Frustrated

[pedspnp]

As much as I love my job I'm frustrated with the things that are put in as urgent visits in my already over booked schedule . Today I was triple booked for a 8 month old who was tripping over her feet , but missed her last 2 well baby appointments , a two year old who woke up with a runny nose and a mom who thought the child's wart on her hand that had been there for months was a emergency . Of course no one showed up on time . I finally told staff that the asthmatic was going to be seen before the late ones. The late ones got upset because they had to wait . Supposedly the nurses in triage are triaging , the office manager goes and ahead and ok'd walk ins with out triage and doesn't bother to see how backed up I am. Why because we are a fqhc and the more patients we see the more grants we get. Every patient seen for a acute appointment has to have a follow up appointment . Rant over .

[Jules A, MSN]

Part of the issue, imo, is setting limits with regard to how many appointment slots you are willing to accept. If you have a reasonable template to begin with even if you are booked solid it isn't disastrous when you get the inevitable not-sick "sick kid" visits.

[BCgradnurse, MSN, RN, NP]

Agreed. You need to set limits as to how many patients can be booked. My office staff know never to double book me without asking me first. More often than not I'll say yes, but sometimes I can't. I also have the same issue with people being late. On a busy day,I will refuse to see them if they're more than 10 minutes late, or if it's for an acute visit, they will wait until I have time to fit them in. I'm not going to penalize the patients that show up on time. Bottom line-quality of care can suffer when there's too many patients and too little time.

[Psychcns]

I have told front desk staff that I will see so-and-so if they can fit them in my schedule. They may have to cancel someone and rearrange my schedule to do it. Another option is to leave a couple of blank spots for walk-ins or last minute.

There may be times a fit-in will be ok but there should be criteria.

[PG2018]

I think the ability to craft your schedule so that you could accommodate an overbook is an outstanding asset. Not everyone can do it, and not everyone is allowed to do it. For example, you might sub 30 minutes for a usual half hour lunch, leave at 5:00 instead of 4:30, or block 3:30 everyday for walk-ins. However, having a boundary set so that your booking staff don't arbitrarily add to and take away from your schedule is imperative. Granted, I'm not a practicing NP. I'm only in my internship phase although I finish in two months. I tend to focus on what my work will be like for me and my family rather than what my work will be like for my patients...or employer.

[pedspnp]

I think the ability to craft your schedule so that you could accommodate an overbook is an outstanding asset. Not everyone can do it, and not everyone is allowed to do it. For example, you might sub 30 minutes for a usual half hour lunch, leave at 5:00 instead of 4:30, or block 3:30 everyday for walk-ins. However, having a boundary set so that your booking staff don't arbitrarily add to and take away from your schedule is imperative. Granted, I'm not a practicing NP. I'm only in my internship phase although I finish in two months. I tend to focus on what my work will be like for me and my family rather than what my work will be like for my patients...or employer.

Lunch forget it if I get 15 minutes I'm happy ,leave at 5 try more like 5:30. Everyone has the same schedule 15 minute appt slots regardless of type of appt they have . Providers have no say in scheduling

[Jules A, MSN]

Lunch forget it if I get 15 minutes I'm happy ,leave at 5 try more like 5:30. Everyone has the same schedule 15 minute appt slots regardless of type of appt they have . Providers have no say in scheduling

Unless you are cool with that I'd suggest bringing this up at the next med exc. meeting. I would never work a place where the providers don't have significant input in scheduling. To me a provider friendly work environment is the second thing I look for, after $, when I'm investigating opportunities. If the Docs are treated like Kings I'm not going there.

[Hi2Jenn]

I did my pediatric rotation in a public/private partnership type clinic. It sounds like what you are doing. The problem with not seeing patients if they are late is that you are frequently working with people without transportation. They had to get a friend to bring them, take a bus or 2, etc. They also had to take time off work, which is huge for them. The other thing that is hard to realize is that most of us have above average intelligence. We don't understand why someone thinks a wart is an emergency. The school system required a doctors note for every day missed. Why? I consider it a huge waste of resources. Yes, Johnny had a cough or an upset tummy. I don't need to see a doc to know to keep my kid at home. It is a very challenging type of practice and I commend you for it.

[Katya000]

Lunch forget it if I get 15 minutes I'm happy ,leave at 5 try more like 5:30. Everyone has the same schedule 15 minute appt slots regardless of type of appt they have . Providers have no say in scheduling

Sounds exactly like my position. Zero control over my schedule, multiple times I say "no double books unless I approve" (rarely happens), double books placed on my schedule without even a head's up they are there (I have to find them on my schedule--and then they'll say "per RN or per another provider" as if that makes it all okay), lunch for 15 mins is a very lucky and slow day indeed, and I leave at 6 at the earliest with my last slot being 420 or 440, plus I spend hours of my "personal" time charting as they don't believe in granting admin time. We hire medical assistants without any experience and nobody knows how to do anything, and you're lucky if you can find someone to do that UA for you as a lot of the time people are either hiding from work or off busy with something else. We have one of the slowest RNs in the world, she takes (I AM NOT JOKING) 2 hours to do a UTI appt. She sees 2 ppl a day and still ends up with tons of overtime (they pay her hourly). Absences by MAs/RNs are so common and ignored it's a joke. And the same day acute visits I get are almost always about controlled substances. My advice? Get your experience and get out! There are great FQHCs out there, they are difficult to find, but look hard while getting experience. Unless of course you signed up for loan forgiveness, then you're stuck with 2 years. I applied, was accepted and turned it down because I could never work at this place for another 6 months, let alone 2 years!

[hunnybaby24, BSN, APRN, NP]

this sounds horrible

[IsabelK]

Been there, done that. Left. The kicker--loved the patients and families. Wasn't hard to leave the job, it was hard to leave the people.

[phillycpnp-pc, MSN, RN, NP]

This sounds like my current job. I tried limiting the amount of patients but my requests are not respected. They do not even triage calls or ask why the child needs to be seen. I have been doubled, tripled, and sometimes quadrupled booked with non urgent chief complaints like coughing X1 day, fevers of 98.9, etc. the office staff decides how many are to be booked. I've seen as many as 48 by myself in an 8 hr day. And Saturdays we are open from 9-12 and I've seen 33 on a Saturday by myself. And I sometimes have to stay 2 hours later to see everyone. I wish I had more control and I have spoken to the partners of the practice and they see nothing wrong with it. 😞 oh I forgot to add most our "MA's" are not certified so I do all the vaccines, neb treatments, UAs, lab collections, etc.

Needless to say I'm looking for a new job.