Those who work in clinics who serve low income patients...

Specialties Ambulatory

Published

Specializes in Clinical Documentation Specialist, LTC.

What do you like about it? Dislike? What is a typical day like? Do you feel you are making a difference? Is there high staff turnover?

I start a new job tomorrow in a clinic who serves majority low income patients and adults and children on medicaid, uninsured and under insured patients. If the patient can't pay they are not asked to, or they charge on a sliding scale based on income.

This is something I have wanted to do for a long time. I have prayed for at least the last three years for a job that would allow me to somehow be involved with/help those in need. I am aware that there will be incredibly stressful, exhausting and challenging days/weeks/months/years, but I honestly feel like I am up to the challenge. If I don't make it, at least I tried right?

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

I work at a community health clinic that is part of a "safety net" county health network (county hospital, as well as several community-based clinics). Our clinic is in a historically "bad" neighborhood (although I've never felt unsafe). About 80% of our patients are Medicaid, 15% uninsured (mostly undocumented immigrants that don't qualify for Medicaid), and less than 5% have private insurance.

One challenge we have is a high no-show rate and disconnected phone numbers. Most of our patients have multiple comorbidities, such as HTN, DM or obesity, and have difficulty with compliance due to multiple social factors (lack of transportation, lack of money for copays, denial).

It is challenging, and many times I don't feel like I'm making a difference. Staff turnover isn't particularly high.

Specializes in Vents, Telemetry, Home Care, Home infusion.

I've worked with this patient population most of my career. Soak up knowledge about resources in your community.

Check what services are available for disabled adults age21-62 as there are Medicaid Waiver programs that can provide homemaker/nursing care for these persons. Over age 62, office of aging then provides services--look for info on Options and Wavier programs.

How to get Meals on wheels, what food pantries available, how to access free medication programs, all info useful for your clients.

Best wishes in this new position.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Yes, community resources are HUGELY important.

Specializes in Clinical Documentation Specialist, LTC.

Thank you klone and NRSKarenRN.

NRSKarenRN, part of my job will be, as I understand it, helping find resources in the community for the patients to utilize, so I really appreciate that advice. There are a large number of Hispanic patients who use the clinic so I think this would be a good time to learn Spanish. The receptionist speaks Spanish, but I would love to learn the language!

BTW, from what I understand non-compliance is a big problem as well. They are trying to find a way to encourage compliance with follow up appts., meds., nutrition, etc...But it's been a real challenge.

Specializes in nursing education.
I've worked with this patient population most of my career. Soak up knowledge about resources in your community.

Check what services are available for disabled adults age21-62 as their are Medicaid Waiver programs that can provide homemaker/nursing care for these persons. Over age 62, office of aging then provides services--look for info on Options and Wavier programs.

How to get Meals on wheels, what food pantries available, how to access free medication programs all info useful for your clients.

Best wishes in this new position.

Yes, definitely keep a list of all your resources. Include your state Medicaid formulary (ours changes at least once a month so I keep the link, never print it) and the WalMart 4$ list. I have made a lot of connections in the community over the past few years- it is invaluable to keep all the phone numbers, every case manager's name and number in the patient's chart.

Probably the two most important things are love your patients and listen more than you talk. People sense when someone truly cares about them. Without that all the teaching and advice you give is nothing.

Specializes in nursing education.

As far as adherence goes, it is all about the relationship. An excellent resource book is Facilitating treatment adherence: A practitioner's guidebook. Meichenbaum, Donald; Turk, Dennis C. New York, NY, US: Plenum Press. (1987). 310 pp.

Get it cheaply on Amazon- it's timeless.

Specializes in Clinical Documentation Specialist, LTC.

Thank you so much SHGR! I will order that book ASAP!

BTW, from what I understand non-compliance is a big problem as well. They are trying to find a way to encourage compliance with follow up appts., meds., nutrition, etc...But it's been a real challenge.

In my personal experience, the most frustrating part of any given day (besides learning where to find those "back-door" services, grants, and what church or civic organization might be able to help THIS month!) was the failure of patients and parents of patients to follow through with treatment guidelines.

What helped me was learning to assess the "WHY" behind what we call non-compliance.......

There are patients who simply do not understand what we try to teach, either due to low-literacy, mild development and cognitive issues, language barriers [this may be just words that mean something different, not neccessarily a FOREIGN language] or fear of the authority figures we represent to them.

Others lack the resources....for example, it is hard to keep to a low sodium diet if you don't have a stove or fridge and eat packaged or fast food only.

Some patients are too impaired to process what is going on around them. Others would rather spend their last $4 on beer rather than medicine.

Other folks like the attention or secondary gain that they get from being in the patient role, while others do not value their own life and health enough to think about it or perform basic self care. Others, of all ages and genders, are being abused at home.

And, there are those who are just jerks, who want a pill to fix their lives without doing anything about lifestyle choices.....and who get royally Tee'd off if they don't get what they want when they want it, and who are rude and abusive to everyone around them.

I am sure you will notice some patterns of your own, but making the assessment of the REASON for not following through is your first step in attempting to correct the situation, within your power. You do what you can for those you can help, and accept that some people WANT to be sick or are just nasty and irrational. Don't let the latter make you jaded and cynical about the rest!!

Specializes in nursing education.
...the failure of patients and parents of patients to follow through with treatment guidelines.

...And, there are those who are just jerks, who want a pill to fix their lives without doing anything about lifestyle choices.....and who get royally Tee'd off if they don't get what they want when they want it, and who are rude and abusive to everyone around them.

... You do what you can for those you can help, and accept that some people WANT to be sick or are just nasty and irrational. Don't let the latter make you jaded and cynical about the rest!!

These don't have anything to do with socioeconomic level. In my experience, people are mostly nice, and there are some pips- doesn't have anything to do with money.

The literature on non-adherence is interesting. Research shows 50% or so of people are non-adherent; meds being the most likely to be adhered to, diet and exercise the least; adherence drops over the duration of a condition; and it really doesn't have to do with education level or how much money the person has.

Adherence is most closely correlated with the relationship between the provider and the patient, and the motivation of the patient him or herself. Social support does help (eg, a family who eats healthy meals together or who supports another in changing). But developing and maintaining those relationships with your patients and their families, that is gold. Let them know they can trust you. Then they will tell you the barriers and you can help them work through it. You will be surprised what the barriers are. It could be anything from "the pill made me feel funny" to "my son was shot and killed last week" to having no idea that a McDonalds smoothie has like 90 grams of carbs in it despite looking so healthy! But you will never know these things unless your patients believe you care and can help them.

These don't have anything to do with socioeconomic level. In my experience, people are mostly nice, and there are some pips- doesn't have anything to do with money.

Agreed that this is not limited to any socioeconomic level....BUT we WERE discussing a low income clinic specifically, correct??? Please don't imply that I was shooting anyone down.

Specializes in Vents, Telemetry, Home Care, Home infusion.

National Nursing Centers Consortium has list of programs others have found helpful:

NNCC ยป Programs

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