It is not a coincidence that NPs who are showing interest in non-clinical positions are increasing. There isn’t a week that goes by when I don’t hear from one or more nurse practitioners looking to leave direct care. Burnout is not a new phenomenon, especially for nurses. It’s long been recognized that the strain of continually caring for others can take a toll on the caregiver. “Compassion fatigue” is the term used, but I am not so sure that is what is going on here. NPs are telling me that it’s not caring for patients that has worn them down; in fact it’s quite the contrary.
Nurse practitioners WANT to care. It’s what keeps us going. We went into this business to form relationships and make a difference. We were drawn to this role, because we believed we would have more time with patients, and we would use this time to educate, inspire and empathize. Instead, what we are encountering in practice now is what I call “compassion frustration.” Despite the focus on patient satisfaction, it seems too many current practice models are doing everything possible to create barriers that result in encounters that are unsatisfying to everyone involved.
Shorter visits, increasing documentation and payer requirements are getting in the way of therapeutic relationships. One of the most frequent reasons I hear NPs want to leave patient care is that the clinic has become like a treadmill, and the clinician is feeling the pressure to keep up or fall off. Fifteen minute visits, of which 5 to 7 minutes are taken up by rooming, leaving less than 10 to see the patient and document. Then on to the next, and the next, and the next. Wash, rinse and repeat. Oh! and answer calls and emails, do prior authorization and, of course, don’t forget the billing. And because NPs love their patients, they maximize their time with the patient, and the end result is the NP staying long past clinic hours to finish documenting and completing these other tasks.
And don’t forget outcomes. Using only the wisdom that administrators and analysts possess, instead of giving the clinician an additional 10 minutes with a patient, more extraneous persons are added to the patient experience. Documentation’s a problem—get a scribe! Non-adherence to a treatment plan—hire another body to ask why! Endless mailings touting a staff of coordinators, educators and of course the website. We now have a host of different people employed to do different aspects of what used to be done by the one person who knew the patient best. How does that save time? Or money? It doesn’t. And it certainly doesn’t increase provider or patient satisfaction. Quite the opposite. Adding more water to the soup doesn’t make it more filling.
I’m waiting for the study that shows fancy programs and initiatives are not a substitute for the good old fashioned relationship between caregiver and patient.