Part 1: Trouble in Paradise

Regarding my experiences working in the clinics in Tampa/Lakeland, Florida, I will be breaking it up into 4 parts.

Part 1 (this post): Trouble in Paradise

Part 2: Enough is Enough

Part 2: Why I Decided to Leave an Assignment

Part 3: How I became a Martyr

My initial reaction working in the Florida market (with the same company I worked with in Virginia) was “this seems easy”. The patients were not nearly as sick and complex as the patients in Virginia. This was due to many reasons such as socioeconomic status and lack/benefit of familial support.

Unfortunately, as the weeks went by, I realized how disorganized the clinics were. For instance, when I first stepped into the clinic I would only have 4-5 patients scheduled. By the time the day ended, I would have seen about 15 or so patients. This meant 10+ patients were either same day appointments or walk-ins.

For a clinic that is only a quarter of the size of the one in Virginia, there were way too many same-day appointments and walk-ins. In addition, after a patient is discharged from the hospital they are supposed to see their PCP within 4 days. Usually these are scheduled appointments. For some reason, almost every other day, there was a “walk-in hospital discharge”. This animated how disorganized the front desk was. They welcomed walk-ins for medication refills and same day appointments to obtain a pain management referral. All of these which are typically handled over the phone, via phone messages or referral requests.

I waited to see if things would improve. They did not. One day I had 15 patients scheduled (none that I was familiar with), and there were 8 walk-ins alone in the morning. I became extremely frustrated when the new (new to the clinic and me) patient I was going to see had to spend 30 minutes on the phone to update his insurance before he could be seen, and of course I was still expected to see him (late). Then with the walk-ins galore, none of the other PCPs had room in their schedule to see them, and I was expected to see them all. At one moment I had a new (late patient), a follow up patient (that I did not know), and 3 walk-in patients waiting for me. I felt like I was going to explode. Fortunately, I was able to ask one of the other PCPs for help when they had a no-show.

The above issues occurred on a daily basis. I was only able to take a 15 minute lunch at the most, would leave 1-2 hours late each day, and always with a headache.

I approached the center manager requesting that I have blocks be placed on my schedule that will give me room to see the walk-ins, instead of having a full schedule with patients that belong to other PCPs. This is pretty much what we did when I worked in Virginia. She told me to just communicate with my front desk person about how I wanted my schedule to look like.

Thus, I looked at my schedule for the following day, a Friday (aka tons of walk-ins), and saw I had a full schedule like usual. I chose about 4 patients that could be rescheduled for a routine follow up with their own PCPs (it’s not like their PCP was on vacation), leaving me with room to see walk-ins. As my front desk person was calling patients to reschedule them, the center manager overheard and made her stop.

The following day the Medical Director of the clinics emailed all of us Nurse Practitioners (yup just the NPs) with this nasty email:

“Each of u should desist from telling the front desk how to schedule ur patients. They cannot arrange your schedules based on what you tell them. Your schedules are set by me and are based on the needs of the patients and markets.
At present the market needs are such that your schedules will remain as they are.”

The other nurse practitioners were upset, as was I, since they too started confronting the front desk about their schedules. Remember from my previous post “The NP Perspective” that we were all being abused.

I chose not to respond at that time because it was the Friday before I was going to Virginia for the holiday party, and figured I would just deal with this later.