lshell7

A raise!

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!

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.

I work for Kaiser, and one of the things I like is that they have specific RN appointments that can be made. (Kaiser uses LPNs, but few MAs where I am, and they have their own appointments as well like BP checks, immunizations, etc.) This way, you have a schedule and a set number of visits that can be done in a day, just like the advanced practitioners. One of the clinics I float to had a real problem of allowing the walk-in patients to "talk" to the RN in the lobby - often, they were getting triaged and free medical advice and using up our time. We finally put our collective foot down, and insisted that the front desk - unless it was a STAT need - advise the patient that IF there is an opening for the RN, AND if it was appropriate for the RN to see the pt - they would be put into the schedule. So this still requires a minute of your time to determine if you can even see the patient. The office uses Sametime, a version of an IM software, so there's not as much phoning or paging from the front desk. You should float the idea to your office manager that the office have a policy of charging for RN visits - and then you make 10-30 minute visit schedules that can be filled in by the front desk. Patients who are walking in with chest pain etc will always have to be attended to - but the walk in "elbow pains" etc can be put into your schedule and wait, or they can go to an urgent care/ED to be seen.