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

Specialties Ambulatory

Published

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?

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
As far as making changes ourselves, everything has to go through Administration.

And what happens if it doesn't? I mean, what would happen if you just went out to the clerical staff and say "Hey, when you answer phone calls, if they ask for the nurse, find out what they need, get their name and number, and let them know the nurse is seeing a patient but will return their call shortly. Then give me the messages." What would happen if you simply refused to take a phone call when you're in the middle of a patient visit, and told the clerk "Take a message and let them know I'll call them back" ?

Specializes in Clinical Documentation Specialist, LTC.

Today I was the only nurse for two providers, with a MA working up patients for the third, but when that provider ordered injections or other treatments for her patients I had to do it since the MA is not certified. I am exhausted. So exhausted I can't relax if that makes sense. I really want to like the job, but when things go okay for a couple of days, all hell breaks loose.

I actually had a patient walk in and demand to see me so she could have some paperwork faxed. I was triaging a patient and refused to just drop everything to come get the paperwork from her. She then got mad and stormed out of the clinic when the receptionist told her she would need to wait a few minutes. Really? When did people become so dang rude? Those are the kind of patients who call administration and complain. They think the nurses should just drop everything and cater to them. *sigh*

Specializes in Peds/outpatient FP,derm,allergy/private duty.

Day-ammmnnn..... is all I can say to that, LTCNS. Trying to send you calming vibes. My opinion is that it takes some actual effort to make an outpatient environment as sucky as yours is and I am ever thankful that I worked for some well-run clinics where it would be once in blue moon that that kind of chaos was allowed to happen. (((hugs)))

Please document that incident. You may need the details in case of a complaint. It is also a good example of how not to run a clinic. I think if boundaries and policies were put in place and patients firmly told about them that things would calm down. Even if you weren't triaging a patient, the clinic needs structure. You've been there long enough to discuss w admin. Make it constructive criticism with ideas for improving workflow. It is a very rare situation where something really needs to be faxed NOW.

Actually, I hope she does complain to admin. No one in their right mind would expect you to stop triaging a patient to fax paperwork. You can explain what happened and propose changes in workflow.

Specializes in Clinical Documentation Specialist, LTC.

You know what's really sad? Several patients told me yesterday that they are used to seeing new staff every couple of months. When I mentioned it to the manager he stated "It's because nurses leave to either better themselves, leave for more money or for a less stressful job." He knows it's a crappy environment but his hands are tied by administration so he can't do a darned thing to try and improve conditions. He tries to get help when we're short staffed, but other clinics in the chain are in the same shape.

Specializes in peds, allergy-asthma, ob/gyn office.

Editing to remain more anonymous

Specializes in Ambulatory care.

Oh boy that is scary ... hang in there and protect that license

Specializes in Clinical Documentation Specialist, LTC.

Wow Oedgar...That sounds almost exactly like the clinic I work in. If you hadn't said your clinic is closed on Friday afternoons, I would think we worked for the same people! I hope you find something much less stressful soon. I'm on the hunt myself. Not only do they schedule appts. 15 mins. apart, they schedule two and three at the same time, so patients end up complaining because of the wait time. It's ridiculous.

Thanks Inori. I'm trying so hard to do just that. I worked too hard for it to let a bunch of BS cause me to lose it.

Specializes in peds, allergy-asthma, ob/gyn office.

Just remaining anonymous.

You are not crazy. It sounds like the docs are either clueless or are ignoring the obvious. I had a friend who left a crazy place I worked some time ago and said she had no idea things could be so much better. She was afraid to leave but is working in a podiatry office and life is good again for her.

Don't underestimate the impact of the continued stress.

Specializes in Clinical Documentation Specialist, LTC.

Definitely not crazy Oedgar. You have to do what's best for your own mental and physical health. Praying for you!

Specializes in Clinical Documentation Specialist, LTC.

Nothing has changed. We're more short staffed than ever now. I'm exhausted and already burned out after just under four months. Today I was the only nurse for two providers and the appts. and walk-ins did not stop. Not one "you did a good job today" or "thank you for working so hard today." Nothing...Not a peep. Injections and UAs out the wazoo.

I have more than 70 referrals staring me in the face. More than 30 phone calls to return and at least 35 labs to call pts. about. I promise to God, if one word is said to me about the referrals, I am going to unload. The pet nurse gets to work on her referrals when her provider is off while I run my legs off, and what does she do instead of offer to help me? She watches my schedule and reports to the supervisor how long my patients are waiting to be triaged. But yet I ALWAYS help her when she is slammed. Always. My referrals are pushed aside so that she doesn't drown. I'm done helping her. She has one more time to run to the supervisor about me, then I am going to sit her and him down and tell them exactly how I feel. And for the record, her patients rarely get called back for triage in less than 45 mins.-1 hour, but I don't go down the hall like a 5 year old to tattle.

The only reason she helps work up 1 or 2 patients on the rare occasion is because she is told to, then she brags about "helping" me.

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