How long before you could see 25 patients?

  1. I am a new NP, with 17 yrs acute care hospital nursing experience. My practice is internal medicine "hospitalist". Until my hospital credentials go through, the last 5 weeks I have been in LTC SNF / Rehab/ Nursing homes. We are expected to see 25 pts a day, obviously an industry standard (even though our group has no office/overhead)

    Either I am the stupidist NP in the world (not likely) or I am in some real trainwreck facilities. I can NOT for life of me no matter what I do see more than 16 pts a day, once I've seen 20.

    Mind you, we cover more than 5 SNF's. Some days you have to drive to 3 in one day. The residents are NEVER in their room (rehab, smoking, "out on pass with family"), the charts are never there, and if I want my vitals, or blood sugars - I have to go to the nursing carts and look them up. Nothing is computerized. Everything is handwritten. Plus I am taking "call" from 8am-6pm for at least 5 SNF's during the work day.

    I feel like I will NEVER see that many patients. How in the world? Unless I ignore every problem and write a 2 sentence note? LOL. I am trying to find the balance.

    How long should it take before I can see 25-30 pts a day? 6 months, a year, now?! I feel like I am not contributing to the group, and it stresses me out.
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    About angel549

    Joined: Jun '09; Posts: 20; Likes: 14


  3. by   traumaRUs
    Hmm - I think once you have an established pattern you will do better. NH pts are similar to my pts: chronic dialysis pts. (In fact, many do live in NH - lol). So, for like one of my pts, if I was seeing them in the NH: my note would consist of only the problems I managed: for instance, I manage all my pts dialysis and HTN meds, I also manage most labs. So, even though my pts have a large problem list, I would only address the problems that I follow. I think giving yourself time is the best answer.
  4. by   BlueDevil,DNP
    I don't know how your practice compares to a family medicine clinic. I remember the day I saw 21 patients the first time, with my previous maximum having been about 16. I thought that day would never end. They just kept coming! And then that night almost never ended, because I spent most of it charting. I think I had been there about 6 weeks at that point. By 12 weeks I was seeing 20-25 patients every day. But "seeing them," and seeing them efficiently were two different things entirely. I'd say it was 18 months before I saw 26 patients in a day, and had all my charts complete by days end. And now, 3 years in, I still have days that don't go smoothly. I had a slow day today. I only saw 19 and I didn't even finish my charts! My first pateint of the day was a psych disaster, and a little later we had a walk-in complaining of chest pain. They came to get me, and my gut said "look at him." I wish my gut had said, "tell him to go to the ED." We did and ekg, and you guesed it, acute MI. We are not really equipped for AMI in the FP clinic, lol. To make a long story short, I was 2 hours behind for the rest of the day, I had a metric ton of paperwork and phone calls, and I still have 2 charts to finish when I go in tomorrow. So I don't know when the magic time is when you will see lots of patients and everything will go perfectly. I do know that week after week, it gets better! I am told the learning curve for new NPs is about 5 years. I believe that. I think the curve is steepest the first three years; I'm still on it, but it is not quite as steep as it once was. I am not quite as dyspneic from exertion as I was in the beginning. Maybe I'm just in better shape. You will get there. Be patient with yourself.
  5. by   angel549
    Whew, that makes me feel better! Hospitalist internal medicine is different from FP because we are responsible for everything on that huge problem list. (or at least referring to a specialty group) Also in the hospital: admits, dictating H&P's on new admits, dictating discharge summaries on all discharges. And it seems like lately every nursing home pt I go in to see has chest pain, shortness of breath, CHF, K of 6, infected surgical wound, HH of 6.8/18, and abdominal pain. So none are easy, lol. I wish!!

    Well, I will keep my chin up and give it some time. They should give a class in school about how terrible it feels to go from expert to novice again Especially after as long as I stayed a nurse before pursuing this....

    Thanks for the insight!
  6. by   nursetim
    How about never? How's never for you. For internal med, which are really sick Pt.s with multiple comorbidities, not realistic and still deliver quality care. I have heard of providers seeing 50+ a day. I call shenanigans on that. Not in an 8 hr. day and do more than say hello and hand them a script. Not unless they have a trusted scut monkey do the H&P and Rx. Then maybe. How do you do a mad steaming emoticon here?
  7. by   mammac5
    The NPs that work with our hospitalist group are limited to 15 patients per day, per their contract. It's a LOT to manage those acutely sick folks, many of whom are elderly.
  8. by   TX RN
    How long should it take before I can see 25-30 pts a day? 6 months, a year, now?!
    Took me about 6 months to really get going with 25-30.
    16 is about average when I too started out.
    This includes call during work hours, so I understand the challenge of working through constant interruptions.

    Much of the speed in developing a high volume day require 2 critical things.
    1. Efficiency
    2. Effectiveness

    Develop those 2 things in each of your SNF/LTC units and you will see the difference.
    One of the other things is timing. Knowing when to round is also critical. I make it a point of being at the inpatient rehab units at one of 2 times.
    1. No later than 0630 -- see them during breakfast but before their 0800 therapy start time.
    2. 11 a.m. - 1pm -- Pts are usually back in their room returning from therapy for lunch.

    I feel like I am not contributing to the group, and it stresses me out.
    15 pt's a day at the 85% physician reimbursement rate should still put you well-ahead of the "average" NP salary, including benefits. My advice is to set a goal for incremental growth in volume. Take it as a 1-2 pts/day increase per week. Share with your group your progress or lack of progress and ask for help on how to build efficiency and effectiveness. Building those 2 critical elements involve developing the facilities you work at.

    Best of luck to you.