Immediate Care RN position

Ellekat2 · Jan 30, 2014

I work a split position in an outpatient clinic run in a hospital setting, plus on the hospital floor two shifts a pay period.

I find that the hospital position actually has more flexibility and independence. I enjoy the lighter physical load (fewer lifts, most patients can walk) in the outpatient setting.

You'll find that the charting is much more time-consuming in an outpatient setting. In our facility, the physician retains control of the patient and the nurse often does not have results of testing, other than labs, so you have no overview of your patient's condition. Our physicians often have us start IV therapy while waiting for test results, then send the patient to the hospital floor if they feel the patient condition merits the acute setting. Every flush, every drop of medication is accounted for several times over in our charting. We have an Outpatient Log (besides the computer log) and we have to log any first-time medications and what physician was available at that time, and if there was a reaction. We put in our own orders and answer our own and one other department's phone.

We have around five to twelve patients scheduled per day, plus an average of three patients sent from our outpatient clinic and physicians' offices.

There is only one outpatient nurse scheduled, and she does it all-gets the chart/orders ready, brings in the patient, take VS, starts any therapies ordered and coordinates with other departments (we're simply told they have Lab or Radiology, etc., not what orders). We also get drinks, warm blankets, pillows, assist some to the BR, and clean the rooms between patients. We have scheduled patients, with no pattern. I've walked in to three patients scheduled at 8:00 AM, all with several IV antibiotics, two with minor dressing changes and one with a forty-minute dressing change. Sometimes we have three acute patients show up at once, and if we have two scheduled patients at the same time, too bad. Our hospital policy requires sitting with some medications for the first 15 minutes-and other patients continue to be scheduled in that same time frame. Blood requires 30 minutes, then vitals every 15. And we do the paperwork for pre-ops.

We have two supervisors and a scheduler "over" the outpatient nurse. None of these do hands-on care in outpatient; they work in other areas. We're working on improving scheduling, but as the scheduler isn't a nurse and also works in other areas, she has little time and no understanding of how long a procedure might take, and isn't available for returned phone calls, etc.

Our ER has been told that Outpatient is to back up the ER, so they call when they are busy and don't understand that we can't abandon our patients to help them. If I admit a patient to the floor and there are orders for the floor, some (not all) nurses get upset because we haven't completed the orders-even though the orders are written for the floor and are not Outpatient orders.

So there are up sides and down sides to working Outpatient. You may have an entirely different experience. I work just as hard, some days harder, in OP as I do the floor, it's just different.