When you literally can't keep up.

Nurses General Nursing

Published

Specializes in Surgical Specialty Clinic - Ambulatory Care.

I think Time Management is such a funny term. Mostly because it assumes that there is time available for me to manage something. 
My current rock and hard place is this clinic I work at. It is my first clinic position and I overall enjoy it more than I have most of my other nursing positions. Like for the first time I have stayed here a while instead of job hopping. But a good portion of that decision is the little country town I live in. The job is 15 min from my house. The next nearest viable area to find work is 45 - 50 min away. 
 

Anyway, I attempt to manage 9 surgeons in 8 specialties. It is a surgery clinic. So we do in office procedures along with preoperative education and management. 2 of my physicians are oncologist so I'm also trying to manage referrals to medical oncology and radiation. Actually all I can say that my managers told me I'd have a small portion of things to do and it keeps getting bigger and more. 
 

My manager tried to tell me that my problem is the physicians that I work with won't do their portion of the work and this is why I'm having problems. However, she also tells me she has asked the director of the doctors to "do their share" and his reply was "I'll ask, but I wouldn't bet on it.”. Which, to me, means that the work she is thinking the doctors should be doing is an overwhelm on their plate and why it is getting pushed to me.

So now my management feels that my clinic "could work" if I wasn't doing all this extra work....all this extra work that my doctors feel like I should be doing. Of course my manager has asked that they do the job her way and they tell her no. And then her answer is for me to "just push it back to the MDs". And I'm thinking if you can't get them to agree to do it why do you think I can? 

It's me and an LVN and 20-40 patients a day with procedures and surgical education and cardiac clearance follow ups and so, so much more.

There are all these basic "housekeeping" things I'm suppose to do like check fridge temps, and keep up with staff education....for me, the LVN, and all the MAs that get floated to our clinic. 
 

And I'm just not now. For 18 months I've stayed late, worked through lunch, tried to come up with systems and pathways. And when I was willing to do all this extra, we weren't to far behind. But I'm done now. I took this job because it was suppose to be 8 hour days. It is regularly 9-10. So I just quit doing stuff. I get as far as I can and then just leave. Things are getting missed. JACO is coming soon and we are soooooooooo not ready. And my manger just keeps saying "get it done".  So I guess I may get fired but I'm only getting done what I can in 8 hours.  
 

2 Votes
Specializes in Critical Care.

Maybe JACHO citing them is what it is going to take to get them to fix things and hire more staff, but yeah you are probably going to be in the crossfire.  On the other hand, when you are the only RN, they still need you.   Hope things getter better for you.  Sadly, it sounds like they will only fix things if something drastic happens like a citation.  In reality, it is really only a slap on the wrist anyway.  Hope it is enough to improve things for you.  Either way, I'm sure you will survive, be able to find another job if need be, and I think you are doing the right thing to only do what can be done in your 8 hours.  If you keep working above and beyond things will never get better and it will just be expected of you.  Your manager telling you to get the Dr's to do "their" job is above your pay grade!  That is between her and their manager.  Do what is right for you.  Keep your resume up to date just in case.  Good Luck!

2 Votes

Anything that you are doing that doesn't require the skills and/or license of an RN is a very bad use of your time and is money being wasted, just like (IMO) anything that the providers are doing that doesn't require their knowledge/skill/license is a very bad use of their time and is money down the drain. You mentioned the extra work the docs think you should be doing--my guess is at least some of that isn't that they think *you* should be doing it, just that it is something they rightfully should not strictly need to do because it doesn't require their skill/license. But leave it to management to set things up as physicians against nurses - tactic as old as time/they aren't particularly creative with their excuse-making, are they?

It sounds as though there is just not enough ancillary help around there. You don't need an MD/DO/PA/NP *or* an RN to check fridge temps and keep track of staff education and set up means by which staff can do competency check-offs etc. And so much more that does not require a professional degree to plan out an accomplish. Focus on the care that the patients need.

All the things that constitute pie-in-the-sky fantasies of administration would automatically go to the bottom of my list. Next time there is a comment about what needs to get done, say "I'm sorry, I don't know what to tell you other than that I *had* to prioritize in order to do this job any justice, and I chose the needs of patients and the things that must be done by an RN." Granted that could bring some wrath down upon you, but at some point if you're going to burn out anyway it becomes more of a risk worth taking.

 

5 Votes

If it is a unmanageable workload... then you must move on.

4 Votes
Specializes in Surgical Specialty Clinic - Ambulatory Care.
JKL33 said:

Anything that you are doing that doesn't require the skills and/or license of an RN is a very bad use of your time and is money being wasted, just like (IMO) anything that the providers are doing that doesn't require their knowledge/skill/license is a very bad use of their time and is money down the drain. You mentioned the extra work the docs think you should be doing--my guess is at least some of that isn't that they think *you* should be doing it, just that it is something they rightfully should not strictly need to do because it doesn't require their skill/license. But leave it to management to set things up as physicians against nurses - tactic as old as time/they aren't particularly creative with their excuse-making, are they?

It sounds as though there is just not enough ancillary help around there. You don't need an MD/DO/PA/NP *or* an RN to check fridge temps and keep track of staff education and set up means by which staff can do competency check-offs etc. And so much more that does not require a professional degree to plan out an accomplish. Focus on the care that the patients need.

All the things that constitute pie-in-the-sky fantasies of administration would automatically go to the bottom of my list. Next time there is a comment about what needs to get done, say "I'm sorry, I don't know what to tell you other than that I *had* to prioritize in order to do this job any justice, and I chose the needs of patients and the things that must be done by an RN." Granted that could bring some wrath down upon you, but at some point if you're going to burn out anyway it becomes more of a risk worth taking.

 

I'm okay with wrath. The next job is always a few days away if necessary. Thanks for this.

2 Votes
+ Add a Comment