I work in a primary care office which also functions as walkin-care. There are three NPs in the office and we work 12 hours a day usually with two nurses. Last week, we had a really busy day. Patients were coming in waves, as always towards our closing time we had four patients checked in. I was 45 minutes behind at that time. Anyway, one of the patients came in for tick bite, and tick was still attached. I removed the tick. She was a young woman and was very distraught about the tick bite. She asked if we can check her body for other ticks because she lives alone. It seemed a reasonable request even though we don't usually have patients ask this.
Because I was already running late and I had one more patient to see, I asked the nurses ( one LPN, one RN) if they can check her for ticks. Both of them flat out refused, saying that:"we don't do that in this office", "I don't feel comfortable doing it".
I was really appalled and exasperated that they were refusing my request. Both of the nurses are very competent and good at their jobs. I had no prior issues with them. Anyway, I ended up doing it. As a result, I left the office more than one hour after closing and with some open charts for the next day because I was just exhausted. Both of the nurses were gone at this point.
When we are really busy, I do my own swabs, wound care etc. As a NP we can still do what nurses do, but they cannot do our jobs. I don't want to create a toxic environment but I strongly feel that this behavior should be discussed.
Now, I want to address this issue when I return to work on Monday. I don't think I am being unreasonable. I would like your input on how to address this with them. We have an interim practice manager who is overworked and a nurse manager about leave in two weeks. I don't want to necessarily escalate to upper management since these nurses are most of the time do pretty good job.
I did not want to further comment on this issue but I felt that I can provide more insight and update. On Monday we discussed how we can improve patient care regarding this type of scenario with the nurse manager, NPs and nurses. If a pt is presenting for skin conditions (including tick bite, poison ivy/sumac etc) whoever is rooming the pt will provide a gown for them to put on.Ask pts whether they want to have their skin checked for other tick bites, so they don't just ask that in the middle of the exam and catch us off guard. Here is the deal, if NP is ready to see the pt at that point, she will just go in and do the whole exam, including skin check. But if NP is with another pt or running late, nurses will do the check and report any findings. No, nurses are not required remove and identify any ticks. All of our nurses have been living in this area for sometime and knowledgable about the ticks.Problem solved!
Somebody made a comment that I should learn how to order not request. Here is a little education on that -risking sounding "snooty" here, I know.
Orders go on pt's EMR with particular diagnose attached to them and you choose from pre-populated options. Then you sign the orders for nurses to complete in the office such as throat swabs, labs, ear irrigations etc. Tick check is not one of those orders. Therefore it was a verbal request because I don't bark orders to nurses, I request them to complete a task.
As a NP I am well aware that I don't make rules or policies as I go. I work for a big health care organization. On the other hand we can bring issues forward to discuss with management to provide better and safer pt care. Thank you again for your comments.
I responded before I finished reading the thread, and this response. Glad everything worked out and you all found a solution.
I'm late to the party, but had to say I was a primary care nurse for the last 10 years or so in a tick infested area. I did tick checks and removed the ticks before the provider poked their head in to write a script if needed. Ticks are actually a nurse visit here- we would have never booked a tick with a provider unless we had tons of open slots. And even then we would have gotten stink eye for doing so. :)
That said, probably would have been quicker for the person in the room to do a quick look, but seems it's now all worked out.
NurseBlaq
1,756 Posts
I responded before I finished reading the thread, and this response. Glad everything worked out and you all found a solution.