Would you stay?

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Hello fellow NP's

So little about me- worked in family practice for 1.4 years- got laid off because of financial issues with office. now am in urgent care- and basically the staff - MA'S are horrible. there was a ma who had what i felt an allergic reaction so I gave her a decadron injection iM and told her to go the ER

5 days later I get written up.

the way the company is structured is medical assistants are managed by managers of whom back up the mA's.

the NPs are managed by medical director (who is a very nice person...)

anyway the OTHER np I WORK WITH is very lienient in his care (nothing wrong) just different. I am a structured individual -like things orderly (to a certian extent) so I correct staff where need be. Staff like the other NP because he is not a rule follower- like doesn't check in some patients and refers them to ER without being triaged properly etc.

so staff are gossiping about me -and the MA I gave the injection to got me "trouble" for helping her.

so now I feel like i walk on egg shells- like im watched on my every move if i make a mistake boom i will get written up.

what am i to do? any tips will help thank you

"the medical assistants have attitude - one doesn't speak with me because she feels she is the provider and when initially i was working she would literally argue with me in regards to who should be seen or not......" I would be out of there like yesterday. That sort of situation is intolerable, IMO.

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ATomic woman

thank you for the reply.

this medical assistant now will not work with me. I know it's easy to say I'd be out of here which I can truly agree with although I am worried it took me 6 months to find this job- and this was through a connection within this company.

another job as posted in primary care right now- which is A LOT harder medically than what I am doing on a daily basis in this job ? I guess I am upset that I have to leave such a great opportunity due to crappy staff...it feels like I lose out.

currently I am at 70/hr - not salary. with full benefits.

other jobs will be about 40/hr after the extra hours I put in at home to document etc.. (not sure if I will have good MA'S there either).

My question to myself will remain- should I start complaining and risk becoming a further target in this company or just leave it all together? Is it worth It?

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Specializes in FNP.

The MA's have a job, and the provider has a job. Everyone should do their job and leave it at that. If you need an MA to do something and they don't, report them. Two can play the game that they appear to be playing with you.

Treat all patients like a patient and do favors for only those who deserve the favor.

Several providers from the company I work for come and see me for Rx's, injections, imaging, ect... I may not see them for everything, but I definitely leave a paper trail in the EMR.

I've never had a situation like you're describing, but I've had a MA with an attitude work with me. I worked him into submission, then it was better.

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Specializes in FNP.

I'd pile the work on the problem ones and report them if necessary. But you'd better keep your nose clean and don't give anyone any ammunition to report you on.

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Hi,

To clarify, it was the issue of treating the patient (giving the shot) without a note or officially establishing a patient- provider relationship on company grounds with company property. Was she so unstable that it necessitated a shot? If so, did she drive herself to the ER? That creates liability for the employer. Also, think of it like when nursing and medical staff give themselves IVs in a hospital or take drug samples- actual grounds for termination in this day and age and I have heard of MDs and RNs going to their respective boards for it in recent years. Had she simply gone to the ED (and called an ambulance), this would likely be a non-issue. Also, had you checked her in and wrote a note, also probably a non-issue. Should something like this come up again, I'd advise just calling the MA management (or better yet have them call their manager as long as they are stable enough) to advise that the MA is leaving because they are too ill to work. Also call your medical director. In the future, you know can't trust you MAs or staff- don't stick your neck out for them. Follow whatever policy for employee health is in place. If they come to you (again and are not in a life threatening situation- then just call 911), advise them that their own management told you that you cannot treat them unless they check in (or whatever direction they want to take).

People will ask you for all kinds of crazy things- I've had a co-worker ask me to prescribe theophylline for their cat but under their own name so they can use their insurance to pay for it. So essentially asking me to not only practice veterinary medicine but commit fraud along with it. It's up to the provider to say no. They then went around from provider to provider until they found someone who would do it. It will make you unpopular sometimes but hey .... I'd rather have a license.

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Also, I forgot to add- many times co-workers treat male and female providers of every type very differently in terms of support, communication, and respecting their medical decisions consciously or subconsciously even if the staff is female. This may or may not be the case here.

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mike fNP thanks for the reply.

I like your concrete perspective. makes me feel better. I know now never to treat anyone without a chart.

egg 122- I felt she was potentially having a allergic reaction yes. and I just acted quickly i guess out of more care- this person was friendly with me, always needing someone to hear out her personal issues... she's missed about 10 days of work...and still doesn't get fired...one day we even had to shut down because she didn't show up to work. it's all taken lightly.

Anyway, I will never attempt to help someone in this way again. I now know it is very wrong, yes puts company up for liability.

I just go to work quietly sit down- and I avoid conversation with staff all together. I know not everyone is bad in the world (esp this medical director ? ) but these people I work with are not good people. I used to buy donuts/bring food, etc. now I've stopped being friendly.

My previous jobs everyone was literally like family....I have never experienced a hostile work environment as this- I can just feel it and I KNOW it's because staff want autonomy.

EGG112:

what do you mean by male/female ? I am a female-all staff are female and the other provider is a male.

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People (of both genders) question the female provider's competence, do not follow orders, offer less support than to the male providers. General passive aggression and bizarre expectations that you will do parts of their job in addition to your own can occur too. The fact that you were having to provide all of this extra emotional labor (support, listening about personal problems etc) at work in addition to doing your job can be perceived as gendered. Does she expect this from the male providers?

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Not an NP, but you must never again do anything even approaching this, as you know. Even now, I am wondering if you could make some late notes. Don't do it without checking with your boss, of course.

Work is work, not a popularity contest. That said, it is a whole lot better when people like you than when they don't, as you also know.

Your MA's sound like typical jerks. If you are going to stay there, you must find a way to get their respect and obedience. Yes, obedience. You give orders, however courteously, however delicately. They carry them out.

Have a frank talk with your boss. Express your thoughts to him and get his help to formulate a plan to rectify the problems. See what kind of response you get. If he will let the staff know, in very certain terms, that they are to do as you say, you might be able to get past this. If not, you might have to leave. He will have to be tactful, not read them the riot act. He might not know how to do this. He could make things worse if he is too direct. On the other hand, maybe frankness is what it will take. Very tough call. I guess all you can do is try.

I wish you all the best.

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I would not leave, what is the point? You will run into something similar somewhere else. Don't leave unless it gets so bad that you can't tolerate any of it, just stay put. The whole leave if you are unhappy only works if you have the option to work in a place that is super rare. The conditions are making you unhappy and these conditions exist in so many places, that is why nurses job hop so much to the point they leave the field completly. Most places have medical assistants like the one your are describing. If someone at work ask me for a tylenol I tell them no. There is too much that can go wrong. Just focus more on providing care to the patients. Keep professional boundaries between you and the staff. If you don't understand what that means, educate yourself on it, like is this or that appropriate before you act. If the staff member did not check in to see you, she is on her own, sorry but that is just the way it goes. Not saying you don't assist her to get help but you don't given her an injection that requires a precription from you. The staff will come around in time. They just have to get use to you. Sadly many assistants do pretty much run places because they are allowed to by higher powers so it will take some gentle pushing to get them to listen. Management or your boss most likely knows this stuff is going on and does not want to get involved so be careful how you go about addressing it. I find that getting the staff to respect you is more effective then reporting them to a boss that doesn't care. It takes time and it is all in how you ask sometimes.

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egg122

very interesting gender point. I do believe that is true.

kooky korky

thank you for the response. Yes you are right it is a hard situation to report or not- considering the main manager has their back.

easy to say report little things sure....but silent retaliation does exist. in medicine it is easy to have upset patients or make an error (something small like forgetting to send in the prescription...) and if staff don't have your back it makes your job difficult.

workitinurfava

I do agree that upper management (medical director) is completely aware and does not want to be involved with fighting with the manager too much. great point.

problem is I went in all energetic and excited i guess with a expectation of work family? that crashed and burned fast and now I can't really get my mind off my work when I'm off.

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I would not move on but I would try to make it a workable environment. The probability that a job change will results in a 30 dollar an hour cut should be a powerful motivator to improve the work relationships. Sometimes that takes a little effort in winning over a few MAs. Everyone wants to be appreciated, maybe buy pizza on a stressful night or bring bagel/donuts and when you see somebody doing something helpful ... make sure to appreciate that. Should you have to buy food ? No, but having a positive working environment is more important to me than being right.

I would also address the issue of the MA who won't work with you with the manager. that is ridiculous and that type of attitude creates a hostile environment.

Lastly , you're best off not treating co-workers or friends. however, sometimes situations arise........My rule of thumb if I choose to help is to have them send me a communication with our patient /provider messaging system and then within that documentation I order the medication and document the assessment/interaction along with the instructions I provided them for follow up. I regularly read the quarterly board of nursing in my state, and where I practice, no having a documented assessment/plan of care....is usually where people get in trouble

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