Question
Can you describe what an average caseload is for an NP in the long-term care setting? I work at one practice with 10 different facilities. I also work 2-1/2 days per week in the office, managing > 400 patients. Other NPs report seeing 10 to 16 patients per day, while I see 20 to 25 patients per 10- to 12-hour day. What variables should I consider when determining whether this is an appropriate caseload?
Response from Carolyn Buppert, NP, JD
There are no generally accepted guidelines on NP productivity in long-term care, nor are there any helpful survey data available. Among the variables that affect how many patients a clinician can see in a day are:
Driving time between facilities;
Amount of time spent on indirect care activities;
The efficiency of the clinician;
The efficiency of the facility at carrying out orders; and
The clinician's need for second opinions or consultations.
Some factors that affect how many patients an NP sees in a day are within the NP's control and some are not. For example, the NP has little control over the efficiency of the nursing facility. In some facilities, NPs will find that lab work they have ordered has not been done, or results are not in the chart. In that case, the NP will need to spend time tracking down the lab results.
On the other hand, NPs can control their own practice style. Some NPs are, by nature, talkative and/or invested in establishing and maintaining relationships. For example, some NPs spend significant time exchanging stories with staff, giving detailed status reports to families, talking with patients and families about their feelings, and so on. Some NPs are less talkative. Some NPs make quick decisions on their own. Other NPs spend considerable time asking colleagues for their opinions and looking things up. None of these practice styles are wrong, but some are more time-consuming than others.
In 2001, researchers found that NPs working for EverCare, a managed care company that specializes in patients in nursing facilities, spent 35% of their working day providing direct patient care and 26% in indirect care activities, which included time interacting with nursing home staff, interacting with patients families, and speaking with physicians. That study found that NPs spent about 42 minutes on each patient each day.[1]
If an NP is working a 10-hour day and spends 42 minutes per patient, the NP can see 13 patients a day. If working a 12-hour day, the NP can see 15. Those numbers fit with what you say other NPs are doing. However, when I advise NP clients who work in nursing facilities, I sometimes hear, directly from the NPs, that they are seeing 30-40 patients a day in nursing facilities. Those NPs cannot possibly be spending as much as 42 minutes on each patient.
An employer who is billing for each NP visit is going to want the NP to conduct many visits per day. The difference between an NP who bills 16 visits per day vs 25 visits per day can mean over $100,000 a year to the employer.
Finding the right mix between attending to detail, being thorough, building relationships, and completing large number of patient encounters can be tricky. The bottom line involves 3 things:
Can you safely see the number of patients you are seeing (without missing a change in status and/or diagnosis)?
Can you physically and emotionally sustain the pace you are keeping?
Is your employer satisfied with how fast you are going and with the quality of your work?
Medscape Nurses. 2005;7(2) © 2005 Medscape
Cite this: Carolyn Buppert. What Is an Average Caseload for an NP in a Long-term Care Setting? - Medscape - Dec 09, 2005.
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