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?

Doctor Tofu wrote:
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)?
<snip> 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?

Does your state's laws require an appropriate certification or license
to do invasive procedures? She may have been a dispatcher for EMS or
been an EMT on a transfer unit where no ALS was done and a ward clerk on
an ICU. The state EMS authority in the other state should be able to
provide certification history. (Some states rely on USDOT
certifications, but that history should also be available.) The nurse
licensure authority should be able to supply licensure history, if any.

She's performing invasive care under kind of physician medical
direction. Is that you, when you're on duty? In my experience (20+ years
licensed paramedic in Texas), it seem to me that when you set someone to
perform care, you're on the hook. I suspect that turning the job over to
someone whom you doubt has the ability to do it is abandonment or
something like it.

You have my sympathy. We both know that the boob who's giving alergy
shots and starting IV's likely wouldn't recognize or responde properly
to anaphylaxis and is not likely double checking med lables. And someone
with obviously limited or nonexistent clinical experience is especially
dangerous doing triage in an environment where serious stuff isn't
anticipated, since she won't be tuned up to catch the true emergencies.
I hope they'd rather have you than her, in case you have to bring it to
a head.
--
Gerald Clough
"Nothing has any value, unless you know you can give it up."

> 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?

As a physician you should remember that you are ultimately responsible for
the care of your patients. I can tell you that your situation sounds strange
to me though since you have not taken any affirmative action already. I have
seen many physicians instruct the nursing staff that "so and so" is to never
touch a patient, institute peer review, or in some cases demand that a
certain nurse be fired. While I don't know how things work where you are, if
your chief of staff doesn't care about the performance of the nurses, you
are in a lot of trouble.

My advice is get yourself into risk management right now and tell them what
is going on; don't make their problem yours by doing background checks. You
will probably be able to throw around a lot more weight than you seem to
indicate. You may want to also call your insurer, particularly if no one in
your clinic listens to you. Remember that you are already the scapegoat
because the people she is screwing up on are your patients, not hers. Make
sure you document every error for peer review (use the appropriate forms),
and go to the actual review and don't sugar coat anything. If your clinic
doesn't take action, consider filing a complaint with the nursing board. You
may have to go out of a limb and take a stand against her, but your nurses
are your problem. If this person really is incompetent, you do not want to
wait until she messes up a blood pressure reading, and you get a malpractice
suit from prescribing a routine birth control method.

On Sat, 22 May 2004 10:41:03 -0400, drtofu66@yahoo.com (Doctor Tofu)
wrote:
Her skills do not correlate with her reported background which is whyI would like to ask my supervisor for permission to look at her resumeand do a background check on her past employment.

You have not only the right but the DUTY to tell your supervisor of
your suspicions if you believe that her "skills" are endangering
patients.

And you may be focusing on the wrong problem. The problem might have
nothing to do with her resume, but simply that she is incompetent.

In any event, you should talk to your supervisor immediately.


*Dan Evans
*Author of the Tax Protester FAQ
*http://evans-legal.com/dan/tpfaq.html

In article <6dpua0dqtend9ps8od92ofprtp46tnsgiv@4ax.com>,
Doctor Tofu <drtofu66@yahoo.com> wrote:This is going to be a long post and I am sorry about that. I'llsummarize my questions up front and if you are so inclined to read therest of this I'd really appreciate it and any advice you folks mighthave. The ultimate question I have is: who is allowed to checkreferences on an employee's resume and where is the line betweenprivacy and background checking drawn? What can I do to protectmyself and the other clinical staff in the event that an incompetentstaff member actually harms a patient (we work in healthcare,obviously)?

[[.. munch ..]]Anyone have any advice to try to 'out' her to the clinic director orcapture her lack of motivation to improve? And to protect ourselvesfrom blame for her mistakes?

By all means, put the concerns *in*writing* (not 'email' but an actual
inter-office memo, on paper), to the clinic director.


Your concerns are =not= that she may have 'overstated' her qualifications,
(even if true, just 'stay far away' from that matter).


Your concerns are:
1) risks to patients, due to deficiencies in professional skills.
2) apparent inability to perform basic job functions, 'adequately'.
3) apparent dis-interest in remedying #2


If nothing happens in a reasonable time, send the *same* memo _again_, adding
only a cite to the previous memo, by date, and content, with a copy to the
college legal dept. (see following, about 'sensitive departments')


There is always the 'exploiting sensitive departments' approach.

Look for 'areas of responsibility' that have "hot buttons", and figure
out what it takes to push _those_ buttons.

Example: You have malpractice insurance, no?

I bet the terms of the policy _require_ you to notify the insurer of
possible 'risk conditions' that you become aware of.

This person, working (sometimes) under your direction, it seems
_could_ be a source of claim against your insurer. ASK THE INSURER
what you need to do, to reduce/eliminate the possibility of a claim
against you.

If it is an 'umbrella' policy, covering all the professional staff at
one time, so much the better. If it is funded by the college, that is
even 'more better'.

Another 'sensitive department' is the college's _legal_ department.
Express concerns about legal liability, due to clinical errors.



An extreme -- but, nonetheless, often effective -- approach is the
"bureaucratic bomb" -- invented (to the best of my knowledge) by an American
officer held prisoner-of-war in Germany, in World War II. It worked as
follows:

Any time one of the guards did 'something' said 'Senior American POW'
"didn't like", regarding the treatment of his men, he just sat down and
wrote a letter of complaint.

To the camp Kommandant.
With a copy to the military unit for the POW camps in the area.
With a copy to the military headquarters that ran _all_ the POW camps.
With a copy to German High Command, in Berlin.
With a copy to the International Red Cross prisoner protective agency.
With a copy (via Red Cross) to Supreme Allied Headquarters, Europe
With a copy (via Red Cross and Allied HQ) to U.S. Dept of War.


The bomb goes off:

1) the Kommandant gets the letter, calls the guard in, and chews him out.
2) a couple of days later, Unit HQ calls the Kommandant, demanding an
explanation; guard gets chewed out again.
3) a few days after -that-, main HQ, contacts unit HQ, demanding
explanation. Unit HQ calls Kommandant demanding more info, to keep
main HQ happy. and the guard hears about it again.
4) A week later, Berlin is demanding explanations -- and the dominos
topple.
5) Red Cross files a complaint with Berlin --- bing, bing, bing, and
the guard hears about it _again_.
6) Allied HQ files formal complaint with Red Cross, who lodges -that-
complaint with Berlin.
7) U.S. War Dept. files, via Allied HQ, formal complaint with Red Cross,
who -again- requests explanation/assurances from Berlin.

Three to five _months_ later, and the guard is *still* being reminded of
his transgressions.

Camp Kommandant isn't very happy either. (*understatement*).

Note: the guards were _not_ stupid! It didn't take them long, at all, to
learn that it was a really BAD IDEA(tm) to do something that the senior
American POW would disapprove of.


The technique is applicable to any large bureaucracy. Original message to
the immediate supervisor involved. 'Copies' to _every_ level on up the
management chain; all the way to the Board of Directors, or equivalent.

CAUTION: It _is_ a '*big* gun', not something to be used 'casually'.