Do you ever feel like a social worker?

BlueLightRN · Jan 1, 2014

I try to listen but we see 150 patients a day and I rarely even get a lunch let alone a break. Some days I do not even get to pee. I feel so helpless when the doctor asks me to talk to a patient but then I get into the room to hear about all the other problems I can't possibly solve. If the patient can't afford 4 dollar metformin, how am I supposed to help? I can't buy medicine for all 50 patients a day who tell me the same thing. I also do not have enough time to call medicaid/caresource/molina about every little complain or question, don't have time to do paperwork for TENS unit, backbrace, kneebrace, member pump, hospital bed, ensure, diabetes supplies, and 5 other things for just one patient. I also take all the clinic phone calls (patient questions, concerns) and have to do so many things that it becomes overwhelming. I don't know what to say or do for patients when I can't help them. I can't get you free diabetes supplies, free medicine, free rides, help with bills and food, and actually do my assigned duties. I just am really struggling with what seem like problems I can't do anything about, they're constant.

BlueLightRN · Jan 1, 2014

The doctors don't help either. Next time the patient is in:

Well, their labs are worse, not better. Didn't you talk to them about diet, exercise, and medication?

Yes, doctor, but they can't afford the medication

Well, help them with that *goes to see other patients*

Ummmm....... :S

LadyFree28, BSN, LPN, RN · Jan 1, 2014

This where one needs to do due diligence in finding these numbers to help people...most companies have a way for free medicine to come to the office.

Bring the other staff on board in getting this information and making sure that this is available to them; it's not hard, it's our job.

As for going to the bathroom, eating breaks, etc...a healthy nurse is a better nurse, just saying; I've worked in clinics, they are ALWAYS busy; however having the resources to get them what they need make a better, efficient nurse; you can't run on fumes and affect the care that they need :no: .

The doctor is going to say that to you, again, they rely on the NURSE to do the "healing management", they treat; they rely on our results; and "not having the money" rationale is not cutting it with the doctor; knowing the resources as well as state resources and getting creative will be a great way to help ensure compliance; even getting in touch with the state and unsung out if thy have disease management programs and help link your pts to this resource; you can do it, it will take time, and using your nursing skills to make it successful. It's all a part of one learning their nursing practice for the setting that they're in. :yes:

BlueLightRN · Jan 1, 2014

We have multiple programs for medications but we can only get them meds for free once a year (and if they are covered) and we do PAs all the time. But for some patients, they have no means and there's literally nothing else we can do. Some patients do not qualify for programs that would help them and some do but do not do their part in getting the help (forms, etc that have to be turned in by them along with paystubs, address information, etc) They come wanting me to basically just have their meds (and we bend over backwards to get samples) and also help them with their utilities (we do medical certs constantly) and get the expensive medical supplies, all without a dime from them. A lot of patients we can help but some of the ones I see there is literally no resources left for them or they do not qualify even though they have a need. I feel like pulling my hair out when my patients don't qualify for medicaid or if they are denied a procedure by the medicaid company that I know they need but I can't do anything about it. And the cots of medications I can't help with 99% of the time. Either there's no manufacturer program, the med is not covered and the patient hasn't tried and is unwilling to try anything else, or they just don't want to pay even minimal copays. I spend most of my time on these things already. I feel like I'm drowning in a sea of needs I can't meet. I can't be relied on to make sure the patient fills out forms that the drug company mails to their home, I can't be relied on to keep finding solutions for medicine for a patient who refuses to pay 4 dollars, and I can't force a patient to come in when they don't want to know matter how many voicemails I leave and letters I send.

LadyFree28, BSN, LPN, RN · Jan 2, 2014

Like I said, we're only healing managers...there's only as much as you can do. The priory is going to be for the ones who DO return.

I am sure you still can find alternatives that are feasible and to the pt's choice; it is still up to you to provide options and provide therapeutic information and commutation; again, an essential nursing practice.

elkpark · Jan 2, 2014

A lot of these issues are social work issues; if the clinic doesn't have social work services and is serving a client population with a lot of these needs, maybe it needs to hire some social workers. It doesn't really much matter what the physicians rx and recommend if people aren't going to be able to implement the recommended tx. Have you (OP) discussed this within the organization of the clinic? Maybe the best way to advocate for your clients is to start talking about the clients' needs that are interfering with their care and ways that they can be addressed, like adding social work services to the clinic. Best wishes!

klone, MSN, RN · Jan 3, 2014

Sometimes, it isn't the solving that is needed, but the listening and understanding that that being compliant with a regimen just isn't the biggest priority that they might have at that moment.

Absolutely. You need to look at Maslow's hierarchy of needs. People who aren't getting their most basic needs met (food, shelter) are not going to be able to meet their other needs (health, for example). Even if you can't help him, it will at least give you some understanding on why he may not be compliant.

BlueLightRN · Jan 4, 2014

We have a social worker 3 days a week but it takes about 4 months before a patient can get an appointment. We have a similar problem with interpreters. My doctors want me to have people who don't speak English in to speak with me about meds, diet, health teachng, etc. but I can't get an interpreter on the spot, can't get one same day due to cost, and sometimes have to wait hours (with this patient, so I can't get anything else done) for the interpreter that does work in the clinic. I can't call people on the phone unless they speak English because the one Spanish interpreter is always too busy with the 30-40% of our patients in the clinic who need them and if they speak anything else forget it because we don't have access to phone interpreters. It's so frustrating. I can't do anything about it though because interpreters cost a lot of money and the social worker can only see so many people per day when she is there.

klone, MSN, RN · Jan 4, 2014

If you have a large percentage of non-English speakers, is there any way your clinic would consider subscribing to an interpreter phone service, like Cyracom or something similar?

BlueLightRN · Jan 4, 2014

Not if it costs them money. We can't even get them to buy plastic cups so we can give the patients a drink of water.

xoemmylouox, ASN, RN · Jan 5, 2014

It's tough and frustrating. Listening is all you can do even if you don't have time? Are you the only back office staff person? If not try to get the others to work with you and share information. You can all agree to tasks that you are better at. Someone do the PAs, someone do medication refills, etc.

BlueLightRN · Jan 5, 2014

Honestly the people I work with do as little work as possible so whenever a patient needs something urgently or has a serious need it comes down to me because everyone else is not available to do anything 'cause they're on "break" or something.