Does your office/clinic allow walk-ins to see the nurse?

[BlueLightRN]

I find myself being called to the front desk 30 times a day for someone who "just wants to talk to a nurse" and oftentimes for a question that the front desk could have answered or a problem they could solve without making me walk all the way up there and interrupting my work. I am curious, does your office just allow patient to walk in and bother you 20+ times a day? No appointment, just walk in and demand a nurse?

[Ella26, BSN, RN]

Yes I have on average about 1-2 patients a day that will walk in and want to talk to a nurse. We also have a triage/voicemail line that we check several times per day. We do not have a policy against walk-ins.

[BlueLightRN]

What do your walk-ins usually need though?

[Ella26, BSN, RN]

It is usually stuff they could have called to ask, but most are there for allergy shots so while there they want to speak to the nurse. The ones that just walk in, it could be anything from breathing problems to them telling us the insurance/pharmacy wants a prior auth.

[lshell7]

I work for Kaiser, and one of the things I like is that they have specific RN appointments that can be made. (Kaiser uses LPNs, but few MAs where I am, and they have their own appointments as well like BP checks, immunizations, etc.) This way, you have a schedule and a set number of visits that can be done in a day, just like the advanced practitioners.

One of the clinics I float to had a real problem of allowing the walk-in patients to "talk" to the RN in the lobby - often, they were getting triaged and free medical advice and using up our time. We finally put our collective foot down, and insisted that the front desk - unless it was a STAT need - advise the patient that IF there is an opening for the RN, AND if it was appropriate for the RN to see the pt - they would be put into the schedule. So this still requires a minute of your time to determine if you can even see the patient. The office uses Sametime, a version of an IM software, so there's not as much phoning or paging from the front desk.

You should float the idea to your office manager that the office have a policy of charging for RN visits - and then you make 10-30 minute visit schedules that can be filled in by the front desk. Patients who are walking in with chest pain etc will always have to be attended to - but the walk in "elbow pains" etc can be put into your schedule and wait, or they can go to an urgent care/ED to be seen.

[BlueLightRN]

Unfortunately where I work even the nurse's visits (which we do have a schedule for) are free and most of our patients uninsured or medicaid so there is no charge. But the system is that the schedule is totally full already and they still call for walk-ins who have "questions" or something.

[klone, MSN, RN]

I think it's that way everywhere (cannot charge insurance for nurse visits). Unless the care provider lays eyes on the patient during the visit, it's not legal to charge for the visit.

[BlueLightRN]

My time is worth nothing I guess. I just am so tired. Tired of running. Tired of questions that the secretary could answer, and tired of requests I can't oblige.

[pfchang]

I don't understand why a secretary would call you for a question he or she could handle. Are there major personality issues in your workplace? Toxic employees? Can you schedule a meeting with your supervisor or admin or someone? It sounds to me like a workflow review is needed. I am sorry for what you are dealing with.

i just read back again and you mentioned that there are other nurses who are always on break so you get called. Are you the least senior? Are you bring taken advantage of by nurses, clerical or both? Are the nurses sharing the workload in other ways or is this passive aggression? You may need to decide how or if to confront this behavior.

Telling you that you need to see every patient who asks for a nurse bc " what if they really need a nurse and something bad happens" is asinine and a waste of money. Something bad can happen when Mr Jones comes in with chest pain and you are unavailable because you are doing something that could have been handled by someone non- licensed.

[pfchang]

Also nurse visits can be charged for under specific circumstances. Not that you can do this, bluelightRn, or that it would help your situation. But I share this for others' general knowledge.

[klone, MSN, RN]

Can you describe under what specific circumstances nurse visits can be charged in ambulatory care?

[pfchang]

I think nurse visits can be charged for educational purposes, like DM and anticoagulation teaching. Also for INR fingersticks and resultant dosage education. But I believe the nurse visits can not be charged for on the same day as a provider visit. It has been awhile so maybe this foes not apply anymore. But I would check it out with insurance companies and your billing people. I do remember being amazed at how much nursing care is umcompensated, though.

[BlueLightRN]

It is a toxic workplace and I am trying to get out. Only RN, least senior employee though, every other nurse is an LPN there and they treat me like I am an idiot yet don't know why potassium is given with lasix...