New to physician's outpatient practice and need help

[amayer]

I am a RN and recently hired as the nursing supervisor to a family practice that also does urgent care. We have 2 sites. The goal of the practice is to book patients every 15 minutes from 830 to 430 with double booking at 9, 10, 2 and 3. 5 practioners to see 20-25 patients per day.

my nursing staff, primarily MA's, and I are having some difficulty and hope someone out there can help me understand the nature of this business. my nursing staff are scheduled 830-5 or 9-5. it is taking 10-15 minutes to check patients in (vitals, complete history, review of systems, medication, etc..), we are also responsibe for following protocols to order labs and diagnostics which we do onsite and the goal is to get them done the day the patient is here. The wait time goal is also 15 minutes for a patient to wait in the waiting room. Providers are supposed to show up from 9-5. Issue is they don't and they also take longer than 15 minutes per patient (usually 30 -45 minutes). My staff work through lunch many times as do I but are supposed to get a 1 hour lunch between 12 and 1.

On top of that we are to review all patient charts, get all pre-certifications and pre-authorizations and call patients back by the end of the day and provide procedures during visits that are required based on patient need.

I am finding this very challenging to accomplish these goals and want to show my staff that I support them and understand their frustration and increase morale and motivate them while making some changes to accomplish the facilities goals. I have been on the job only 4 weeks and feel like the goals may be unattainable? my nursing staff work between 3 floors and another site facility in another town. The one plus is that we have an EHR so no paper records.

Is there anyone else working in a profitable practice that can assist me with ideas in improving our patient care, patient flow and scheduling issues....

I would appreciate any input as this is a new arena for me but I am eager to learn.

[tnbutterfly - Mary, BSN]

Moved to Ambulatory Care Nursing / Clinic Nursing where you will hopefully get some helpful responses.

[newrnltc]

Hello I am an RN working in a single physician practice (also 4 weeks!) We average 55 pts a day. There is me and 2 MAs. We all do pt intake and while we wait for the Dr to get to our room we are at our desks doing electronic PAs or calling for lab results etc. I think our team has great communication. We help each other out and everyone stays busy.. restocking, making calls, cleaning rooms, popping in on complex pts to assist etc. If there is a procedure I numb the pt while the doc sees pt in the next room. Doc is very good though. She is always early and takes about 10 min for follow up pts, 20 for new. She knows her staffs strengths and teaches us new things all the time in a way that enhances critical thinking and effectiveness. You and I as nursing team leaders should do the same. I think a major prob u mentioned is your docs are late. This needs to be addressed because no matter how fast or organized u guys get if the dr is not there to see the pt the whole clinic schedule is delayed. This can be mentioned in a way that is beneficial for the practice (ie Pt satisfaction) as opposed to calling the doc out on their lateness. See why pts are taking so long..do they try to fit 10 complaints into one visit? Perhaps a limit needs to be set and additional issues put for a follow up visit. Is the doc in there explaining the same thing over n over? Pt teaching is also an RN responsibility! We have created handouts for common issues so pt can take home and all staff is consistent with what they tell pt. As for morale, I thank my MAs for what they do just like my CNAs when I was in another facility. Your attitude is important, have a calm exterior even when the place is swamped, smile when talking to others and at the end of each day think what could I have done to make this day smoother? These are just my 2 cents. I hope they're helpful. Good luck and yay for clinic nurses! :)

[amayer]

Thank you for your thoughts and comments. I will continue to address how important it is for our practitioner's to arrive on time.

[CSThelen]

Dear Newrnltc,

I just read your advice, and loved it: realistic, empathetic, and team-building. Thanks for sharing!

Pax et bonum,

Carol near Baltimore

[newrnltc]

My pleasure best of luck to us hard working nurses! :-)