Major Office Issues Help!!!!

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I am an RN working in a primary care office with 5 physicians. I was hired in to do telephone triage, and odd and end QA stuff. We have been having alot if staffing issues, recently had to let go 2 long standing employees due to some issues and cannot find new staff. We have hired an MA and RN and they are just not working well. The MA used to be spot on with skills, but super slow (snail speed) and the RN was doing great and now seems to be getting an attitude and making stupid mistakes. The staff cannot keep up with the doctors and it is becoming very stress ful for me. We have 1 nurse to 1 doctor, each doctor sees up to 40 patients per day. The nurses are responsible for rooming patients, charting, vitals if needed, immunizations and other typical office procedures. Any input on how your offices flow would be greatly appreciated. right now we have 3 RNs and 1 MA in the nursing area in addition to me. All the offices in our area are staffed by MAs and LPNs, how does that work? We haven't had a good MA in years!!!!! please help!!!

Specializes in Peds/outpatient FP,derm,allergy/private duty.
I am an RN working in a primary care office with 5 physicians. I was hired in to do telephone triage, and odd and end QA stuff. We have been having alot if staffing issues, recently had to let go 2 long standing employees due to some issues and cannot find new staff. We have hired an MA and RN and they are just not working well. The MA used to be spot on with skills, but super slow (snail speed) and the RN was doing great and now seems to be getting an attitude and making stupid mistakes. The staff cannot keep up with the doctors and it is becoming very stress ful for me. We have 1 nurse to 1 doctor, each doctor sees up to 40 patients per day. The nurses are responsible for rooming patients, charting, vitals if needed, immunizations and other typical office procedures. Any input on how your offices flow would be greatly appreciated. right now we have 3 RNs and 1 MA in the nursing area in addition to me. All the offices in our area are staffed by MAs and LPNs, how does that work? We haven't had a good MA in years!!!!! please help!!!

It doesn't sound so much like an office-flow issue as a not recruiting and retaining qualified employees kind of issue. The workload sounds doable, but 40 patients per doctor per day really is pushing the limits. It could probably be done if you had an extra person not assigned to a doctor to pick up doing immunizations while the nurse or MA calls the next patient in, as keeping your rooms filled at all times is the number one efficiency strategy.

So basically somebody needs to work with the new people to get their speed up to standard or the best office staffing structure in the world "on paper" won't work in real life. If they aren't improving after a specified probationary time period they have to be let go. I don't mean to sound cruel, but somebody who takes forever to take vital signs is throwing a wrench into everyone else's day, and it isn't fair to have some employees habitually picking up the slack of the others. Resentments are sure to build under those circumstances. Anyway, my :twocents: Best wishes and good luck finding the right co-workers to work with your team!

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All the stuff coming across the fax that requires a chart before the doctor can address it, WE have to pull. Medical records people rarely, if EVER pull it, without asking them and/or feeling like we are begging. It is maddening! Yes, the bold caps mean I'm yelling. :)

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Specializes in Outpatient/Clinic, ClinDoc.

Wow, 40 patients a day? Even when I am working the pediatric side of the office, the doctor's max is 30 and he's running on those days. With 30 patients the peds doc gets TWO nurses.

We have one nurse per MD (can be RN LPN or sometimes an MA) and we don't do phone calls or triage. There's a separate nurse for that, and she also does pre-auths. Our docs see 20-21 on a really busy day, but we have higher acuity patients with more needs (lower income patients who don't come in much and need more time due to DM/HTN/etc). Nurse rooms patient, does vitals, shots, glucose etc. Even with only 20 patients we are running our butts off most days with fingersticks, urine dips, etc. Oh, and we have paper charts which doesn't help. I am fast fast when rooming patients and I think 40 would run me into the ground LOL.

I'm starting a new job monday which has EMR - that's gotta help! No idea how many patients the doc sees, but I am guessing based on the population that it is not anywhere near 40..

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Specializes in Operating room.

well I have had to to some hiring and firing before, I always offered employment conditionally on a probationary period, just because the work ethics of people today are not very good at all. And when you have one person that is slower than the other it ruins the moral of all the employees you should probably hire some new grads and train them to work hard and fast. Someone who doesnt have a job right now would love to be working and probably would do anything to keep their job.

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Our office has 2 docs. 5 RNs and 1 currently training. One doc gets 3 nurses the other gets 2. The doc with 3 nurses can see up to 60 pts a day. It's absolutely crazy. Our front desk takes messages, pulls charts and leaves them for us. If we get a chance between pts(we are with them the entire visit to document it and help with procedures) we do a call, if not we just have do prioritize them at the end of the day. We just started going electronic and it's really slowed us down and work right now is down right madness, but when it all calms down it will go back to being a job that I love! We all get a long well and make a good team as a whole

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