Pros and cons of RN clinic nursing?

[Wuzzie]

I’m afraid I won’t be able to offer you much. I work in a large oncology clinic that is physically in the medical center and our patients are super sick. We also are an all RN clinic with PCA support. I will say one thing you want to find out is how often you will be expected to stay late. We routinely put in anywhere from 3-10 hours of overtime in per week due to clinics running late and admit holds. You’ll want to know about patient phone calls as well. Are you given a specific time to do them or are you expected to fit them in around your other duties which can be very difficult. We average around 700 but can get up to 1000+ calls a day. Yes, that’s per day. We are supposed to have 7 nurses assigned to phone triage but that doesn’t happen often. Will you be doing PAs as well as med refills? What EMR are they using? Clerical support? Medical records? Case manager? The support staff makes all the difference. If you have to be everything to everyone it can become an overwhelming grind. Whose responsibility is it to prep for clinic? That’s a huge job depending on your patient load. The good news is at 2 days per week you’ll likely escape a lot of the heavy responsibility but still…

[Davey Do]

I've only worked in an outpatient psych clinic, so I don't know how much my experience will help you, Emergent. However, I do want to voice my pleasure in hearing you're successfully dealing with your trauma and are pursuing nursing in a less stressful environment. I believe you are one of The Good Ones!

Workload is a factor that may help you determine if you want to do clinic nursing and for how long. In my experience, the load was initially pleasantly tolerable, but it seemed that the better I got at it, the more duties and responsibilities were piled on me.

Mine was a FT position, so that may not even be a point of contention with your situation.

I wish you the very best, Emergent, and please keep us informed!

[Daisy4RN]

What?! No more country store job, eh. Well I am glad you are doing what makes you happy!

My biggest gripe with the out pt setting was having to babysit grown adults who won't do the job they are getting paid for without constant prodding. It got real old real quick. But who knows everyplace is different. So, I would definitely ask about any supervisory roles of unlicensed staff etc. and expectations for reporting when/if issues come up (handle yourself, report to manager etc). Hopefully you will only be responsible for your own position and won't have to worry about it! I would also ask about OT, one placed I worked required the RN to be the last to leave and lock up so I got off late sometimes and if so of course you would want to be paid. I would also ask about chain of command re: any medical issues, can be a little different.

Hope it works out for you and congrats on the new job and glad you feeling better!

[Wuzzie]

To give you a more accurate answer what kind of clinic is it? I work in one but it’s not at all what people think of as a clinic. New hires are required to shadow a day with us and they are overwhelmingly shocked by the experience. 

[Davey Do]

11 hours ago, Emergent said:

I'm not certain this is the right path for me.

After I was fired from Wrongway in March of 2020, I wasn't sure which path was the right one for me either. My medial nurse wife Belinda supported my wish to retire, but I just wasn't sure that I was ready yet, so I applied at an LTC facility a few miles from my home.

Working one shift at that LTC facility told me it would be the same old frustrating struggle in order to just merely do my job, so I decided to hang up my nursing guns.

To paraphrase Leonard Cohen, "You ask for signs, the signs will be sent".

Good luck, Emergent!

 

[klone, MSN, RN]

So, I am the manager of a primary care clinic. I can tell you what our RNs do....80% of their job is phone triage. They also do insulin and glucometer teaching, BP checks, once in a while they may help with a clinician who needs a patient to be straight cathed, if a patient walks in off the street complaining of chest pain, we do an overhead "RN Stat" page and the RNs will triage the patient and prep them for transport to the hospital. They do the pre- and post-assessment of ear lavages that are on the nurse schedule (the nurse schedule is run by an LPN). They are responsible for calling patients who just got a +Covid test, and triaging them to determine if they meet criteria for antiviral therapy or mAb, and then we have a standing order protocol for them to place that order. But most of their job is triage over the phone and via our Epic in basket messages. 

[gemswanson90]

I worked in outpatient clinics for about seven years. Overall, it's more about being okay with office politics and kissing up to certain influencers and doctors than any other nursing jobs I have ever had.  Even though you might not be running your *** off all day from room to room, it is stressful to triage over the phone. People will call in, you will give them three or four options, and they will not want to agree with any of those options.  You will need to be a skillful negotiator.  Also, after not starting an IV or obtaining an ABG or EKG for years, a new MD will pop that on you out of the blue. You will need to have good communication skills with DME providers and the vendors who come to the clinic, and it will be key for you to have good relationships with your assigned MD's.  You may or may not like these people, but you will need to be able to have working relationships with them.  

[JKL33]

8 hours ago, Emergent said:

What really makes me nervous are the medical assistants. I really want no part in overseeing them because that can be a minefield.

They work under the direction and supervision of the provider. They are not nursing assistants so it's different than inpatient/ED where everything a tech/NA does has supposedly been delegated by an RN and and RN is ultimately responsible to see that it gets done and is done properly.

[Enarra, BSN, RN]

in my clinic MAs reports to RNs and documents it as so we do oversee them and write them up if a verbal warning doesn't work.   I tell you the MA to report to me if vitals are out of range once and 2nd time you don't do it I tell you again 3rd time I catch you you're written up and if its a serious out of range vital such that I need to write and occurrence report you the MA is getting written up on first violation.

OK BACK TO TOPIC

I work in a primary care clinic,  what I do is triage, in person and by phone, and by secure email messages, conduct nurse visits to educate manage DM and HTN issues, give vaccinations, educate on chronic diseases, using motivational interviewing techqniques to empower patients to manage their own disease processes, respond to clinic emergencies, discharge patients, occasionally transfer patients to ER, or floor admission which is a hassle, I do the occasional EKG and venipuncture just to maintain my skillsets and get street credits as this way my MA and PCAs know that this nurse knows her job and their jobs too and if need be can do theirs and know if they are cutting corners, I administer meds PO or injectables meds as ordered, I double triple check the orders as residents are doctors in training so I'm afraid they'll make a mistake and I'll be the one losing my license.  I do not involve myself with office politics or kissing up because I believe that my skills speak for itself and make it very clear I am not interested in such games by ignoring all gossips and doing my job to the best of my ability and smile and say good morning to people from janitor up to the Admins Execs.  Anyone insisting on dragging me into politics gets to meet my alter ego that few have seen and lived to talk about it. LOL

[gemswanson90]

Yay for you, primary care RN.  I worked in Specialty Clinics...not primary care. If you're in primary care, you get to funnel your "problem" elsewhere... that is where my specialty clinic takes over.  Primadonna Specialists abound, and you've got to have a Very Strong back and stomach to put up with it.  You've Got to know where your RN authority ends; do not Ever expect an MD to cover your behind if it comes to it.  It can be "implied" all the way uptown and downtown, but that will not hold up in court.  Never feel embarrassed or intimidated into Not asking and/or calling the MD to verify orders. His or her angry and/or intimidating speech will of course cause your heart to race and thoughts to be scrambled.  Don't fall for it; repeat your initial concerns and what you would like to do; their dinner or sleep is of no concern to your license.  They are getting well paid to be on call; the only people to suffer from a bad choice is your patient and you, if you don't advocate for the patient in distress.  

[2BS Nurse, BSN]

Long time clinic nurse here. Every clinic runs its workflow differently. Your concern about workplace culture is paramount. There are definitely politics to consider. Will they let you shadow for a day? If so, take note of the provider-MA-office assistant relationship. Does the clinic have the tools you need to do your job (I.e. a Dynamap)?

Most clinics have RNs triage only and their work involves managing the Epic in-basket. They leave their desks to insert IVs, etc (every state has different laws around MAs and scope of practice). MAs seem to come and go through a revolving door. Do you have to fill in for the MA when she/he leaves or calls in sick? Train new MAs? This means an extra long day for you. Who will be filling in for you when needed? Are you expected to float to other areas/specialties (without float pay)? Will you be expected to take on projects? If you commit to 2 days/week, will you be expected to work extra? I've never had a part-time job where I wasn't expected to add on days. 

Even though MAs work under the provider's license, unless you are in a room of your own you will be overseeing them. Will you be sitting in the nurses' station or in a triage room?

Having to babysit grown adult patients who won’t take their medications properly yet you're still responsible for their outcomes is huge. Internal medicine is "graded" on BP, A1C, patient experience, etc., etc. Your company will expect you to be every patient's best friend. Get ready to have nasty EMR messages sent when your patients don't get what they want. 

The office assistant's capability is a big one too. Most of them have no health care training. Are they allowed to constantly interrupt you with questions, or are they expected to message you when a patient calls? 

 

[klone, MSN, RN]

2BS Nurse said:

MAs seem to come and go through a revolving door. Do you have to fill in for the MA when she/he leaves or calls in sick? Train new MAs? This means an extra long day for you. Who will be filling in for you when needed? Are you expected to float to other areas/specialties (without float pay)? Will you be expected to take on projects? If you commit to 2 days/week, will you be expected to work extra? I've never had a part-time job where I wasn't expected to add on days. 

Even though MAs work under the provider's license, unless you are in a room of your own you will be overseeing them. Will you be sitting in the nurses' station or in a triage room?

Clearly every clinic is different. What you said about the MAs is not at all what it's like at our organization. The RNs would have NO IDEA what the MAs do or how to train them. They sit in a completely separate area of the clinic. The RNs at our clinics (my clinic is one of dozens in our organization) have NO oversight of the MAs/rooming staff (the. rooming staff are either MAs. or LPNs).

Also, our MAs have quite a bit of longevity at. our clinic, so no revolving door. The MA with the least seniority has been with us a year. The ones with the most have been with us for 20+ years (two of them).

Emergent said:

The interview was fun

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