Does this seem fair to you?

[PreppyPA]

Looking for some advice. I am a new graduate and accepted my first job at a local hospital outpatient clinic. Because this clinic is a county medical center, I am considered a state employee. I have been working here for 2 weeks so far. Overall, I am happy with the job so far. The staff seem nice, and I like the nature of patient care that is involved. However, I have some concerns that I am starting to be stepped on by some of my superior staff. 

 

Over the past couple weeks, my day to day supervisor (a nurse practitioner) has mentioned that the clinic would like me to take over certain administrative tasks in the months to come. These include filling out and submitting paperwork for our department and other closely related departments to receive CME credit for patient chart review meetings held every week and being in charge of joint commission stuff for our department. 

 

They have also expressed the desire to start having staggered shifts in the next few weeks so that we can all stick to 8 hour shifts on days that we usually get out late (it's a state employee thing). I originally saw no problem in this, but now I realized that they suggested I take the late shift, meaning that I would work from 10am-6pm on these days. My issue with this is that normally, 8am-9am is a work catch up / get stuff done time before we start seeing patients at 9am. I would lose out on this hour, plus I feel that the other midlevel providers would not have incentive to efficiently get through patients because they would go home at 4 irregardless of whether we still have patients. I would be stuck with all the work at the end of the day and would not be able to go home until it was done (mind you this is without any other staff because the nurses and secretaries always leave at 4pm whether we still have patients or not. once again...state employees). It would just be me and the doctor. 

 

Because I am a state employee, it is not up to people within my department if and when I get a pay raise, it is up to the actual hospital itself. I am receiving a much, much lower salary as it is because of working at a county hospital. I would like to think that I should be compensated more for undertaking administrative tasks and taking the least desirable shift. I am all for being a team player and helping others out within the department, but I can't help but feel that I am getting more dumped on me than I should be. 

 

 

What do you think? Am I justified in how I feel and what should i do about it?

[moestown1016]

Is it possible to decline?

 

 

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[PreppyPA]

theoretically i believe i should be able to decline both. i can guarantee neither clauses are included in my job description, but I don't want to come off as being lazy and not being a team player. I have to see all these people every day at work and I don't want them to resent me or cop an attitude with me. I also don't want to get abused by their power. 

[Reality Check 2]

Do you have a contract?

A job description?

Does the contract or job description list your hours or list some nuance such as "to be determined"?

 

Start there.

Then, talk with HR or whomever actually does the employee staffing.

 

You are being dumped on.

 

Yep, you are the newbie and the new kid but this sounds kinky and sounds like the NP is taking advantage of your "youth" and new status.

 

PS - WHY is an NP your supervisor? Department thing? Who is your doc?

 

Don't cave or you will always be a doormat.

[Reality Check 2]

Dear Lord - auto spell check

 

I wrote HINKY not kinky.

 

Deep sigh

 

Sorry

[PreppyPA]

HR had me sign a "letter of employment" and this is basically my contract. It states that I would be hired with my stated starting salary pending passing my boards, drug test, and includes details on my benefits. it does not say what my hours are, however it states i must work 40 hours a week. the department's specific hours are 8am-4pm as per the booklet given out by HR. 

 

The NP is my supervisor because she is the most senior person that is there every day. each day of the week there is a different doctor. the one doctor is head of the department, but he is only there seeing patients in the clinic one day a week. my training and everything else has been deferred to the nurse practitioner.

[Reality Check 2]

If the department is 8-4 then I bet the MA/LPN/RN staff quit at 4.

You would have no support.

 

Radiology and the lab probably clock out at 4 as well.

 

So, no support staff = no workie in my mind.

 

My take - in a meeting with all present - bring up the subject and mention that the department is open until 4 and you are going to stick with the listed department hours.

 

Just that simple statement and be done. No further explanation needed.

 

If the NP pushes - ask to meet with NP and the office manager who governs other staff.

 

Wish you had a doc or PA to help mentor you and guide you into your first job. NOT saying NPs are bad. Just wish for every new PA to have a good mentor in their first job who has walked the walk and can guide you.

[seekingtruths]

Maybe you can push to have the late shift rotated between all APPs. That way no one gets stuck with it all the time. It doesn't seem fair that you would be without support staff at the end of the day, will likely be there past 6 pm sometimes, and will lose out on the morning hour that is blocked for administrative tasks. I think you're justified in wanting a more fair arrangement, especially since your original understanding was that you would have the day shift like everyone else. 

[PreppyPA]

There are 2 days a week when we always seem to run over schedule. We usually get out at 530 as opposed to 4. all the nurses and other staff leave. it is just me, 2 NPs, and the doctor. for now we all stay and obviously finish seeing patients. difference is the NPs get overtime because they are union. I get nothing else additional but i am expected to stay.

[Reality Check 2]

There are 2 days a week when we always seem to run over schedule. We usually get out at 530 as opposed to 4. all the nurses and other staff leave. it is just me, 2 NPs, and the doctor. for now we all stay and obviously finish seeing patients. difference is the NPs get overtime because they are union. I get nothing else additional but i am expected to stay.

 

 

Figure out how many other PAs are in this institution and go union

[PreppyPA]

Figure out how many other PAs are in this institution and go union

 

 

 

There are other PAs at this medical center but there is a catch: they are all outsourced by other companies. For example, the ER has PAs, but the medical center leases out their ER to a medical group that hires the PAs. I am the only PA that I have come across for now that is an actual employee of the hospital and therefore a state employee. We are grouped into a class with some doctors and administrators and other random positions. 

[rev ronin]

No support staff means I can't see patients.  Even if I wanted to room them myself, I don't have a chaperone for any procedures that might need one, let alone anyone to just assist in any procedure where that might be appropriate.

[PreppyPA]

No support staff means I can't see patients.  Even if I wanted to room them myself, I don't have a chaperone for any procedures that might need one, let alone anyone to just assist in any procedure where that might be appropriate.

 

 

this is definitely one of my concerns. as a new PA, there are certain office procedures i feel comfortable doing, but there are certainly more than I don't feel comfortable with. I have expressed to the NPs that I would like them to grab me whenever they have procedural things so I can see how to do it. Unfortunately, this is a reality of working at a county medical hospital where all the nurses and support staff are out the door at exactly 4pm. it is expected that the NPs and maybe one senior nurse that stays behind for overtime rooms the patients and takes care of stuff for the doctor who is still seeing patients too. There is no way that i could ever fix not having support staff after 4pm.

 

 

based on everyones input i definitely think I am going to stop by HR tomorrow and talk to someone about what I can do about these situations. i am thankful for the input and to know that my concerns are validated. I want to make a good impression on my new co-workers and work my hardest but this is a fine line that is straddling abuse of power.

[Reality Check 2]

Expecting to see patients without support staff is absolutely not acceptable.

 

It leaves you in a potentially unsafe situation with a whacked out patient or without assistance if someone crashes - yes, ambulatory patients do crash.

 

As Rev pointed out - no chaperone or assistant.

 

I don't even like being in our building alone with the doors locked much less continuing to see patients while the crickets chirp.

 

Stay safe, stay smart

[rev ronin]

I did a mini-minute-clinic type thing INSIDE Group Health that ran later hours than regular family medicine.  I roomed patients and got VS myself, BUT I had MDs downstairs in the urgent care to whom I could immediately turf anything that belonged more appropriately in their wheelhouse, as well as lab and rads still open all the hours I was.

 

However, I would not have gone ahead and done family medicine with regular visit expectations with no support staff.  If they want you to do after hours work, they can pay you AND a nurse or MA to stay afterwards.  If they're union, that working conditions change will have to be negotiated appropriately, which is fine.

 

In my current position, I work evenings and weekends 2-4 days a week, and love it.  It's more relaxed, we often get to see patients who would otherwise go to the ER or UC, and we can cater to working adults.  It's awesome and I think more clinics should do it, especially ones where you have enough providers to spread the "love" around.

 

* Needs to have full service, full support, otherwise it's not safe for you or for the patients.

* Have a plan to deliver everything you could do during the day, during after hours.  How are lab draws and rads going to be done?

* I agree that the evening shift should be spread around.  I like having some mornings free, but I like having dinner with my family some days too.

* Need as good access to an SP as days, especially for a new grad.

 

If you want to be the hero rather than the obstructionist, I would point out the liability concerns, and come up with a plan to do it well.  If they like it, you may have scored points.  If they ignore you and do it anyways in a haphazard/slipshod manner, you have all the documentation you need that you warned them about it, while you go find a safe job.

[KMD16]

An NP as your supervisor is unacceptable!

[ventana]

Ok here goes

 

Welcome to state employment where sometimes people just want to do less, and get everyone else to do their job

 

 

 

ABSOLUTLEY DO NOT agree to this

This is a set up to make you a recessive employee and yes "dump" on you

 

Simply state that you are not able to work late as you have commitments that you are to make - ie daycare, another job, helping family members (or whatever it is - just come up with something). As for doing other people's paperwork - ahhhh NO.

 

 

As people have pointed out - you must look into getting another CLINICAL supervisor - the NP can do Administrative supervision, but no clinical, and this needs to be spelled out.... Now, I am not going to say that it should not be this, as I think it truly needs to be determined by actual skill level, and not"time on the job" as the deciding factor. But atleast look at it - ideally you should be supervised by a senior PA or an NP. If they really question you on this, just state that you practice medicine and since an NBP is trained in and practices ADVANCED NURSING they really are not qualified to supervise you.

 

 

Good luck - but stand firm as you they are trying to set up a tiered system with you at the bottom.

[PreppyPA]

I am the only and first PA the department has ever had. It is virtually impossible for me to get a PA to be my supervisor. As for the MDs, each doctor only has 1 day a week in the clinic, so it is hard to have that continuity. The NP has been with the group for almost 10 years and is here every day, so that is why she was defaulted to be my day to day supervisor. The lead physician in the group is my supervising physician on paper. 

[ventana]

I am the only and first PA the department has ever had. It is virtually impossible for me to get a PA to be my supervisor. As for the MDs, each doctor only has 1 day a week in the clinic, so it is hard to have that continuity. The NP has been with the group for almost 10 years and is here every day, so that is why she was defaulted to be my day to day supervisor. The lead physician in the group is my supervising physician on paper. 

reasonable enough

 

I would just make sure everyone knows that she is your ADMINISTRATIVE supervisor

Make sure you learn you state laws about what is required for PHYSICIAN supervision - that way you can demand time with the doc - as it is a requirement of your employment/license and this clearly takes HER out of that role...

 

Just stand firm........

 

Ask yourself this - If I got hired as a 15 year PA in the same office, would they be asking me to do this???  Heck no 

And if that is not enough - I can clearly tell you that their is now way that I would EVER agree to doing other providers scut work....

[PreppyPA]

How do you think I should explain this to the department without coming off as rude or being a "lazy millennial"?

 

I have a meeting with HR this afternoon so I will see what they say!

[rev ronin]

How do you think I should explain this to the department without coming off as rude or being a "lazy millennial"?

 

I have a meeting with HR this afternoon so I will see what they say!

Liability.  A nurse or MA is there for your protection and the clinic's protection against unfounded accusations of inappropriate behavior.  It is not appropriate to not have one for a family medicine position.

[Poetsiren]

I would just make sure everyone knows that she is your ADMINISTRATIVE supervisor

Make sure you learn you state laws about what is required for PHYSICIAN supervision - that way you can demand time with the doc - as it is a requirement of your employment/license and this clearly takes HER out of that role...

 

 

Yeah, I was thinking this.... Your Supervising Physician is attached to your license, then who is it and are you meeting with them at all...? This NP has zero stake in your license to practice within your state.

[Reality Check 2]

How did the meeting go?

Results?

[Katera]

So personally, I have a different take.  You are their first PA.  Sounds like this is your first job out of PA school.  This seems like a nice chance to make a good impression.  Doesn't matter that your sup is an NP.  She has been there longer, end of story.  

 

I would do it with a good attitude and cement your status as a team player.  Start getting salty and you will cement your status as something else.....It's called "paying your dues".

[Febrifuge]

So personally, I have a different take.  You are their first PA.  Sounds like this is your first job out of PA school.  This seems like a nice chance to make a good impression.  Doesn't matter that your sup is an NP.  She has been there longer, end of story.  

 

I would do it with a good attitude and cement your status as a team player.  Start getting salty and you will cement your status as something else.....It's called "paying your dues".

How long have you been out of school yourself? You mention the importance of "paying dues" as a function of that, so I think it's relevant.