One of the most frustrating parts of my work as a nurse practitioner is administrative duties. Diagnosing a case of otitis media takes a grand total of five minutes, but completing the chart for that patient may take longer than the visit itself. Not to mention, there’s always concern for thorough documentation looming overhead should a patient’s chart be audited or the circumstances of the visit called into question. The time and stress associated with charting frequently creates tension in the nurse practitioner-employer relationship.
Many nurse practitioners find they simply cannot complete the amount of documentation required of them during normal business hours. Patient visits, phone calls, and trying to find a precious 5 minutes of downtime to each lunch take up most of the day. So, NPs are left at their desks long after clinic doors close. However, many employers feel that patient charts should be completed at the time of the visit and drag their feet when nurse practitioners stay on the clock completing administrative tasks after hours. NPs who are salaried may feel they have been duped as additional admin time essentially goes uncompensated. How should nurse practitioners deal with the age-old problem of completing documentation after hours?
First, anticipate the problem. Whether you work in the clinic or hospital setting, you will be required to document a history, physical exam, treatment, a plan and more on each and every patient you treat. No exceptions. If you are applying for a position in a high-volume or high-acuity setting, anticipate that you may not have time to complete your administrative responsibilities and patient charts during the work day. Ask current nurse practitioners how long they spend on these tasks after hours to get an idea of what to expect in your new position.
Second, ask to be compensated for administrative time. There’s nothing worse than being a salaried employee sitting at your computer after hours typing away with the realization you aren’t earning any extra cash for staying late. To avoid this frustration, ask to have administrative time built into your schedule when you accept a position. This gives you time during or at the end of the workday to play catch-up. If you are an hourly employee, your employer should compensate you for time spent charting. Make sure the expectation as to when you complete documentation is clear on the front-end. If you accept a job in urgent care and are expected to treat six patients per hour, realize you will likely be staying late on occasion. Plan accordingly.
If you have already accepted a position and find yourself working extra hours you didn’t anticipate, it’s worth bringing up the problem to your boss. If you are a productive employee and keeping up with other demands of your position, your employer may be amenable to building admin time into your workday. Some employers allow nurse practitioners to stop seeing patients 30 minutes to one hour before the clinic closes, or will compensate for an early arrival to catch up on the dreaded lingering charts.
Finally, manage your expectations. If you are a new nurse practitioner, transitioning to a new specialty or position, or are simply one who tends to work slowly, keeping up with the demands of your position may be difficult. You will likely end up with a stack of charts and sticky notes on your desk at the end of the day. Don’t act prematurely. Give yourself some time to adjust. As you become more accustomed to your work setting and treating the kind of patients in your specialty, your day will begin to flow more smoothly. Don’t approach an employer asking for a raise or extra time to chart month number one. These frustrations may sort themselves out. You must prove yourself as an organized and efficient individual before accommodations will be made on your behalf.
Be it on paper or EMR, the patient chart is here to stay as is the hassle of documentation. Learn to be as efficient (but thorough!) as possible with the systems your employer has in place. Once you have mastered these systems, consider how you are being compensated for this time. If you feel your arrangement isn’t fair, it’s possible you and your employer can come to a mutually agreeable solution.