Do you think this is reasonable?

[BCgradnurse, MSN, RN, NP]

I graduated as a new NP in May 2009 and have been working as an NP in urgent care in a community health center. I was told upon my hire that I would start at two patients an hour, and would have 1 to 1 1/2 hours built in my day for lunch, charting, etc. I was promised that I could take my time building up to seeing more patients per hour. I now see 3 patients per hour in the AM, and 2 per hour in the afternoon. I work 4 ten hour shifts, as do the other NPs and MDs at the center.

The NPs were just told that we now have to book a minimum of 3 patients per hour for the entire 10 hour shift, and make sure that all of our charting is done within 24 hours. The MDs are exempt from this, as they all have contracts that clearly state their obligations, but the NPs are non-contract employees. We were also told that we can't run behind schedule. This is nearly impossible to do, as the majority of our patients are non-English speaking and we are always waiting for interpreters. Also, there are some cultural issues surrounding the concept of time in our population, and many patients show up 30 min to an hour late for their appointments. The registration staff are supposed to tell them they need to reschedule if they are 30+ minutes late, but they often register them anyway and send them to the floor, at which point we are required to see them.

When we questioned this, we were told that this is the norm for community health centers and we should expect to work at least 60 hours per week while being paid for 40. Has anyone worked at a community health center and does this sound "normal"? I don't mind working hard, but this seems to be a bit much. How can I give good care in this kind of environment, particularly as a new grad? I feel like I'm being set up to fail. I love this job and the people I work with, and had hoped to stay for at least 2 years. Now I'm wondering if I should start looking around for a different position. I know it looks terrible to leave a job after just three months, but I feel like I was given the "bait and switch", and I don't want to fail. Any thoughts or advice? Thanks!!

[akoster]

Im confused? If you are working urgent care, like I do, those should be short focused visits? You should be seeing alot more patients than if you were doing primary care visits? Not sure why you would only see 2-3 an hour.

[BCgradnurse, MSN, RN, NP]

In theory they should be short focused visits, but in reality, they never are. We're kind of a hybrid between urgent care and primary care. We do a lot of follow up on patients with multiple issues who can't get an appt. with their PCP. We also handle the overflow that GYN can't handle, and those visits are never short. Very few of the patients come in with just a rash or sore throat. We also deal with a lot of mental health issues cause people can't get in to see MH providers. And again, there's that 15-30 minute waiting time for interpreters. Yes, seeing 2 patients an hour doesn't seem like much, but seeing 3 or 4 becomes very challenging when you don't have the infrastructure to support you.

[akoster]

I agree sounds like you are doing primary care visits and alot of those visits to take longer

[westcoastgirl]

the NPs are non-contract employees

is there any hope of this changing? why shouldn't you be contracted as well? I work in a similar environment but have the same contract as my PA and MD colleagues.

[BCgradnurse, MSN, RN, NP]

The other NPs and I are going to meet and talk about drawing up a prototype contract. Our executive director is pretty autocratic, and it's going to be a hard sell. Meanwhile, I've gotten very pro-active about having my medical assistant call registration every time a patient has not arrived within 30 minutes of their appt time, and telling them that the patient will have to be rescheduled when they show up. If they don't listen and register the patient anyway, I write an incident report. I hate being this way, but it's the only way things are going to change.

[sandnnw, BSN, MSN, EMT-B, APRN]

How many NPs are there? Enough to walk into the admin's office and have a heart to heart?

If this is a urgent/walk-in care, you should be seeing more than 3 an hour. I let the primary care folks wait and skip ahead, knocking out the quick stuff. What kind of charting system do you use? That also may help w/time.

There are always going to be outliers. Suggest that one of the NPs see the primary stuff, see if the admin will buy in w/that. Have to prove to him the reality. You should NOT be working under a different contract. This is simple discrimination!!! A lawyer would love it.

good luck!

[BChapp3182]

I don't think being paid hourly and working an extra 20 hrs a week for free seems like a good deal, period. If your salaried then that's a different matter.

[BCgradnurse, MSN, RN, NP]

I am salaried, but I still think 60 hrs a week is a bit much.....8-10 extra hours a week is about my max. There are only 3 NPs in the center, so we don't have strength in numbers, but nothing ventured, nothing gained. As of today, they haven't taken away our lunch break yet, so I still have an hour of unbooked time in the middle of the day. I think the key is getting a contract. Then it will be very clear what is expected of both sides, and the rules can't be changed midstream, without warning.

[Gator FNP]

I worked in a privately owned practice-family/pediatrics/internal/pain mgt, I had a contract. It does not mean anything, patients arrived 30+ min. late, they were still registered, we ran late often, lunch was 30-45", was supposed to be 1-1 1/2 hours. Worked late to catch up on charting. I stuck it out and starting looking for a new position at about the one year point.

I now work in a large hospital system, outpatient setting, great hours, more time off, & benefits.

[BCgradnurse, MSN, RN, NP]

Well, gator....I may be following in your footsteps at the one year mark. I am getting great experience now, but if my job starts taking over too much of my life I'll have to move on at some point.

[seb3m]

Ideally you should focus on the acute problem during the visit and have them follow up either with you or the PCP for the remainder of the issues...dont ignore them, but don't try to tackle them all in one visit or you will be perpetually behind. Up to 4 patients an hour should be reasonable for an urgent care facility - even in primary care appointments every 15-20 minutes is pretty standard. Agreed, you need to have an enforced late policy - exceptions of course as warranted. You have to work to create a culture of accountability and responsibility for health care - they can learn to come on time and keep follow up appointments and regular checkups with the PCP.