New Graduate Trouble- please help!

[PhysicAsstinNY]

I  am a new graduate and have been at my job now at the hospital for 4 months in a high stress speciality. I thought it had been going really well. There is definitely a learning curve but I thought I was doing okay.

ANYWAYS, 3 weeks ago, I got in a disagreement with my supervisor (a senior Nurse Practioner). After the incident, I had concerns that she was being retaliatory towards me. Since her supervisor was involved in this disagreement, I had communicated my concerns regarding retaliation against me by my boss as I had noticed definite signs she was all of the sudden after me. There was a meeting last week where I was assured the issue had been resolved and we all were to move on.

This week I got notification that all of the sudden multiple complaints (all by individuals close to my boss) had been lodged against me and that I was being written up in a “formal counseling” session. I was literally shocked because other than that incident, at no point had anyone EVER voiced concerns about me.

I listened to the complaints and all were situations I handled with the best intentions and to the best of my ability.  For example- One of them I had slightly misworded something  and offended a nurse, and IMMEDIATELY apologized and made attempts to correct the situation.  Another one a resident threw me under the bus to avoid a mistake that she made.

Do I have room to improve myself? Yes, because I am human and I’m not perfect.  I’m also a new provider. My role is to continue to learn from these situations and improve myself.  My problem is that it’s hard to feel like the threshold is so low that if everything doesn’t go exactly perfect all the time, I will be fired.

Does anyone have any advice? I LOVE my job, I’m a very hard worker, and I’m ALWAYS continually willing to improve myself and learn. But at the same time, I am so afraid this is retaliatory and what this means for me going forward.

[EMEDPA]

9 minutes ago, PhysicAsstinNY said:

 

ANYWAYS, 3 weeks ago, I got in a disagreement with my supervisor (a senior Nurse Practitioner).

what does your actual supervisor, a physician, have to say about the matter?

[PhysicAsstinNY]

24 minutes ago, EMEDPA said:

what does your actual supervisor, a physician, have to say about the matter? 
 

My supervising physician agreed with me regarding the incident. That even though I handled it differently than the nurse Practioner would have, it was still within the standard of care. 

HOWEVER I was advised by the PA/NP team boss  that regardless of what I was told to do by my attending over the phone (which was opposite what the NP had told me), that I must instead follow the NP because she was the senior, was on site, and also “supervises me clinically”.

I was told because I am a new PA, I must ALWAYS do what the nurse Practioner tells me. I was not aware of this and I do not agree with it. 

[mgriffiths]

39 minutes ago, PhysicAsstinNY said:

ANYWAYS, 3 weeks ago, I got in a disagreement with my supervisor (a senior Nurse Practioner).

This is your first problem.  A PA should NEVER be supervised by a NP.

Secondly, this is a serious problem.  If you are truly concerned that you are being retaliated against then you need to go to HR and talk with them NOW!  Hopefully you have something in writing from that previous interaction, but that should stand as evidence of the infraction and this "senior" NP should be demoted at minimum.

The result of this situation determines your next steps.  If nothing occurs, then you need to find a better employer.  Now might not be the best time, but you can start setting yourself up for that transition by getting your resume together, determining who might serve as professional references, etc.

[UGoLong]

In large organizations, there is often a chief of APPs (not a fan of the word, but not sure what else they could use). Sometimes it's a PA and sometimes an NP. It doesn't change who your real supervisor is.

A warning light is flashing and I'm not sure you are going to be able to work this out. It sounds like you might be getting set up with a formal probation so they have a trail to let you go.  

You use the word "disagreement" with your supervisor; difference of opinion lightly discussed: sure. "Disagreement": often not a good idea.

[EMEDPA]

6 minutes ago, UGoLong said:

In large organizations, there is often a chief of APPs (not a fan of the word, but not sure what else they could use). Sometimes it's a PA and sometimes an NP. It doesn't change who your real supervisor is.

A warning light is flashing and I'm not sure you are going to be able to work this out. It sounds like you might be getting set up with a formal probation so they have a trail to let you go.  

You use the word "disagreement" with your supervisor; difference of opinion lightly discussed: sure. "Disagreement": often not a good idea.

agree with this. I used to be the lead PA for a group of 12 PAs/NPs. This basically meant I went to meetings, interveiewd people, wrote the schedule, etc. I did not direct the care of any of these PAs/NPs. Sometimes they would ask my advice, or I would ask theirs , but this is not supervision, it is chatting with a colleague about an interesting pt. Your only actual boss with the ability to discipline or fire you  should be a physician.

[PhysicAsstinNY]

6 minutes ago, EMEDPA said:

agree with this. I used to be the lead PA for a group of 12 PAs/NPs. This basically meant I went to meetings, interveiewd people, wrote the schedule, etc. I did not direct the care of any of these PAs/NPs. Sometimes they would ask my advice, or I would ask theirs , but this is not supervision, it is chatting with a colleague about an interesting pt. Your only actual boss with the ability to discipline or fire you  should be a physician.

I was told that if the lead APP instructs me on how to clinically manage a patient, I have to follow it regardless of the circumstances. Even if my attending, who is off site, tells me to do something differently. 

[Mayamom]

Sorry but time to start looking for a new job.   Lots of red flags here.   

[PhysicAsstinNY]

18 minutes ago, UGoLong said:

In large organizations, there is often a chief of APPs (not a fan of the word, but not sure what else they could use). Sometimes it's a PA and sometimes an NP. It doesn't change who your real supervisor is.

A warning light is flashing and I'm not sure you are going to be able to work this out. It sounds like you might be getting set up with a formal probation so they have a trail to let you go.  

You use the word "disagreement" with your supervisor; difference of opinion lightly discussed: sure. "Disagreement": often not a good idea.

My attending told me to do one thing and the nurse practioner told me to do another. I couldn’t do what they both asked at the same time and make both of them happy, so I did what the attending asked me to and in doing so was considered to be “insubordinate” to the lead APP. 

[GetMeOuttaThisMess]

27 minutes ago, EMEDPA said:

agree with this. I used to be the lead PA for a group of 12 PAs/NPs. This basically meant I went to meetings, interveiewd people, wrote the schedule, etc. I did not direct the care of any of these PAs/NPs. Sometimes they would ask my advice, or I would ask theirs , but this is not supervision, it is chatting with a colleague about an interesting pt. Your only actual boss with the ability to discipline or fire you  should be a physician.

I have been the lead PA/"APP" in a couple of prior positions and I was in a similar administrative position.  I was NOT there to oversee their quality of care provided.  If something was clearly amiss then it would be forwarded to the manager (who after being made aware of the error and the consequence of same, would then take it to one of the SPs) or the SP themself.  Sometimes if it were brought up to me as a "curbside consult" by the other provider and it was discussed between the two of us then it was left there.  If it was a GLARING mistake not picked up on till long after the fact (review of a prior visit record before myself seeing the patient at a new visit for example) then it would be forwarded onward.  I agree with those above that you may very well be being set up for a fail situation.

As an aside, if this were a physician who was not your SP but was onsite at the time of the care being provided and yet you felt the need to contact your SP regarding the suggestion made, I would still probably follow the SP recommendation since they're on the hook and the other physician can discuss it with the SP.

Edited May 9, 2020 by GetMeOuttaThisMess

[rev ronin]

52 minutes ago, PhysicAsstinNY said:

I was told that if the lead APP instructs me on how to clinically manage a patient, I have to follow it regardless of the circumstances. Even if my attending, who is off site, tells me to do something differently. 

Get this in writing, as subtly as you can, if you want to make this point, and then the next time it happens, you will be able to document contemporaneously, and complain to the MEDICAL board that the NP is practicing medicine without a license by countermanding the direction of a physician to a PA with a supervisory relationship.

Of course, that might be career suicide, so your other option is to just leave as fast as you can.

[mgriffiths]

4 hours ago, PhysicAsstinNY said:

I was told that if the lead APP instructs me on how to clinically manage a patient, I have to follow it regardless of the circumstances. Even if my attending, who is off site, tells me to do something differently. 

I am very sorry you are in this position, but as I alluded to above and others have stated, you need to run as fast as you can.

[Cideous]

Welcome to the future....supervised by NP's......

[SedRate]

20 hours ago, PhysicAsstinNY said:

HOWEVER I was advised by the PA/NP team boss  that regardless of what I was told to do by my attending over the phone (which was opposite what the NP had told me), that I must instead follow the NP because she was the senior, was on site, and also “supervises me clinically”.

I was told because I am a new PA, I must ALWAYS do what the nurse Practioner tells me. I was not aware of this and I do not agree with it. 

Who is your "PA/NP team boss?" Perhaps you can explain to them that PAs are supervised by physicians, not nurses. Does your SP have any idea that your "boss" is advocating that they undermine legal physician supervision by deferring final clinical decision to nursing? The physician's name on the chart, not the NPs. I wonder how he/she'd feel about that. 

 

19 hours ago, PhysicAsstinNY said:

I was told that if the lead APP instructs me on how to clinically manage a patient, I have to follow it regardless of the circumstances. Even if my attending, who is off site, tells me to do something differently. 

See above. Nurses do not direct clinical practice of PAs legally. 

Unfortunately, as someone said above, it sounds like they are building a case against you. It's not right, but it does happen and it doesn't sound like there's a winning scenario here for you... You can either ship up and do what they want or prepare to ship out. But as Rev said, the other option is to record all the events at that hospital in which you are instructed to abide nursing instruction over physician, continue to do what you think is standard of care, and then forward said info to the powers that be. I'm sure the hospital won't like the idea of what happens when their providers aren't practicing medicine legally. Also, once they do build a case against you and terminate your employment, you could always try to sue. 

[TWR]

I would not just leave the place and work elsewhere.  I would do all of the suggestions offered above except leave. I would add one more, get an attorney who specializes in medical personnel.  Get the situation resolved........................ and THEN LEAVE on your terms! Leaving now just sets the next PA up for failure.

[Hope2PA]

9 hours ago, TWR said:

I would not just leave the place and work elsewhere.  I would do all of the suggestions offered above except leave. I would add one more, get an attorney who specializes in medical personnel.  Get the situation resolved........................ and THEN LEAVE on your terms! Leaving now just sets the next PA up for failure.

Rather than setting future PA up for failure, could result in the  nurse team boss pressing to never hiring a PA again. Only NP’s that she/he can legally supervise and demand they follow her/his  POC.

Edited May 12, 2020 by Hope2PA
Added sentence

[iconic]

2 hours ago, Hope2PA said:

Rather than setting future PA up for failure, could result in the  nurse team boss pressing to never hiring a PA again. Only NP’s that she/he can legally supervise and demand they follow her/his  POC.

NPs can't supervise other NPs just as PAs don't supervise other PAs

[Hope2PA]

2 minutes ago, iconic said:

NPs can't supervise other NPs just as PAs don't supervise other PAs

I Should have phrased it differently, a team boss NP could more easily tell or influence  an NP On how to practice since NPs practice nursing care and not medicine like  physicians and PA’s. Said this because based on info, the team boss, NP, wanted to over ride physician guidance to PA. Either way, to OP, don’t give up, learn from every encounter and be the better practitioner/person for your patients. 

[cinntsp]

4 hours ago, iconic said:

NPs can't supervise other NPs just as PAs don't supervise other PAs

I think it's important to make the distinction between administrative supervision and clinical supervision. 

[Cideous]

2 hours ago, cinntsp said:

I think it's important to make the distinction between administrative supervision and clinical supervision. 

exactly what I was thinking, but what the original poster described was not administrative, it was definitely clinical.

[SedRate]

10 hours ago, Cideous said:

exactly what I was thinking, but what the original poster described was not administrative, it was definitely clinical.

Yep, which is why I was interested in knowing who this "PA/NP team boss" is. Sounds like admin or NP.

I wonder how the physician would react when they found out their name was cosigned on the chart of a patient whose clinical course was being micromanaged and changed in the background by an NP. 

[rev ronin]

On 5/13/2020 at 9:25 AM, SedRate said:

I wonder how the physician would react when they found out their name was cosigned on the chart of a patient whose clinical course was being micromanaged and changed in the background by an NP. 

Does it matter?  They're just an employee too, have a massive ton of debt to manage, and will be told to toe the line or be terminated.

[Cideous]

2 hours ago, rev ronin said:

Does it matter?  They're just an employee too, have a massive ton of debt to manage, and will be told to toe the line or be terminated.

And that's exactly right.  For you guys that don't work in the more corporate aspects of medicine, the docs are nothing more than co-employees.  They are told to fall in line or we will find another to fill their slot.  It has left them angry and bitter and honestly, I don't blame them.  When I entered medicine 27 years ago, seeing a doc treated like these guys are now a days would have been unthinkable.  Yet here we are...

Edited May 14, 2020 by Cideous

[CAdamsPAC]

On 5/9/2020 at 3:38 PM, PhysicAsstinNY said:

My supervising physician agreed with me regarding the incident. That even though I handled it differently than the nurse Practioner would have, it was still within the standard of care. 

HOWEVER I was advised by the PA/NP team boss  that regardless of what I was told to do by my attending over the phone (which was opposite what the NP had told me), that I must instead follow the NP because she was the senior, was on site, and also “supervises me clinically”.

I was told because I am a new PA, I must ALWAYS do what the nurse Practioner tells me. I was not aware of this and I do not agree with it. 

I'm confused over a PA being clinically supervised by a NP. I don't know where you practice but I suspect there isn't a provision for PA supervision by a  NP in your state PA Practice regulations. If I am wrong someone, please clarify the issue for me.

Edited June 8, 2020 by CAdamsPAC

[CAdamsPAC]

On 5/9/2020 at 4:16 PM, PhysicAsstinNY said:

I was told that if the lead APP instructs me on how to clinically manage a patient, I have to follow it regardless of the circumstances. Even if my attending, who is off site, tells me to do something differently. 

So go home and burn your license and NCCPA Certificate as you apparently don't value them.