I think I have a little PTSD from working with the same company in Kentucky where the patients were just awful. Since then I am always apprehensive to meet a new patient (to me) and relieved when they are normal and kind.
I find this type of work more rewarding than my job in San Diego. Although working in San Diego was easier and I had more free time, I didn’t find the job to be too rewarding. I didn’t feel like I was making much of a difference. I think it’s because the patients were fairly stable and I didn’t see them more than once or twice.
This is in comparison to my job here, where all of my patients are 65 and older and very sick. I see them once a month or sometimes even weekly depending on how complex they are. I am able to develop relationships with them and their families. I am able to help them improve their health and witness them get better. I love when we get to the point of knowing each other that we can begin to joke around.
At the same time, since the patients are vastly sicker here, I barely have any free time at work. I often have to work through lunch or stay after hours to finish my work flow (medication refills, review lab results etc.). Luckily, I am paid overtime but I would rather have the free time and feel less mentally exhausted by the end of the day.
Unfortunately, the work life balance at this job isn’t good. The physicians often respond to phone messages or do medication refills even on their days off. They are usually still working even after I have left – and like I said I leave late.
Initially, I had a few patients that were upset about not having a “doctor”. The medical assistant would warn me about this and explain why the patient’s blood pressure is high. It didn’t bother me because I knew that they just had no idea what a nurse practitioner is. When I went in the room I introduced myself to them, listened to their concerns about seeing an NP vs MD, and explained the similarities and differences between each profession. By the end of the visit, they calmed down and their blood pressure went back to normal. They had no more concerns about seeing a nurse practitioner since they realized they still got everything they needed medically.
So far, I have had only one hiccup – which sadly happened during my first week. The referrals we place to specialists have to be approved by the medical director of the clinic for cost reasons. I placed a referral to neurology for a patient with a brain mass and swelling, and physical symptoms such as expressive dysphasia and hand tremors. The medical director asked to speak to me about the referral. He said he didn’t have enough information to approve it. He needed to know what I expected the neurologist to do for the patient.
I told him I disagreed as I provided more than enough information, and since I was not a neurologist I didn’t know what they would do. I also told him I wasn’t a new provider and knew what to include in my referral notes. I had never had an issue with my referrals in the past 5 years that I have worked for this company.
He still kept going on and on about what he needed to approve the referral. I was so mad that I just walked away as he continued to talk. I went to see another patient and when I came back his demeanor had changed. He told me that I was doing such a great job and had already noticed an improvement in the patient numbers; and that he was so grateful I was here.
I don’t think I even responded – just stared, because I was dumbfounded. I thought to myself ‘yes you better suck up to me because you need my help’. One of the physicians had retired earlier than expected so the physician that would be taking that panel wouldn’t start until the end of summer. Thus, they were grateful to have me cover the 3-month gap. The funny thing is that medical director had shadowed me when he was a resident my first time working for this company 5 years ago. So, I really didn’t care for his feedback.
He ended up approving the referral – if he hadn’t that would have been a big lawsuit waiting to happen. I just want to do what I enjoy which is seeing patients and not be bothered with trivial things. If he bothers me again I may decide to discuss the matter with the chief medical officer. She told me to let her know if I came across any issues.
This sounds like of one the “high acuity” facilities that only see patients who are Medicare/Medicaid; who are the sickest of the sick, like the highest users of medical services.
I interviewed for one of these agencies (for permanent position), and actually got called for the in-person interview as well. They discussed the heavy workload, and the need to see patients weekly or more often, the need to see patients if they just walked in, and the rationale was to prevent ED visits or unexpected hospitalizations. It sounded like a lot of work, but also pretty fulfilling. But if this type of micromanaging is common, I think I’m better off.
I understand the need to keep costs down. But at this point in your career, you surely have the skills to know when someone has to be referred, and what information is required. Micromanaging is a problem. I have learned how to better work with office staff after having been micromanaged a few times myself. I do find, oddly enough, less micromanaging in locums than in the permanent positions I have had.
Haha yeah sounds like a similar practice. It definitely is rewarding and it gets easier with time. I’ve worked for them for a year before and after 6 months I knew the patients really well that it became a breeze. But it’s definitely challenging as a locum providing coverage there because everyone is new to you but they still have the same expectations on metrics.
I’m so confused on how an explanation was needed for a brain mass- man I’m in physical med & rehab inpatient & outpatient and see these go south quick- they’d of just got sent straight to the ED by me w/out time for any oversight by another provider. Your posts inspire me- if you ever make it out the Pacific NW again message me – & we can link I’m in Portland. I also have a nonprofit that serves in Haiti so we have some commonalities. May the Lord bless you~ Charmika
Oh that’s awesome! Will do thanks 🙂