Posted: 16-Feb-2012 22:44|
I have worked as a NP in general practice for the last 10 years and it has mostly been a positive experience. recentley we have introduced a new service of same day appointments where I expected to see 40 patients a day. I am finding it really difficult and stressful. I have asked the RCN what the guidance on what the upper limit of safety is but they have been very non commital.
Does anyone have any hard figures/ evidence on what constitutes safe practice please?
Posted: 16-Feb-2012 22:56|
How many hours are you expected to see 40 patients in? Do you have admin/catch-up time? How long are your appts? Do you have access to clinical support if you need to ask for help in decision-making?I see pts at 15 minute intervals, approx 50% same day stuff with a little time for catchup/breaks etc. I usually feel like a limp rag after 8 hours but I am fairly new to the role. I don't know about any hard figures....
Posted: 17-Feb-2012 10:06|
i can see 40 pt in a morning some day. :(
.. cant say they get a full NP MOT in that time ,but 10m usually ok for minor stuff... problem is if you do a walk in and get anything and everything thru the door time can easily get pressured....would deffo need to be part of a team wiht help forthcoming in needed in this situation.
i think 15m appt is normal for NP with a little catch up _ GPs do it on 10m appt but then get admin time as well ...
Please be informed that the above is personal opinion only.
Posted: 17-Feb-2012 10:17|
Our NPs get 10 minutes for normal surgeries - minor illness, etc. But for their specific clinics, they get an appropriate amount of time to reflect the work.
I think, hammy, it depends what the GPs are expecting in the time available. 40 pts in a day for simple minor ailments doesn't seem too onerous. 40 Diabetic Reviews in a day would be much tougher. So perhaps you need to confirm what's expected of you and then the negotiation can start (to reduce numbers / duties, build in admin and coffee time, etc).
My GPs can see 40 in a morning, let alone in a day, if they're Duty Dr, covering the emergency surgery. Then they have visits on top too. And they rarely get admin time - they do this before and after surgery and in their own time...
(Please be aware that I am a Practice Manager / Monster (delete, as appropriate!) and that this is my opinion only. I do not represent any other body or organisation. Nor do I necessarily have any specific qualifications on this matter and am basing my opinion on experience and common sense only)
Posted: 17-Feb-2012 11:03 2|
are your GPs partners or emplyees tho? i would expect partners to put the extra time in but us salaried nurse need protected time to complete the work load or else it explotative manipulation IMO
Please be informed that the above is personal opinion only.
Posted: 17-Feb-2012 11:29|
They are partners and, I agree, should and do put in the extra.
Posted: 17-Feb-2012 12:30|
My appointments are 10 minutes long. I have 20 minutes admin time at end of both surgeries. However the walk in clinic can not be called minor illness. Anything is booked in- abdominal pains/ depression/ medication reauths/chest pains/ headaches/ dizziness. as well as the minor illness of UTI/coughs/ sore throats/ otitis media etc which would be expected.
there is a GP working alongside me but because of the pressure of work there is no time for discussion re challenging presentations.
Whilst I appreciate what the practice manager is saying about the workload of a GP partner, I am not a partner and my pay does not reflect the level of responsibilty. The GP is only on call one day a week and this is now my daily work.
Posted: 17-Feb-2012 15:15|
As I said, hammy, you need to review this with the GP. Give it a couple of weeks, so that you have some hard facts and evidence, then sit down and go through it. It's perfectly reasonable to put a meeting in the diaty now, to review the changes. in fact, it would be daft and inappropriate not to.
So speak to them, ask for a time in their diary to review the new working pattern and then monitor it in the mean time. Take the positives and negatives to the meeting and go from there.
Posted: 17-Feb-2012 22:46|
Are you doing on-call as well? Home visits? Can you present a case for 15 min appts and getting more QoF done? And some admin time if you are expected to chase stuff up? Or some clinical supervision eg 20 mins with GP after session each day to run through cases you have seen and what you did? Or an hour once a week? Are you being included in clinical meetings?
Posted: 18-Feb-2012 09:09|
you have my sympathy.I am an experienced NP, I see both walk in pts and registered.I do 8-10 hour days with,if lucky,a 1/2 hr break.I am only given 10 minutes per reg pt, even though the GPs get 15mins. Would like to say this is because my patients are easier but it's no longer true. I see patients with complicated sx, also we have huge numbers who are either depressed/have substance or alcohol problems and quite a few homeless. On top of that the business manager expects me to tick various KPI boxes!
I survive because I gave learnt to have the bladder of Maggie Thatcher, the dietary needs of Posh Spice and the fluid needs of a camel[:D]I pray for DNAs and nearly cry when a pt really does only want a rpt px or has just got a minor ailment. If we got a bonus like John Lewis staff, perhaps being worked into the ground might be a little more acceptable. Try to stand your ground, if you are rushed you might make mistakes and guess who will carry the can if that happens. let us know how it all goes.
Posted: 18-Feb-2012 09:22|
The NPs where I work have 10min slots with 10 min catchup every hour or so. They have triage/tel reviews for the last 1/2hr and have an hour gap at the end of the session (1/2hr for lunch) but may also have a HV to do. They also get 1/2hr at the end of the day for referrals etc. I do think they often have difficult consultations with depression, domestic violence issues, three members of a family trying to squeeze in one slot etc. Not easy and not something I would like to do! All I can do is keep slipping in with cups of tea!
Posted: 19-Feb-2012 18:41|
The NP at our practice recently left as they reduced her appts from 15mins to 10mins- I had total empaphy with her, as Gps have 10mins, & have the BMA to watch over them if they make a mistake.
whereas NPs have a tiny amount of training compared to them, so have to do a really through examination to cover themselves, and be confident-
40 patients in a morning sounds like extreme- even if it is quick work(which usually minor illmess isnt)Im quite sure most GPs dont see this many patients in a morn and yet we get paid a fraction of them
Posted: 19-Feb-2012 18:47|
sorry got caught up with what avreed said 40patinets sounds like a lot- the important thing isnot to work outside your comfort zone too kuch- we are responsible and liable which others outside often forget, and when it has been reported in recent practice nurse mag that twice as many nurses have been reported in last year, we need to all be confident what we do has enough time and knowledge
Posted: 19-Feb-2012 22:44|
I am a trained NP, get 15 mins per patient which brings swings and roundabouts for catching up and work about 3 hour clinics I fight against anything else as I can get anything in. Our GPs get 12 min appointments
Posted: 28-Feb-2012 16:15|
Hi there, can u tell me what the difference is between a nurse practitioner and an advanced nurse practitioner.