As I walked out of the doctor's office, I could hear the door click behind me, and I thought with relief, "I'm glad that's over." Being in generally good health should help make doctor visits more pleasant, but it often lines up as a chore-something to be checked off the list. The one thing that really makes a difference, though, is the nurse. Invariably friendly, competent and efficient, she makes the difference between pure drudgery and a tolerable experience.
I asked my friend, Kim, about what it's like to be an office nurse. She is an RN and has worked for three years in a Family Practice office. Prior to going back to school to get her Associate Degree in Nursing, she worked as a special education teacher in the public school system. She said that her prior experience in the school system helped her learn how to communicate with patients and families. "Communicating effectively with all types of people is probably the most important skill that I have as a nurse."
She went on to tell me that people expect more from a nurse and a doctor's office than they do from most other professionals. Being a good office nurse requires the ability to help people navigate the sometimes confusing health care system and to help solve problems when barriers to care arise. With insurance coverage in question and payment for expensive tests sometimes unclear, the role of the office nurse as an advocate, has never been more critical.
The office nurse becomes an integral part of the health care team, not just helping the patients while they are in the office by doing the usual-vital signs, heights, weights, pulmonary functions, injections, ear lavage, dressings,assisting with office procedures, etc.-but also scheduling tests, making sure refills get taken care of, test results are called back, and medications not on insurance formularies are substituted. All of this administrative work can make for very busy days between an incessant flow of patients, triage phone calls and paperwork.
"There is a certain satisfaction with seeing a task, doing it well and checking it off the list. I do more administrative work than I expected, but there it is rewarding to knowing that I'm doing a good job and that I am able to be thorough and careful." Kim went on to add that when she was in nursing school, she did not think about being an office nurse. In fact, most of her training prepared her to work in hospital settings. "I have learned a lot working in this setting, and my provider is excellent at explaining and helping me to learn, too."
In addition to administrative tasks and clinical procedures, office nurses also help with patient teaching. During the intake, they go over preventive health, questions about smoking, substance abuse and responsible sexuality. Sometimes the teaching extends to diabetic issues, heart disease management, medication teaching and other areas of concern. Office nurses are on the front line for detecting possible problems-both physical and emotional. During that first contact, the nurse listens for any red flags to pass on to the provider because sometimes patients will chose to confide their problems to the nurse.
"I have kids, so I especially enjoy relating with the teenagers about things they are going through, including teaching about acne, women's health, and general self-respect. Getting positive messages from health care providers can really make a difference in young people's lives."
Some of the challenges that affect office nursing are no different from those that come into play in other clinical settings, and include the occasional bout with low morale and negativity. The providers help set the tone for the staff, but it is up to the nurses and other ancillary staff to treat one another with common courtesy, to leave outside personal issues at home, and to avoid excessive negativity. While everyone acknowledges that we all need an occasional opportunity to vent, a daily dose of anger, frustration and sarcasm do little to help us be the professionals we all long to be or to provide the excellence in care that we know our patients deserve.
Kim went on to add that working with a good provider who genuinely cares about their patients, makes all the difference in her job satisfaction. "When everyone works as a team and acknowledges that great patient care is the result of a group effort, then we can be truly successful." For the office nurse, having open lines of communication with the providers, being able to ask questions, and feeling respected as a member of the team can be professionally rewarding. As another friend of mine once said, "Behind every good doctor is an even better nurse!"
Kim pointed out that seeing patients repeatedly, over long periods of time, helps to build a relationship of trust. Patients feel free to call and ask her questions, trusting that she can steer them in the right direction. "I love it when they call up now and ask for me-it makes being an office nurse so worthwhile."
What has your experience been with the nurse at your doctor's office? Do you feel that she or he adds value to your overall experience with that professional? If you are in home health or hospice or facility nursing, how has your relationship with the various doctors' offices impacted patient care?
