How far do you go?

When I give a 9-10am window, I'm confronted with 'can you make it 9:30?'

When I get that, I just say I will try my best, but I can't promise.

As far as the lady demanding you to come right then when you are 45 minutes away, I would just politely tell her that you are on the other side of town and simply can't be there asap. We all want to make out patients happy, but it's a waste of time and gas to double your driving when it's not necessary.

Here's an email that went around at our agency a couple weeks ago, addressing the very situation. Place names changed to protect the innocent (as well as the guilty!). (We cover a six county region, very large area, and some nurses drive up to 200 miles/day, but not every day and not all that often.)

The method I used when in the field was I would take my schedule and arrange the patients by zip code and number of visits for the week. If I had 4 patients in Whoville, 8 in Whereville and 5 in Whatsitville I would then look to see who had labs due and schedule everyone around those patients that had specific needs. I tried to plan my day for the traffic and for the best route. I would then plot them out in a schedule and start calling the patients. I gave them very little choice in when I was coming. I would say Mrs. Jones I have you scheduled for 2 visits this week. I am going to come to your house on Monday and Thursday morning. I have 8:30 am, 9:30 am or 10:30 am available. Then let her pick. The next patient for that day would only have 2 time slots to choose from and I would leave my easiest one to schedule for last so that I knew they didn’t mind what time I came. I would then submit my schedule to my scheduler on Monday so she knew where I was going and knew when I had open times in my schedule to take on more patients. You will run into a lot of trouble if you call a patient and say I need to see you twice this week when do you want me to come? That just sets it up for you to be running all over town. It really helps if you have a copy of your written schedule in front of you when you are in the patients home and you can show them how full you are and that they need to work with you. Once you set up your schedule you should always try to stick to it. It will keep you on track for hitting your units and it will help with keeping the patient happy if they know that you are always going to come when you say that you are.