This is going to be a long post and I am sorry about that.
I'll summarize my questions up front and if you are so
inclined to read the rest of this I'd really appreciate it
and any advice you folks might have. The ultimate question I
have is: who is allowed to check references on an employee's
resume and where is the line between privacy and background
checking drawn? What can I do to protect myself and the
other clinical staff in the event that an incompetent staff
member actually harms a patient (we work in healthcare,
obviously)?
The background: I am a physician who works at a college
student health center. For the most part things go smoothly
but there are times that it can get very busy to the point
that extra hands are needed to help draw blood, triage
patients, start IV's, etc. Last year, a clinic manager was
hired as an administrator to help deal with scheduling
issues and also to help out clinically; we (the clinical
staff) were hoping that the hire would be a nurse
practitioner so that this person would be able to triage
(and treat, even) patients when appointments are no longer
available, give allergy injections, put patients in rooms,
start IV's-- pretty much be a jack of all trades when things
get crazy busy to absorb the extra work.
Unfortunately, a nurse practitioner was not hired (for
whatever reasons-- salary demands possibly). This person
holds a BS in nursing but we thought-- ok, a good nurse
should be able to do most of what we had hoped (though she
would not be able to *treat* a sick patient since she is not
a clinician as a NP would be. At best she would have to
determine who needs to be seen now versus later). She seemed
to be overwhelmed with all of the job duties at first but I
thought to myself that it was just growing pains and that
she would improve.
After 8 months it became apparent to me that she would not.
For one, despite her claims to me that she worked for an
ambulance company, worked in a cardiac intensive care unit,
and that she holds a BS in nursing, she has had a LOT of
trouble drawing blood and starting IV's. Other nurses in the
clinic have REPEATEDLY offered to help her with her skills
in these and other areas and she invariably gives a excuse
that she needs to work on the schedule, has to work on this
or that-- anything to avoid actually working on her skills
it seems. She had mistriaged at least 2 patients (one was
mine, another was another nurse practitioner's) and sent
them home when they should have been seen right away. And
she seems to have no concept of sterile technique when
catheterizing patients. Even worse, routine tasks that she
should know how to do by now just by virtue of working here
for 8 months (like how to check the computer for schedules)
she cannot remember how to do them.
I (and several other nurses and nurse practitioners) have
taken our concerns to our immediate supervisor (the senior
physician) who in turn has taken it to the director of
student health. The nurses also took their concerns to the
director directly before the senior physician did (since the
director is a nurse also) and they were told to essentially
teach the clinic manager the needed skills and help her out
(yes, the clinic manager is supposed to be the nursing
staff's supervisor and yet they are supposed to teach her
nursing skills that she should already have). The senior
physician and medical director also might have met with the
clinic manager though I do not know what was discussed. The
effect on her performance has been nonexistent in my
opinion. I have offered to help her in any way-- especially
with triage and patient assessment but after one half-
hearted meeting where I don't think she heard a word I said,
her efforts to improve have evaporated. Since one of her
excuses for her poor performance has been that people
haven't helped her with her work and haven't shown her how
to do things, I sent her a followup email outlining my
position on what she needs to improve on, gave some specific
advice on how to improve, and pledged my help. I don't
believe she has followed any of that advice but at least I
have a written record of offering to help and how she can
improve some of her skills so that excuse is dead (I hope).
Since I can't be watching this woman all the time to make
sure she doesn't make any bad mistakes I am fairly certain
that a patient is going to be hurt by her and I don't want
to accept the blame for her. And I don't want her to be able
to blame any of the good nurses that we have. The only thing
that keeps things reasonably safe is the relatively low
acuity level of our patient population. Really sick patients
rarely come but it can happen. I have recommended that the
nurses keep a written record of when they offer to help her
with a certain skill (whether she accepts or claims to be
too busy) and sign and time/date it each time. This way we
can demonstrate that they made every effort to help this
woman and she just did not accept it. Is there a better way
to do this? Any way to get a time-stamp of some sort on the
record so they won't be accused of faking it later on? It
doesn't necessarily have to be legally accepted (though that
would be great), just something more believable than a
written piece of paper. [More bizarrely, the word to us from
the clinic director is that her position is "only 10-15%
clinical" so her clinical skill deficiencies aren't all that
serious(!)].
Her skills do not correlate with her reported background
which is why I would like to ask my supervisor for
permission to look at her resume and do a background check
on her past employment. I am certain that she
lied/exaggerated her skill level. If that is true and I can
show that to the clinic director, I can't see how anything
but immediate termination would be the outcome (but maybe
I'm just being naive about that). Still, I am so dumbfounded
by Diane's lack of medical knowledge that I feel I must do
SOMETHING to keep my patients safe. [BTW-- there is no
nepotism or cronyism involved here. She comes from another
state far away and wasn't friends with the clinic director
before in order to get the job. My university just got that
lucky]. And I sure don't want to be the scapegoat here.
Anyone have any advice to try to 'out' her to the clinic
director or capture her lack of motivation to improve? And
to protect ourselves from blame for her mistakes?