Would this get on your nerves?!

Thank you, I do try to be! I had some awful mentors as a student and I promised myself I’d never make any student of mine feel how I felt on some of my placements. This poor girl ended up with a quiz I knocked together to fill the time

That was today, it’s rare that the list doesn’t get filled, but that happened today. Tomorrow is fully booked, all 40 of them might all turn up, or they might all decide to stay at home instead! No two days are the same, it’s impossible to predict who will or won’t come through the door. Monday was full, but a third of them didn’t turn up.

As I said, we are looking at the attendance data and trying to improve it but we need to know why they’re not coming. I could spend half an hour triaging a woman and counselling her for every method of contraception there is, she will come to a firm and enthusiastic decision, let’s say a coil, I will then book her an appointment (another 30 minutes) and she then just doesn’t show up! That’s an hour of wasted time.

And the problem is?

There’s no problem, as a missed hygienist appointment isn’t a public health issue. If we are expecting a patient in for syphilis treatment, for example, and they don’t turn up, we can’t just shrug our shoulders as it becomes a public health issue rather than just that one patient’s issue. If they don’t care enough to be treated, they won’t just abstain from sex until they’ve been seen; they’ll go and pass it on to four or five more people. We can’t start sanctioning missed appointments for GUM as we will scare patients away and STIs will spread. There are also a lot of deprived areas around the clinic I work at; a lot of patients say that they can barely afford the bus fare to get to us, let alone a deposit for an appointment.

It is an absolutely maddening service to work in at times, and it has a far higher DNA rate than any other health service I’ve ever known because some people just do not care, or are too chaotic in every element of their lives to attend an important appointment.

It wouldn't be so irksome if there were appointments and treatments available for the reliable majority but there aren't.

This is the crux of the issue. There could have been an appointment for the person who called at 3pm needing help, but the 6pm patient didn’t turn up, or bother to tell us that they weren’t coming! If they let us know they’d been called into work/their car broke down/their granny’s sister’s cat is stuck up a tree, we could offer their slot to the person who called at 3pm. But they don’t call, and by the time you have realised that 6pm patient has no intention of turning up, it’s now 6:15, and your 6:30 patient has arrived.

Are we overstaffed when we have every appointment full, extras squeezed in between existing slots, people on the phone begging for appointments that we simply don’t have, as well as people walking in and asking to be seen? That might happen on a Tuesday, and then it’s a ghost town on the Wednesday, such is the nature of the service and our service users.

I agree that it should be sanctionable in some way (my NHS physio, for example, would discharge my referral if I missed an appointment or rescheduled more than once!) but that’s a long and slippery slope to privatisation.

Our service isn’t overstaffed (not understaffed either, we are at a safe staffing level!), but our locality has a particularly high DNA rate within the service, and we are currently running a project to highlight the common reasons for non-attendance and how to tackle it. We had eight no-shows on Monday alone, all appointments which had been triaged and booked throughout last week, with no calls to cancel/rebook.

I would imagine (and hope!) that a gynaecologist would be very good at smears seeing as it’s their area of expertise. YMMV with practice nurses as some are better/more experienced with smears than others, I’m lucky that mine is very good. I had my last smear done by a female colleague as I was overdue and struggling to book in with the GP and I daresay she was even better at it than my practice nurse. A lot of women approach us for smears (we’re not strictly commissioned to offer them routinely, but I’d never turn a woman away after she has plucked up the courage to come in and ask!) as sexual health nurses are generally a lot more experienced in performing female intimate examination than the average practice nurse, who might do a smear clinic once or twice a month, whereas we examine women daily.

He can see women and I can see men if they give fully informed consent for it. For example, if I triage a woman and can see that clinic is full apart from a slot with him, I will explain that we can see her on X day but the clinician is male, is that okay or would she prefer to come on Y day when there is a female clinician available? Usually they’ll say they’re happy to see him but occasionally they will decline, in which case I add ‘female only’ to their notes (he definitely wouldn’t go against that, for all his flaws!)

Occasionally there will be a male patient booked in for me and they’ll get there and then ask to see a man (but rarely do they mention a preference on the phone!), if there’s a male staff member available I’ll do some shifting around so they can see a man there and then, or will rebook them. Most men don’t seem to mind one way or another (if anything, more men request to see female staff instead of male staff), but a lot of women do have strong feelings on it. Most of our nurses are female so it’s never usually an issue to do a bit of switching around there and then.

The majority of women booked to see him are happy to see a man, but they have been given the choice in advance! I would also hate to turn up to a sexual health clinic with a problem that meant I would probably need to be examined and it wasn’t mentioned in advance that the clinician would be male. I would most likely ask to be rebooked if I turned up and wasn’t expecting to see a man, but I know a lot of patients would feel awkward having that conversation so might just go along with it, and I don’t think that’s right.

Male nurses can do smears though, yes. Most gynaecologists are male! It’s funny - I don’t think I’d have a problem seeing a male gynae but I don’t think I’d want a man to do my smear. I can’t rationalise it, but that’s how I feel!

It’s tricky as it’s an ‘on demand’ service for the most part, some patients are seen once and then don’t need to return because their treatment is complete in one appointment, some need to return weekly and some need to return every few months.

I absolutely HATE a dripfeed and wasn’t planning to reveal the more specific details, but I can see how being deliberately vague isn’t helping me explain why this is such an issue! As I’ve namechanged and this can’t be linked to previous posts (I hope!), I might as well explain that the service is sexual health and that my colleague is male. I particularly hate when he takes a female patient from my list when I (a female nurse) am available to see her, as invariably women prefer to see women in sexual health, especially if an examination might be involved in the appointment. Even the questions we ask all patients would make a lot of female patients feel uncomfortable coming from a man.

I specifically didn’t explain this in my OP as it is quite outing, especially if colleagues read it, and deliberately didn’t mention that colleague is male and that the majority of patients are female as wanted to gauge whether IABU or not based on the reasons I gave in my OP without going into the rest of it. Colleague is categorically not interested in women, so no nefarious motives on that front, but I can see how this context might explain why it’s much more of an issue than just how it affects my own working day. Hope it clears some of it up for you too @Missingmyusername, I didn’t mean to be snarky with you but didn’t want to go into all of that for my own privacy. It’s not that I don’t care about the patients - far from it - but can see why it might have looked that way.

It is a concern, but I JUST explained why I deliberately didn’t mention how it affects patients. Presumably you read that post, seeing as you replied to it?

Am I not allowed to be pissed off about it for the reasons outlined in my OP alone without divulging the nature of the service I work in and why this impacts on patients as well as me and my student?

I deliberately didn’t address why it would be awkward for the patient in my post because it would be quite outing re the service I work in and why they might prefer to see me instead of colleague.

But don’t be shy, do tell me what you’re so upset about.

Oooh that’s a good idea, thank you! Gets my point across without making it personal. We don’t currently have a huddle but I may suggest that we start doing so at our next team meeting as I think it is a good idea to have one anyway, to address things such as having students in clinic, supporting our newer nurses, etc. We all arrive 30 mins before the first appointment so plenty of time for it in the morning.

We have a huge influx of nursing and medical students in the coming weeks so now is probably a good time to start ‘huddling’ in the mornings to discuss who is best placed that day for teaching.