Those who work in clinics who serve low income patients...

Specialties Ambulatory

Published

What do you like about it? Dislike? What is a typical day like? Do you feel you are making a difference? Is there high staff turnover?

I start a new job tomorrow in a clinic who serves majority low income patients and adults and children on medicaid, uninsured and under insured patients. If the patient can't pay they are not asked to, or they charge on a sliding scale based on income.

This is something I have wanted to do for a long time. I have prayed for at least the last three years for a job that would allow me to somehow be involved with/help those in need. I am aware that there will be incredibly stressful, exhausting and challenging days/weeks/months/years, but I honestly feel like I am up to the challenge. If I don't make it, at least I tried right?

Specializes in Clinical Documentation Specialist, LTC.
That's the nature of being a newbie; you are going to feel rushed, as well as the fact that our pts are very complex, even in the community setting.

Breathe, soak everything up; also realize that you are human, and you can't be pulled in many places.

Thank you LadyFree. I would rather take my time than to give the wrong patient an injection, or the wrong medication to the patient the injection is meant for because I'm rushed and worried about getting in trouble for taking my time.

If I can get the computer "stuff" down and develop a system to manage my time I will be golden lol!!

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Specializes in Pediatrics Retired.

Yea, the settings today revolve around regulations, certifications, insurance authorizations, technology, computer charting, etc., etc....if the patients needing the medical attention weren't such a damn distraction we could get that stuff done a lot easier!!!! Know what I mean?? ;)

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Specializes in Clinical Documentation Specialist, LTC.
Yea, the settings today revolve around regulations, certifications, insurance authorizations, technology, computer charting, etc., etc....if the patients needing the medical attention weren't such a damn distraction we could get that stuff done a lot easier!!!! Know what I mean?? ;)

Right! How dare those patients take up my precious computer time! Shame on them! :p

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It helps to learn the language and learn the cultural differences. That's my experience. Also remember who they are, each one has a friend or family member that they will refer to your clinic if they were treated well. Keep in mind most patients are illegal and don't have the resources available to follow through write certain treatments. Help them with phone calls, find out what is available close by. 90% of your pts. Will be locals that ambulated to your clinic when they are already very sick, prepare for urgent care situations and always have your clinic fully stocked with supplies. Patients teaching is crucial so that they understand why were doing the treatment also you have to almost scare them to knowing the consequences of neglecting individual health issues. Some times local hospitals will give classes on DM and nutrition and so on, good luck. I've been administrating a family practice serving a low income area for 4 years now. The physician has been here for 17 years and it is an experience unlike any other.

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Specializes in Clinical Documentation Specialist, LTC.
It helps to learn the language and learn the cultural differences. That's my experience. Also remember who they are, each one has a friend or family member that they will refer to your clinic if they were treated well. Keep in mind most patients are illegal and don't have the resources available to follow through write certain treatments. Help them with phone calls, find out what is available close by. 90% of your pts. Will be locals that ambulated to your clinic when they are already very sick, prepare for urgent care situations and always have your clinic fully stocked with supplies. Patients teaching is crucial so that they understand why were doing the treatment also you have to almost scare them to knowing the consequences of neglecting individual health issues. Some times local hospitals will give classes on DM and nutrition and so on, good luck. I've been administrating a family practice serving a low income area for 4 years now. The physician has been here for 17 years and it is an experience unlike any other.

Thank you so much for this. I was speaking with someone last week who interprets for those of us who cannot speak Spanish about learning the language. She happens to give Spanish lessons so I will be seeing if we can set up some times to get together after work.

There is so much to learn but I look forward to soaking it all in.

I'm pretty sick right now with a nasty URI and will be out until Wednesday (went to work this morning) Hope it doesn't mess me up. I really do love the job.

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Specializes in Clinical Documentation Specialist, LTC.

Okay. I'm not going to lie. I am drowning. I have been there 1 & 1/2 weeks and I feel so lost. There are so many things the nurse is responsible for it seems impossible. We have to do our own pre-certs, call pts. about their labs which can amount to more than 25 calls per day, follow up on referrals, etc...I just don't see how one person can get all that done in an eight hour day. I'm told not to worry so much about referrals, but to concentrate on calling pts. about labs, then get to the referrals if there is time, but I spend the entire day triaging, rooming, giving shots, assisting with procedures, trying to call pts. back when they leaved messages.

I really want to love the job but I am feeling like a failure. Like I will never get it, you know? There is a big possibility there will be just two nurses for three providers tomorrow. I honestly don't know if I can handle it but I will give it my best.

It would be so nice if they would offer training for more than one day, especially since the majority of the nurses they hire have never had clinic experience. I really don't think they have the staff or resources to offer any kind of training though.

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Specializes in NICU, PICU, Transport, L&D, Hospice.
Okay. I'm not going to lie. I am drowning. I have been there 1 & 1/2 weeks and I feel so lost. There are so many things the nurse is responsible for it seems impossible. We have to do our own pre-certs, call pts. about their labs which can amount to more than 25 calls per day, follow up on referrals, etc...I just don't see how one person can get all that done in an eight hour day. I'm told not to worry so much about referrals, but to concentrate on calling pts. about labs, then get to the referrals if there is time, but I spend the entire day triaging, rooming, giving shots, assisting with procedures, trying to call pts. back when they leaved messages.

I really want to love the job but I am feeling like a failure. Like I will never get it, you know? There is a big possibility there will be just two nurses for three providers tomorrow. I honestly don't know if I can handle it but I will give it my best.

It would be so nice if they would offer training for more than one day, especially since the majority of the nurses they hire have never had clinic experience. I really don't think they have the staff or resources to offer any kind of training though.

The CHC that I worked with (also serving a very large migrant Hispanic agricultural population) employed MAs as well as RNs.

In our setting, we were allowed, by the physicians, to delegate some of the tasks to the MAs leaving us more room for the things that could only be accomplished by an RN.

Remember that when you change specialties it takes a minimum of 6 months before you don't feel dangerous and about a year before you are routinely comfortable with the work flow.

Take a deep breath, actually take lots of deep breaths. Make a daily decision about what is priority and what simply needs to get done. Focus on the priorities and discuss the need to get done stuff with your manager and your nursing peers.

Good luck.

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In response to the drowning/over tasked. We have a WONDERFUL staffer in our office who handles the pharmacy assistance program and the referrals to other physicians altho we don't do too many of those. She also handles scheduling any special testing after the nursing staff completes the orders plus a lot of other tasks as well. If there are special directions for a test (fasting, drinking water an hour before test, etc) then those directions come from a nurse. We also instruct patients when drawing labs that if all labs are WNL then we do not call them or the physician instructs us to call with new medication instructions. That helps a ton! But we still get a few calls about labs that were WNL. We also ask patients to have their pharmacy fax in refills-many times we'd get calls for refills, we check the chart and find they have refills-they may not have checked the label on their med bottle. This also helps lessen confusion on which pharmacy and which med. Hope this helps-nothing like feeling what you see as the opportunity of your career not being so.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Tell me about your lab reporting process. Do you call ALL patients, or just for abnormals?

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We typically call only if a physician instructs us to call a pt re labs (either high, low and needs med changes or additions, dietary changes) or if the physician wants us to pass long good news such as a previously out of range value is within normal limits due to pt compliance with meds/nutrition. Otherwise, when we draw the labs, I instruct patients that if all values are within normal limits, we do not call them but that we will call if the physician requests us to call as described. Many times we schedule a patient's appointment for a lab draw a week before their appointment with the physician or nurse practitioner and the results are reviewed at that appointment.

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