How to prepare for new office nurse job?

[Shihtzulover16, BSN]

I just landed a new job at a outpatient clinic. Patients with no insurance or underserved population. What should I expect? I have some LTC exp over my belt. I would shadow in three areas: peds, women's health and internal medicine. Thank you!

[amoLucia]

You may find that 'your poorest pts are your sickest, and your sickest are your poorest'. TOUGH population to work with. That may be helpful or a hinderance to acclimate.

Be prepared for lots of educational needs.

Position sounds interesting & intriguing. 

Good luck to you.

[Shihtzulover16, BSN]

@amoLucia Thank you! I'll keep you an update ?

[HiddenAngels]

The most important thing in outpatient is trying to keep them from being inpatient so make sure your HTN population have BP cuffs and are checking/documenting for follow up appts. Diabetic pts,  Insulin meters and supplies. Make sure they keep logs etc.  Asthmatics, inhalers and which ones to use (know the green yellow and red warning signs). Teens birth control and STD prevention.  This stuff is usually kept at the clinic so you’ll be good. Babies, immunizations and update their parents baby books etc.  Vaccines exp dates etc. ..Mental health patients usually see the SW, but sometimes the disciplines overlap so make sure someone is always doing outreach with them… Typing this makes me miss my outpatient life ha ha ha! Best of Luck to you! ?

[CommunityRNBSN, BSN, RN]

I work in an FQHC (federally-qualified health center) and I bet its similar to what I do.

I really enjoy it!  I got hired as a new grad so it's the only thing I know, although now I do some other per diem things as well.

My observations:

1: It is a zoo, which you will either enjoy, or you'll leave.  The providers are typically new-grad PAs who have no idea what they're doing, and also no confidence in the knowledge that they do have.  The staff-- from nurses to receptionists to our CEO-- are not necessarily the best and the brightest either.  And I say that with love because, well, I work there too!

2: You have a LOT of autonomy.  The strict oversight and procedures that people experience in hospitals are basically absent at my clinic.  There are no barcodes to scan, nothing is time-stamped.  You make a lot of your own decisions and learn to prioritize tasks and triage. 

3: I definitely get a full lunch break every day and almost always leave on time.

3: Patients are often really grateful if you are just nice and treat them with respect.  Most of our patients have been so abused by their slumlords, the justice system, their employers, etc., that they are genuinely touched if you just smile and treat them like adults.

4: A lot of stuff that you want for your patients just can't get done.  People who need a homecare nurse can't get it because Medicare won't pay for it.  Someone who needs a wheelchair that is an appropriate size, ditto.  A patient who desperately needs an urgent referral to GI has to wait six months instead. 

 

Bottom line is that I really enjoy working there.  As much as I have my days of "This is bull***t, I am quitting," like everyone has in their jobs, overall, it's been a good fit for me.  I wish more people would go into the field, because we constantly struggle with simply not having applicants for RN positions.

[Shihtzulover16, BSN]

@CommunityRNBSN I wonder if we work at the same facility? Thanks. I will give you an update how it is.

[CommunityRNBSN, BSN, RN]

3 hours ago, Shihtzulover16 said:

@CommunityRNBSN I wonder if we work at the same facility? Thanks. I will give you an update how it is.

Yes, keep us posted!  I'm in Connecticut, and there are a slew of FQHCs: CHC, CHS, CHR, COHC.... I work at one of them.  ?

[Shihtzulover16, BSN]

@CommunityRNBSN It is federally funded. LOL I live in Chicago, IL. Considering working after I become NP, but IDK we will see. Would be good experience and I am happy for the 1 hour breaks!! Not like that in hospitals or nursing homes. Can I message you if it's OK, if I have any questions related to work maybe you can help answer them? I am really lost already during orientation LOL, but I like it so far.

[2BS Nurse, BSN]

"A lot of stuff that you want for your patients just can't get done".

This! 

I always felt like we were so focused on metrics like A1C, BP, etc and ignored the psychosocial issues (This obviously had to do with payment). Is this still the case in FQHCs?

"Patients are often really grateful if you are just nice and treat them with respect". 

I have often found this population to be the most thankful. 

[Shihtzulover16, BSN]

@2BS Nurse I worked in psych for 4-5 months, so I am putting a lot of emphasis in this. I don't think providers or nurses really get it, that mental health comes first too. It's not taken really seriously and it should be.

[NutmeggeRN, BSN]

On 4/1/2022 at 9:29 AM, 2BS Nurse said:

I have often found this population to be the most thankful. 

Indeed!I worked part time 17 years at a Family practice and I loved the population we dealt with. Many patients  with HIV and Hep C.  Often disparaged and shunned by society, we welcomed them into our practice and treated them with grace and respect. I learned a lot about life from some folks just by listening.

Best of luck to you!

[Shihtzulover16, BSN]

I work in internal medicine. I couldn't work in peds. WH is OK. It's been almost 6 months since starting this job. Learning something new every day. I still get confused w/ the phone notes, so I brought a triage book for nurses to help me out.  Still don't know a lot, because we don't just get calls about symptoms, we get others calls too besides that. It can get busy w/ up to 3 providers sometimes. It's a very good job for me at least and I am happy I found this job. You are more independent in this setting as someone mentioned already. Triage is supposed to be < 5mins whether its walk-in or by appointment. I wonder if any one has suggestions on what books I should brush up on in internal medicine?