leaving clinic with Patients still in exam rooms?

[bethburlson]

The large Hospital I work at, I transferred to an eye/plastics clinic-in interview I was told I would work clinic hours-stay over a little once in a while/in reality a Dr stays over 3 times a week and sometimes till 9pm-I questioned this and the (non medical) manager told me just to leave when I'm ready (with Pts still in exam rooms)-the only one left in this clinic is the Dr and a resident (not even a front desk person). when I asked to talk to the head nurse-they would not let me (she works at a different site). These eye patients are not optical Pts and some are in bad shape. I feel this is unethical leaving Pts.

Can I have fellow Nurse feedback?

Thanks, Beth

[bethburlson]

I am not working while they figure it out!!! And it's been a month - that's how complex this is to them

[Altra, BSN, RN]

I am not working while they figure it out!!! And it's been a month - that's how complex this is to them

OP, it has been hard to follow some of your posts. Are you saying that:

1. You have been the staff member to raise concern about medically fragile patients in your clinic?

2. Clinic management is re-evaluating the practice of providers continuing to see patients late in the day without nurses present?

3. This re-evaluation has been ongoing for the last month but no formal decisions have yet been made?

We don't work where you do, OP. Help us out - fill in the blanks. It will make for better discussion.

[macawake, MSN]

Yes, you are right. HR doesn't seem to know, charge nurse is off site , that's what I'm saying, it is a clown show

This response sounds like it's to a different post than the one you quoted. Is that really what you got out of all that JustBeachyNurse wrote? What exactly is it that you think that she's right about? She didn't say that your clinic is a clown show.

For what it's worth, I think that JustBeachy offered some real solid advice to you OP.

As you've probably guessed by now, I really don't understand your reasoning. In your OP you said this:

When I asked to talk to the head nurse-they would not let me (she works at a different site).

Now you're saying:

I am not working while they figure it out!!! And it's been a month - that's how complex this is to them

Help me understand. Why haven't you simply picked up the phone and called your nurse manager if you have concerns. You are obviously not afraid of any disciplinary action being taken against you or being fired since you are now prepared to not show up to work, or at the very least show up but not work. Calling your manager would seem like the lesser risk of the two and also more constructive.

You have been asked by several posters why you feel a nurse (specifically) has to be the "closer" in order to guarantee patient safety. It would be very helpful if you could clarify if you have any solid facts to support your opinion. In my opinion physicians are at least as capable of carrying out the duty of clinic "closer" as a nurse. What makes you think differently?

I really would like to be of help and I think that many other posters would too, but unless we can have some sort of meaningful dialogue where everyone actually tries to answer questions asked of them, I fear that won't happen. As it stands right now with vague answers and incomplete information, I can't really seem to be able to shake the feeling that we're being punked.

[JustBeachyNurse, LPN]

Yes, you are right. HR doesn't seem to know, charge nurse is off site , that's what I'm saying, it is a clown show

if you inquire with HR in the same cryptic syntax you are using here I can see why they are not responding. It's quite possible they cannot comprehend what it is what you want to know.

Sibce you now state you will either call out or report to work and refuse to work in an act of protest for what you think is an ethical dilemma (hint: it's not again the specialty surgeon and resident are more than qualified to finish up with remaining patients, handle emergencies and close the outpatient clinic) this won't be your issue much longer as you will be terminated for work refusal or job abandonment.

So call out in protest, or show up and refuse to work and see how long your employment lasts. You're the one turning the specialty clinic into a clown show worrying about non issues that are perceived only by you. Good luck in your future endeavors

[cayenne06, MSN, CNM]

When elderly patients wait 5 hours to be seen, and when they finally get to he exam room they could be hungry, tired or.many things ( and like I said, our hospital has pts that may have things going on with them, sick).

This is such a weird conversation. I can assure you that I am fully capable of caring for a patient in my outpatient office- even an acuteish patient that I need to transfer to the ED immediately- without the clinic nurse. She is awesome and indispensable in her role and I am grateful for her work every day, but I am quite capable of doing everything that a clinic nurse can do.

The bigger issue here seems to be time management. It's not good that patients are routinely waiting an entire day to be seen. I would hate to work in that environment.

[bethburlson]

Pt safety is most important. But after that: it is bad that Manager, HR cannot figure out pt related matters, why are medical staff there? For the Patients!!! Money people need to be off campus figuring out the money, let the medical people do their jobs with the right staffing

[bethburlson]

That is why I have a problem with leaving for the day, if something does happen, the money people will worry about money and not me

[bethburlson]

And patients.....

[Altra, BSN, RN]

OP has given some indication that some of her clinic's patients have been at the hospital for other appointments by the time they arrive at her particular clinic to be seen.

I also work at a large tertiary care hospital with virtually every specialty and subspecialty represented in our attached professional office buildings. Overall, the patient population trends toward the elderly and those with multiple comorbidities. During the week -- daily, yes, daily, we get ER patients who initially arrived somewhere on the hospital campus but are now in the ER with syncope, near syncope, generalized weakness ... etc. Not to mention those wheeled down from whatever outpatient office because they "arrived looking like s**t and will probably need to be admitted". So I can definitely visualize the issue that the OP raises.

Many patients have transportation issues as well. I can easily picture a scenario in which patient goes to Internal Med clinic but mentions that they have not followed up with Opthamology Surgeon clinic since their procedure and Internal Med staff try to facilitate the patient seeing Opthamology "while they're here in the building" ... and Opthamology agreeing to squeeze the patient in later in the afternoon. Nothing like 4+ hours of shuttling around different clinic offices and diagnostic departments to tax an elderly, infirm patient ...

Just saying -- many patients receiving care in outpatient settings do not exactly resemble those smiling, energetic folks pictured in my hospital system's advertising ...

But back to the OP ... you've gotten some great info here which hopefully helps alleviate your concerns about responsibility for your patients once they leave your clinic. To improve further discussion, please help us understand exactly what is occurring, and steps you and others have taken / are taking. Thank you.

[dishes, BSN, RN]

When elderly patients wait 5 hours to be seen, and when they finally get to he exam room they could be hungry, tired or.many things ( and like I said, our hospital has pts that may have things going on with them, sick).

What does the nurse say/do if the patient is tired and hungry? Do the clerical staff book and remind patients of their appointments? If so, can they be proactive and forewarn patients that their appointments can take more than five hours. If patients are made aware to expect delays, they can plan accordingly by bringing food and water to their appointments.

[NotAllWhoWandeRN, ASN, RN]

That is why I have a problem with leaving for the day, if something does happen, the money people will worry about money and not me

I think pretty much every responder here has included the fact that if something happens at the clinic and (1) you were not there and (2) you were not supposed to be there, it has nothing to do with you. It is not your fault and not your responsibility legally, ethically, or in any other way.

You're imagining creative scenarios where patients might come to harm, which tells me no patient has actually come to harm because of the clinic's late-visit practices. I stand by the suggestion that if you're focusing on patient care and safety the more effective plan is to discuss streamlining the visit process so that patients are not waiting "five hours" to be seen.

[JustBeachyNurse, LPN]

Maybe the most complex and fragile that are stuck waiting need a nurse navigator or complex care case management team to streamline their care with one system designated office.

Children's Hospital of Philadelphia does just this with their complex care team:

Diagnostic and Complex Care Center | The Children's Hospital of Philadelphia

There is no reason the same can't be set up for complex geriatrics