Will things ever get better?

[Eileen Meyers, RN]

I've been in my clinical coordinator role in a busy endocrinology/weight management practice for 8 months.  I am beyond frustrated.  I ended up with minimal training- nothing specifically for my position except the EHR and payroll systems.  We are severely understaffed with 4 clinical staff, 1 triage nurse, and me for 10 providers.  We also have various providers going to outreach clinics multiple times a month, so I lose staff each week to that.  I really dislike all the paperwork- we do all the prior auths and scheduling for all the endo testing, diabetes supplies, and meds, etc.  It's really involved and there is nothing anywhere in writing.  I've been making a reference binder as I learn procedures, but still a long way to go.   I am supposed to be 0.8 coordinater, 0.2 staff, but is more reversed at this point.

I absolutely love the providers I work with- except for one.  She, unfortunately, struggles with mental illness (she has told us this), and I feel for her, but she keeps the office in chaos with some of her behavior and admin doesn't seem to want to do anything about it.  I am the quintessential middle manager- all the responsibility, none of the power.

I found out that my old job is hiring and I most likely could go in and pick right back up.  There were some downsides to it, but at least I knew what I was doing.  The two major things that are stopping me:  I have really good benefits now, and I feel like I would really let my team down by leaving so soon.  I'm really torn on what to do!  Suggestions or thoughts?

 

 

[klone, MSN, RN]

Are you hiring, or is the "severely understaffed" a state of being that you need to accept?

[caliotter3]

Yes the benefits are better, but do you absolutely need better benefits? And don’t forget there was a reason you left the old job. Anything changed that you know of?

[Eileen Meyers, RN]

The staffing issue is supposed to be temporary, but it's a bit of a revolving door, particularly with the MAs.  They have never increased the staff even though when I worked here before we had 3 providers and now we have 8.  The keep seeing they will approve 2 more, but we're still waiting for the budget to be approved.  We still haven't filled one of the spots from an MA leaving in April.  We did make an offer to a great candidate, but we couldn't match her current salary. 

As far as benefits, it's not a deal breaker, but it's really been helpful.  

Most of the reasons I left dialysis are still there, but the managers I interviewed with for this job weren't up front with the situation I was walking in to.  If they had been up front I probably wouldn't have taken it.

Still, I hate to leave the providers I work with; I know they are hoping I can turn things around.

[2BS Nurse, BSN]

I can empathize with you. Those prior authorizations themselves are so time consuming! You need one staff member who ONLY works in that role. You are severely short staffed if you have 10 providers! The private practices can't pay an hourly rate equivalent to the bigger health care companies. Competition for MAs is fierce right now!

[Circus Director]

I hate to say it welcome to middle management.  The providers are upset because "you" haven't provided adequate staffing.  The staff are upset because they are overworked.  Your boss is annoyed because you can't get anything completed.  And most importantly you are tired. 

Its getting worse because of the nursing shortage.  Particularly in the outpatient world where salaries are less for front line staff.  The ANA just issued a letter to the Director of Health and Human Services asking to declare it a national emergency.  

I don't mean to sound doom and gloom. Despite all the challenges I enjoy my job most days.  I have flexibility in when I come and go most of the time.  The days can be long but rewarding.  You have to ask yourself if you are doing it because you like the type of work or if you are doing it for the money.  OR maybe it really is a tough position and you need to work to find yourself something that is better for you.  There are a lot of tough leadership jobs but you also have to have work/life balance.

[KalipsoRed21, BSN, RN]

Ha! I'm not management at my job, and I get on here to try to figure out exactly what it is they are doing. Because unfortunately, as much as I've liked most my mangers in the past/present as people, I just don't see what it is they accomplish. And their responses are usually for me to come up with an answer, which is funny, because my answer is always hire some more people. But in the 15 years I've been a nurse I have learned that will never be the answer. So while I try to take care of the scary stuff, paperwork just goes out the back window. 
I work in a surgical clinic. I am the only RN for a clinic that sees 30ish people a day. I have 1-2 MAs that work with me and an LVN. We have 9 providers that cover general surgery, colorectal surgery, urology, plastic surgery, and oncology surgery.

We usually have 3 or 4 different clinics running on the same day. My MAs are in a state of learning. We do surgical procedures (vasectomies, cystoscopes, biopsies, cyst removals, etc.) that really require quite a bit of education on set up and clean up. We have to insert Foley catheters, teach people how to catheterize themselves, do ostomy care and education, wound care and education, set people up for surgeries in the hospital, do pre surgical education, put in surgical orders, get cardiac clearances, check urine cultures for up coming procedures, reschedule patients for their surgeries as issues arise, get prior authorization for medications, triage phone calls and so, so, so much more. I regularly cannot meet the expectations on answering inbasket messages, filing out FMLA forms in a 10 day period, getting prior authorizations in a timely manner....and to be frank my managers can *** at me and make me fill out corrective coaching forms all the want. I am going as fast as I can with the help that I have and the accountability my co-workers are willing to accept (they are learning and they need time....so I can't just say go do this, I usually have to do it with them.) 

My manages keep asking me why we can't keep up with their goals and I'm really and truly at a loss of how I would be able to obtain them. And my manger's response is "I need to manage my time better" unfortunately I'm just putting out fires there is no time management. I get told that I can consider coming in on the weekends (I work a M-F 8-5)…I LAUGH so hard at that! Not a chance in hell. 
 

So I guess what I'm saying is I don't really know that nursing has an answer. Nursing does not create a good life balance in my opinion...at any job; and I've done bedside, homecare, and now outpatient. So I really wouldn't base your decision on where you are going to be "happy". I would base it on what schedule works with your life best and start telling people no more often.