[work4choc]

I am certain this varies but I was hoping to get a general idea of how common it is for RNs in the outpt setting to perform hands on patient care duties? I am considering a BS to BSN program (former pre-bsn student - 10 years ago! - who changed majors to health education now wanting to go back to nursing) and would like to work outside of the hospital setting, with clinic or physician office work being one of the areas I am interested in.

In my experience as a pt and a parent of 3 small children, the RNs seem to be chained to a desk or phone most of the time, and the MAs or techs do all of the hands on work. I would like to work as an RN but would also like to perform some direct patient care and patient teaching. I would like to develop a relationship over time with the patient/patient's family. Is this possible?

I would prefer to work as an RN over an MA for many reasons, but would not want to do nothing but telephone triage, etc....all day. I don't think I would want to be limited to the scope of an MA, but don't want to trade that for drowning in a sea of phone messages and paperwork.

Are there certain specialites or clinic types that allow the RN more opportunity to interact and care for patients? Does it vary by size? Is it more a factor of what the individual MDs delgate as tasks to be performed by the RN vs the MA?

Thanks for any input.

[bestblondRN]

I work for a large, incorporated group practice with a number of specialties and each office does their own thing when it comes to care models.

There are practices in which the RNs are used only for phone triage, paperwork and refills and the MAs have the clinical responsibilities (rooming patients, VS, chief complaint, meds, etc. I have worked in Neurology and Neurosurgery, both of which have RNs working for 2-3 physicians, NPs working with one physician, and no MA or only one for an entire practice of 20 MDs. Obviously, this is the other end of the spectrum--we clean and stock our own rooms, perform phone triage, run our clinics (4 days per week), set up surgeries, exams/testing and perform other coordination of care duties, fill out all LOA and disability paperwork, make appointments at times, and see patients in Nurse Visits on half-day or non-clinic days for suture and staple removal, reassessment and education. As I have said in the past, I feel like chief, cook and bottlewasher! There is almost never downtime for lunch or even a bathroom break at times.......

If it were in my power to design a staffing model which accomplishes the end of excellent patient care and running the clinics smoothly, I would have MAs partner with RNs (1-3 depending on the patient load and clinic schedules)where the MA spends 85% of their time in clinic, 5% of their time stocking, ordering supplies and straightening up rooms, and 10% of the time returning calls that are appropriate to their experience level as well as doing some of the coordination of care--setting up exams, tests and such. RNs would continue to do phone triage but would also see all new patients to establish a relationship, obtain a history, and identify specific care and educational needs. Return patients should also have access to the RN as needs are identified. I believe that RNs are terribly under-utilized when they are "chained to a desk" and never see patients or perform hands-on care or teaching.

Every office or practice should be evaluated individually, and the question of how a RN is utilized within the practice should be asked during the interview. I would also find out how flexible they are about having RNs develop educational programs and actively perform teaching and other care responsibilities during clinics.

Good luck to you in returning to Nursing!

[work4choc]

Thanks for your response!

[ms_orion]

I agree with bestblondeRN.........I have been working in Family Practice for 13 years. I love the relationships that are formed with our patients and their familys. I also assist with procedures; colposcopys, sigmoidoscopys, biopsys...etc. Whatever your providers specialize in at the clinic will determine what skills you will use. I have assisted with treadmill stress tests, appplication and removal of holter moniters, ekg's, typanograms..................
On occasion we will do catheterizations and rarely IV therapy. We do many, many injections. Alot of time is spent on the telephone referring pts to specialty clinics and discussing problems/solutions with pts on the phone.
I think each area has its good and bad/ favorite and less favorite duties.

[stephiebob/lpn2rn]

I work for a solo practice & I'm the only nurse so I do it all! Phone, RX call in's, lab draws, vitals. It's nice to work one on one with the doc.

[cleo]

The RN's in our office are telephone triage and patient education. Through out the organization, we are multi specialty clinic, RN's are utilized in the specialty areas, oncology, urology, etc. to do specialized procedures, minor surgery, and some testing. RN's are alos the preceptors for new staff. When interviewing for the position I would ask how exactly what is the role of the RN in that particular department.