Tag : nurse practitioners

How did caring become so complicated?

It is no coincidence that the number of Nurse Practitioners are showing a growing interest in non-clinical positions. There isn’t a week that goes by when I don’t hear from one or more nurse practitioners who are looking to leave direct care.

Burnout is not a new phenomenon, especially for nurses. It’s long been recognized that the strain of continually caring for others can take a toll on the caregiver. “Compassion fatigue” is the term used but I am not so sure that is what is going on here. NPs are telling me that it’s not caring for patients that has worn them down, in fact it’s quite the contrary.

Barrier to Caring

Nurse practitioners WANT to care, it’s what keeps us going. We went into this business to form relationships and make a difference. We were drawn to this role because we were told we would have more time with patients, and we would use this time to educate, inspire and empathize. Instead, what we are encountering in practice now is what I like to call “compassion frustration”. Despite the focus on patient satisfaction it seems too many current practice models are doing everything possible to create barriers that result in encounters that turn out to be unsatisfying to everyone involved.

Decreases in visit time coupled with increasing documentation and payer requirements are getting in the way of therapeutic relationships. One of the most frequent reasons NPs tell me they want to leave direct patient care is that the clinic has become like a treadmill and the clinician is feeling the pressure to either keep up or fall off. Fifteen minute visits, of which 5-7 minutes are taken up by rooming, leaving less than 10 to see the patient and document then on to the next, and the next, and the next. Rinse and repeat. Oh, and answer calls and emails, do prior authorization and of course don’t forget the billing. And because NPs love their patients they maximize their time with the patient and the end result is the NP staying long past clinic hours to finish documenting and completing these other tasks.

Using only the wisdom that administrators and analysts possess, instead of simply giving the clinician an additional 10 minutes with a patient, more extraneous persons have been added to the patient experience. Time for documentation is a problem? We’ll hire a scribe! Non-adherence to a treatment plan? Let’s hire another person to find out why!

More money spent on endless mailings touting a staff of coordinators, educators and of course the website. We now have a host of different people employed to do different aspects of what used to be done by the one person who knew the patient best. How does that save time? Or money? It doesn’t. And it certainly doesn’t increase provider or patient satisfaction. Quite the opposite. Adding more water to the soup doesn’t make it more filling.

I’m waiting for the study that shows fancy programs and initiatives are not a substitute for the good old-fashioned relationship between caregiver and patient. A girl can always dream but I am not holding my breath…