Surgical clinic—-is this really doable?

[KalipsoRed21, BSN, RN]

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]

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.

[KalipsoRed21, BSN, RN]

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

[Peachpit]

It's been a few months since you posted this and while I don't work in an ambulatory clinic, I still identify with everything you said - including going to work in a grocery store. I have told me spouse the same thing multiple times, but like you, it's just be being the breadwinner so for now, I am in the same boat as you as far as being stuck in nursing. What is being asked of you on a daily basis and your coworkers is unsustainable. For you, for them, for the patients and the providers. At some point something is going to happen, something is going to "give" because there is no way, none, that volume of patient appointments on a daily basis coupled with all the other responsibilities can be accomplished. The fact you are even staying to try to get it all done is admirable. 

While I was not one who felt I was "born" to be a nurse, I did find it interesting and overall liked/enjoyed the profession. Now, I, like you and many others on here, don't just dislike nursing, I hate it and the effects of loathing the profession has on my mental health. 

I hope you are able to find something else or at least get more support in place. Nursing has just become abusive.

[KalipsoRed21, BSN, RN]

Peachpit said:

 

I hope you are able to find something else or at least get more support in place. Nursing has just become abusive.

Thank you for the show of solidarity. Yes, I think nurses need unions now more than ever. It is so hard going to work knowing something is going to be missed. It has been hard for the last 15 years to have leadership say things that make you feel like if you can't keep up with the important stuff, then you shouldn't have become a nurse. Now they are backing off and just saying,”I know you can keep up, I have faith in you, Hero!?????

I am doing this for 5 more years, then hi tailing it to the grocery store. I hope you find some peace too.

[CrunchRN, ADN, RN]

That is an insane workload and expectation. DO the patients not complain to management so that they will have to add staff?

[KalipsoRed21, BSN, RN]

Update: They have gotten me an additional MA. Everyone has finally been around enough that I can say some tasks are getting done regularly. Management is just screwy as ***. My supervisor looks at me in shock when I say some things. Like I completed an online module to be the "HLD/Sterilization super user" for the clinic. I did not realize this would entail me keeping logs for TJC and other such responsibilities. I told her that I know I'm the super user but I don't really have a good idea of what that means. She looked at me like I slapped her in the face.....did they think 20 page slide show was enough? Also as part of being the HLD super user I am to ensure that other staff are educated on proper sterile processes. BUT it has been made clear to me by my supervisor that I have absolutely no supervisory authority over those that I work with. I like my co-workers...and when the place is insane they work their little hearts out. But when we have a day or 1/2 day to catch up, they sit around and talk instead. My supervisor said, "I'll organize it, you do it.” But I don't think she can tell who is doing what. It isn't a great situation, but it certainly isn't the worst nursing job I've had. I don't lift people and I don't work weekends or holidays and it is 15 minutes from my house. So I guess I'll just take the abuse until I finally figure out how to get out of nursing.