Charting on my free time

[Bonosgrrl]

I work with a podiatric surgeon. There is the doctor myself and one other NP. We are both paid hourly. We were told that our charting has to be completed within the time frame of our appointments, so if my last patient is at 2:45 ....its a 15 min appt so im done at 3. Im told if i still have charting to do from the day if its after 3 im doing it off the clock. Thoughts on this? I have always been docume ting my time in and time out when im done and no one has said anything i dont feel i shoukd work for free. And some days it takes me an extra 20-30 min to complete my documentation from the day. The doc says "well im always here extra hours charting and i dont get paid for that" well you OWN the practice!

There is nothing in writing on this, i did not sign any contract aggreeing to this.

[Psychcns]

Can you schedule your appointments earlier so you get out on time. Can you ask for administrative time to review labs, make phone calls and finish charting. I worked one place with continuos appointments and they gave 1/2 hour in am and 1/2 hour in pm for admin time.

Also check out the billing to see how much you are bringing into the practice. There is probably a formula about how much you are bringing in to cover your salary and 20percent or more to overhead.

Might be time to start looking for another job that has admin time built in. And a less clueless boss.

[Bonosgrrl]

They were giving me built in breathing room, 2 morning 15 min appts were given 30 min. But the physician said that is too much and now i get 15 min built in for "breathing room". Im expected to look at labs make calls etc all while seeing patients. I see pstients from 8:30 -12 then from 1-3 sometimes til 4

[PG2018]

You need some paid admin time built in. Block some of your schedule for charting. Other than that, I don't know what to say. Praise psychiatry because I literally do nothing but type while people talk.

[Goldenfox]

Go with the flow . If you know your people and you know that the appointment will be 15 minutes then plan on using 10 minutes for the visit and the remaining 5 or so to quickly document your notes. Obviously the block time will vary depending on the complication of each case, but since Dr. Scrooge won't give you admin time then you have to make it up yourself. No matter what the case is, always be aware of your time and wrap things up so that you have at least several minutes to make your notes before the next patient comes in. Don't save anything for the end of the day. Once your brain gets into the habit of that procrastination it will lead to you routinely staying over after office hours...at first for a little, and then longer and longer.

One of my secrets is I place very small clocks discretely in a few locations in my office, so I can see the time from any angle. I've become an expert at stealing a quick glance at the time (with slightly downcast eyes). Its better than letting patients see me looking at my watch while I'm talking to them (a no-no). In your situation you're not doing primary care so your assessments are very focused and you can make your documentation brief and to the the point.

Unfortunately, admin time is a thing that many of them don't want to pay for---even though they are expecting you to steamroll through the patients at a rate of at least 4 or 5 per hour. For them, its all about the $$$. I'm a big fan of $$$ myself, but some people are just greedy and ridiculous. Still, even if you can stay late to do documentation and get paid for it, not a good thing to do so routinely.

[wannabecnl]

My PCP charts as we go through the appointment. She never did that until they got their new system, and while it may make the appt take a little longer, she rarely has to do anything else before I can pick up my discharge instructions and go. Would that be an option for you?

[cayenne06, MSN, CNM]

I am salary, but have admin time built into my schedule (not a lot, but enough). My regular day is 8:30-4:30, which means I have patients starting at 8:45, with the last appt at 3:30. And a half hour for lunch, which I almost always work through even though it is "unpaid." But I am always able to leave and run errands, or get lunch with coworkers, if I want to.

I can count on one hand the number of times i have had to stay past 4:30. And I am not a fast charter. The more I hear from other NP/CNMs, the more grateful I am for this schedule.

[cayenne06, MSN, CNM]

I do want to add that being able to chart in real time is crucial. As a general rule, i ALWAYS do my ROS and HPI in real time. And whenever possible, I finish my chart (or at least chart my exam and add in all my orders) before moving to the next patient, even if my rooms are full. Of course I frequently am not able to do that, but keeping it as a goal helps keep me on track. And charting in real time helps me be more accurate, even if I do end up having to go back and translate my HPI into less of a word salad. (I check off the damn boxes as required by meaningful use, but you'd have to pry my narrative notes out of my cold dead hands)

It took me a while to get comfortable having my computer in the room with me, because it very easily becomes a wall between you and your patient. But while I still find myself spending more time than I would like with my eyes on the screen, it is not hard to learn the little tricks that help keep you engaged with the patient- simple things like always sitting directly in front of them, looking at them directly when asking questions and hearing their answers (being a good typist is helpful!), halfway shutting your screen and resting your arms on top of it to signal that the patient has your full attention, etc. I also sometimes go over results on the screen with my patient, which I think helps break down the barrier quite a bit.

[ambobam]

Start applying elsewhere... no one should work for free

[ndnursepract]

That's ridiculous. Some charts take 1/2 hour or more to really complete! Especially if you are updating diagnoses, medication lists, etc. To say nothing if you are having to order meds as well. Now I'm in Family Practice, so some visits are short and focussed and some are quite extensive. That may be different in podiatry. The difference with the doc "staying extra and I don't get paid for that" is that he is salaried (I'm assuming), so he actually is getting paid for it. It's part of the job, which he knew when he agreed to it. Sounds like you need to do some negotiating or start looking for a new job.

[sailornurse]

Every minute counts when you are in the exam room, any minute you can save will shave time that can be used to document. Study the layout of exam rooms and see if the layout is efficient for you. Efficient movements, efficient questioning, and an MA that does their job can speed up your moving through patients quicker. You want to be thorough but efficient. But no, I won't work for free.