Hello,

I am a new FNP who has full office (Mon-Fri) schedule and call, in addition to 35 nursing home patients in 4 local nursing homes.  Would appreciate input from those experienced in NH visits. There has to be a way to see NH patients and provide quality care and utilize efficient time management? 

Just physically locating the patients within the LTC facility is time consuming (not in their room, are they at Bingo, the beautishop or....).  Then their active charts are several inches thick and organized very differently from facility to facility.  It takes me much longer to see a routine follow up LTC patient than a level 3 or 4 office patient. 

Additionally, during the week I receive and respond to all the LTC patient's routine and abnormal lab and test results.  All of this is on top of full office patient load and phone messages. 

There has to be a better way....

Hi--I can't help but respond.  I really hope you are getting paid well!  It sounds like you are working over time, and as a new NP I would hope you are not setting yourself up for potential errors.  You need some time to learn---and it sounds like the staff at the nursing home needs a little training about appropriate times to call and to assist you when you are there.  I know they are busy, but it sounds like you need some assistance.  Again--I hope this is a high paying position!  You need to love what you do before you get burned out:)

As a Federal employee, I had a full schedule of hospital primary care and nursing home residents.  For the NH visits, I delineated time for answering RN current health issues, setting up lab work for residents with upcoming bimonthly/annual examinations.  Given the fact that you are spread out in 4 different nursing homes, ylu need to schedule your timne and have the pertinent staff work w/you to have the patients ready for your visits.  That means you have give YOURSELF the convenience of a mapped out day/week/month.  As a new NP, it is essential not to get burned out too soon.  Plan yourself accordingly and work w/the doctor and staff to be behind you in your efforts to see your patients timely and address their daily issues w/less stress.  Would be glad to converse more on this subject---much bears repeating as organization can be 'disorganized' as it evolves!!!

Laurie, I am an FNP with an office practice and nursing home rounds as well.  I schedule my time in the office and allow time each day for nursing home rounds.  May be 2, 3, or 4 hours daily depending on how many residents I have at that particular facility.  I do NOT do 40 hours in the office and then schedule nursing home time on top of that (I do work more than 40 hours a week, I think most NP's do, but you can't do more than you can manage safely)!  I am blessed in that the staff know when I am coming, have a list of problems for me to address in addition to my routine visit.  I have found that when the Director of Nursing position turns over, I make direct contact with him/her and let them know what I need from them and their staff.  This includes grouping calls to my office and what info I need from them when they call (i.e., when they fax me the PT/INR, they must include current dose of coumadin, allergies, vital signs, etc.)  I have been at it for about 5 years now, so I have the advantage of knowing the residents, their history, etc.   The profession of caring for the frail elderly is a tough one, but I find it very rewarding.  Thank you for trying to find a better way to provide quality care, they need you! 

 

Melinda Taylor, FNP

Hi Laurie,

First of all, your office needs to value the time that you spend in the facilities and give you time to go the nursing homes during your usual work day. You are billing, so it's work time. Second, learn each facility's schedule best you can and avoid mealtimes and any special times when your residents are more likely to be away from their rooms. Schedule specific days for each facility and order routine labs for those days (if you go late in the day) or the day before (if you go early), so you can see the labs at the facility instead of being called or faxed about them. Have the nurses keep a list of issues for you to deal with. It will get easier as you get to know your patients. If there is an event about to happen, I will quickly see my patients and then look at the charts - it's all about being flexible. It will also help if you can devise a form that you can use to check off as much as possible. There are some templates at the Gerontological Advanced Practice Nurses Association website if you are a member. I hope this is helpful.

Susan

Hi Laurie,

When I started out as a new NP (1st as a GNP), I had a full time NH practice and covered 5 facilities. Fortunately, I did not have an office practice on top of that.  Over time, I learned that it was best if I worked with the nurses - making sure they got what they need, the residents got what was needed, and I was able to utilize my time more efficiently.

So, in addition to what the others have said, you need to find a way to "befriend" the nursing staff to help you out. Schedule your time with them and let them know you'll be happy to respond to their requests/needs, etc. It may take a bit of time...but it will help you out so much in the long run. Oh...and don't forget the CNA's...they will make your life much easier.

Good luck,

Barbara

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Barbara C. Phillips, NP
Facebook: http://profile.to/barbaraphillips/
www.NPInterviews.com
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Laurie:

One of my good friends did this type work for 13 years. Here is what she said:

it sounds like she works at a place like i had too. she could call the nursing homes and tell them to give her a list of patients she is to see today and have someone make rounds with her and get the patients in the rooms and have them show her the recent labls etc. or she could send them a list of her patients she needs to see that day and have someone making round with her.

Hope this helps you.

Brenda