Gaps in the clinical setting from a DNP student.

Posted on: December 5th, 2020 by Ashley Barr

Mentoring for employees in this specific clinical setting is minimal. Only having experienced one department in the organization, I am hopeful not all areas are the same. New hired APRNs and other medication services staff are not continually mentored from initiation of employment but instead they are provided minimal on-the-job training and then left to devise their own routine for clinical practice. The on-the-job training is more focused on learning the EMR, policies and procedures, patient flow, and roles of other positions within the team. This being an outpatient mental health clinic, available time for mentorship is basically nonexistent. Providers are only afforded 60 minutes for new evaluations and 15-minute medication follow-up appointments, with 20-25 patients scheduled per day. Providers do not receive any administrative time, and all worked hours are scheduled for clinical time. Unfortunately, this leaves no time between clients for on-the-go mentorship either, the providers only see each other in the hallway while passing between their offices and the waiting room. With the current pandemic, providers are working remotely which isolates them even more.

In the state of Missouri, collaborating physicians are required for APRN practice. At this clinical setting, each APRN has a one hour per week meeting with their collaborating physician that is used for a review of charting and identification of missing information. It is presented that the physician is more of a supervisor than a collaborator in these meetings, even though the collaborating physician is not the APRNs direct supervisor. In this clinical setting, there are multiple physicians. Instead of each physician each having a collaboration with an APRN, the medical director is given all collaborative APRNs until the maximum amount is reached (six) before any other physician is then designated as a primary collaborator.

Interprofessional collaboration is dependent on the individual provider. There are no interprofessional team meetings and the provider manages their own caseload. Collaboration between different treatment providers for each client depends on that identified group. This can include an individual therapy provider, group therapy provider, substance use treatment provider, case manager, health care home nurse and treatment providers, and primary care provider or other medical providers. From the interactions I experienced within the disciplines, the collaborative element is fairly solid. It varies on the level of engagement of the individual providers but does not seem to be a significant gap in the organization.

In this setting, there are identified gaps in the collaboration between APRN and physician. The weekly scheduled time with the APRN and physician would be an ideal time to provide mentorship in the clinical setting while simultaneously reviewing the necessary charting. How do you think mentorship could be improved in the organization? How can the relationship between the collaborating physician be improved from the current state as an interpreted supervisory role to the collaborative, mentorship role? Especially since the collaborating physician is indeed not the direct supervisor of the APRN?

Is this common practice for the medical director to be assigned a maximum number of collaborative APRNs allowed (6) before other physicians are designated as primary collaborator? There could be more availability for collaboration if the APRNs are assigned evenly across the physician staff instead of overwhelming one physician. Or do you think it is better to minimize one physician’s clinical time to provide collaboration to multiple APRNs?

Feedback is welcomed and appreciated. Thank you.

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