Normal for clinic nursing?

  1. I have been at this GI office/clinics for a little over a week and I'm contemplating leaving. I have 7 years experience in the hospital in surgery and IR experience and this is first time in clinic but has been VERY stressful. I have been running a clinic within a clinic and feel like there isn't enough hours and know there are not enough hours in the day to get everything done. Between answering 60-70 patient phone calls, helping the doctor with clinic, checking all the labs/reports, making appointments, insurance authorizations, med refills, and traveling to and from satellite clinic there aren't enough hours in the day. I have had NO orientation at all the girl I replaced left before I got orientation. So basically been on own. Other nurses in clinic help when they can but that's not that much. Is this normal clinic nursing? Because I find it much more stressful than the hospital. Oh I also took a $6/hr pay cut for the job.
    Last edit by AJ1980 on Mar 20
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  2. 12 Comments

  3. by   SaltySarcasticSally
    Oh yeah, that's normal! I have been in ambulatory care as an LPN for about 5 years now. I'm now at ab urgent care, we see 100 patients/day between 2 docs. Its insanity but less complicated issues than specialty practices since we do not manage chronic illnesses. You will get used to everything, see if one of the other nurses mind staying with you after work one day so you can write down some tips from them to make your day easier. GL!
  4. by   SaltySarcasticSally
    And can you delegate insurance authorizations to the MA's? The authorizations can take up so much time and it doesn't have to be an RN who does it (at least it my state).
  5. by   Been there,done that
    " I have had NO orientation at all the girl I replaced left before I got orientation."
    Do not refer to your colleagues as girls, part of the problem here is, you are not getting the respect you deserve.
    Now.. ask yourself why the previous clinic nurse cut and ran.. and why you did not get an orientation.
    The job is unmanageable. Doctor is making you do the work of 2 people.. to increase his revenue. Bet his wife has a lot of nice jewelry.
  6. by   AJ1980
    Apparently we aren't allowed any overtime or will be written up. So apparently I'm suppose to have everything done at end of day. So can't stay late to learn.
  7. by   AJ1980
    Its been a challenge and I have been constantly compared to the nurse I replaced. How great she was and how she did it all. It's frustrating.
  8. by   traumaRUs
    Moved to ambulatory care forum
  9. by   cleback
    Don't be too concerned with the comparison to your predecessor. If she was so great, she would've trained you, no? Anyway, you are not her. You bring your own set of skills and gifts. Besides, I have noticed workers who tend to do everything lightening fast tend to make more errors, even without realizing it.

    Some of what you mention can be delegated to MAs--notably the insurance authorizations and appointments (once triaged). If staff is resistant to making these changes, there really isn't much you can do except keep trying. You will get faster with practice but I have a hunch that anyone would have difficulty with the pace. Good luck.
  10. by   TriciaJ
    Quote from AJ1980
    Its been a challenge and I have been constantly compared to the nurse I replaced. How great she was and how she did it all. It's frustrating.
    Yeah, she was so great she ran away screaming. What did it take out of her to be that great? Obviously wasn't sustainable.
  11. by   nursel56
    You'll pick up speed, and get to know people and routines, but it's difficult for me to imagine how all of your responsibilities could be reconciled without more help, or the ability to have some uninterrupted time to catch up on your referrals, callbacks, lab reports, etc.

    The doc might not mind the whirlwind pace, but when patients get irate over their expectations not being met, you'll get the brunt of it.

    Some nurses thrive on the feeling of things being just about to spin out of control, so could fit in after the normal new person awkwardness resolves.

    There are also providers who see dollar signs, and as others mentioned, may view staff as a disposable commodity you replace when the current one wears out or has a nervous breakdown.

    If you're neither of the above types, it may become too frustrating to be worth it, but like anywhere else, there's a culture. I've been fortunate to have mostly good ones.

    Hope it gets better!
  12. by   ivyleaf
    Ditto what nurse l56 said
    I have worked as an ambulatory float for a year and a half now, and your responsibilities sound unsustainable. What do the other nurses and MAs do?
  13. by   sjtamblin
    I'd like to know what the other nurses do as well. We have 8 (soon to be 11) providers in our Family Medicine clinic; 1 MA for each and 2 RNs. Our titles are 'Triage RN' and 'Staff RN' and we do a lot of everything you describe but our main focus is our what our title is (Triage does phone Triage; staff RN does nurse visits).
  14. by   ivyleaf
    In our group (we have 20-something offices) there are a few different nurse roles, although they vary by office and some offices have more than one

    resource nurse- phone triage, nursing visits (meds; MAs do immunizations), help w some case management duties, some pt/disease education

    case manager- hospital follow up calls, BP checks, diabetes/nutrition/htn/etc education, help w in office meds (b12, testo, depo, etc), more focus on quality/outcomes

    offices that don't have a CM have resource nurses that also do hospital follow up calls.

    although mas technically aren't allowed to do "triage" they do "screen" low acuity patient calls (cough or rash without other symptoms, nasal congestion, sore throat). MAs also do rooming (vital signs), Rx refills, immunizations, ppd testing/reads, some bp checks/urines/simple nursing visits, and respond to a lot of pt calls/questions that are not high acuity and do not require a nursing degree. coumadin management is either done by the MD, nurse, or an experienced or certified MA (md always 'confirms'/signs off on dosing changes).

    we also have some specialty offices with specialty nurses-- in derm, helping with procedures; in rheumatology, doing biologic injections and helping with some of the more complicated results calls

    in general, unless you are the person responsible for pt/inrs, the doctors are responsible for their own labwork and imaging results. results letters are generated by the computer (very little work required). we have psr's/secretaries who make the majority of pt appts (unless you are triaging someone and then need to schedule them- then you do it yourself). insurance auths are mostly done by ma's, although sometimes an experienced secretary or nurse will do them as well.

    sounds like OP is understaffed- i dont know anyone in our group who fields 60-70 calls a day! i guess i am also lucky in that our group is run pretty well overall and we are afilliated with a major hospital group with arguably the best hospital in the state. we have a robust group of float MAs and secretaries/front desk folks. i am the only full time float nurse at the moment, although hopefully that will change eventually.

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