Clinical Nurse, Are You Doing Right By Your Patients?

You've graduated from a nursing or medical assistant program and have landed a job in a clinic in the position of a clinical nurse or clinical medical assistant. Perhaps you've been working in this position for quite some time. Working in a clinic as the clinical nurse or medical assistant can be rewarding or frustrating. Often times your behavior can make all the difference.
You may be doing things that have a negative impact on the patient without your realizing it. Medical Assistants working in the back-office are often referred to as the clinic or clinical nurse, when there are no LPNs or RNs on staff. This article addresses everyone who may be working in the back-office position at a healthcare clinic or physician's office.
Did you ever learn in nursing school or medical assisting school, "The Patients are the Bread and Butter of Our Practice. Without them we would be nothing and not have jobs." I didn't learn it in school either. It was given to me by a rural physician that I was fortunate enough to work for. Every patient was treated with courtesy and respect regardless of their financial status, community status, or ability to pay. They were our patient and a member of the Human Race.
This physician, a gentle soul, who just wanted to be a gentleman farmer, taught his staff more than one ever learns in school. His code and our main focus was doing right by our patients.
The Code, Do Right By Your Patients
Taking a patient back to an exam room

• Read the patient's history notes or current medical problems prior to taking the patient back.
• Ask the patient if they need assistance or would like to hold on to your arm.
• When you take a patient back to an exam room, match your gait to their gait.
• Don't walk in front of them and not look back. It's not only rude but dangerous.

Example: the clinical nurse was in a hurry; she grabbed the chart and called the patient's name. She waited for him to stand up and advance to her; she introduced herself, and told him to follow her. She then went walking off at a fast gait, not bothering to see if her patient was keeping up with her. She got to the exam room and no patient, she went back to look for him and found him on the floor having a seizure. This could have been avoided by reading the chart, asking the patient if he needed assistance, and walking next to him at his gait.
Taking the patient's Blood Pressure (BP)

• Taking the patient's blood pressure as soon as they are in the exam room.
• Pumping up the BP cuff over 220 without checking to see if they are hypertensive.
• Releasing the pressure part way and re-inflating the cuff.
• Using the wrong cuff.
• Not listening to the patient when they tell you what their normal BP range is.

Example: You have the patient in the room and immediately take their BP without giving them time to sit. You're not sure if you heard anything so you re-inflate the cuff half way through taking their BP. Any BP reading you get is going to be a false reading. Most patients are nervous when they come to the clinic. This can raise their BP; just the walk back to an exam room can raise their BP. Let the patient rest for at least 10 minutes prior to taking their BP so you get a true reading. Look at their chart to see what it normally is, if a new patient - ask them. Use a large or extra large cuff on a large patient. Using a regular cuff will give a false reading on a large patient. If the patient says their BP is normally 90 over 60 and that is their normal range, don't try to tell the patient they have low BP. You are not the physician and only the physician can make that call. Do not re-inflate the cuff, use the other arm if possible,
Taking a patient back who has severe body odor
It could happen to any of us. They may perspire heavy when nervous. Do not let your facial expressions convey and negativity towards the patient. As the clinical nurse, you are representing the clinic. Treat this patient as you would every other patient, with courtesy and respect.
Taking a patient back that is on Welfare, Public Assistance, Disability or L&I
Treat them with respect and courtesy. You don't know why they may be on one of the programs and it isn't your place to ask. Remember you may be injured or need help one day and the clinical nurse may treat you with disgust.
Look at your patient, make eye contact, and listen to them, Yes LISTEN TO YOUR PATIENT
Sometimes a patient who is nervous, afraid, or embarrassed may tell the clinical nurse things that they don't think are important and will forget to tell the doctor. Make a note of these items in your nursing assessment and relay them to the physician before he enters the room.
Never leave a patient in an exam room for more than 10 minutes
When you put a patient in an exam room, give them an idea of how long the wait may be before the physician can see them. Do not close the door and forget them. Anything could happen to the patient, check on them, and let them know that you are still running behind but that he will be with them ASAP. Ask if the patient would prefer to have the door left open especially if you know it could be over 30 minutes before they are seen. If the exam calls for the patient getting undressed and you know their wait could be 30 minutes or longer, wait to have the patient undress.
Clinical Nurses doing right by your patients also means going above and beyond at times
If you patient is alone and extremely nervous, ask them if they would like you to stay with them during the exam and take notes for them. After the exam, ask your patient if they understood what the physician said and do they have any questions. Many times a patient has questions but won't ask the physician. Take time to answer their questions and go over directions of any medications or supplements that have been prescribed. Walk the patient back to the checkout desk. Tell them to call with any questions.
As the physician, a gentle soul, would say, "These are simply acts of kindness, and are the way we would want to be treated when we go to a physician's office." Basically this is the golden rule we learned as children, Treat others the way you want to be treated!

Jaylyn Huson has over 30 years experience as a healthcare professional working in all areas of healthcare from managing clinics, clinical nursing, assisting in surgery, developing healthcare software, to HIPAA Advisor. She has been fortunate and blessed to experience taking care of patients in rural settings and bartering with patients for payment along with doing house calls on patients that couldn't make it into the clinic; to working in metropolitan clinics with insurance, and clinics where only cash was accepted.