Newer nurse defining a new role...No idea where to start.

[LoliLolly]

Hey all, so I have a predicament I'm hoping you experienced guys and girls can help me figure out what to do! Sorry this is so long!!

I have a PICU background; I started off in the PICU/CVICU as a nurse tech for a year and worked on the floor in a nursing role for just under a year before I had to relocate states. I took a position with an organization that's rapidly expanding and one of the roles they wanted to bring to the clinics were pediatric nurses. Neat, I said. I applied and interviewed. I was told during the interview that the role was not clearly defined but that there was another nurse they had already hired who could help me. I was in a hurry to find a position as my move date was rapidly approaching and the prospect of defining a new role in pediatric primary was very interesting and exciting to me so I took it.

Now, I've been with the clinic for only a few weeks and the tasks before me seem insurmountable. The pediatric providers have no idea what to use me for (they have MAs doing everything from rooming to paperwork/school forms), so they just ask me to call for ED visit follow-ups to see how patients are faring after D/C. I'm telephone triaging from time to time but there isn't a large established patient base yet so I'm not seeing many patients as walk-in or on the phone.

My orientation has been pretty non-existent and self-driven (I've been asking to go to other clinics and shadow, going to another next week); The clinic manager oversees multiple clinics so he's never around, and the other nurse has no idea what to do either. I have spoken with the RN Manager, who told me it's "the nature of the beast" and it'll take time for everything to fall into place.

I know I can't expect everything to be figured out instantenously, but when I haven't even been formally educated on the clinic's eMAR, I feel like I'm at a total loss of where to start. I'm starting to think I need to go back to acute care where things are more organized and familiar.... ;(

Help!

[Ann.E]

Hey LoliLolly,

I want to share my experience and hopefully it will help. I was hired right out of nursing school to be a patient educator at a family practice clinic. They wanted me to mostly do diabetes education, but since I didn't have a lot of experience or knowledge I couldn't go on to be a certified diabetic educator. Any way, I was the only nurse who worked in the clinic, all other clinical support staff were MAs. It was really hard at first because I didn't know where my place was. I didn't have a true job description and my managers hadn't had a nurse working in the clinic for so long it's like they forgot what a nurse could do! So I just made my own description and list of duties. One thing that I did do was a lot of patient education. Depending on how well the MAs are trained, they usually do not provide very good education just because they themselves haven't been educated. I had my own office (within the office) where patients could set up appointments with me to just learn more about pretty much any medication disorder, but I did a lot of education on diabetes, hypertension, high cholestrol, being over weight. I also had cooking classes where people could come and sample food from healthy recipes. The other thing that I did a lot of was educating the MAs. A lot of doctor's offices are using MAs a lot more and while at times it is frustrating, in the end they aren't going away and I wanted to make sure that they were providing the best education to the patients as possible. Every other week I had a meeting some with where we discussed a certain disease process and I answered (tried any way!) any questions they might have. Other things that I did was take walk in appointments for things such as flu shots, IMMs, teaching patients how to give self injections for things like lovenox or insulin, blood pressure checks, etc. I also filled in for the MAs when needed. I also took it upon myself to check for expired medications and supplies. I wasn't at that clinic for very long mostly because I felt as a new grad I wasn't advancing in my skills very much. Before I left I was also educating the doctors on what nurses could do and trying to get more patients to come to the clinic for things such as dressing changes. I hope that things are looking up a little bit! Education for everyone was definitely the name of the game for me!

[groovetta]

My suggestion would be to look to see what is working well within your unit and what could use improvement. I would delegate tasks that can be done by others consistent with their competencies and within their scope of practice. IOW, delegate what can safely and lawfully be delegated and you yourself, do what only you can do (scope of practice and competencies).

I'm afraid if you routinely do tasks the MAs perform, then when you get increased responsibilities that only you can do, there may be role confusion and resentment from the MAs that you are no longer performing MA tasks. They may see you as slacking off, not recognizing that you have new responsibilities that only you can do. Perhaps you could develop some standard operating procedures (SOPs) or just anything you see that you think could help such as aids to help new incoming employees, etc. I'd be careful in my approach to the above. OTOH, I'd pitch in to help the MAs with their tasks, but let them own their own work. Use this time to evaluate things from patient's, provider's, and employee's perspectives.

Sometimes I think the work will define what you need to do as time goes on. You're really in a good position, IMO, to help create a smooth running ship. Trust me, you will get busier.

Anyway, just some ideas. I'd suggest not letting the MAs know you are struggling with finding your place or defining your role in the clinic-- exude confidence and confide perhaps in persons outside your workplace.