Would this get on your nerves?!

[grinchlet]

Namechanged in case colleagues are lurking

I’m a nurse in a clinic, we all have our own slots on the list so we know who is responsible for seeing each patient, but we all help each other out if we’re running behind, offer to take each other’s patients if we already know the patient from previous visits, etc. The nature of our clinic has a high non-attendance rate, so sometimes there are lulls in the day but there is always something else to do!

One of my colleagues has a habit of ambushing my patients at the door and calling them in before they have checked in via reception and been flagged as arrived, and the first I see that my patient is in the building is either them walking into my colleague’s room, or seeing my colleague’s name flag up next to the patient’s name on the list. If they haven’t got them at the door, sometimes they will take them from the waiting room after they’ve checked in, but not flag that they’ve ‘started’ them, so I’ll go into the waiting room and call the patient’s name several times, and another patient will tell me that they’ve already been called in, making me look a bit daft. This is all usually several minutes before the patient’s actual appointment time, so it’s not as if I’m running late and my colleague is trying to help me catch up.

Today, I had a student nurse with me and my colleague took FOUR of our patients, so four potential learning opportunities were missed and it must have been quite frustrating for my poor student, not to mention embarrassing for me as a mentor!

The most annoying part is that after the patient has left, my colleague will come and say “saw your 4pm for you” and look at me expectantly, waiting for me to thank them. It drives me absolutely bananas, nobody likes being bored when their own patients don’t turn up, but there are other things to do instead of poaching a colleague’s patients, surely! I’ve no idea if they do it to other staff members as I’ve not spoken to anyone else about it as don’t want to seem ungrateful or petty. No doubt my colleague would say that they are just trying to help, and they probably genuinely think they are being helpful but I can’t bear it!

AIBU or would this drive anyone else up the wall?!

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.

Similar work history to you OP although different branch as it were!!
could your colleague be an ‘over achiever’ in that he wants to prove he’s just as good as everyone else?
how long have they worked in your clinic? Is he an overeager newbie keen to show how efficient he is Or has he recently had supervision or a performance review that may have suggested he’s not pulling is weight or could gain brownie points toward climbing the ladder if he ups his numbers?
it’s difficult & I suspect he’ll get defensive if you just try a quiet word.
Introducing a huddle sounds like a good plan going forward (even though I was never a fan, one benefit of lone working!!lol) possibly identifying empty clinic spaces & flagging jobs that need to be done before stealing patients.
One other thought if patients not getting to book in/not being updated on computer would your admin or management have a word as it will make clinic auditing a nightmare?
good luck it’s a pain when something rocks the ship.

If you are sitting there twiddling your fingers due to high numbers of DNAs, you are overstaffed.

Perhaps some of those DNAs should be charged a deposit to attend next time. This is the problem with a service that's free at the point of delivery.

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.

You said earlier on the thread that your colleague nicks your patients and the student nurse has no tuition and wastes their time. If you were fully booked your colleague wouldn't be able to muscle in on your patients/service users.

Someone needs to look carefully at the attendance data.

My dentist takes a deposit for him and the hygienist. I think it's £20 for the hygienist, £30 for the dentist. If I FAIL to give 48 hours notice of a cancellation, I quite rightly lose the deposit. And the problem is?

Why should public money subsidise those who don't even have the basic courtesy to cancel their appointment? It wouldn't be so irksome if there were appointments and treatments available for the reliable majority but there aren't.

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.

This does put a different spin on it. I would maybe get a line manager to explain this to him or he has to check with every patient he ‘poaches’ that they can see him now or wait for a female clinician.

I went for a private early pregnancy scan that needed to be transvaginal. I found out when I got there that it would be a man carrying out the scan and I felt blindsided and uncomfortable. He was good at his job and a professional but I still didn’t like it. Him not being interested in women wouldn’t have changed that feeling for me. Whenever I book in for a smear, I ask for a female nurse even though I know there are no male nurses at my GP. Don’t want to risk a male student being allowed to do it instead because I didn’t specify.

I didn't think your post made it look like you didn't care about the patients....quite the opposite as you were clearly pissed off on their behalf! And you sound like a great mentor too!

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

@grinchlet Same! And I said the same as you, I'll never make a student feel the way I did. Well I think you'll be a great role model for your student and the quiz sounds brilliant!