anyone work in a primary care clinic before?

I have over two years experience as a bedside nurse. I'm considering changing to a clinic job. I'd be going from three 12 hour shifts to 5 eight hour shifts and would like to get out of the hospital setting altogther, but I'd like to hear from those who work in outpatient clinics (with previous hospital experience) how they liked the change.

any input appreciated. thanks Last edit by rainbowbright2 on Jan 4, '11
"Outpatient clinic" is very broad.Could you define the position a little more?

Outpatient primary care clinics are no place for a 2y inexperienced nurse. I have worked acute care for 27 years- med/surg/oncology, same day surgery, endoscopy icu/telemetry- agency-per deim and travel and staff. Believe me- they are not easy and it is no place for a new nurse. You have no resource other than yourself- your judgemnt, your own experience and skill to draw from. There is no RRT team, no code team, no other dept to call if you need a to start a difficult IV -no emergency drugs in the building to give- because that is not what your primary is. You have to know what's in your waiting room- any one of those patients could stand up and drop suddenly to the floor. Most primary care clinics/offices do telephone triage- you have to distinguish between what is the caller saying, what are they not saying, what am I hearing(because you can't see them) Is this someone who belong in the emergency room, urgent care center, needs to be seen in the office today or can wait. You have to be an excellent history taker. You have to be an 'expert' at symptomology. You have to have a vast body of knowledge to draw from. This is not a controlled environment- yes there are some with computer documentation, you think the hospital is busy- there are days when I am so busy, I can't get my daily work done- patients calling in for referals, medication refils, need ing an appt or lab work scheduled before their next visit and which labsto order or radiology reports to call another facility for- did I mention- there's no lab techs, no radiology depts. Patient ratio's - there is no 4,5,6,7,9 patients to one nurse. Primary care offices and clinic waiting rooms are packed and there are some days you feel like the feild of dreams- build it and they will come- they keep coming- even when the day is closed! After all those years in hospital acute care-I was no longer challenged- This is a challenge- it pulls from disease I have come across in 27yrs. This is not the place for a novice nurse.

I forgot the mental health calls- the primary clinc where all the care centers around. It's the spring board for all other referrals out to specialties. A diabetic suddenly feeling depressed- the primary starts the patient on an SSRI but after a few months and a zillion daily phone calls to you the nurse, the patient needs the mental health specialist/psych. but the patient is still the primary clinic's patient, (the diabetes doesn't go away)

Quote from kcmylornOutpatient primary care clinics are no place for a 2y inexperienced nurse. I have worked acute care for 27 years- med/surg/oncology, same day surgery, endoscopy icu/telemetry- agency-per deim and travel and staff. Believe me- they are not easy and it is no place for a new nurse. You have no resource other than yourself- your judgemnt, your own experience and skill to draw from. There is no RRT team, no code team, no other dept to call if you need a to start a difficult IV -no emergency drugs in the building to give- because that is not what your primary is. You have to know what's in your waiting room- any one of those patients could stand up and drop suddenly to the floor. Most primary care clinics/offices do telephone triage- you have to distinguish between what is the caller saying, what are they not saying, what am I hearing(because you can't see them) Is this someone who belong in the emergency room, urgent care center, needs to be seen in the office today or can wait. You have to be an excellent history taker. You have to be an 'expert' at symptomology. You have to have a vast body of knowledge to draw from. This is not a controlled environment- yes there are some with computer documentation, you think the hospital is busy- there are days when I am so busy, I can't get my daily work done- patients calling in for referals, medication refils, need ing an appt or lab work scheduled before their next visit and which labsto order or radiology reports to call another facility for- did I mention- there's no lab techs, no radiology depts. Patient ratio's - there is no 4,5,6,7,9 patients to one nurse. Primary care offices and clinic waiting rooms are packed and there are some days you feel like the feild of dreams- build it and they will come- they keep coming- even when the day is closed! After all those years in hospital acute care-I was no longer challenged- This is a challenge- it pulls from disease I have come across in 27yrs. This is not the place for a novice nurse.

No I don't work in a crazy urgent care- it is a primary care office practice. It is not a place for an RN with 2 years of experience- there is no way 2 years can give anyone the experience, critical thinking skills, the intergration of pathophysiology, pharmacology, psycho-social, environmental factors, being aware of ALL the possible outcomes of any and every disease processes and judgement that much autonomy demands. As the RN in this practice- I don't check patients in, get their vital signs or assist with any procedures. The tech's do that. My assessments are not brief sometimes I have to see some of the patients instead of the physician because he is busy with the regular scheduled patients. I have to run my assessment findings to him and he verbally tells me the orders, sometimes he and I discuss the case before hand and he decides what to order, I enter it in to the computer or I fill out most of the script for what he has ordered, he reviews it and signs it. The doc never sees these patient- they are only seen by the nurse. On symptom based calls, I computer document what the patient tells me, I e-mail it to his office, he e-mails me the treatment or if a patient is asking for labs to be ordered before their next visit- he emails me to review the patient's PMH and "order the appropriate labs" I have to know which labs are appropriate. The autonomy and judgement is that of an APN without the prescriptive privledges. There are times when a patient he may not have seen before is just discharged fromthe hospital- ie with AML, on chemo, went into septic shock, spent weeks in the hospital ICU is discharged and now needs to follow up with a primary, or comes into the practice is on chem, and taking one look at the patient, you see something is wrong(ie a skin rash and sudden HTN that turns out to be a chemo reaction) and end up sending them to the ED to be admitted. It's alot of independent critical thinking, that is built on years of experience.

Quote from kcmylornOutpatient primary care clinics are no place for a 2y inexperienced nurse. I have worked acute care for 27 years- med/surg/oncology, same day surgery, endoscopy icu/telemetry- agency-per deim and travel and staff. Believe me- they are not easy and it is no place for a new nurse. You have no resource other than yourself- your judgemnt, your own experience and skill to draw from. There is no RRT team, no code team, no other dept to call if you need a to start a difficult IV -no emergency drugs in the building to give- because that is not what your primary is. You have to know what's in your waiting room- any one of those patients could stand up and drop suddenly to the floor. Most primary care clinics/offices do telephone triage- you have to distinguish between what is the caller saying, what are they not saying, what am I hearing(because you can't see them) Is this someone who belong in the emergency room, urgent care center, needs to be seen in the office today or can wait. You have to be an excellent history taker. You have to be an 'expert' at symptomology. You have to have a vast body of knowledge to draw from. This is not a controlled environment- yes there are some with computer documentation, you think the hospital is busy- there are days when I am so busy, I can't get my daily work done- patients calling in for referals, medication refils, need ing an appt or lab work scheduled before their next visit and which labsto order or radiology reports to call another facility for- did I mention- there's no lab techs, no radiology depts. Patient ratio's - there is no 4,5,6,7,9 patients to one nurse. Primary care offices and clinic waiting rooms are packed and there are some days you feel like the feild of dreams- build it and they will come- they keep coming- even when the day is closed! After all those years in hospital acute care-I was no longer challenged- This is a challenge- it pulls from disease I have come across in 27yrs. This is not the place for a novice nurse.