office setting nurses

[littlekaneRN]

Hey everyone,

this is a question and a rant so I apologize in advanced but I truly feel stuck.

i am a nurse at a relatively small practice with 3 providers. Each doctor gets 2-3 nurses to help see their patients. Our responsibility is to assist in procedures and transcribe the visit documentation. Rarely we have a nurse on the phones, the nurse who is usually scheduled to do calls ends up having to see patients if we get behind.

I am curious how your office does calls? How are the divided up between nurses? Frequently, at the end of any given day there can be anywhere from 20-30 calls left to do after all of our patients have been seen at the end of the day, they vary in priority. I find it so frustrating to have to try to do all these calls at the end of the day and we generally stay an hour later than scheduled to do them. We have nurses that avoid doing calls or are extremely inefficient which does not help. I live an hour away from our office so leaving so late every day makes me really bitter about it.

I have tried talking to my manager about this but nothing ever changes. She did start assigning nurses to certain desks at the end of the day to have a nurse in front of the phone but that doesn't mean they pick them up to call anyone. I have been told we will not have a full time phone nurse.

what is your offices strategy on calls? Do you experience the same issues? Thanks so much for your time and input.

[littlekaneRN]

Thanks for responding, at our office no new is good news in terms of our biopsy and lab results. However, we have a lot of positive paths for skin cancers, we call new results daily.

We don't have a nurses line, when you call in you speak to someone directly. Anyone who calls in that day gets a call back that day. We also don't have standard phone ours, hey just start at the time the first pt appointment is and are off when the lay one leaves. It varies every day.

Nurses also have to follow up on people who didn't get bloodwork done, we call and badger people about when they're going to be doing labs. We don't draw in the office, sadly. We also have to review a huge list of skin cancer calls we had previously notified pts and scheduled to see if they cancelled if they haven't rescheduled we call them as well. These types of calls I try to reAch them once a week for 3 weeks before notifying the doc for a certified letter to go out.

How often are you trying people back? Such as if we call someone and need to talk further with them and they don't answer, we try them again in 2 days in most cases. We do this up to three times before we stop calling. I try to leave as many detailed messages as possible to avoid this but some nurses do not like leaving details on the machine even if that pt allows it. I think this is most of our volume of work.

I feel like my NM "babies" our nurses. She will defend their behaviors in avoiding calling people because they "don't know how to do it". I agree with this to only a certain extent for NEW people but in general what we do in dermatology is not rocket science and after 6 months you should be able to field some calls. we have "scripted" answers to diagnosis questions. I learned by doing and by not being afraid to say " you know Mr smith, I don't know but I'm happy to check with the doctor and call you back ". And of course no one wants to call and tell a pt they aren't going to get what they want, and neither do I but I still do it because it's my job. I don't know if they are just taking advantage of the fact that my manager allows them to be less accountable or they genuinely just don't know how to handle it. I am always happy to teach anyone that asks :/

I really love my job but I'm just frustrated that it's only me and a few others that pick up the slack, because we don't get to leave until it's all done and I want to go home at the end of the day.

[pfchang]

I can't imagine defending RNs that don't want to call patients unless they are very new, like less than one month of experience. I would be annoyed if I hired RNs that didn't want to learn what was needed to complete these calls. Someone should be teaching them or they should get back with the patient after discussing with the doc. Do they just sit while you call patients at the end of the day?

I was thrown in as the only triage RN in a FP clinic seeing 120+ patients per day with several providers, several part time. I was responsible for so much, it makes my head hurt thinking back. I had to learn by asking and researching, etc, and had to get back to patients all the time. Your clinic makes RNs look bad. Tell them to just ask for heavens sake. And to do their share.

Doesn't everyone one want to leave on time?

[littlekaneRN]

Pfchang,

YES! We have one new nurse, the rest of the nurses are easily at minimum 6 months along! Most of us have been in the office for years! Years!! And I do not mean to sound like every nurse I work with is like this but there are several. They just sit there in the cubicles and pretend to be busy or say "I cant do that call" because they seem complicated. Which they can be, no doubt , but it's always the same 2-3 nurses doing the "hard" calls.

They are all smart nurses too, good with their patients in the office. I just do not understand it. Another nurse had brought it up w/ management not just our NM and she was told that WE weren't being team players ??

I wish I knew how to fix it or at least help. I feel like we'd be ok if we all chipped in to divide and conquer the calls efficiently. I believe half is actually doing the call and the other is efficiency.

[pfchang]

I meant to add that anyone not leaving detailed messages when you have the patient's permission is just making more work for those who have to take the return call. Ask them WHY they want the patient to call back and start telephone tag. Of course, not everything should be left on the phone message, despite the patient's permission, like a cancer dx or issue that may scare the patient until more explanation can be provided. Is your manager even managing? Who has set up these policies where RNs don't have to call back and don't have to leave messages even with permission to do so?

i am a busy professional. I don't have time for telephone tag. I need my 30 min lunch break to eat. That's why I use email portals whenever possible. I do not want to miss my lunch waiting on hold for someone to give me a message they could have left in my vmail with permission. These scenarios people report make me crazy.

[pfchang]

Sorry to say it but they sound lazy. If you made it a financial thing, maybe it would get attention. Example, how long does everyone stay while the few are still doing calls? If everyone took calls, easy and involved, could all nurses leave, say, 20 minsearlier each day? What Would be the impact on saving wages? If you are all hourly, it could be huge.

I am so big on documentation. I would start documenting details of this problem. Take your time and document types of calls, who takes what , etc. Hhow does everyone know which are complicated? Do they listen to vmail and then just skip over the hard ones and pick and choose?

Is there any training that could be proposed, then required, to supposedly get everyone up tyo speed? I think you need more nurses to talk as a small group with the NM. But get your documentation and ducks in a row first with constructive solutions to propose.

[littlekaneRN]

Thank you for the advice.

i should clarify how our system works, nurses don't have a v mail line. All messages are created by the front desk (or who ever answered the call) and it's made into an electronic message in the pts chart. All messages are sent to a general "nurse" inbox where all nurses can access it to work on them. You can easily preview the topic of the message and avoid it or open it and work on it. I want us all to be able to and willing to handle whatever message we open.

We are all hourly. I'm sure the boss man pays dearly for it bc we almost always do OT to finish up. It's been this way for so long though. Even our part time nurses can work 38 hrs a week because of having to stay late.

i will take your advice, hopefully i can come up with something that can help us out :/

[laKrugRN]

OMG there are 8 of us nurses at my clinic and we take ALL THE CALLS. So we are doing all the triaging. LPNs and RNs doing triage. We even do our scheduling. It can get frustrating between all of that, seeing patients, and carrying out orders.

[mrsmsh42]

I know this is an older post, but I'm flabberghasted.

I have FIFTY-TWO providers.

I have TWO medical assistants and THREE nurses.

We do fine.

I don't know how your docs are affording eleven nurses. Sounds like a toxic environment to me. Come work for us. We're busy. (And our docs do not expect our staff to write their notes for them....how ridiculous and entitled of your providers....)

[klone, MSN, RN]

52 providers who all see patients at the same time? The numbers we've given is a per-day number. For our clinic, it's 2-3 providers per day. If I'm counting all of them, we actually have about 12 providers. But all of them are on a very part-time basis, from 3 days/week for our most full-time provider, to once every 3 weeks to our most part-time.

[mrsmsh42]

Oh! In that case, I typically have four to seven providers per day. I misunderstood. :)

[littlekaneRN]

Wow mrsmsh, I couldn't even imagine. I was in shock and worried when we found out we were getting our 3rd provider.

Things have settled down for the most part at work due to having a nurse on phones most days of the week but I'm telling you, it is absolutely crap sometimes what some of my coworkers refuse to do. And, a lot of times I feel like we have become the social worker with how much we do beyond what is necessary.

There are still 11 of us and we've had at the minimum of 5 nurses in the 3 yrs I've been at this practice.

What specialty are you in? I've wondered if because I work in dermatology and nurses mainly function as the transcriber. I am aware of other derm offices that have staff that do this but not aware of it in other fields. How many pts do your providers see an hour/per day?