Classof2013 Posted June 28, 2012 Share Posted June 28, 2012 My doc wants to give me a lot of freedom, maybe too much. He just told me that he wants me to cover one of his office-visit days, all by myself. He said I could contact him if I'm worried about any of his cases. This is my 6th day of my first rotation. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 28, 2012 Moderator Share Posted June 28, 2012 not cool. autonomy is one thing but as a student a preceptor should always be on site. Link to comment Share on other sites More sharing options...
Classof2013 Posted June 28, 2012 Author Share Posted June 28, 2012 I guess it's time to report this guy to my school. Too bad, because he's been teaching me a lot and lets me do a lot. Link to comment Share on other sites More sharing options...
greenmood Posted June 28, 2012 Share Posted June 28, 2012 You should tell your clinical coordinator. If your school is anything like mine, it has policies in place to deal with situations like this without damaging the relationship between you and your preceptor, or your school and the site. Link to comment Share on other sites More sharing options...
discogenic Posted June 28, 2012 Share Posted June 28, 2012 Can't you just talk to him before doing anything else? Link to comment Share on other sites More sharing options...
greenmood Posted June 28, 2012 Share Posted June 28, 2012 It's easy to say that, but six days into the first rotation when you're trying to learn the rules yourself, it's not always that easy. I'm not saying it's not worth a shot, but what happens if this guy laughs it off and says he'll be fine? Then Classof2013 is still obligated to go to the school (because being left alone at the site is NOT okay) and the preceptor will for sure know where the problem came from. When a preceptor is responsible for so much of your learning opportunity and your grade on the rotation, it's best to follow the policies set in place by the school. We were given a little presentation before being sent out on rotation - any problems with the rotation or preceptor should be brought to the attention of the clinical coordinator. She has had years of experience dealing with these issues and can provide perspective and guidance on what to do, and can visit the site as a "routine" site visit if necessary to make sure things are going well. Link to comment Share on other sites More sharing options...
Classof2013 Posted June 28, 2012 Author Share Posted June 28, 2012 My coordinator said it's o.k. if it's billed as a nursing visit. He said his nurses will be there. The nurses know more than I do. I've already had to tell him I'm not signing perscriptions. Everyone else is complaining that they aren't getting to do things on their rotations, and I've got the opposite problem. Link to comment Share on other sites More sharing options...
Craigk Posted June 30, 2012 Share Posted June 30, 2012 If a licensed provider is not in the house I don't see a patient, period. As a student I'm not licensed to practice medicine, I don't care how it is billed out through the office, if they ain't there I'm at the house sleeping in. Our program has made this clear and up front to us, no preceptor means you get a free day off. Link to comment Share on other sites More sharing options...
Piper Posted June 30, 2012 Share Posted June 30, 2012 My response is.......are you KIDDING me!?? This is NOT okay, and although you say he is a good teacher and lets you do alot, you are a student, not a licensed PA yet. I am truly flabbergasted that your clinical coordinator gave the stamp of approval on this. Link to comment Share on other sites More sharing options...
joanna.nola Posted June 30, 2012 Share Posted June 30, 2012 So essentially you are being supervised by nurses? What exactly are you doing that wouldn't require the doc to be around? Link to comment Share on other sites More sharing options...
Joelseff Posted June 30, 2012 Share Posted June 30, 2012 Your coordinator not only told you to break the law (telling you the doc doesn't need to be around), she offered a cover up (just bill it under RN visit- wth does billing have to do with no supervision of a PA student?). Wow.....just.....wow.... I would talk to my advisor about this if it happened to me. Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Classof2013 Posted June 30, 2012 Author Share Posted June 30, 2012 My preceptor said patients would be coming in to have their incisions checked, bandages changed, and stitches removed. Are these things that nurses usually handle? The nurses will be there and I can make sure they're in the room. I appreciate all your opinions, as this seems somewhat questionable. My advisor is on vacation, but I do like the idea of a day off. Link to comment Share on other sites More sharing options...
primadonna22274 Posted June 30, 2012 Share Posted June 30, 2012 NOT OK. You cannot work when your preceptor is not there. Take the day off. What state is this?! Link to comment Share on other sites More sharing options...
Joelseff Posted June 30, 2012 Share Posted June 30, 2012 My preceptor said patients would be coming in to have their incisions checked, bandages changed, and stitches removed. Are these things that nurses usually handle? The nurses will be there and I can make sure they're in the room. I appreciate all your opinions, as this seems somewhat questionable. My advisor is on vacation, but I do like the idea of a day off. It doesn't matter if you were just doing vitals. You are not (NOT) supposed to see patients without your preceptor. Even if there's another doc there, if they are not your assigned preceptor it is not allowed. At least at my school that's how it was. It's illegal because you are not licensed and the malpractice insurance does bot cover you without your preceptor. That's why they have to sign a contract to be your preceptor. Or I could be wrong.... Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
pagirl82 Posted July 1, 2012 Share Posted July 1, 2012 Initially, you made it sound as if you were going to do regular appointments by yourself. Obviously, that's not OK. This seems more harmless, but are you really sure they're only doing nursing visits? Even if they are all scheduled as nursing visits, you aren't a nurse or nursing student and don't provide nursing services. You are a PA student and provide medical care (or whatever the official wording is for PA students in your state), under the supervision of your preceptor. Everything you do falls under "medical". If you're there and you participate, it's no longer just a nursing visit, liability-wise. I'm not for you about worried about the billing. But if something goes wrong and a patient decides to sue YOU and your preceptor, they can. Of course, they always have that option, but with a preceptor present, it's a lot less likely something will go wrong. You're held to different standards than the nurses. This is a problem because your presence elevates the entire visit to medical standards... at least that's my opinion. I might be wrong. This seems innocent and your preceptor probably just wants you to get a well-rounded experience, similar to sticking a PA or med student with a triage nurse in the ER, but in the ER, your preceptor is still in the building. It may seem overly cautious to object, but that's how medicine is. Your preceptor should know better. I can't believe your clinical coordinator says this is OK. If anyone in this situation should object, it should be your CC. They put you in a bad situation. It would be nice if you could "blame" someone when telling your preceptor you aren't allowed to do this. If you can find someone else in your program to talk to and agree that you shouldn't be in the office do it, so you can have something backing you up. If not, you need to find a way to tell your preceptor that you can't do this. You know him better than we do, so you might know how best to phrase it. Say, "I'm not allowed", say "I'm not comfortable", but definitely speak up. Let him know you appreciate the opportunity, but you can't take it. Link to comment Share on other sites More sharing options...
greenmood Posted July 1, 2012 Share Posted July 1, 2012 My preceptor said patients would be coming in to have their incisions checked, bandages changed, and stitches removed. Are these things that nurses usually handle? Sure, maybe. You said your preceptor was available by phone. If you're truly just observing the nurses, I wouldn't have a concern. But your original post said your preceptor was asking you to take care of these patients yourself. Meaning you will see them, examine them, talk to them, make recommendations. If you touch a patient without your preceptor and something - anything - goes wrong, even if it has nothing to do with you, you are in deep doo-doo. Patient comes in to have his incision checked. You notice the area is angry red, swollen, and acutely TTP. The patient hasn't had it looked at because he knew he had an appointment today. He is hypotensive and running a fever of 102. He loses consciousness in the office. PA student left alone? Deep doo-doo. Not because you wouldn't handle the situation as best you could, but because you're not licensed and you shouldn't be handling it alone. Link to comment Share on other sites More sharing options...
Apreski Posted July 5, 2012 Share Posted July 5, 2012 Good question, classof2013.....is wound care usually handled by the nursing staff? Is your preceptor present on this day normally, or are his nurses running the clinic? I think it may be fine for you to observe to learn wound care techniques. However, in no way should they ask you for specific treatment: wet v dry bandage? ....Should we use silver nitrate? ...etc. I would use this day for OBSERVATION only. I worked in a wound clinic 2 days a week during my plastics rotation. The surgeon was always there and saw every patient, then directed the nursing staff to care for the wound (staple removal, changing packing, etc) After 1-2 days of observation, I was changing packing, removing sutures and staples, cauterizing, etc. Link to comment Share on other sites More sharing options...
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