Working at a community clinic

Let’s start with saying I never imagined working at a community health center and after my first job at one, vowed to never do it again. Fate had something else in mind. I love my current job working with kids, speaking in Spanish all day, and really feeling like I make a difference. Before considering a nursing job at a community health center, find out more about your role there.

My first nursing job was at a community health center constantly on the verge of bankruptcy. They are still standing today, which makes me wish they had given me that darn raise! Anyway, for some reason, they give all new nurses one of the hardest jobs at the clinic: Triage. I started out doing mostly phone triage. For my one day of training I learned how to answer and transfer calls and how to schedule appointments. Of course, there were very few appointments available, so I was expected to give phone advice. Being a new nurse, I wasn’t confident giving advice without ever seeing the patient. Those first few months were BRUTAL. I had to learn through trial and error since no one had the time to help. No one even told me there was a phone triage book that I could reference. What a mess. 8hrs a day answering back to back phone calls was tiring. I was always happy when I got the chance to do in-person triage at the front of the clinic. Those were in the days of paper charts, so I would often be seeing a patient before their chart would be delivered to me. I spent a lot of time negotiating with irate patients about their narcotic prescriptions and being frustrated not having any equipment (like O2 sat machine) for proper assessment.

Even after being promoted to work in the Adult care department, things did not improve. I did not have a lot of patient time and I spent a lot of time doing prescription refills and return calls. I was in charge of managing 3 medical assistants and had to be signing time cards and serving as liaison between the providers and staff.

Now compare that experience with my current position. I believe the key difference is time with patients. Depending where you work, a RN may be only in charge of doing immunizations, paper work, and case management. I’m lucky to have had these two experiences and know the potential RNs have in outpatient settings. I work very closely with all the providers, getting amazing feedback. I’ve learned a ridiculous amount about common illness, vaccine schedules, asthma management, lactation consulting, outpatient procedures (like urine catheters and blood draw) and the limitations of primary care. It has given me an incredible edge in my masters program- much more than those with inpatient experience.

Although I wish I had gotten more acute care experience as an RN, I am very happy with my job. Because we have limited resources, the scope of my position is stretched to its limits. I get to be intimately involved in the care of most of the patients. I love getting to know the families and watching the kiddos grow up. Triage is definitely my favorite part. I would recommend any RN interested in becoming a Pediatric Nurse Practitioner to get a job in triage. I do focused assessments, present to the providers, get feedback and discuss assessment and plan. RNs can do a lot in primary care. With standing orders and protocols, I can administer vaccines without ever speaking to a doctor, can do family planning visits, can follow up with patients for medication reconciliation, and give home care advice for common illnesses.

I know some practices that only use their RNs for vaccine administration. What a waste! I hope that with the ObamaCare and an increased need for medical homes and primary care providers, RN jobs will really expand, using more of that great education and experience we have!


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