think you already know what you need to do - you're just waiting for us to validate your decision. From the information you've provided, you're in an environment that does not meet professional, ethical, or even legal standards. Physician offices in Ca that perform in-office lab testing are required to be certified. If you are involved in the billing process (including documentation of services that are billed) for 3rd party payors - you could be caught up in some legal issues that may have a very negative effect on your license and ability to practice.

Trust your gut instinct.

[Charslight]

Thank you for that. Yes, I do know what I need to do. I just need to hear it from someone else. After years of working with wonderful fellow nurses, I find I am by myself trying to apply all the principles that I know to be appropriate and feel somewhat in a vacuum. For example the other day- the physician put his burrito in with the lab specimens and the vaccines. When I mentioned this was not allowed he said he wasn’t going to listen to me.

He now wants me to do a fitness test on a gentleman in his 60’s. This man has not had an EKG, in at least a year. MD takes offense when I say that these things need to be done, as if I am undermining him.

Thanks for the feedback.

[Charslight]

Can you please direct me to the site where it is mentioned that in order to do phlebotomy in a Physicians office there needs to be a certification. I just see phlebotomy certification. I am doing complicated lab draws and glucose tolerance tests - I am perfectly capable of drawing the specimen - but the processing is another story. Most specimens need to be centrifuged and then have serum separated into transport containers, then different specimens kept at different temperatures and some protected from light. I do not even have a space or a table to do this, other than my office desk. Where there are other people around. There is no splash station either in case there is accidental splashing . Wow. I was initially told I would be going to people’s houses to draw blood - which is acceptable as I can drop it off at a nearby lab - but this is horrendous.