Surgical clinic—-is this really doable?

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In July I switched from bed side to a Surgical Specialty Ambulatory clinic. I do like that my body is not as abused as it was in the hospital, but the trend where the employer is asking far more than I can do in one shift continues. I hate nursing.

Anyway, it is me, an LVN, and a medical assistant. The LVN and I are heavily experienced and the MA is brand new. All excellent co-workers though. We also have a front desk person for scheduling appointments (no medical background). This is a clinic associated by a large medical institution. It is a satellite clinic so we have fewer resources.

In my clinic we have 7 surgeons. Not all the same specialty though….not even similar specialties. General surgery, Plastics, Colorectal, Urology, Breast Oncology, Surgical Oncology, and Vascular surgery. 
 

Our satellite clinic recently opened a sister satellite clinic 15 minutes away and they hired one nurse and one scheduler for that office but I will be sharing my LVN and MA with that office some days. 
 

We see anywhere between 20 to 60 people a day. Several specialties on one day. We do preform minor procedures in this office (vasectomies, cystoscopes, cyst removal, breast biopsies, etc.). So the LVN, the MA, and I have to set up and assist with these while also rooming the other patients. The 3 of us also have to field in coming calls, teach ostomy care, the catheter care, exchange catheters, teach self catching, do voiding trials, provide presurgical information as the MDs advise, schedule surgeries, put in the pre-surgery orders, submit cardiac/medical clearance request, follow up with those requests,  follow up with pre surgical labs and ordered interventions, refills, medication prior authorizations, and an in basket of non emergent patient questions and MD notifications and responses, and call patients their test results after the doctor has reviewed them. We also have to keep up with supply orders, QCing equipment, and pre cleaning used surgical equipment, taking surgical equipment to sterile processing, and we have to take all our urine labs and surgical specimens to the lab at the end of the day. 
 

As the RN I am also responsible for assessment calls and I have my own patients to see for bladder infusions, testosterone injections, and when someone with a catheter needs a urine culture I have to exchange the catheter to get the sample (that is what the urologist demands). Honestly, the LVN and the MA don’t like any of the urology stuff, so I end up doing most of that.

My LVN is currently off a lot because her husband has stage 4 lung cancer. 
 

Literally I have not gotten to some refill requests in 14 days. I’ve stayed late, I’ve taken partial lunches, but I really do not think that this much work can be done between 3 people. And we have been “lucky” because this time of year is “slow”.  So maybe half or a whole day a week we have few enough patients that I can let the MA and the LVN run the clinic and I try to get on top of the paperwork. Apparently after the holidays this won’t be the case. 
 

I don’t know guys, I’m just feeling tired of trying….like nursing is stupid and unrealistic and I have told my husband 100 times I just want to go work at the local grocery store for 30K a year. But I have a 2 year old and my husband is staying at home with her, so it’s just me.

 I don’t have time to try to get organized and the few times I did the doctor changed how they wanted things done and so my organization did nothing for me. 

 

There is this movement in China called lying flat or let it rot. Basically youth in China are over educated, housing costs are ungodly high, they work 9am to 9pm 6 days a week. They cannot work enough to get ahead, to have a home, to have kids and a life and they know it. So the idea is just to not do any of it. Because it is pointless to try. And this is really where I see healthcare in the USA currently and our country going as a whole.

klone, MSN, RN

14,406 Posts

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 17 years experience.

That workload, with 20-60 patients/day, and 3 clinical staff, is insane. If you're not willing to quit, my suggestion is to just accept the fact that you can only do what you can do. Your priority is the patients in front of you right now. Inbaskets, phone calls, PAs, all need to take a backseat, unless they can get you another person.

I assume the front desk person is also checking people in, in addition to scheduling f/u's? If they have down time (which I'm guessing they probably don't if they're the only person) they should be able to help you with some of the paperwork stuff like PAs (can fill out everything demographic/non-clinical) and phone calls (can start a telephone encounter, gather all the info needed, pend medication refills, make sure the pharmacy is listed and up to date before passing it on to one of the clinical staff).

Other than that, I've got nothing. I'm sorry you're being stretched so thin. Is there at least a clinic manager there? Who runs the place? As the clinic manager, part of my job is to help the staff when they're drowning and take some of those tasks that I can do off their plates.

Specializes in Surgical Specialty Clinic - Ambulatory Care. Has 15 years experience.

Yes the front desk person does check in and check out patients and she is excellent at fielding calls. She already does everything you suggested (she is the only one who has been there the longest, so she know more than me, the LVN, and the MA.

I have a manager and a supervisor. My supervisor tries to help organize us. My manager is kind of useless. She comes by and asks if she can help but she doesn’t actually know how to do anything. 
 

My supervisor is supervising 3 clinic. I feel she is as overwhelmed as I am. 
 

I’m not really willing to go elsewhere because this kind of overwhelm has been pretty much the requirement at every nursing job I’ve had for the last 15 years (ER, Cardiac, Med-Surg, travel nursing, Home Infusion coordinator, Home Health). I’m really just tired of the *** we call care, but I am grateful that no one is in need of life saving care or lifting regularly at this job, that is really the only difference. 
 

And thank you for confirming this is just plain unrealistic. I feel like it was but I just don’t know if I’m just old and tired or if things really are getting worse. 
 

Thanks