Day in the Life: Charge Nurse at a FQHC

Ambulatory care offers a different setting but many of the same frustrations as in-patient care. Nurses General Nursing Article

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Day in the Life: Charge Nurse at a FQHC

FQHC

I’m the charge nurse for the women’s unit at a federally qualified healthcare center (FQHC) in San Diego. The nonprofit company has about 30 different locations throughout the region and being an FQHC means we see underserved patients for primary care. I oversee the hub of the women’s clinic, located in the heart of the Latinx neighborhood in my city, so most of my patients are poor, uninsured or underinsured, Spanish-speaking women of color. Since we’re the company’s hub for women’s health, we are also busy, usually seeing around 120 patients each day.

This is my first ambulatory care job and I’ve been at it for a year and a half

My primary duties include triaging patients, staying on top of compliance, keeping our equipment in working order, and, perhaps most importantly, managing a constantly changing roster of providers and MAs (medical assistants). MAs provide most of our direct patient care and my team is, for the most part, very young and new to the medical field. They need reminders to recheck high blood pressure, refrain from eating at the nursing station, use a cover sheet for faxes, comport themselves like adult professionals and not middle school mean girls, etc. I know that sounds harsh, so let me add that I adore my MAs. They require closer supervision than I would prefer but are also, without exception, bright, compassionate, and hardworking. Empowering, inspiring, and encouraging them is often the best part of my job.

Barrage of questions

Day to day, my job mostly consists of taking laps around the clinic and doing my best to answer the barrage of questions that arise:

  • Why hasn’t this lab been resulted?
  • A patient in the lobby says she’s dizzy. Can you come talk to her?
  • Can you call someone in IT to fix the printer again?
  • Can I have next Friday off?
  • My provider is running 45 minutes behind; what do I do?
  • Compliance says we should change the way we label our spray bottles; can you find all the bottles in the clinic and change the labels by this afternoon?
  • I’m worried about this patient’s PHQ-9 score; can you coordinate a warm handoff with mental health?
  • Can you huddle with the MAs and remind them hoodies are against dress code?
  • Why hasn’t this patient’s stat referral to breast clinic been processed?
  • Why is the A/C in the providers’ office still broken?
  • This patient says she’s been bleeding for six weeks but can’t get an appointment; can you talk to her?

Being able to address this constant stream of questions while also triaging patients, responding to the occasional code, and filing various reports makes me feel capable, and I take some pride in my ability to juggle myriad competing responsibilities. However, the amount of effort required to resolve a seemingly straightforward issue can be infuriating. For instance, I’ve been trying to get a working iPad to use for video translation in the clinic for eight months. I know that sounds absurd, and it is. It’s the kind of thing that makes my job exhausting. I can handle the never-ending questions, the upset patients and the traumatic stories they share with me, and the learning curve of being in a management position for the first time, but attempting to provide care in an environment that is unwieldy, inefficient, and controlled by people who work in offices located far away from patient care areas makes me want to scream. Knowing that I am not alone in this—that, in fact, nurses and providers the world over feel frustrated by systems designed to serve companies, not patients—does not make me feel better. It makes me feel trapped.

It probably sounds like I hate my job and the company I work for ...

I don’t. I took this job because I’m passionate about preventive health and patient education, I’ve always enjoyed working with Spanish-speaking patients, and I was burned out from in-patient care. I thought the work would be somewhat slower-paced, affording me the opportunity to build relationships with patients, learn from providers, hone my management skills, and deepen my clinical knowledge. Our clinic is so fast-paced and high volume that I haven’t gotten to know patients as I’d hoped, but I have learned a lot about women’s health, become a better manager, and had the opportunity to advocate for patients who our healthcare system fails.

I don’t know if I want to stay in ambulatory care

I realize now that what I was trying to escape wasn’t in-patient care, it was the American healthcare system’s obvious disregard for so many patients’ health and wellbeing. I hoped that by working at a FQHC I could be a small part of improving (or, ideally, overhauling) that system and helping people get the care they deserve. On good days, I feel like I get to do that, and, for now, that’s enough.

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Elizabeth Kohout

About Elizabeth Kohout, MSN, RN

Elizabeth is an RN, MSN working in sunny San Diego. She's passionate about women's health, patient education, and health equity.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.
10 hours ago, Elizabeth K said:

attempting to provide care in an environment that is unwieldy, inefficient, and controlled by people who work in offices located far away from patient care areas makes me want to scream

I'm glad that you are able to see the good in what you are doing for your patients and for your staff. It sounds like you are truly making a positive impact in many ways!

Your quote above seems like such a good recap of what so many people are dealing with in patient care these days. I think that almost no matter what setting it's in, there are aspects that are truly infuriating because they hinder people from doing what they know is best for patients and families. 

Whether you remain in your current role for a long or short time, those that you're working with now are lucky to have you with your passion and drive to do what's right.

(We've been waiting for an iPAD since July of 2020 if it makes you feel any better, and the one that we did have hasn't had a charging cord in about a year. But the sign at the door says we have technology to facilitate family involvement in care- ha!)

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Specializes in ambulatory care/ women's health/ pt education.

Thank you so much for your kind comment-- it made my day!

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Specializes in Med/surg, oncology, telemetry staff RN.

I appreciated your article and needing to escape the inpatient nurse life resonates! You are in a highly responsible position there, sounds like you are responsible for everything! But I know you are making a huge difference at your women's clinic, and they are lucky to have you overseeing all!!

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

I was the charge nurse of a large women's health FQHC in Denver for 3 1/2 years and I loved my job. It was while in that job my views went from "pro-choice" to "pro-abortion."

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Specializes in Sm Bus Mgmt, Operations, Planning, HR, Coaching.

Thank for your honest and candid portrayal of your position.  Blessings to you for making a difference.  It may not always feel that way but you have a solid and healthy attitude, and your work will leave behind positive ripples for a long long time.

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Specializes in Med-Surg, Geriatrics, Wound Care.
On 7/17/2022 at 10:25 AM, klone said:

I was the charge nurse of a large women's health FQHC in Denver for 3 1/2 years and I loved my job. It was while in that job my views went from "pro-choice" to "pro-abortion."

While I fully support abortion, I dunno if saying "pro-abortion" would also include support for forcing an abortion on someone, so I always tell people I'm pro choice, because I would never deem my choice to be mandatory for them. 

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

"pro-abortion" does not mean "forced abortion". 

Pro-choice: women should have the right to decide if they want to carry a pregnancy or terminate. Abortion should be safe, legal, and rare. Abortion should not be "used as a form of birth control." 

Pro-abortion: Abortion is essential healthcare. Abortion should be destigmatized, made more easily accessible, and offered at more places. Women should not be judged for having had multiple abortions. As a part of essential healthcare, government funds should go to providing it for those women who choose one.

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