Saturday, August 23, 2008

The final countdown

NewFNP's CEO signed her final loan repayment form yesterday.  Her last full-time day is one week from today.

There is not one part of newFNP that is sad to be leaving full time practice at her clinic.  And that makes her very fucking sad.

Provider burnout is not new.  Articles have been written, schools talk about it, practitioners live it.  And for what?  There is a lot of talk about a broken health care system in every media outlet to which one chooses to listen.  But it's not just the Medicare reimbursement or the HMOs and PPOs that are broken.  

It's organizations like newFNP's clinic - where the average shelf-life of a provider is less than three years; where there is not one hour - hell, there's not one minute - of administrative time scheduled for providers; where there is no one to follow up on referrals to specialists; where there is not one registered nurse, not one LVN, not one CNA; where providers work through lunch every day; where lab results, correct phone numbers and vital signs aren't in charts; and where patients are double and triple booked.

NewFNP is partially to blame for her own burnout.   But, you know what, her clinic is responsible as well.  It doesn't seem too far fetched to make efforts to take care of one's employees.  NewFNP's senior management believes that providers are just there to see patients, and as many as possible each and every day, all the while fixing the errors of other staff members, filling out endless forms and attempting to care for the physical and, often times, emotional well-being of the patients.

It's too much.  NewFNP isn't sure if it's her - if her lack of personal fortitude is the problem, or if it's the dysfunctional environment in which she works.  She thinks that, given her degrees from top schools, it's the latter, but it's not in newFNP's nature to let herself off the hook that easily.  Perhaps it just means that she needs to choose her next practice site more wisely, if she ever goes back to full time practice.  Perhaps she needs to impact health outcomes from a more hands off venue.  

NewFNP thought that she would be working with the urban poor forever.  She sought out a free health clinic in the frigging ghetto.  And now she wants to get the hell away from it.  That is sad

One thing newFNP can say is that she learned a lot these past three years.  And she continues to learn every day.  And that is a really lovely thing about nursing and medicine.  But when it's time to go, it's time to go.

And it's time.


Onid said...

I recently found your blog and read it often. I am an FNP student and have shared your writings with many of my classmates. I am sorry to hear about the lack of support you have received from the powers that be and wish you well in your search. Please keep writing!

Anonymous said...

It seems it's the same everywhere. I'm saddened for you too. All we want to do is provide good health care for our clients. It shouldn't have to be so difficult.

Best wishes of some sense of control over the practice you keep, and best wishes for me to last 2 more years without loosing heart.

Serena said...

And again, it does seem to be the same everywhere. I'm winding down in my little CHC in rural southeastern Washington, and I have taken to calling in sick and taking more vacation days than ever. I am ready to have support. I am ready be listened to. If I have to go to private practice, I will. I'm going to have to read the linked article, but I am believing in compassion fatigue.

It's amazing we've been on such the same path in opposite ends of the country and demographic.

Lesbonurse said...

No wonder you're fatigued, with no administrative time and 20+ patients in a day! I work in a clinic with a very similar demographic, but my schedule is capped at 16 patients a day and I get 4 hours of admin time a week. So there are some better community health centers out there...

On the other hand, sometimes I wonder how long I'll last, too! I feel exhausted at the end of a 14-patient day.

Anonymous said...

Regarding the statements on burnout...I agree with it not being your fault. It is easy to let stuff get to you, sure, and that can be your fault...but sometimes too much is too much for anyone. I work in a community health center too and have so for many years and for the same reasons that you have and it is hard to imagine leaving but for sanity should......anyway...for those who do are great and don't let any patient or administrator tell you otherwise!

BostonFNP said...

Perhaps it is because we work where we do, but I have started to feel that healthcare in this country mimics the economics and lifestyle that is so ingrained in this country. Practitioners who practice in wealthy areas to wealthy patients seem to have the best quality of life within their practice. Cushy offices, supportive office staff and lots of perks built into the schedule. Those of use who work with the poor and disadvantaged are those who have much less administrative support, higher expectations about patient load, less access to specialty care and therefore, a much higher rate of burnout. The net result is that good practitioners, like us, who have a mission to serve end up leaving because we can no longer provide the kind of care we want while maintaining our own sanity. In school, I believe this type of pattern was called a negative feedback loop. Where is the sense in this? As I also tick off the weeks until my contract is done, I commend you for continuing part time. Your break is well deserved and your patients will ultimately benefit from it.

Laurie Anderson, RNP said...


I worked in a FQHC equivalent for a total of 5 years; 3 FT and the last 2 very part-time. I stayed on PT because I loved my patients; I left overall because of lack of administrative support, lack of professional respect on the part of administrators, and a crappy income. During my FT employment I worked 2 other per diem jobs to make ends meet. I took a 13,000 dollar pay cut to go there (from hospital RN with longevity to new FNP :>) and received 1 salary increase of $1,000 over my 3 FT years (that I had to b*tch to get). When I left I went to an ER job working 3, sometimes 4 days a week and a salary increase of $27,000 overnight ; since I moved to the ER I have received 2 serious raises and an annual bonus based on the team's productivity. The biggest kick in the teeth was that the health center didn't even TRY to keep me; I would have stayed for even a modest salary increase and a little professional respect, but now I've seen the other side. My quality of life with one job is far better, I am treated as a professional member of the team, and my opinions are valued. Night and day! It's hard to go; you'll miss those patients for some time. But hopefully you'll come to find a place you love again and it will be rewarding professionally, personally, and financially. I certainly have. My very best wishes for you in your new position! Laurie