Tips to increasing efficiency as an Outpatient NP?

Updated | Posted
by Alicia777 Alicia777, MSN, NP Member Nurse

Specializes in Surgery.

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Starting my first position as an outpatient NP soon. I’ve strictly worked in inpatient surgery prior to this and since I’m adding to my overall weekly hours I want tips to getting out on time. I’m already assuming I’ll be brown bagging my lunches and they’ll be working lunches. But beyond that, what other tips help you work efficiently?

TY!

MentalKlarity, BSN, NP

Specializes in Psychiatry. Has 9 years experience. 220 Posts

Chart during the appointment, and ensure that you have ample time to finish your work during the day. Ask your employer for dedicated time without patients to call clients about results, finish charts, etc.

You shouldn't be giving up your lunch or working late or it means you're being overworked.

djmatte

djmatte, ADN, MSN, RN, NP

Has 7 years experience. 1,146 Posts

Understand your EMR inside and out. Use automation to power through your notes. If there are smart phrases, have a series of common diagnoses, assessments, and plans to document the most likely things you will discuss or assess. 

anh06005, MSN, APRN, NP

Specializes in Cardiac, Home Health, Primary Care. Has 6 years experience. 1 Article; 769 Posts

As others said you shouldn't be giving up lunch. That's your time. I've worked outpatient for 6 years now and can only think of less than a handful of days I worked through lunch because they were just those kinds of days.

Also second knowing your EHR in and out. I have worked both primary care and specialty and have worked with several EHR's at this point. All of them have the ability to have some type of template or form that makes documentation so much easier. I also do quite a bit of my charting in the room itself if I can. This is easier in specialty rather than primary care, though, as specialty has much more repetition and certain questions you ask.

Do you know which EHR you'll be using?

Alicia777

Alicia777, MSN, NP

Specializes in Surgery. 312 Posts

18 minutes ago, anh06005 said:

As others said you shouldn't be giving up lunch. That's your time. I've worked outpatient for 6 years now and can only think of less than a handful of days I worked through lunch because they were just those kinds of days.

Also second knowing your EHR in and out. I have worked both primary care and specialty and have worked with several EHR's at this point. All of them have the ability to have some type of template or form that makes documentation so much easier. I also do quite a bit of my charting in the room itself if I can. This is easier in specialty rather than primary care, though, as specialty has much more repetition and certain questions you ask.

Do you know which EHR you'll be using?

I’ll be using Epic which everyone raves about. We have it at my hospital now as an external ‘view-only’ and it looks user friendly so I know a bit about navigating. I’ll be working in urology outpatient. 
Good tips! Thank you all ?

djmatte

djmatte, ADN, MSN, RN, NP

Has 7 years experience. 1,146 Posts

8 minutes ago, Alicia777 said:

I’ll be using Epic which everyone raves about. We have it at my hospital now as an external ‘view-only’ and it looks user friendly so I know a bit about navigating. I’ll be working in urology outpatient. 
Good tips! Thank you all ?

Epic is great.  What I recommend is to come up with a smartphrase system.  Use it for common things as you make your notes.  Often I would use letters to guide the direction of the phrase such as using  A in the phrase name for "assessment" and the P in some for "plan". 

For instance, shoulder pain.  I had a smart phrase called .ashoulderpain which put the general assessments we do for shoulder pain and the option to put positive or negative for the specific tests (hawkins, empty can, etc).  Equally, I had a plan for that as well called .pshoulderpain.  This pulled up a list of the common things I discuss with a patient going forward.  These lists were often broad enough to select which applied to each patient.  Anytime I came up with a new diagnosis, I would create smart phrases around it.  By the time I left, I had over 80 smart phrases that I had shared with my colleagues to make their notes easier and more through for billing purposes.  

Working in urology, you may have much less to deal with than I did.  But you can still pull these ideas and mold them into your own practice.

anh06005, MSN, APRN, NP

Specializes in Cardiac, Home Health, Primary Care. Has 6 years experience. 1 Article; 769 Posts

On 8/31/2021 at 10:11 AM, Alicia777 said:

I’ll be using Epic which everyone raves about. We have it at my hospital now as an external ‘view-only’ and it looks user friendly so I know a bit about navigating. I’ll be working in urology outpatient. 
Good tips! Thank you all ?

I've never had the chance to use Epic myself but I'm sure others can help you with how to do templates. 

But YES working specialty you'll deal with MUCH less. I do sleep medicine so I have very basic templates cause I ask the same questions about 90% of the time. I just have an * where I need to input information from the patient.

Sleep habits/hygiene (Bedtime: *   Rise time: *    Sleep latency: *)

CPAP use and info (DME company: *     Pressure: *     Usage: *)

Benefitting from therapy (must be in there for insurance purposes. Of course I adjust this if they are having problems but usually they are benefitting)

Epworth Sleepiness Scale score

Basic "you're alive" physical (AAO, gait stead, HRRR, lungs CTA"

Basic plan of "use your CPAP, wash it regularly, untreated sleep apnea can increase CV risk, call us with questions, F/U in * months"

 

Most of what I handle is sleep apnea but also have info for insomnia, hypersomnia, RLS, narcolepsy, etc. that I can add.

AndriaG

AndriaG, BSN, MSN, RN, APRN, NP

Specializes in PACU, Family Practice. Has 8 years experience. 5 Posts

It also helps to have a good nurse to be able to delegate nursing duties to in between patients. I am able to come out of the patient room, give orders for meds, diagnostics, referrals, etc, come back to my office and complete the note before moving on to the next patient. My nurse is completing her tasks and rooming the next patient while I’m in the next room. We have a really good system in our clinic where each provider has his or her own nurse that doesn’t have to run around for different providers. Makes it more efficient.

traumaRUs

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 30 years experience. 164 Articles; 21,142 Posts

I work in nephrology (so kinda related) and we use Epic. It's all about the HCC's. We have templates and some smart phrases that our practice uses in order to capture the charges. I've also added some of my own.

Don't get caught copying and pasting previous notes - thats just asking for an audit. Make each visit stand by itself. For instance, I see pts every 20 minutes on an office day (and yes, I work thru my lunch). For a pt I'm seeing for CKD, I have an education smart phrase for each stage. I then individualize it to the particular circumstances: for instance, today I saw a pt who has celiac disease so my dietary instructions were geared to that need. I also have a standard "don't take NSAIDs, make sure ALL providers know you have CKD..." that I use for many pts.

Ask to sit with a biller for a day. I truly wish I knew more about coding and they are the experts. 

I look ahead on my schedule and pre-chart the labs and I update problem lists at each visit, prioritize them as to what I'm seeing them for, etc.. Though someone may have had a CVA in the distant past, I'm not neuro so I don't include that as a problem that I'm seeing them for. However, if their cognition was affected, I will chart something along the lines that they were accompanied by so and so who is their friend, child or HCPOA and they all verbalized understanding and agreed to the plan. 

If you are new to the office situation, I would ask for 30 minute appts and work down to 20 or 15 minute appts as needed. 

I hope this helps and good luck...

cheights

cheights

5 Posts

Im transitioning from out-patient dialysis to acute care any tips or suggestions 😊