Sometimes working with a patient is like herding chickens! They run all over the place, and it’s hard to get to the heart of the matter. Or the patient may be so focused on the appointment, you have a difficult time ending the visit. We talked to other NPs and found these tips and tricks that work for them and might work for you too!
Scripts to Focus the Challenging Patient’s Attention
Redirect patients to the subject at hand. “I love catching up with you, but I really want to be able to address your medical needs. How are you tolerating the X that we started you on last time?” At the end of the visit, “I don’t mean to cut you off, but we only have 5 minutes left, and I’d like to discuss X with you. Can we focus on that now?” Then change directions with direct questions, if possible.
When patients come in with a laundry list of complaints (isn’t this all the time?!), say something along the lines of, “Wow, you have a lot of concerns. Since we only have X minutes, what do you feel is most important to focus on today?”
Tactics for Ending the Appointment
Practice scripts to end your patient visit politely and kindly. “I’m so sorry, but I really need to get to my next patient,” or “I’m so sorry, but we really need to end the visit for today.” You might feel you need to add, “Do you want to schedule a follow-up to address this more?” “Why don’t we follow-up in X days/weeks/months to see how things are going.” “You know, I really want to be able to fully understand and address this issue. Can we schedule a follow-up appointment to discuss it?”
If you’re still having trouble, assign office staff to knock and say, “Excuse me, but Dr. Black is on the phone for you,” or a similar code word when an allotted time is passed, especially if you are in a room with a known Chatty Cathy. Telehealth/telepsych providers also find this technique helpful. Alternatively, staff can announce on the overhead intercom that you are needed to help end the visit.
Telehealth/telepsych providers can also try saying, “Oh, it looks like my next patient is online. I’d better wrap this up. Is there anything else we need to talk about, or should we get you scheduled for a follow-up?”
Near the end of the appointment time, review the most pressing problem and possible treatment plans. As appropriate, suggest 2-3 options for plans: Do we change the dose or therapy? Do we start or change medication or treatment? Do we refer? Do we want to give it some more time? If appropriate, bring the patient into the decision-making. The answer can help guide the timeframe for the next step. Then, sum things up. Review any med changes or instructions and head towards the door. One hand on the doorknob helps give patients the hint.
If that doesn’t work, walk the patient to the scheduler to make their follow-up when you need to get them out the door. Most patients appreciate this extra step. Yes, it takes a little more time, but it can help show the end of the visit. (Hopefully, your scheduler can manage him/her!)
As you walk away, remind patients they can message or call you, as needed and can always move up a visit. I often end with a very warm, friendly comment. “It was so good to see you, and I’m glad you are well,” or “I’m so glad you came in to discuss this with me. We’ll work together to get to the bottom of this.”
In the end, you may need to just schedule a longer appointment for some patients that always need more time.
Benefits of Digital Communication
Not every patient question or concern requires an office visit. Educate your staff on how to screen calls and messages before they come to you. Provide guidelines for when the patient needs an office visit or when it needs to be referred to you for a call-back or follow-up. (Err on the safe side though. Your MA may not understand what is important!) Along this line, one popular suggestion was that if a patient message requires more than a yes or no answer, an appointment should be scheduled.
Some clinicians find messaging back instead of calling back is a more effective way to respond to patients, however, if a patient is always calling in or messaging you, consider scheduling him/her for more frequent follow-up visits or a telehealth call where you can at least bill for your time.
I love working with my patients and helping them address their health concerns, but we all have patients who require more time than others. What tactics have you found to help you manage your time with these challenging patients?
Clinicians are always looking for ways to manage their patient care time most effectively. You care about your patient and want to hear about their trip to the Grand Canyon/Daughter’s Wedding/List of complaints a mile long, but you still have to maintain your schedule and your sanity! We got feedback from NPs across the nation, and here are some tips that might help!
Take Full Advantage of Your Staff
Your support staff acts as the front line to your schedule. Educate and delegate to your support staff so they pre-screen the visit and manage patient expectations. You may even provide scripts for them such as, “I’ll let the NP know that you have several issues to discuss, but she/he might not be able to address them all today. We can always schedule a follow-up visit if needed though.”
As part of this pre-screen process, have back-office staff give patients depression screens, vision screens, etc., as appropriate before you see the patient. Depending on why the patient is there, checklists or templates can be helpful and may be completed by the patient ahead of time or with you.
A good Medical Assistant/back-office person can help you know what to expect before you enter your patient’s room. A sticky note or message that says, “Pt here for a rash on back but BP 180/100” can help you focus on the most important things. Learn your staff’s knowledge level. Sometimes they know the patient better than you, especially if you’re new to the practice.
Implement Standard Processes
While some visits require more than the allotted time, others may not fill the entire appointment.
Use these “simple” visits (if there is such a thing) and refills to help you make up/save time. If someone is just there for a refill, and they are doing well, create a process where you review things as appropriate, give them the refill, and move on to the next patient. “It sounds like things are going well on your current regimen. I’ll give you x months of refills and see you back in X months. Does that sound like a plan?”
Some clinicians find starting the day 30-60 minutes before patients to prep charts can be a time-saver in the end. Review your schedule, review records/labs/imaging, prep notes, including the Plan section to note the things you intend to address, such as a prior complaint, lab work, med changes, etc. In many settings, over time you will get to know your patients and their diagnoses, and this can help in being able to cut to the core of the visit.
If you find yourself routinely going over on time, using a timer app or timer on your phone/watch can help you keep an eye on the clock. You might even let the patient know that you are doing this to help keep you on time with patients. Set an alarm to warn you of the half-way point and/or when you have 5 or 10 minutes left. Train yourself to cue the patient on the time limit when the timer buzzes. “It looks like we only have 5/10 minutes left for this visit. Is there anything else you would like me to know?”
If you are in a setting where you see the same patient regularly, during your patient’s first appointment, outline the amount of time you have for visits. Let them know you value their time, and you will do your best not to be late. Along that line, you or your practice setting might want to establish a late patient policy. Do you accept late patients? What is the cut-off? If a patient is 10 minutes late, let them know that you want to provide them the maximum amount of time you can, and if they are late, it may cut into the time you can spend with them. Obviously, this only works if you are generally on time!
End the Charting Time Warp
Charting eats up more time than we’d like, and it’s often left to the end of the day to complete. Use these ideas to chart faster and prevent this task from eating up your precious time.
Caring for patients can be extremely rewarding, but it can also be full of challenges. What techniques do you use to help manage your patient care time with quality and TLC?
PreceptorLink was born from necessity. Nurse practitioner students like you have struggled to find preceptors for years. As clinics require NPs, PAs, and physicians to see more patients in a day, we’ve witnessed the availability of preceptors decline. Paying preceptors an honorarium for their time fills the gap for students who can’t find a preceptor, however, we never intended for it to be your first stop. Before you give us a call, check out these five ways to find a preceptor without paying. (Hint: #1 is a little-known secret that will widen your opportunities immensely.)
#1 Compact State
Thirty-nine states participate in the Nurse Licensure Compact (NLC) that allows RNs with a license in one of those states a reciprocal license in the other participating states. If you cannot find a preceptor in your state where you are licensed, you are legally able to cross state lines to take a preceptor if both states are part of the NLC. This opportunity opens many doors, especially for NP students looking for psych preceptors where telepsych is accepted.
As you search for preceptors, consider areas where you have relatives who might allow you to stay with them during your rotation. You may also weigh the pros and cons of staying in a hotel for the duration of your rotation if you find a preceptor out of town.
If your state is not an NLC state, it might be worth checking into getting a license in an NLC state so you have the option of finding preceptors beyond your state’s borders.
(This applies only to your RN license, not your APRN, and you should always check with your state board to confirm compact state status.)
#2 Be Prepared
Take a minute before you start your preceptor search to inventory your professional persona. Finding a preceptor is increasingly competitive. You’ll improve your chances dramatically by polishing your resume to ensure it highlights your nursing experience and background. Start with the most recent NP rotation experience, but also include your RN experience where relevant.
While you’re updating your resume, scroll through your LinkedIn and Facebook accounts. Your LinkedIn account should include the same or similar information as your resume. As you view your Facebook account consider how posts you’ve written or shared might be viewed by prospective preceptors. Many times preceptors will review a candidate’s social media for a idea of their personality and fit.
#3 Your Network
Remember the old saying it’s not what you know but who you know? When it comes to finding an NP preceptor, who you know makes a big difference. Your instructors, co-workers, family members, and friends all offer potential connections to NPs, PAs, and physicians who could be willing to act as your preceptor. Ask everyone you know.
You widen your network by joining your state association for nurses and nurse practitioners along with national associations. Start with the general nurse practitioner associations, then widen your net to include associations for the specialty with which you need a preceptor. Some of these associations have opportunities for you to announce your needs to their members. And now that associations are conducting in-person meetings again, you have opportunities to meet potential preceptors face-to-face.
#4 Social Media Resources
Right behind your network, your Facebook and LinkedIn profiles have the potential to be your second greatest asset. Use the platforms to connect with nurse practitioners, NP groups, and nursing organizations. Some NP groups on both LinkedIn and Facebook allow you to announce your need for a preceptor. Other groups have the sole focus of connecting students with available preceptors for free.
Use social media to research prospective preceptors to find who you may know in common and ask for an introduction. Or reach out through private messaging on a clinic’s social media page. Prior to the COVID-19 pandemic, NP students routinely hit the pavement going clinic to clinic seeking out preceptors. With an influx of patients and concern for safety, this method has been discouraged over the last two years making finding preceptors that much more difficult. Social media can help fill the gap.
#5 Online Ads
Online ads with Indeed and LinkedIn offer additional digital sources for finding your next preceptor. While online ads aren’t free, you’ll pay for the ads versus paying a preceptor which is typically less expensive. Do some research on the best way to word your ads and how to target those ads to reach your top prospects.
Finding a preceptor can turn into a full-time job in some areas where competition is high and preceptors are less plentiful. If you’re struggling to find the right preceptor for your upcoming rotation, check out our list. We work with thousands of preceptors all across the United States. If you don’t see the rotation you need, reach out to us. We have new preceptors joining us every day.
As a longtime NP with a desire to help and make positive changes to her beloved profession, Lynn often writes opinion pieces about the NP profession.
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