I knew I had been spoiled in Washington but I didn’t realize how much until I began my next assignment in California. This was a hospital affiliated clinic near Monterey, CA. It should have been a red flag to me when the orientation process was only 1-2 hours, and my EHR training was 45 minutes long. To be fair my assignment was only 2 weeks long.
On my first day, I met another locum tenens nurse practitioner that had been working there for one month. She told me she usually has to stay about 3 hours after her shift to catch up on documentation. She told me she didn’t charge overtime or tell the front desk not to overbook her schedule.
My first thought was that she was nuts not to charge over time and to stay all of those extra hours after her shift. One of the perks of working locum tenens is – NOT having to work more than 40 hours per week. I also assumed that she was the reason why she stayed late and it would not happen to me.
Boy was I wrong. Right away I noticed that they booked patients every 10-15 minutes, even if they were new patients, needed procedures done, or had a lot of complex illnesses. Not to mention, the EHR system they use is the oldest version of Meditech possible. Meaning it was not at all user-friendly, and I would have rathered done paper charting (which I hate), it was that bad.
I normally like to do my charting with the patient in the room. However, this EHR system was sooooo slow and complex, it was too much of a burden to use while the patient was present. I do not like having my patients wait too long so I typically get them in and out. I found myself seeing the patient and doing my charting afterwards.
Just because the patient left the room/clinic didn’t mean I was done with them. Unfortunately, if the staff saw an empty room, they put a patient in it, whether they were originally scheduled or not. Meanwhile, my charting started to accumulate and I could quickly see why the other locums nurse practitioner was staying after hours to chart.
I am definitely not a push over, so as soon as I saw my charting was going to accumulate, I demanded for 1 hour of charting time at the end of the morning and evening shift. This helped ease the burden, but I had to make sure I at least wrote a little in the HPI and plan so I would not confuse the patients.
Moreover, I noticed that I would have walk-in patients without even being asked. This meant that although I had a 10 am patient and 10:15 am patient, I suddenly also had a 10:10 am patient. I made it clear that I needed to be asked before placing walk-in patients on my schedule. Does it make sense to fit in an uncontrolled diabetic in my tight schedule? No. Yet, some patients came in for the flu vaccine or depo-provera injection, so these types of walk-ins would be fine since they are quick and easy.
For the first time in my life, I hated my job! I began having symptoms that a lot of people I know have before going to work each day. For example, I couldn’t sleep well at night; I had stomachaches the mornings before working; I felt so exhausted by the end of the day I did not even want to eat. I thought of all the people who go to work every day and hate their jobs. I was grateful that this was only a brief and temporary assignment, and I sucked it up for the two weeks I was there.
I believe the main problem stemmed from the facility being unorganized. Since I wasn’t trained properly, having to figure out internal processes made my days longer than they should have been.
The front desk staff aren’t trained well enough on triaging patients and scheduling them. There was confusion even between the nurses and medical assistants, in which they told me I was responsible for doing all wound care (a nurse’s job)….. I wasted time ordering flu vaccines for patients, compared to many places I have worked at previously will have the MA/RN order and administer the immunization, with me just signing off on the note.
Of course the horrible EHR system contributed to the disaster. Since the affiliated hospital owned these clinics, you would think I would be able to see why the patient went to the emergency room the other day (that was not the case). The electronic prescribing was always lagging that pharmacies continuously told patients they hadn’t receive the prescriptions, and in return patients were constantly calling the clinic.
During my interview, I was told I would be seeing 20 patients per day, which is pretty average. I found myself actually seeing 30-36 patients a day. I wouldn’t call that safe, and honestly if I hadn’t hustled my butt off, I would have probably ended up staying 3 hours after my shift every day like the other provider.
In between seeing 30+ patients per day, walk-ins, and charting on an ancient computer system, I was also expected to review the provider I was covering’s messages. These messages included medication refill requests, lab results, imaging results, specialty consultations, and general patient messages.
On my last day I saw the other locum tenens nurse practitioner. I told her I saw what she was talking about but she should know that it’s not her fault. The way the clinic is set up, it is causing her to be stressed out and overworked. I told her she should definitely talk to her recruiter about it and charge for over time. I told her that by her not saying anything, the facility will continue to abuse and overwork providers.