One nurse for three busy providers. This can't be safe, right?

toomuchbaloney · May 29, 2014

When is the next staff meeting? Ask the clinic manager to have a sit down with you and the providers to develop a reasonable game plan. This is not your burden alone.

LTCNS, LPN · May 29, 2014

We have one every Wednesday, so not until next week. I'm hoping the CM will be able to pull a nurse from another clinic, as that is what usually happens in these situations, but sometimes a nurse might not be available to be pulled so I'm trying to prepare myself for worst case scenario.

The nurse who just lost her father has been there for six years and had to work the whole clinic alone for the three providers once. She said it was a nightmare. Patients getting mad because they had to wait, providers pulling her in every direction, patients calling for lab values, referrals to follow up on, and she wasn't allowed to tell the patients she was working alone, as if they couldn't tell.

The thing about this particular "chain" of clinics is administration has very unrealistic expectations of the nurses. We need help desperately but as long as we can skate by on the skeleton crew we have, and nobody gets hurt, they don't care. We have to do our own referrals, follow up on labs, return phone calls, etc...and do all this in an 8 hour day. Needless to say, some things just don't get done, but the patients are seen and taken care of.

ETA: I need my job and am not planning on quitting. I guess I'm just looking for ideas on how to handle the situation if the CM can't get some help in there.

xoemmylouox, ASN, RN · May 29, 2014

You have to prioritize. If you have people who answer phones utilize them. They can help screen out really urgent calls, they can make routine return calls, etc. You will have to address urgent things first:critical labs, phone calls, xrays, etc. The providers will think the patients in the office are priority because they don't want to be standing there with no one to see. Don't count on taking a lunch, but make time for 30 second bathroom breaks. Let them know you will not be doing this for more than a few days as it is impossible. Good luck!

allnurses Guide · May 29, 2014

I don't see how it's humanly possible for you to be responsible for calling in 100 or so patients, doing chief complaint, vitals, and whatever else they may need in addition to the phone callbacks, labs, etc.

I've been very fortunate in my jobs because if a situation like you are describing occurred, very likely our providers would call in their own patients, do some of their own phone callbacks, etc. They would have no hesitation to tell the patients one of the nurses had a personal emergency. Most people can understand that a lot more than they can understand a crazy circus going on with no explanation or reason to it.

You really don't need another nurse if you can get someone to help you keep your rooms filled and deal with the complaints from impatient people in the waiting room. If you absolutely must do this yourself, I would definately make a list of priorities with you at all times that you update throughout the day so that nothing falls through the cracks. I'm really sorry you work for a place that lacks a team spirit and is willing to throw you to the wolves like that.

LTCNS, LPN · May 29, 2014

They got some help from another clinic so that helped a lot, but then I ended up having to leave at 2pm as I have been pretty sick with a nasty URI and am still not feeling well at all, but they were able to get another nurse to come in and help the other nurse. I'm out until Monday. B/P shot up to 170/100 and temp. was up over 100* when I left. I shouldn't have gone in today at all, but I couldn't leave them with no help.

Unfortunately there is nobody to screen calls. In fact, if a patient calls and insists on speaking to one of us, we are interrupted during triaging patients to take a call, and 9 out of 10 times it's someone wanting to know their lab values or needing a refill. One of the providers wants her stuff done "now" and another wants her referrals done "now." The nurses are responsible for pretty much everything and when we can't get to it all, administration wants to know why. Patients are left waiting more than an hour-two hours at times because they overbook and take walk-ins left and right. Receptionist is told not to turn anybody away. To be honest, a zoo is more organized.

LTCNS, LPN · May 29, 2014

I don't see how it's humanly possible for you to be responsible for calling in 100 or so patients, doing chief complaint, vitals, and whatever else they may need in addition to the phone callbacks, labs, etc.
I've been very fortunate in my jobs because if a situation like you are describing occurred, very likely our providers would call in their own patients, do some of their own phone callbacks, etc. They would have no hesitation to tell the patients one of the nurses had a personal emergency. Most people can understand that a lot more than they can understand a crazy circus going on with no explanation or reason to it.
You really don't need another nurse if you can get someone to help you keep your rooms filled and deal with the complaints from impatient people in the waiting room. If you absolutely must do this yourself, I would definately make a list of priorities with you at all times that you update throughout the day so that nothing falls through the cracks. I'm really sorry you work for a place that lacks a team spirit and is willing to throw you to the wolves like that.

Sadly it's very hard to prioritize when all the providers feel their orders are priority, so the nurses are left running around like loons trying to please them.

I have referrals I need to work on but never have time to sit and work on them. Then the patients call and want to know about their referrals. I had a referral for a patient to see a cardiologist I needed to do today and didn't get even a minute to sit down and work on it. We also have to do our own pre-certs, and that can take forever depending on hold times.

There is a pretty high nurse turnover rate because of all the nurses are expected to do, so the stress finally gets to them and they go where there is more support. It's really a shame as the providers are all easy to get along with for the most part, but administration makes it hard on everyone.

pfchang · May 30, 2014

An clerical person can do referrals and pre- certs. That is a crazy thing tyo assign to RNS. But since that is the way it is now, you have to triage your own work. The numbers and scenarios you stated are unbelievable and I agree with you that they could be unsafe. If admin wants to know why things are not done, tell them. Keep track of what you do for a week or so. It is a huge hassle to do this, but it may show admin why things are not getting done. Good luck to you.

Aall clinics are not like this. I was very often swamped, but it was not as bad as you have described.

allnurses Guide · May 30, 2014

Sadly it's very hard to prioritize when all the providers feel their orders are priority, so the nurses are left running around like loons trying to please them.
I have referrals I need to work on but never have time to sit and work on them. Then the patients call and want to know about their referrals. I had a referral for a patient to see a cardiologist I needed to do today and didn't get even a minute to sit down and work on it. We also have to do our own pre-certs, and that can take forever depending on hold times.
There is a pretty high nurse turnover rate because of all the nurses are expected to do, so the stress finally gets to them and they go where there is more support. It's really a shame as the providers are all easy to get along with for the most part, but administration makes it hard on everyone.

We had an employee who's only job was to work on pre-certs and referrals. It is extremely time-consuming as pfchang pointed out.

It sounds to me like this job is stressing you out to the point your body rebelled to save your mind and spirit from the toll the job is taking on you. It sounds like there are systemic problems in the way this company operates, from the top down. I shake my head at this, because it so obviously will turn around and bite them in the rear end. Unless there is no choice most people return to a provider who provides a positive experience as a whole. Nursing and support staff are a huge part of that.

If you choose to stay, the job will go more smoothly when you get to know the regular patients and providers, they will get to know you and hopefully trust you. I find it really helpful to call your patients waiting for a refill or referral appointment and tell them when they can expect their needs to be taken care of rather than leave them hanging. They will grumble sometimes, but in the long run it works out better that way.

One of my jobs was to do literally everything office staff would do by myself for two doctors who each worked part-time. The only way that could work in my case was to do anything I possibly could ahead of time and clear the decks when there was a full schedule plus extras to see. Naturally, everyone believes their need is the most urgent, but it isn't and you can only survive by politely informing them of that reality.

Maybe at the next staff meeting you could suggest that a block of a few hours of time to do non-urgent callbacks and referrals would help the whole operation run more smoothly. Maybe you could work with another nurse and the two of you could cover each other while one does tasks that take a while or answer calls when you will be busy doing something of higher priority. Anyway, just a few ideas I've thrown out there. Hope you are feeling better soon.

LTCNS, LPN · Jun 2, 2014

So after doing some research, I realize it is not the norm for one nurse to be responsible for triaging, pre-certs, referrals, returning calls, labs, etc...Too bad the powers that be think we're machines. I'm thankful for the experience though, as it will be valuable down the road.

Have a blessed day my fellow nurses!!

SHGR, MSN, RN, CNS · Jun 3, 2014

I don't think it's the norm for a provider to see fifty patients in a day, either! That clinic sounds just manic. Hope things settle down for you.

LTCNS, LPN · Jun 3, 2014

I don't think it's the norm for a provider to see fifty patients in a day, either! That clinic sounds just manic. Hope things settle down for you.

They have this "turn nobody away" thing going and yes, it is like a madhouse most days. When patients get tired of waiting at one clinic, they come to us as walk-ins and are put on the schedule for one of three providers, and because most of them want to see an MD, they stack up until some days the MD sees patients non-stop. She barely gets a lunch break because she is bombarded with patients. On days like that we are all triaging, rooming and doing labs.

The two other providers are NPs and get the ones that just want to see somebody for cold symptoms or med. refills and don't care if they see an MD or NP. The most the NPs might see in a day is 25-30 patients, with 24 being the average.

I just wish we could get the ones who sit behind a desk all day wondering why we can't get everything done, to come and watch what we do for one day, then maybe they would get it.