On call question

core0 · Sep 16, 2008

I am a new NP. I work for a cardiologist that covers with a primary care group. On call consists of covering the office calls after hours as well as rounding on patients in 3 local hospitals (~ 20 mi radius) on the weekends. The census has been running ~18 - 25 pts. I am totally overwhelmed by this and am wondering what the census is for other NPs when they are on call. The dr. says this isn't bad and I should just "buck up" basically. I would love to know how this compares to others. Please be honest. Am I just overwhelmed or is this crazy. Thanks

The biggest issue is are you admitting or consulting. 18-25 patients that you are admitting is ridiculous and there is no way that you can give good care. If you are consulting on 18-25 patients then its very doable (ie admit to hospitalist service and consult on the patients). When I did GI we covered as many as 30 inpatients at 4 different hospitals with in about the same radius.

The other issue is what is the physician doing. If you are doing this all by yourself then again - ridiculous. If you are doing it with the physician, how is the workload divided. I worked with one physician that wanted to follow behind and review everything. Made for a long day. Another physician would divide the service. He would start on one end of town and I would start on the other. He would do whatever procedures on that end of town and get whatever he could done as far as inpatient notes. I would do all the notes and consults on the other end of town then head south. He would head north. I would pick up any left over notes and new patients. We could do 30+ patients and 6 procedures and be done by one. Made for a very nice day.

On the other hand I remember arguing with the MD at one in the morning whether the note counted for today or yesterday after getting 22 consults in one day. Some times the bear gets you sometimes you get the bear.

So I guess the answer to your question is - depends. If you are admitting and getting all of the orders for a patient then 8-10 is reasonable for a day along with a few consults or new admissions (in my opinion).

David Carpenter, PA-C

Joan Z · Sep 16, 2008

I would agree with core0, depends on whether you're talking admitting or rounding, also what kind of backup you have. I would assume you have a backup MD if you can't handle something?

Part of the problem is being new (and, being new and in a similar situation and feeling a bit overwhelmed, I totally sympathize--the rest of my life is on the back burner while I adjust).

Keep track of how many hours you are spending and what you are doing. When it comes time to negotiate a productivity bonus you'll have evidence to back up your request.

JEKA · Sep 16, 2008

Thanks for your replies. There is physician back up but by phone only. I do the actual rounding and note writing on the patients. This includes admissions, ER, consults and discharges. Another question I have is, How much do you (everyone else :wink2:) write on a progress note? I usually include VS, labs if current, and assessment (cardiac, resp, GI etc) as well as recommendations etc. This is time consuming and I know it's more than others are writing but I am not sure what the "minimum" should be. I have seen some drs not even open the chart but simply write

doing well, VSS, no complaints and then sign it. Any suggestions? Thanks again

Trauma Columnist · Sep 16, 2008

Hi Jeka - being new can be overwhelming. I'll address your last question first. In order to bill for the max, you have to include 7 systems in your assessment. Here is what I write:

1 VS

2 Labs/xrays/other test results

3 HEENT

4 Lungs

5 Heart

6 Abd

7 Extremities

8 Neuro

If it is new consult then you have to include more such as reason for consult, etc as well as the PMH, PSH, allergies, meds, etc...I also have to dictate these.

If it is an established patient, then I write a soap note.

As to call, I work in a large nephrology practice and I take hospital call every 5th weekend. I do rounds on two hospitals 55 miles from my house. I do the new consults, admits to our service and discharges. Even with two years experience, it still takes me about 45 minutes for a new admit or new consult. However, I'm doing much better timewise with the established pts and I can get them done in 15-20 minutes. (I say this because cardiology and nephrology have similar complexity).

For my call weekends, I usually have around 12 pts. The physicians are on call at 5 hospitals and they usually see my patients too. Our call is 7am to 7pm on Sat and Sunday. Also, we do telephone call for 15 dialysis units and returning the calls is more time-consuming then actually seeing patients - lol.