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On a working interview, I witnessed several situations I was uncomfortable with and also possible violations. Should I report this?

Thursday October 25, 2012
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Dear Donna,

Is it appropriate for nurses to make diagnoses? I had a working interview recently and the physician kept stressing the importance of the medical assistant and the LPN diagnosing the patient properly. He even summoned the MA into the exam room and showed her a recent test on a patient, reviewed the symptoms and asked the MA what test should be ordered. I was taught that physicians diagnose and order tests — nurses assess and schedule or perform the test. The MA did not know to order a CT angiogram based on an abnormal hearing test from four months ago.

Also, I suspect billing and coding violations. All new patients get certain in-office tests, even if their complaints or symptoms don't warrant it, and the right diagnosis code is used to justify the test. There is no benefit check done prior to testing, so all new patients are signing consent forms without authorization and having tests done that costs hundreds of dollars. If the deductible hasn't been met, they are forced to pay for a test they might not have needed.

I was there two hours and saw so much I would be uncomfortable with, if I had taken the job. Should I report this?


Dear Donna replies:

Dear Uncomfortable,

Based on what you observed and have stated above, it certainly sounds like something that should be reported and requires further investigation by an outside agency. Make a list of all you saw and heard and contact your state board of medical examiners. Anyone can report suspected or actual improprieties and the board will, hopefully, further investigate.

If for any reason this does not seem like the right course of action in your state/area and you need more assistance, you can speak to a local assemblyperson, congressperson, or a county/state ombudsman for further guidance.

Best wishes,

Donna Cardillo, RN, MA, well-known career guru, is Nurse.com’s “Dear Donna” and author of “Your First Year as a Nurse: Making the Transition from Total Novice to Successful Professional” and “The ULTIMATE Career Guide for Nurses: Practical Advice for Thriving at Every Stage of Your Career.” Information about the books is available at www.Nurse.com/CE/7010 and www.Nurse.com/CE/7250, respectively. To ask Donna your question, go to www.Nurse.com/Asktheexperts/Deardonna. Find a “Dear Donna” seminar near you: Call 800-866-0919 or visit http://Events.nursingspectrum.com/Seminar.