littlekaneRN

Wow mrsmsh, I couldn't even imagine. I was in shock and worried when we found out we were getting our 3rd provider. Things have settled down for the most part at work due to having a nurse on phones most days of the week but I'm telling you, it is absolutely crap sometimes what some of my coworkers refuse to do. And, a lot of times I feel like we have become the social worker with how much we do beyond what is necessary. There are still 11 of us and we've had at the minimum of 5 nurses in the 3 yrs I've been at this practice. What specialty are you in? I've wondered if because I work in dermatology and nurses mainly function as the transcriber. I am aware of other derm offices that have staff that do this but not aware of it in other fields. How many pts do your providers see an hour/per day?

We are in the same boat! I'm also 25, I work in an office and I am walking or standing most of the day. I don't get it. I wish I had some good advice for us!

Thank you for the advice. i should clarify how our system works, nurses don't have a v mail line. All messages are created by the front desk (or who ever answered the call) and it's made into an electronic message in the pts chart. All messages are sent to a general "nurse" inbox where all nurses can access it to work on them. You can easily preview the topic of the message and avoid it or open it and work on it. I want us all to be able to and willing to handle whatever message we open. We are all hourly. I'm sure the boss man pays dearly for it bc we almost always do OT to finish up. It's been this way for so long though. Even our part time nurses can work 38 hrs a week because of having to stay late. i will take your advice, hopefully i can come up with something that can help us out :/

Pfchang, YES! We have one new nurse, the rest of the nurses are easily at minimum 6 months along! Most of us have been in the office for years! Years!! And I do not mean to sound like every nurse I work with is like this but there are several. They just sit there in the cubicles and pretend to be busy or say "I cant do that call" because they seem complicated. Which they can be, no doubt , but it's always the same 2-3 nurses doing the "hard" calls. They are all smart nurses too, good with their patients in the office. I just do not understand it. Another nurse had brought it up w/ management not just our NM and she was told that WE weren't being team players ?? I wish I knew how to fix it or at least help. I feel like we'd be ok if we all chipped in to divide and conquer the calls efficiently. I believe half is actually doing the call and the other is efficiency.

Thanks for responding, at our office no new is good news in terms of our biopsy and lab results. However, we have a lot of positive paths for skin cancers, we call new results daily. We don't have a nurses line, when you call in you speak to someone directly. Anyone who calls in that day gets a call back that day. We also don't have standard phone ours, hey just start at the time the first pt appointment is and are off when the lay one leaves. It varies every day. Nurses also have to follow up on people who didn't get bloodwork done, we call and badger people about when they're going to be doing labs. We don't draw in the office, sadly. We also have to review a huge list of skin cancer calls we had previously notified pts and scheduled to see if they cancelled if they haven't rescheduled we call them as well. These types of calls I try to reAch them once a week for 3 weeks before notifying the doc for a certified letter to go out. How often are you trying people back? Such as if we call someone and need to talk further with them and they don't answer, we try them again in 2 days in most cases. We do this up to three times before we stop calling. I try to leave as many detailed messages as possible to avoid this but some nurses do not like leaving details on the machine even if that pt allows it. I think this is most of our volume of work. I feel like my NM "babies" our nurses. She will defend their behaviors in avoiding calling people because they "don't know how to do it". I agree with this to only a certain extent for NEW people but in general what we do in dermatology is not rocket science and after 6 months you should be able to field some calls. we have "scripted" answers to diagnosis questions. I learned by doing and by not being afraid to say " you know Mr smith, I don't know but I'm happy to check with the doctor and call you back ". And of course no one wants to call and tell a pt they aren't going to get what they want, and neither do I but I still do it because it's my job. I don't know if they are just taking advantage of the fact that my manager allows them to be less accountable or they genuinely just don't know how to handle it. I am always happy to teach anyone that asks :/ I really love my job but I'm just frustrated that it's only me and a few others that pick up the slack, because we don't get to leave until it's all done and I want to go home at the end of the day.

Wow I wish we'd try it out. nurses with providers see that pt from start to finish, any thing that happens during that visit is our responsibility, handling specimens, getting then lab slips, sending rxs. When that's done we move on to the next one, take their history, write their visit note, send em to check out. By the time we're done with one patient, my doc is in with the next nurse and my 3rd nurse is probably waiting for the doc to come in her room. I am one of the only nurses who will call someone when waiting for the doctor to go in my pts room. We do, most days, have 1 rn to do calls but they are the "float/desk" where if any provider gets behind they abandon ship at the desk to take back their patients. Usually you just get stuck seeing patients all day while the calls stack up. We asked to please have one nurse at the desk full time and it got a resounding "no" from the doc who owns the practice. For a doc who has so many employees you'd think he'd go for it. No nurses are allowed to leave until all the nurses are done working. Ugh. Anyway, thanks again for your replies, I was wondering for so long "how do other offices do this?"

Klone, how are things run in the clinic you work at??

The nurses all see patients with the providers. I only ever see my own when I do cosmetics(it's a derm office so some of us do peels or laser), which isn't all that often. Our docs see 6-7 pts/hr each. Nurses do it all, turn over rooms, take histories, assist. Our main function is to assist and transcribe the visit, so we are essentially writing the docs notes. The physician who owns the practice feels he gets a better quality employee with RNs which is why there are so many of us but we do have one MA, she does all the same tasks as the RNs except injection of local anesthetic.

Thanks for the reply klone. Our office actually has 11 RNs!! We have probably 8-9 working together on any given day and it usually comes down to 3-5 of us responsible to finish the calls. It all depends on the leave time and experience of the nurses. Literally all calls are forwarded to the nurse, with the exception of only scheduling. We call our test result pts, refills, prior auths, follow up on any issues, questions, ect. Our front desk situation is tricky, we had a time where if a pt hadn't been seen in over a year and wanted a refill they needed a follow up. They weren't comfortable telling that to people, so nurses had to. It's so ridiculous sometimes and it's really stressful to try to finish it all in one night.

Hey everyone, this is a question and a rant so I apologize in advanced but I truly feel stuck. i am a nurse at a relatively small practice with 3 providers. Each doctor gets 2-3 nurses to help see their patients. Our responsibility is to assist in procedures and transcribe the visit documentation. Rarely we have a nurse on the phones, the nurse who is usually scheduled to do calls ends up having to see patients if we get behind. I am curious how your office does calls? How are the divided up between nurses? Frequently, at the end of any given day there can be anywhere from 20-30 calls left to do after all of our patients have been seen at the end of the day, they vary in priority. I find it so frustrating to have to try to do all these calls at the end of the day and we generally stay an hour later than scheduled to do them. We have nurses that avoid doing calls or are extremely inefficient which does not help. I live an hour away from our office so leaving so late every day makes me really bitter about it. I have tried talking to my manager about this but nothing ever changes. She did start assigning nurses to certain desks at the end of the day to have a nurse in front of the phone but that doesn't mean they pick them up to call anyone. I have been told we will not have a full time phone nurse. what is your offices strategy on calls? Do you experience the same issues? Thanks so much for your time and input.

I don't solely do mohs but I am in derm where we do mohs once a week-ish. I make 25.50/hr, living in PA. Did you just start? What are you making?

I will say we have had a higher turn over in the past, not so much in the last year. I feel many nurses are looking for that "dream job" in a hospital. I feel lucky to work somewhere that's off all major holidays and weekends. I also feel that I am paid very fair as compared to hospital floor nurses. Mohs cases to me are generally similar, but I also work in a practice where there are 2 suregons both work one day a week doing mohs, so we may only have 10 cases a week. They also do not do mohs on very complex areas often, like the ear or peri ocular. Some can go deep. When they get very deep or wide we will coordinate closure with plastics. I really like working with mohs cases, personally. I know nurses who have started with us concerned that they would be stuck in derm if they started there but it hasn't been true. They sometimes move on to OR or plastics.

Hello! I work as an RN in an office that does mohs. i am responsible for setting up the sterile tray, rooming the pt, ensuring consents signed and review their hx. When the surgeon evaluated and marks the site, I will numb with local anesthetic and clean the skin with whatever that physician prefers. During surgery, I blot blood. After, bandage them and review wound care. Depending on the surgeon, I may take the specimen to the lab. I was trained to do the processing of tissue at one time but another nurse functions only as a mohs tech. Please let me know if I can answer any questions.

- PA, outside of Philadelphia- $24.50/hr- Dermatology office- RN- ASN- 2 years exp- Full time- M-F days- No differential because no other shifts!- Assistant nurse manager

At my derm office we keep syringes for 1 week after drawing up lido w/ epi. We don't use clinda though so can't comment on that. We had an OSHA inspector come in and afterwards we limited use to 1 week. I don't know if it was his suggestion or just prompted a definite time limit on them, we used to use them until gone which didn't last long when you numb all day long!