Primary Care nursing - new to me!

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Hi all,

I recently started in a Primary Care clinic (peds-adult-older adult) that uses RNs for RN in clinic visits and phone triage.

I have four years of experience as an RN, but in med/surg and orthopedic hospital nursing and women's health clinical work.

So, I am used to the pace and the multi-tasking and the customer service.

What I am NOT used to is being the primary health care provider for the patients in person or over the phone. The company I work for has SmartSet charting that can help lead me through urgent/semi-urgent/non-urgent plans of care, and has a ton of patient info that I use to help educate myself as well, but I just feel like I'm drowning all day under the weight of what I don't know. How do I learn, faster than trial-by-patient, parameters on how to care for these patients?

There are two books on Amazon I'm thinking of purchasing: Clinical Guidelines in Primary Care and Telephone Triage for Nurses. Before I lay down $100+ for these tho I would love any help from you all.

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I use Barton Schmitt pediatric telephone protocols. I'm the peds nurse so those are the only calls I do. Good luck!

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Specializes in nursing education.

I love the Briggs telephone triage book and highly recommend that.

Are you talking about Clinical Guidelines in Family Practice (Uphold and Graham)? That is more than you will need. For the RN scope of practice, you are not the primary care provider; the physicians, PA's, and NP's are.

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In situations that are outside my scope of practice I always have the patient wait while I consult with the MD. I'm not prescribing meds or diagnosing illnesses - but the way RN visits and phone triage are set up you are kind of put into that position - I follow the protocol guidelines of course and am not making independent choices..but, for example, one of the other experienced nurses will say "choose an antibiotic out of the list that will also treat her chest/cough symptoms" and I'm thinking...huh? How do I know? Is it just back to the books for me?

I am going to school to be an NP, so I thought the Clinical Guidelines book (the one I looked at was by Hollier and Hensley for Primary Care) would do double duty - make me feel more informed during my conversations with patients and the MDs alike, as well as helping me to prepare for when I'M the provider.

I will definitely get the Briggs book!

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Specializes in NICU, PICU, Transport, L&D, Hospice.

Just remember that no matter where you practice, when you change specialties it takes 6 months minimum before you feel like you have a good grasp on the basics of the job 90% of the time. In that time frame you begin to feel like maybe you are not dangerous. It takes about a year before you feel more or less competent in all aspects of the specialty. It takes about 5-6 years for the average nurse to achieve expertise in a given specialty.

Good luck.

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Specializes in Family Medicine, Pediatrics.

I know how you feel. I was brand new to telephone triage and clinic nursing when I started it a year and a half ago and I was petrified.

Make sure you follow your clinic's protocols. If someone fits the criteria for strep throat (i.e. positive

result), what have the doctors in your department approved for a protocol to prescribe antibiotics? For us, we are comfortable choosing the antibiotics the docs have approved. Otherwise, we'd have to constantly ask them. If nothing like that is in place, find out if it can be. As for choosing an antibiotics out of a list, verify the patient's allergies and assess their previous medications when it came to a certain illness and what meds did and didn't work. If you still don't feel comfortable, ask the patient's primary physician.

I know you started this post back in February, so hopefully things are working out for you much better now! =)

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