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

[LTCNS]

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?

[Oedgar]

Wow. I do not think it's possible at all for you to be the only nurse for three providers. My job is nuts, but yours is more so!! We had a similiar situation come up today. We have two ob/gyns, each seeing a pt every 15 mins. Other doc's nurse had to be out this morning. So it was going to be me working for the two docs. The only thing that saved me was.... our receptionist has done some MA work in the past. We've never had time to train her for our back office... but I quickly reviewed with her the basics of getting pts urine dips, vitals. Having her help was the only way this morning was not a disaster. And that said, we were still more behind than usual.. but not a complete disaster anyways.

I hope your situation improves soon. It does not sound like a good place to work at all~

[Nurse acewa]

Bronze4- Did you not know before you went to work what the pace would be? I think that this is abusive of your time and talents and you should look for another job pronto. Not all clinics are run so slavishly. We do at the most 30 and I have not seen those numbers in over a year. We avg. about 15 pts. daily. I would not jeopardize my license and suggest a game plan of some sort. Try to get some help and explain that it is a matter of pt. safety that you all work together. I would find another job with more reasonable expectations and before you join their group make sure you know the working conditions. Volunteer someplace first. I hope you figure it out and win at this.

[LTCNS, LPN]

Thanks Oedgar. I'm submitting resume's everyday. I would like to get the experience and move on to another clinic after awhile. There are clinics everywhere local to me, but most want 6 months-1 year experience so I'm toughing it out for now, unless another offer comes up before then.

Nurse acewa, thank you. I didn't know the clinic was run that way when I interviewed. They have a good bit of turnover, so I imagine they don't want to scare nurses away. I probably would've ran the other way had they told me about the ridiculous, unrealistic demands they put on their nurses. Even the most seasoned nurse there can't handle the extra workload. Just going to hang in there and do the best I can do.

[pfchang]

You are learning a lot with all they expect of you. Soak it all up and try to change some work flow if you can. But hanging in there will pay off since you are new to ambulatory care.

[LTCNS, LPN]

You are learning a lot with all they expect of you. Soak it all up and try to change some work flow if you can. But hanging in there will pay off since you are new to ambulatory care.

Yes. I am definitely learning a lot! This past Saturday was my first Saturday to work. We only take walk-ins from 8am-11am on Saturday and it was crazy! I had not been cross-trained on Peds. and was so lost.

To be honest, had it not been for the Pediatrician who was there I probably would not be going back today. The MA who was supposed to be there to help me went home after staying for just one hour. I am going to talk to the supervisor today. They need to stop putting nurses in the positions they do. It's our licenses ion the line!

[CrunchRN, ADN, RN]

That is a crazy amount of patients to room along with everything else. I guess prioritize the most important tuff and do what you can do. Get your experience and then get out.

[LTCNS, LPN]

That is a crazy amount of patients to room along with everything else. I guess prioritize the most important tuff and do what you can do. Get your experience and then get out.

I keep telling myself this over and over every single day

This morning, as soon as I walked in the door, I was told I was going to have to work for two providers by myself, a total of about 45 patients for the day. I basically said "it is what it is" and decided I would do the best I could do, but since I have a great provider who looks out for me, she promptly got on the phone, threw a fit and the clinic manager had another nurse there to help out within the hour lol!! She doesn't want another nurse to be run off, but unfortunately if things don't change and Admin. doesn't get a clue, the turnover will continue until things finally change. We have a terrible rep. with pharmacies and other clinics and hospitals because of the way things are ran.

Too bad the help is not guaranteed on Saturdays

[klone, MSN, RN]

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.

A phone call should never interrupt an in-person visit. We have a "nurse triage line" at our facility - if they want to talk to the nurse, they leave a message on the triage line. I check it multiple times per day, then *I* am the one who is responsible for figuring out the best person to parcel the call off to. And that way, I can prioritize the callbacks and get to them on MY time.

[LTCNS, LPN]

klone, the nurses have been begging for several years to put people in place who can handle referrals and a triage nurse. Until they improve conditions, nurses will continue to jump ship.

[klone, MSN, RN]

Even though it would be impossible to get a voicemail line without the cooperation of administration, you COULD tell the clerical staff or whoever answers your phones that all calls requesting a nurse, they TAKE A MESSAGE, have them find out exactly what the patient wants/needs, and then the clerical staff gives you the messages, which you then decide how best to address/delegate (as others have said, clerical staff are more than capable of doing pre-certs and referrals). I say that if you're not getting any support from admin, you take the reins and make some of these changes yourself.

Oh, how I would love to be office manager at your clinic and whip it into shape!

[LTCNS, LPN]

LOL! Believe me klone. We would LOVE to have you as office manager! The clinic manager is not a nurse and has no medical background. He does the best he can do, but he just doesn't have a clue about some things.

As far as making changes ourselves, everything has to go through Administration. I wish I did have the power to make some changes. *sigh*

[pfchang]

Do you have patient complaints which effect the bottom line? Like patients leaving the clinic to go elsewhere due to the shortage of nurse time? Are you working overtime? Are patients angry over long wait times for referrals and prescriptions?

I really don't see how you can do all this. I had a job like this once and I ended up w palpitations and a cardiologist who made me take 2 weeks off. When I came back the supervisor and I made some workflow changes. She was a nurse, though, not some non-medical so-called manager. Things were better but not ideal. But better. It can be hard to change old habits with long-time staff. But it is worth trying.