Working in Kentucky

As usual, everything seemed great in the Kentucky clinic in the beginning. Within my first week, I already noticed the medical assistants were slower than I was accustomed to. It became unbearable when my new patient waited an hour just to be brought into a patient room. I was busy seeing patients at this time or else I would have asked my medical assistant or the nurse in charge ‘what’s going on’. Usually new patients get all of their work up before the provider sees them such as labs, EKG, and other screenings. These can take up to an hour, so normally it would have worked out to have these completed while I was seeing the other patients.

I ended up not getting a lunch that day because by the time they brought back the new patient it was 12pm. I was livid. In Chicago, even days I didn’t have a medical assistant (for one reason or another), I still finished on time because everyone worked as a team to make sure my patients were brought back. There didn’t appear to be that sense of team work here. The medical assistants (not just mine) worked pretty slowly. I have worked for this same company in 5 other clinics, but this is the first time that I had ever seen a patient wait 1 hour to be brought back after being on time for their appointment.

I sent an email asking my boss if the nurse lead in my Chicago clinic could come help out for 1 week to show the nurse and medical assistants here how to be more efficient and work together as a team. He was all for it. This is something I have seen a lot, one market supporting another market.

Once he forwarded it to the Kentucky leadership though, all hell broke loose. Apparently management was upset that I made them look bad. Because obviously if a patient is waiting an hour to be brought back, that means the medical assistants aren’t doing their job; the lead nurse isn’t doing his job; the clinic manager isn’t doing his job, nor is the front desk doing their job. Of course, I had mentioned this problem to all of the leaders at my clinic (medical director, lead nurse, and clinic manager) prior to sending the email, and they admitted it was an ongoing problem. In fact, they said they were happy an outsider noticed. But the moment that they “looked bad” they were upset that I said anything at all.

The email wasn’t even to complain about the clinic. It was really to offer a solution.

The clinic manager and lead nurse had a huddle with the medical assistants to talk about the incident. I noticed since then that they have been working more together and patients are being brought back much quicker. Since then, the clinic manager asked me how everything was, and I told him everything was good. He then asked if I could send a follow up email letting everyone know things are good and we no longer need help. I said no I would not be doing that, because I think the team would still benefit from having the Chicago nurse help them.

I was annoyed by that request because everyone only cares about saving face. And I was starting to think they didn’t like me for speaking up. My boss called me the same day and apologized for everything getting blow out of hand. He also said that the clinic manager told him I am requesting 40 min for follow up patients and trying to finish by 3:30pm (we finish at 4:30pm), which are both absurd. I only requested 40 min appointments for new patients to me (which is the norm) and I said I want my last patient scheduled at 3:30 pm because by the time I finish that 40 min appointment it will be 4:10pm, and I can complete my workflow with the remaining 20 minutes.

I told my boss I obviously have a target on me ever since I mentioned the above incident, and was wondering if I should even bother staying. He said not to worry that he will take care of it. I was a bit sad thinking about leaving because the physicians here truly are so great. They care enough to ask about my personal life and invite me out. They’ll even offer to see a walk-in that the medical assistant was asking me to see since I have the most flexible schedule.

Later that day, the entire Kentucky leadership team met with me to see how things are going. We revisited the above incident and they agreed that no patient should ever wait 1 hour to be brought back. They informed me I will be having the same medical assistant from now on to make sure there is a good flow, and if any issues arise, to inform the supervisor of the nurse/medical assistants.

I also brought up some scheduling issues and the clinic manager said he will make it his duty to make sure my schedule is correct on a daily basis.  Everyone was really positive and supportive. They kept mentioning that they are so glad I am here to help. And they would love for me to consider staying longer than the 3 months…..

Since then, things have run more smoothly, but I do still wish the medical assistants could work faster.

I want to end this post by saying I already know not to expect perfection in any place I work. But it is sometimes challenging being a locums nurse practitioner because I have often worked in “perfect” places before, so I know it is possible. Thus, if I can suggest a way to make things better, I will definitely speak up. It’s funny to think that working in the Chicago clinic was nearly perfect – minus the toxic physicians. On the other hand, the physicians in Kentucky are amazing but the clinic itself isn’t the most organized/well run.