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

LTCNS, LPN · Mar 14, 2015

That's fantastic Oedgar!! So happy for you!

I was terminated today because somebody told the head guy I was turning patient's away, when in fact it was the doctor who was turning them away. I couldn't even defend myself or tell my side of the story. Their minds were made up. Hard work and excellent work ethic don't mean squat anymore.

pfchang · Mar 14, 2015

I am sorry for you and happy for Oedgar. Oedgar, why would you give so much notice? That's usually not a great idea.

LTCNS, I am sorry. Sounds like it was a toxic environment. Keep searching. There will be something out there.

tyra_nursetye · Mar 14, 2015

As of today, I am temporarily the only nurse available in the clinic where I work for three providers, which altogether see over 100 pts. per day. The two Nurse Practitioners see on average about 24 each per day, and the MD sometimes sees over 50.
One nurse just lost her father yesterday and the other is out for the duration of her first trimester of pregnancy, so about another month.
I am still new and have not had to work the whole clinic by myself, but if the supervisor can't bring in a nurse from another clinic there is a possibility I will have to do so. I don't feel this is safe at all. I don't feel it is safe for the patients and definitely not for me or my license. I was thrown out on my own on day three and have been there for only five weeks.
So my question is, what would you fellow clinic nurses do? Especially being new to the clinic?

Omg! This sounds a little like an experience I was in. I worked for one provider who couldn't keep a nurse. After I started working there I began to see why.

I felt as if my license would get stripped of state came in. Lol. I terminated my employment. I gave them time to hire and develop policies that would help protect me (as the only clinical staff) but they did not do it. The office manager had ZERO healthcare/clinical experience and that made her a horrible manager for me. The physician was overwhelmed and left me to my own devices. There were ZERO policies and procedures anywhere.

I met resistance with manager when it came time to order supplies that we needed and so on and so on. It was a mess and after talking with my hubby we both decided that my license meant more than that stressful, hostile work environment. They still used paper charting (even though we had an EMR) and there were HIPAA violations EVERYWHERE.

The patients suffered because as one nurse, I couldn't complete a days work in a day. Smh. It was a mess. I worked so hard that it was always "five o'clock". Meaning, the day went by so fast. I prayed about it for weeks and since leaving, life has been great.

Do what you have to do!! Whatever is best for you and your family! Be blessed.

TA

Oedgar · Mar 15, 2015

LTCNS... I am so sorry you got thrown under the bus for no reason. How unfair. It sounds like it was a situation that was beyond repair. Just unbelievable. As for my situation... my doc and I are currently in a shared small space. The hospital is building my doc and three others a brand new clinic from the ground up. We were just told the goal is a June opening. I want to give enough notice so the hospital can hire somebody new for her, and perhaps have them trained? There are procedures specific to ob/gyn that you can't just grab a float nurse from day one and hit the ground running. And trust me.. she will be running. My doc has no idea yet that I do not want to go to new clinic. She asked me awhile back.... 6 months ago.. if I was going. I did not clearly answer... expressed concerns about how much support staff were they giving her? I did tell her I was interested in working part time, or maybe as an intake nurse. But no, I can't be her only nurse working in the back and doing intake, procedures, rooming patients, turning over rooms, and phones anymore. Recently the hospital opened a new family practice clinic. New, beautiful. Still not enough bathrooms. Still not enough nurse work space. And still ONE nurse per doctor. No. thank. You. I still really want to leave on good terms.

Oedgar · Mar 29, 2015

For those of you who have taken in interest in my situation... the latest.... I actually began mental health counseling due to the stress of my job and my inability to just walk away from the awful situation. My counselor says my childhood history, including an addicted, neglectful, abusive mother, and my still-addicted mother continuing to use and manipulate me well into adulthood... taught me to tolerate the intolerable. I don't know if I really buy all of that, as I am a firm believer in being better than whatever my childhood was. I am certainly a better mother than my own was. However, my brother, who is also a Master Degreed LPC/LCDC with the same credentials as my own counselor... agrees. I estranged myself from my mother two years ago, and, while it was hard, it has been a very freeing decision.

Right after I started counseling, a light at the end of the work tunnel appeared. My doc/boss was told that her new clinic is opening in June. We originally only had a vague idea of it being this Fall, and, given already the history of the date being pushed and pushed back, I really did not know when the move would happen. Now that I have a more certain date of escape, and it really is just a couple more months, I can hang in there. I have seen and observed the progress on new building and it's moving right along.

Other nurse told her doc, the one who hired me into the office-sharing situation, that I was not interested in moving to new clinic. I had not yet shared this with my boss, given that we are just getting started after her being on leave, and I just wanted to not have any extra awkwardness with her. Too much notice can be a bad thing. I know I should not have shared my intent to leave with other nurse, but we are friends. This place defies description, and we all vent and lean on each other for support.

Other nurse's motivation was good, but word has gotten to my boss. She made a comment about me "wanting to go home," when I had said nothing of the sort that day. She has become cold and more b*thy to me, which was the reason why I had not yet told her. For example, an ultrasound report came in Friday on a pt she had been worried about. She came in, I told her the report was in, and she snapped at me in front of everyone, "I know it's in! I already saw it and spoke to the patient!" UH... ok... I had no way of knowing you already saw the report. I thought my job was to report/flag abnormals. I actually wanted to sit down with her Friday, when we had no patients in office. But she brought her baby, left her with the front office to watch, rushed through her dictations, and left. I have learned do not mess with her when she is dictating. Really, she is always just in a rush to leave office..... one of our problems. She ends schedule early, we can't work people with problems in, it makes other days more crazy when she takes off a half day.

For example Monday afternoon... in 4 hours' time I have 16 patients, with 4 spots that are double booked. And this does not factor in our shared pt bathroom/work/lab area and the fact that other doc will have pts too. It's going to be BAD. Tuesday morning (she is out Tues pm) I have 3 double booked slots, including one 15 min slot that is both a new patient and an IUD insertion. Its going to be chaos.

My big boss, who does not plan on moving, wants me to stay on as a prn nurse with them. He is still crazy-busy... but he is much more straightforward to work with. He does not get mad when you work people in, which fits more with my belief system as a person and as a nurse. And, if he is the only doc in there, things will run more efficiently than they are now.

I can't wait for June, let me tell ya.

klone, MSN, RN · Mar 29, 2015

Are you starting to look for something to switch to? I would start now, and have no qualms about giving 2 weeks prior to the June change.

Sounds like you have 15 minute slots? What is your no-show rate?

We have just started implementing double books into our provider templates to try to make up for our high no-show (averages about 20%). Our goal is 9.5 patient visits per session. But we only put in 1 or 2 double book slots per session for the providers. We have 20-minute slots, though.

Oedgar · Mar 29, 2015

You know, our no-show rate varies widely... I would say 20% is a good estimate. However, it seems on the days when it would help to have some no shows, EVERYONE for both docs shows up!! Also, we have something going on which other nurse and I call 'surprises.' We have one receptionist who does check out, while simultaneously answering the phone, scheduling the person checking out for their mammogram, scheduling their next appt, and taking orders for meds to be called in as the doctor tells her when the person is checking out. He never just writes on Rx pad. He tells reception always to call in whatever, which adds more work to the front office. Anyways, this one sweet lady often forgets to put the patient's next appointment into computer system... which means that also causes double booking and we have no way of finding out till we have a 'surprise' patient show up for their next appointment. and we have to see them because it's our fault. I would say these surprises average from 2-4 per day on both doc's schedules.

pfchang · Mar 29, 2015

There is so much wrong with that office. I'm sorry you needed to get counseling bc it has been so bad but it sounds like the validation you need.

15 mins for a new pt? And 15 for IUD insertion? And overbooked. Your patients must get mad at wait times (and we all know who gets the rants and complaints!). I would get out of there or take time off until June if you take the prn position. Can you handle 2 months without pay?

klone, MSN, RN · Mar 29, 2015

Is it even legal for clerical staff to call in Rxes? I thought only an RN could call in prescriptions on behalf of the provider.

pfchang · Mar 29, 2015

The FP office I was in had MAs doing it all the time I never looked into it in detail as I never had time and it wasn't my license. The clerical staff would have refused, though.

Oedgar · Mar 30, 2015

I can afford to go without pay. Things will be tighter financially, but my sanity is more important to my health and my family life. This is the 2nd physician office I have worked in, and clerical staff has called in Rx's in both places. I would say our wait times average 30 mins to an hour past pt apt times. What gets us in a tighter spot is when we start at 1 pm with a couple of double booked spots, and then the doc doesn't come back from lunch till 1:30. Happens all. the. time. Some of our pts are happy, because they have transferred from another practice nearby where wait times are 2.5 hours. It is still not the kind of service I want to provide to patients. Every day my mind is just screaming to get away from there.

LTCNS, LPN · Apr 18, 2015

Oedgar, I pray you find peace and happiness in your new job. It's just not worth it to be anxious and stressed all the the time with your heart about to beat out of your chest and stomach tied up in knots every single day. *HUGS*

I haven't updated on my situation since I was let go from my last job. The hiring manager from the clinic I was with prior to going to my last job called me the following Monday asking if I would be interested in coming back. I thought well...I don't have anything else going so I may as well go back but keep looking in the meantime. BIG MISTAKE! The clinic I was placed in had 5 or 6 nurses and lab techs walk out in a months time so I was the only nurse in the clinic for THREE Nurse Practitioners. In addition to triaging, phone calls and referrals, I also had to draw labs and do EKGs. Thank God I found a job much, much closer to home and resigned this week.

I'm done with clinics for awhile. I'm going back to geriatrics. It's only 30 hours a week but the pay is more and the money I will save in gas will pretty much balance things out. If all clinics are like the last two, I don't think I ever want to go back to one lol!