Nov 23 2007
A short week at the office
This Thanksgiving Holiday has found me giving thanks that it was a short week at the office. I thought I’d share a few highlights.
1.  Made a home visit over the weekend because my patient is caring for his 95 year old mother at home and couldn’t get anywhere with his provider…so she transferred care. It’s nice to be able to do that. I was also fortunate the medical director for hospice thinks it’s ridiculous (I’m leaving the stronger words out) I can’t admit to hospice and agreed to sign the hospice orders.
2. I interviewed someone for the back office. We’ve gotten so busy, I really need someone who knows how to handle the back office, can multitask like a super-hero and still hold a smile. When I checked her references, my heart sank. Back to the drawing board. We just don’t have a great pool to draw from here.
3. Closing for the holiday and of course, everyone wants in before hand. Busy…but that’s okay…we like busy.
4. The practice is growing steadily, I see several new patients each week. We also turn down several. For example, someone called up and demanded that we see him and give him one bottle of Percocet and one bottle of Soma each month. We gently suggested that we were not the office for him.
5. I had a young woman come in with a lump under her arm. Not unusual these days. Except her presumed MRSA infection consisted of at least 5 distinct abscess’s, with more forming. This was not going to be an office I&D. I called the new surgeon in town (she was the one on call)…only to be asked if I had given her an acupuncture treatment in that area (we have an acupuncturist in the office). That was her only question. Give me a break.
Yep….I’m thankful it was a short week. What was your week like?
Tags: General, NP Practice
Hi Barbara,
I really liked your excerpt, so I decided to tag on, and give you my week, and for others reading as well, I would love to hear your stories.
More than “House” Calls
1. I made one housecall to a woman who has chronic pain, who also cares for her ill Diabetic husband. I ended up seeing him as well, as he was staggering in the hallway, with a cup of sugar free tea in his hand, and his blood sugar was 28! Well, I definitely put some sugar in that tea, among other things! Then, I ended up making two “cat calls” (and not the kind construction workers sound like), as this same woman left to visit family for Thanksgiving, and asked if I would feed her cat and the neighbors for a couple days!
2. I made two more housecalls to administer flu shots to my neighbors’ teenage nephews that were visiting for the Thanksgiving weekend.
2. I have not been officially assigned Care Oregon (Oregon Medicaid) as of yet, although I am credentialed since October 17, but still need the computer orientation, which was cancelled this week as the provider relations contact fell ill. However, I did see a family of 4 Care Oregon patients, and when the one child came back for an ear lavage, I happily saw that the very ill 14 month old little girl was laughing and running around the clinic, feeling so much better. The mother took a bunch of my cards to put out at the local sandwich shop she manages, as she was so happy with the care. That was very gratifying.
3. The local pharmacist called me the day after Thanksgiving and asked if I could “see” him for an eye infection. As he was at work and could not leave, I said, sure, but I would want to “eyeball” him, and set off to make a “pharmacy call” with my pocket oto/opthalmoscope. While at the pharmacy, a father and his little girl walked up to the pharmacist, with the little girl holding onto her ear. You guessed it! The pharmacist said “I can’t help you, but this Nurse Practitioner can!” The father was amazed when I just happened to have the otoscope handy that I pulled out of my purse. After a quick exam of both cerumen impacted ears, I quickly directed them to “Aisle 2″ for the generic Debrox drops, and cotton balls, (remember I used to work for the TakeCare clinic in this very store, so I knew my way around) and will see them tomorrow in my office 1/2 mile away for ear lavage and further treatment if necessary.
4. Just as I was leaving, the pharmacist paged me back to the pharmacy. A new Care Oregon patient had just arrived from California, and she had Rx’s for about 20 prescriptions, but the pharmacist could not fill them, as they were written by an out of state doc. She was running out of her meds, but she needed an Oregon prescriber. I was able to assist, and now have another new patient, that will be calling on Monday to formally establish care in my office locale.
This was the last few days of Thanksgiving week, and as I like being busy too, I hope this keeps up. I have a part time medical assistant, but she has a full time night job, and I can only afford her for about 5 hours a week right now, although I need her for more paperwork duties. Unlike Aberdeen it sounds like, I advertised for a part time front desk person, and got 40 responses in two days on Craigs list! Many people have years of experience, but my issue is financial. I have to get to at least 6 patients a day before I can feel confident to pay someone full time, and I would not want my part time medical assistant to quit her full time benefitted job, if I am not able to guarantee her full time work yet.
So we are continuing to play it by ear, and stay with a skeleton crew for now. We are getting busier, but it is still sporadic. Look forward to hearing from others, and Barbara hope you had a great Thanksgiving!
Carla, –and Barbara–
Thanks again for more valuable info. House calls are something that our clients are not used to having–they are a thing of the past. This is something that some of us (NPs) may be able to offer, and boy oh boy are they surprised to have that offered! And so grateful. Just one of the things that we, as nurses, can do for those in our communities…
Good going!!
–Julia
I agree fully that offering house calls is a plus for any NP not only because it is quite lucrative in that you can charge a $400 + fee for a first visit and a $300 + fee for a subsequent visit, but it makes a difference in the people you serve because it is so essential in protecting those elderly from getting out and possibly breaking something or catching something from all of those horrible people who do not practice good hygiene when coughing, sneezing, etc and covering their mouths and noses. I have been visiting a 99 yr old woman since January who has round the clock sitters who watch over her like mother hens and keep her quite well. But a month or so ago they became worried when i wasn’t there the minute they called me and almost took her to the hospital. This woman has never been to a hospital, doctor’s office or taken any medicine. Now can you imagine bringing her to the hospital which is probably one of the dirtiest places in healthcare along with all the germs from different illnesses and once their she would have undoubtedly have been given such strong antibiotics IV that it would have finidhed her with the resultant damage to her already almost non functioning kidneys.
I treat any of my 80 and 90 year old patients at home and even 70’s if they are ill 70 somethings. They and their families are so grateful that you know that you have indeed done a great deed - one of high humanitarian effort!
Sincerely,
Nina Ravey