clinic nurses-late patients?? What to do?

jadednurse · May 25, 2003

At the clinic I managed there were 4 physicians, each w/ her own approach to dealing w/ late-arriving patients (which of course made my job miserable!). It took awhile for new nurses there to get to know the doctor's styles. One would see all her patients, no matter how late they arrived...and she was ALWAYS behind; another would require that patients reschedule if they were more than 15 minutes late...and she was rarely behind. Does anyone else see the connection there?

I recently visited my doctor and had to sign the wonderful HIPPA inspired Disclosure of Privacy paperwork. In addition to that I had to sign a form that I understand that if I miss an appointment, cancelled less than 24 hrs before an appt or arrived so late for an appt that it had to be rescheduled, that I would be charged for it. OK, since this has become a rather standard practice, fair enough. Although, I'm toying w/ the idea of making the doctor sign a form that states that if the same courtesy is not extended to me than I get some sort of reimbursement for my valuable time being wasted!

nimbex, RN · May 25, 2003

Devil's advocate here....

Could the patients be comming late... due to constantly WAITING??

I have seen MANY doctors due to various problems and have NEVER been seen on time, mind you I arrive ON TIME. I expect the same courtesy. It is different if the doc sticks her head out in the waiting room and announces "I'm sorry to keep you all, several patients have needed more of my time... thanks for waiting".

Might solve the problem.

jadednurse · May 25, 2003

Originally posted by nimbex
Devil's advocate here....

Could the patients be comming late... due to constantly WAITING??

I find myself doing that more and more...

renerian, BSN, RN · May 25, 2003

My doc has a policy, more than 10 minutes late you lose your appointment and have to pay 10.00. Do it three times, and they no longer are considered their patient. What bugs me is sometimes I have to wait an hour to see the doc.

renerian

luvbug · May 25, 2003

I am so happy about what you all had to say. I can definitely identify with the "what if the prvider is running late" thing. We geberally go out to the waiting room to let all of the patients knowif the dr. is running late, and we leave it open to them if they want to reschedule or not. I am also glad to see that many of you have similar policies in place that we have been condsidering proposing to our lead nurse. It has become so difficult, because we hardly ever turn anybody away, so people are now under the impression that no matter when they come, we will still see them. We have only 1 time of the day to 'catch up' but it never works that way, because our docs have to go into the next town (1/2 hour away) to see their hospital patients over their lunch hours (which is also their 'catch up' time). I have also been the patient in the position where you have to wait an extraordinary amount of time, but being that I work behind the scenes, I tend to be a little more understanding and I allow myself plenty of time to get back to work after said appointment. Our orthopedic doctors are notorious for having long waits, but most of our patients know this and bring along a book or something. :) The day that I was venting was just SO bad, I don't think I had a single one of my patients on time. We have many patients that we KNOW will be a certain length of time late, so we tend to use those appointment slots to overbook if we have to. Sad when you can almost count on somebody being late-or not showing up at all. Again, thank you all for your input, I think it will be good facts to support my reasoning when I bring this issue up (again) at our next staff meeting.

Bookie · May 25, 2003

This sure is a problem. I never rrrealized how severe. I used to see a doctor who reoutinely kept me waiting out front for at least an hour, then another hour or more in the exam room. She never returned calls, neither did her staff even bother to call. If I really wanted to talk to her, I used the exchange after hours. Finally got tired of it and found someone else.

As far as late-arriving patients, I would make them wait rather than make an on-time arrival wait while the late one was seen. That's not fair to the on-timer. I see there's no easy answer. I do understand why people hate to go to the doctor, though. I've seen women with squirming, screaming babies and restless toddlers have to wait for as long as 3 hours, routinely. What a bunch of hooey that is. It shows total lack of respect for the patients. As for that drug rep, I'd have told her we don't want her samples or her donuts and not to come back any more. BTW, to luvbug, must nurses work late routinely, significantly to accomodate the late-ies? Does your manager also work late?

luvbug · May 26, 2003

about the manager working late thing-funny you should ask. Our actual "manager"works in the main clinic, so conveniently, she is not on the soam site as us, and does not know how busy we are. she can see the schedule for the day (for our office) and just goes by that. But, like I mentioned, we know what patients take the longest and where we can overbook things, etc. It all presents a sticky situation alot of the time, and cause for tempers to flare. But, for the most part, I am able to grin and bear it. Better now that I have this site to vent on :) I try to work late whenever possible, but I have a daycare where I have to pick up my daughter by 5:15pm. I have had to pick her up and bring her back to work with me, but what else can you do?? I like my job, so it is all worth it in my eyes. Well, so far!! :chuckle

James Huffman · May 26, 2003

If someone (physician or whomever) is consistently behind schedule, this is a scheduling problem, not an emergency.

If you are consistently made to wait more than a few minutes, you need to speak up. Explain to both the provider and the receptionist that you have alloted the time for this appointment, and you expect to have that time respected.

If that brings no results, you are dealing with someone who ultimately does not respect you or your time. Period. I would find someone who does. I would also write them a letter of complaint, explaining why you are leaving.

Persistent tardiness is an attitude problem. It's a way of saying to the world "my time is more valuable than yours." If you tolerate such rude behavior, you will continue to get it. A customer service attitude is long overdue in health care facilities, and if we -- as consumers -- insist on it, it will -- eventually -- happen.

Jim Huffman, RN

http://www.NetworkforNurses.com

Vailgang · May 26, 2003

Luvbug,

I work in an office that is historically behind but that still doesn't mean the patients can show up late. I tell them to check in and that they can run an errand if they need to. I again feel that it would help you to make a policy. My front office staff doesn't tell the patients this information and it makes the patients that wait mad.

I know how it feels to love your job but need to vent and know that is what we are here for.

I also know how it is to work late. I get done anywhere from 5:30-7:00pm. You never know when we will be done. I love my job and when I consider leaving I always decide to stay.

I do have a question for you and other office nurse. Do you help with the scheduling? I mean if there is a patient that needs worked in do you help decide where to schedule them and if they need to be scheduled?

Nurse Ratched, RN · May 26, 2003

Vailgang - we have what we call "clinic office" slots. If someone was seen by a provider (doctor, NP, PA) in the past three weeks for the same problem and comes in through the walk-in area, then they are put in the clinic office slot so their chart is requested. Then it comes to the nurse covering for that provider to decide whether it's something the provider needs to address today, or whether it's a matter of further education needed from the nurse or what have you. Sometimes it's a problem that is well over three weeks old (screening nurse didn't get the whole story) and we either set them up for an appt time with the provider during their next available time, or if the patient insists, we can send them through walk-in to be seen by one of the providers covering that area. If it's emergent, we obviously treat that as such.

We run pretty well on time for appts when we stick to our policies. Walk-in area can be an ugly wait at times, but it also moves smoother when we follow our policies for that (for instance, patients are seen for 1 problem in walk-in, not four - i.e. - I have a horrible cold and my lower back has been hurting for 8 months - pick one for this trip. We also do not do routine physical exams through walk-in - pts must set appts for those and waiting til the last minute to schedule one does not make it an emergency problem. We run into that a lot this time of year as students are preparing for overseas travel or need physicals for summer work, camp, scholarships, etc.)

Vailgang · May 26, 2003

NurseRatched,

I work for two neurosurgeons and so only have one doctor in the office at a time. We don't have a walk-in, which would be nice. They are looking for a PA but may be a while. One of the doctors has been deployed and won't be back until July. Speciality scheduling is difficult. The reason I am asking about scheduling is that I used to be the office manager and now that I am "just the nurse" I am trying to make boundaries as to what is a nurses job and what was my manager's job.

SmilingBluEyes · May 27, 2003

Originally posted by RN2007
I just had to bring this up, because respect for peoples time works both ways. What about the drs. that have their office staff to double and triple book their patients appointments, and make their patients wait in the lobby for 2 hrs or more on a regular basis, while those pesky pharmaceutical reps zoom in and out of the office without an appointment? How are the patients respected when this happens and where is the "patient service" when it happens? Oh, and this used to happen to about 3 of my primary care dr. offices, all of which I had to quit seeing each because of the office problems such as this. Sure, I understand that all offices are not this way, so kudos to your office for not being that way and be glad that it is not. And most definitely, patients should be on time for their appts. or call if they are late, and they need to be more understanding and should know that if they are late that they just might need to be rescheduled.

EXCELLENT POST!!!! Bravo! I SO agree. If you want patients to respect YOUR time (the doctors', actually) then it would certainly help if the respect were reciprocated. It goes both ways after all. Do your doctors ALWAYS see their patients on time? After all, MY time is MONEY to me, as well as them, even though they don't give this a passing thought! (time off work, paying a sitter, etc, it all costs me money, too).

There are TWO sides to this problem. Where I go, (military hospital), if you are more than 15 minutes late, you are asked to reschedule and the next person is seen. It helps cut down on late time for everyone, but does not eliminate it. I know at many dr offices, this is true. It will take some creativity and a liveable policy to solve the problem. just remember, your patients have lives and issues, too. Respect on both sides of this problem sure helps. Good luck.