Advice or Ideas Regarding Patient Compliance...

[AngelfireRN, MSN, RN, APRN]

Just looking for some insight about how things run at my clinic, and what tools or methids I can implement to have the desired effects.

Background: My clinic is touted as a general practice clinic, but we primarily treat pain. This is the job that I left and came back to, after the growing pains sorta tapered off. Since my return, we've really cracked down on dismissals for positive drug screens, verbal abuse, threats, etc. But there's one area where I could use some help.

We have had a sign posted for aeons at the door that plainly states "Do NOT stand and wait at this door. Wait in your car. If the door is locked, DO NOT rattle, shake, knock, or yell through the door. Violating this policy is grounds for immediate dismissal. If the door is locked, anyone caught coming through the back door will be considered a trespasser and dealt with accordingly."

So far, it's not done a lick of good. Yesterday, they started lining up a half hour before we reopen after lunch. This is irritating, not only because it's a violation of rules, but when we open the door, these folks descend like locusts, every last one hollering to be heard over the other, and all try to beat each other to the sign-in sheet. Not that it matters, we see according to appointment time. One memorable day, one patient stood at her car and screamed to the others in line that they better move cause SHE got there first!

The back door statement is not without warrant, people come in through the back when the front is locked, for any and all reasons. People will stand at the door and rattle and scream, sometimes for the whole lunch period.

My question, short of dismissal from the practice, how can I get my patients to comply? Most are not bad, and I love them dearly, but these chosen few, as we call them, just think it shouldn't apply to them.

Any ideas would be much appreciated. Thank you.

[traumaRUs, MSN, APRN]

Hmmm - maybe:

1. Not close for lunch - have a clerical staff member stay and have people sign in as they come in - this would eliminate the rush when the door is opened.

2. If you see pts by appt, then do away with the sign in sheet and just call people from the waiting room.

[AngelfireRN, MSN, RN, APRN]

I'll pass this along to my OM and see if she thinks it'd fly. Thank you , Trauma!

[lovingtheunloved, ASN, RN]

Cattle prod?

[AngelfireRN, MSN, RN, APRN]

We considered that... that and shock collars.

[tigerlogic]

I can't understand why the patients are acting like that. Understanding their motivation to act like that seems to your first step towards intervening. A different sign or a 'no stand/loitering' zone only works if they are literate and have a car to go to.

[Alibaba]

Please forgive me as I have never worked in a place such as you describe, but your post made me laugh!

I am sure to you and to those in the middle of dealing with the issue it is a serious issue.

Have you thought about having a security guard to maintain order in the clinic when you are open, and in the parking lot and by the door when you are out to lunch?

I did my community health practicum at the local city clinic and they had a guard in the clinic enforcing such rules as no talking on cell phones, everyone must wait in the designated area etc. Maybe if the problem is considered bad/annoying enough by the people with the money, they will be willing to part with some of it to provide a guard.

[SueBergRN]

traumaRN,

What a logical idea!!! Seems to be a very simple solution. Some of the other comments suggest that some pt.'s may not have cars and are illiterate. Also the comment on the door seems to be presented in a disrespectful tone. I understand the frustration and why the sign was put up. But it does sometimes pay to have someone from the outside give solid advice. It takes away the personal frustration. Good job trauma RN

[BCgradnurse, MSN, RN, NP]

Has anyone talked to the individual offenders about their behavior? Perhaps they think it's ok if no one has approached them about it directly.

[Earth_Nurse]

Dear AngelfireRN,

It sounds like a very frustrating situation when you are trying to run such an organized clinic! TraumaRUs has a couple of good suggestions, if they are even possible. However, change like that can be difficult, and may not even provide that answer to the problem.

I suggest trying to get at the bottom of the behavior. Have you attempted an open dialogue to really understand why "The Chosen Few", as you refer to those that do no heed your rules? I wonder if you had someone ask these good people about their experience - someone who doesn't provide care or hold any authority over some of these good people if they might share why they do not stay in their cars, and instead line up at the door making attempts to get into the building before they are allowed. I ask this, because I have seen this very behavior in a few different clinics, and here is what I observed and found when I asked about the seemingly rude behavior:

1) Some appointments were reserved on a "first come first serve" basis, so it made sense for folks to stand in line.

2) Many folks that stood had taken the bus or, lacking money, walked to the clinic and had nowhere to sit and wait.

3) Safety was either a real or perceived concern, so standing close to the door felt more secure than lingering in the parking lot.

4) The clinic was only open during traditional business hours, and closed for lunch. Clients/patients had to take time off work for their appointments and hoped that the earlier they got to their appointment, the earlier they would be seen.

I know nothing more of your pain clinic, but I hope this prompts some thought about your client's perspective. I will also gingerly add that perhaps honoring the pain that your client's feel and the shame that they face simply walking in the door might help, too.

Respectfully,

The Earth Nurse,

Former pain-clinic patient

[nurseprnRN, BSN, RN]

You probably have your patients sign a pain contract monthly or every quarter or something that says no early refills, no going to other practitioners for meds, etc., etc., so make sure these provisions are in it if it's important to you.

Have them make timed appointments-- make them at the end of this appointment for next month-- and do not allow line-jumping or being seen late. Make your appointment on time or not, your choice, but that's how you get seen, in order. Doing otherwise will take you down the "I lost my pills/prescription," "My babysitter spilled them in the dishpan," "My house was burgled and they took my pills" kind of road.

If you say something is grounds for dismissal and you don't do it, you're inviting them to ignore any other rules you set. Either do it or remove that sign. That said, I agree c traumaRUs and Earth_Nurse.

[imintrouble, BSN, RN]

Cattle prod?