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Tell the World Project - Responsibilities of a Physician's Office Nurse

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by snh208 snh208 (New) New Nurse

snh208 specializes in Nephrology.

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                                              Reflection of a Clinic Nurse

Choosing a nursing career path that takes me away from the bedside and into a clinic environment has caused me to lose some technical nursing skills, but I have gained so many others.  Often, I hear phrases such as “can’t someone else do that job?” or “when are you going to go back to real nursing?” In an attempt to reflect on the importance of my nursing work, I reached out to my coworkers.  I work as a registered nurse in a clinic that has many specialties including pulmonary, endocrinology, nephrology, urology, and rheumatology.  My focus in the clinic is working with clients with various renal diseases and disorders.  For my Tell the World Project, I would like to discuss the responsibilities as a nephrology nurse within a clinic setting. 

I conduct patient intake on approximately 22 patients each day.  This duty entails taking a patient’s vital signs, review medical and surgical history, medication management, review current symptoms, perform venipunctures for lab tests, and administer medication.  Medication management is a large portion of this responsibility.  Elderly patients with many specialty doctors is the majority of our patient population.  Patients are often confused by their medications, which medications another doctor started or discontinued can become quite overwhelming for patient.  I encourage patients to bring medication lists then review each medication, its indication, and proper dosing instructions for each.  

Patients and their families call in with various concerns and questions throughout each day.  Prioritizing the importance and triaging critical phones calls that require immediate physician attention is an essential skill for a clinic nurse.  Nurses in the clinic are often used to communicate between various patient providers.  I often have to speak with physicians or their nurses to clarify orders for a patient, as teamwork between disciplines is important.  Speaking with patients and their families regularly both in the clinic and over the phone, I begin to build a rapport and trusting relationship with patients.  Patients trust my instructions or educational advice when they are calling in a crisis. 

I act as a patient advocate while completing insurance company appeals and prior authorization requests is another responsibility of my job.  Most insurance companies have formularies for particular medications they will and will not cover.  I spend a lot of time on the phone with insurance companies trying to understand their formularies, answering questions about the medication, patient diagnosis, and reasons the physician feels this medication is necessary.  In a timely manner, I am required to respond to prior authorizations for new medications that are not listed in the insurance company’s formulary.  Using my knowledge about medications, the patient’s history, and disease processes, I provide accurate documentation and provide multiple rationales in an attempt to reason with an insurance company.  Before most imaging services, such as renal biopsies or ultrasounds, I have to have prior authorization from the insurance company to assure that the patient’s out-of-pocket cost is not tremendous.  If a patient cannot afford medication, I try to find grants or patient assistance programs that will help make these vital medications more affordable.  

Finally, I spend time education patients about the stages of kidney disease, medications, and diets prescribed by the physician.  Physicians often explain details of the disease process or treatment options quickly in a language that some patients may not understand.  Keeping in mind that the average patient may not have the health literacy skills to understand the complexities of their disease, I attempt to education in a variety of ways.  To begin patient education, I start with simply asking the patient what they know about the disease, treatment or diet we will be discussing.  To enhance my teaching, I use the handouts provided by clinic to discuss the particular diet or disease.  If questions become too specific when reviewing a particular diet, I will often refer the patient to a dietician that is better equipped to educate the patient.  I will follow-up with a patient after starting a new medication or diet to see how it is going and if the patient is having any issues.  

Stepping away from bedside nursing, my responsibilities are different now.  The important thing to keep in mind is that my passion for helping patients continues even in this nontraditional nursing role.  Helping patients now involves more background work while communicating between interdisciplinary teams, pharmacies, and insurance companies.  Patient advocacy, prioritizing, and patient education are essential skills that I, and most nurses, use on a daily basis while caring for our patients. 

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