Can Nurse Annie Call Me Back Please? (A typical day in the clinic.)

I'm a clinic nurse in primary care. Just an LPN but I'm the only nurse they have. I relate to a lot of what you wrote. I have, over the past few years, been burned by some patients who take and take and take. People  I am up at night sleepless worrying about. People I have spent hours and hours for on the phone trying to help out. Finally I realized one day I can't fix everyone's whole life and I had to start setting some limits and start expecting people who are able to do some things for themselves. Personally, I would never give my phone number to anyone. I know someone who gave hers out a lot and she did end up getting texts and calls day and night and got so overwhelmed and burnt out. 

 

I also envy the access your clinic has. My clinic has no appointments and I spend so much time struggling to get people in that need to be seen. I am happy to take a look at someone's wound or edema or take a listen to their lungs...but if I identify a problem I am left with a major dilemma  with no way to actually diagnose or treat the patient as often their PCP just cannot see them for a same day. 

 

I also have to be responding phone calls constantly all day and be available for the MD to do the shots, med administrations, wound care, ear flushes, spirometry etc that they need done during clinic. People on my schedule I have to keep moving as much as possible because the docs are waiting for me and so many people need phone calls. Everything documented in EMR of course. I also do a lot of prior auths, refills, all the home health referrals and communications (and they call a lot!) And write most of the docs letters and do all the FMLA etc paperwork that comes in. Also do all the ordering and stocking (down to the toilet paper and garbage bags) and manage the stare vaccine program and OSHA stuff. 

So anyway yeah clinic work is definitely busy! A different busy than when I worked the floor but still busy. 

So true.It is like a PE! If you are not looking, you may miss the boat! You hit the ground running and most days are fast paced. You also have to know what to do and how to stabilize a patient while waiting for 911. I once had a patient on Coumadin with a non healing  foot ulcer and a tendency to bleed. He went to the bathroom and turned his wheelchair hitting his foot against something and bleed like crazy. Luckily he pulled the emergency cord and we went in to a blood bath and called 911! Between the doc and I, we tied a tourniquet, lifted his leg up and put an IV in, all in the bathroom. I walked out of the bathroom feeling like I was in a murder scene! Lol! Later he came back and thanked us as they transfused him with 2 units in the ED! I joked with him that I was a blood relative at this point!

3 hours ago, NotFlo said:

I'm a clinic nurse in primary care. Just an LPN but I'm the only nurse they have. I relate to a lot of what you wrote. I have, over the past few years, been burned by some patients who take and take and take. People  I am up at night sleepless worrying about. People I have spent hours and hours for on the phone trying to help out. Finally I realized one day I can't fix everyone's whole life and I had to start setting some limits and start expecting people who are able to do some things for themselves. Personally, I would never give my phone number to anyone. I know someone who gave hers out a lot and she did end up getting texts and calls day and night and got so overwhelmed and burnt out. 

 

I also envy the access your clinic has. My clinic has no appointments and I spend so much time struggling to get people in that need to be seen. I am happy to take a look at someone's wound or edema or take a listen to their lungs...but if I identify a problem I am left with a major dilemma  with no way to actually diagnose or treat the patient as often their PCP just cannot see them for a same day. 

 

I also have to be responding phone calls constantly all day and be available for the MD to do the shots, med administrations, wound care, ear flushes, spirometry etc that they need done during clinic. People on my schedule I have to keep moving as much as possible because the docs are waiting for me and so many people need phone calls. Everything documented in EMR of course. I also do a lot of prior auths, refills, all the home health referrals and communications (and they call a lot!) And write most of the docs letters and do all the FMLA etc paperwork that comes in. Also do all the ordering and stocking (down to the toilet paper and garbage bags) and manage the stare vaccine program and OSHA stuff. 

So anyway yeah clinic work is definitely busy! A different busy than when I worked the floor but still busy. 

Wow! That's a lot you are doing super nurse! Thank you for helping your patients in spite of all the work they throw your way! I have to stand my ground and ask them to put patients on my schedule if they want me to see them that day. I am not afraid to say no. I say it nicely though! When I am scheduled to attend interviews for new staff and they put pts on my schedule, I skip the interview as I can  only be at one place at one time.It is a tough job but I am glad I can make a difference.  Don't underestimate the good you can do where ever you are. It does sound like a lot for one LPN.

We don't have access all the time and sometimes I send pts to the ED or Urgent care the same day. If they can wait for one more day safely, I put them on the next available slot. Sometimes I speak to the doctor and overbook them if it is urgent but does not warrant an ED visit or is unstable for Urgent care like an asthma exacerbation.

I had no idea.

I am glad you enjoy your work, but you should not be giving out your personal cell number.  This is violating professional boundaries and will not be good for you or the patients in the long run.

I am exhausted just reading your article.  I think clinics are understaffed just as badly as the inpatient facilities after reading your article.

Bless you, but tighten up on that personal phone number business.

Thank you Kooky Korky! Will definitely tighten up as I know you all have good intentions.I honestly do not give my number to every patient, just 1 in 3000! Lol! Did not mean to exhaust you with details of a clinic day but you are right. It is understaffed as even the management that runs the place do not get what the nurses do! Most people have this "all they do is vital signs attitude "and I am guilty of that too before I started working in a clinic.I guess, when you don't work in a place, you don't realize the details whether it be inpatient or outpatient.

Clinic UC nurse here... yes that sounds like a typical day!  And for the "new grad" comment, the clinics are constantly short-staffed just like the hospitals.    Moving to the clinic requires a salary decrease, no overtime and no holiday pay.  Sometimes they have to take the staff they can get.  The shortage is only going to get worse.  We need to get past the "new grad" prejudice and figure out how to get them up to speed!

We are undervalued and almost everything we do is behind closed doors. Administration doesn't have a clue.

It is frustrating on most days but you touch many lives and after a while we are part of their family----! I would rather a new grad that I could train but that will happen only i f you have input into the hiring process!

56 minutes ago, spotangel said:

 I would rather a new grad that I could train but that will happen only i f you have input into the hiring process!

Exactly! If you have input. I didn't!!! Sometimes it worse having bad help than no help at all, because you have to clean up after them. I have a nurse who was kicked out of 3 jobs before coming to my office, she has been barely a nurse for over a year. It really depends on how savvy and intelligent the new nurse is.

On 6/17/2019 at 12:44 AM, spotangel said:

Wow! That's a lot you are doing super nurse! Thank you for helping your patients in spite of all the work they throw your way! I have to stand my ground and ask them to put patients on my schedule if they want me to see them that day. I am not afraid to say no. I say it nicely though! When I am scheduled to attend interviews for new staff and they put pts on my schedule, I skip the interview as I can  only be at one place at one time.It is a tough job but I am glad I can make a difference.  Don't underestimate the good you can do where ever you are. It does sound like a lot for one LPN.

We don't have access all the time and sometimes I send pts to the ED or Urgent care the same day. If they can wait for one more day safely, I put them on the next available slot. Sometimes I speak to the doctor and overbook them if it is urgent but does not warrant an ED visit or is unstable for Urgent care like an asthma exacerbation.

I do work with some awesome medical assistants who help tremendously. The doctors I work with are also great, I can always discuss concerns and triage calls with them. Some doctors will allow overbooking if it is really necessary and a couple just can"t or wont.  So I do have to use walk in and ED if not walk in appropriate more than I would like to. 

 

Sounds like my clinic. No med Tecs but 4 PCTs, around 25 LPNs and 3 RNs . Around 30 providers including family medicine, ObGyn, Psycologist, psychiatrists, podiatrist , cardiologist, Dermatology NP, nutritionist, social workers, Health educators etc. We offer many services!

Finally!! Someone who feels the same way I do at the end of the day! It’s a tough job! Rewarding but tough. I worked ER and trauma for 20 years half adult and the last half pediatric and also did pediatric flight. Those jobs ended at the end of shift. Clinic nursing continues on day to day you are never finished with everything. In addition 75% of my patients don’t speak English so communication is very difficult and we are a free clinic so resources can be scarce. It definitely takes a village. Keep on keeping on! ✌

Sara! You are not alone. I wish there was a way to capture the time we spend especially with care coordination and translation and a way to ping each interruption that requires more of our time.Unfortunately, the attitude is that more and more can be done as our schedule shows empty slots and we must  have a lot of "free time". The visits spill over the allotted slots between the 80 year old Spanish speaking patient who has the beginnings of dementia, is hard of hearing that has brought all his meds in a pillbox for med reconciliation , the 16 year old pregnant girl who lives in the shelter and needs WIC and the non compliant 35 year old man who feels that if he ignores his HbA1c of 14, it will go away! The reward is when you are working through your lunch hour but manage to get them the help they need and they are truly grateful that you care enough. At least I do have resources that I can hook them up with and for that I am truly grateful!