EP 4: Making It Count—Your First 90 Days on the Job

How can I make a good impression during my first 90 days as an NP? In this episode, our hosts give tips and tricks for pivoting to a new specialty or position, and fostering positive relationships with clinic leadership. By taking it day by day, you can build confidence, distinguish yourself amongst clinic staff, and make a positive impact on patients.   

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Have questions, an inspiring story, or clinical pearls that you’d like to be heard on air? Email nplaunchpad@fhea.com. 

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Transcript

Voiceover 0:01

Welcome to NP Launchpad, presented by Fitzgerald Health Education Associates, the podcast created for newly graduated nurse practitioners navigating the transition from school to clinical practice. Hosts Jason Gleason, Christopher Gleason, and Vanessa Pomarico-Denino deliver real talk, real experiences, and practical guidance to help you succeed from day one. So if you're ready, let's jump right in.

Jason Gleason 0:28

Welcome back, everyone, to the NP Launchpad Podcast. Vanessa, Christopher, and I are so honored to be with you again today as we celebrate our fourth podcast with you. This is episode number four for you. And we have such a treat planned for this podcast. We're just delighted about this topic. Vanessa, I have to say though, you did such a great job with our last episode because talk about dry as a desert as far as the topic goes, right? Yeah, it was so entertaining. You did such a great job moderating that.

Vanessa Pomarico 0:55

So thank you.

Jason Gleason 0:56

Lively discussion. And you survived it, right? You survived it.

Vanessa Pomarico 1:01

It really helps to have two people that were as engaged in the in the topic. So thank you.

Jason Gleason 1:06

Well, thank you. And I and I truly learned a lot from that podcast episode as well. So thank you. Thank you so much.

Vanessa Pomarico 1:12

You're welcome.

Jason Gleason 1:13

So welcome back, everybody. Dr. J here coming to you from Big Sky Country, where I'm at in Montana with Christopher here, Vanessa. How are you doing today? How was your week?

Vanessa Pomarico 1:21

Week was great, thanks. Coming to you from Connecticut.

Jason Gleason 1:24

So excellent, excellent. Now, what's the population of Connecticut?

Vanessa Pomarico 1:30

Uh we have a very mixed bag. So uh we very mixed because don't forget, you know, back in the day that there was a lot of immigrants that came over to um um Ellis Island and then ended up in Connecticut because we're so close to New York.

Jason Gleason 1:48

Excellent. Wow. Yeah. Montana's pretty interesting too. We've had a lot of immigrants over the the uh the century, and and it's so interesting in Montana. Just recently in the last few years, we exceeded one million for our population. That was a huge milestone for us because before that it was under a million people. But again, as I mentioned in our previous podcast, we're the fourth largest state geographically, so we're spread out everywhere. But our population is growing uh thanks to the show Yellowstone out there. Yes, thank you so much for the show Yellowstone. Wonderful show. But now everybody in the country wants to come to Montana and own a ranch with horses. But what they do not know is that our uh our winters, we usually go about 40 below zero. So they get here in the summertime, it's wonderful, nice. They're gonna buy a ranch and ride horses, and it's all romantic and amazing. And then the freezing weather comes and they're out of here. So please, uh please recognize that. But Montana's a great state. We're so delighted to be here, and and we cannot wait to come out and visit you in Connecticut sometimes.

Vanessa Pomarico 2:46

I'd love that.

Jason Gleason 2:47

So our topic for today is your first 90 days of NP practice. And I'll tell you what, talk about overwhelming. I was so overwhelmed during those first 90 days, and you kind of get lost in the mix. But we want to move you. We want to move you from saying, What the heck am I even doing here? Why did I even go into this profession? This is not meant for me, to I've got this. I've got this. That's our goal. So throughout this podcast, we specifically are gonna dive into your first 90 days of practice and what that should look like. So, as with our other podcast episodes, let's dive right in and talk about our hot topic discussion issues that we're gonna bring up. And here's our first question: What would you suggest are the priorities, a new NP or an NP changing specialties or practice for those for those seasoned NPs out there, if you're changing your specialty or practice? What again, what would you suggest are the priorities for them that they tackle in their first 90 days? Christopher, what do you think?

Christopher Gleason 3:41

I think in the first 90 days, especially as you're if you're transitioning to a new practice, one of the key things is to find a mentor in that in that new practice. Like we we touched on it in our previous episodes, having a mentor um just can be key and it can really kind of help you sink or swim in in those cases. Um Vanessa, what are your thoughts?

Vanessa Pomarico 4:00

I completely agree. The mentor is the top of my list. And if if they don't if they don't offer one, ask for one. Everybody needs a mentor. Nobody was born knowing. And it's so important to have somebody that you can go to when you get overwhelmed or if you have a question. And I find that the majority of nurse practitioners who are disillusioned with the role as a nurse practitioner, their first year out, and they leave the profession is because they didn't have that support, especially in those first 90 days.

Jason Gleason 4:33

Excellent. Yeah. And what comes to mind with mentoring again, that that triangle of mentoring, right? Somebody to be your clinical mentor that you're asking day-to-day clinical stuff about, but even within that, set boundaries. Like, boy, can I spend 10 minutes with you on these days out of the week? Can we schedule this and carve that out in our schedule? Can you please spend that time with me to go over clinical cases? Then obviously, if you have a patient in the office, it's a big challenge for you. You're not going to say, well, I got to wait till Tuesday to ask them about this question or her about this question I have. Obviously, you're not going to do that, but carve out that time, be respectful, but have a clinical mentor, an administrative mentor. Gosh, what do I do with all this stuff that we learned about in our last podcast? DEI and licensure and renewal, clinical privileges, all of those kind of things. And then have that career mentor, you know, that person that really inspires you, that you really admire, and you want to uh go after the similar things that they're they're doing in their professional walk as well. So mentoring is so important. Here's some additional tips for our friends out there listening or watching us today. A disc a 30, 60, 90 day plan. What does this do? It keeps things organized for you in your brain. So not only do you need a 90-day plan, but you should really think in the terms of what am I going to do during the first 30 days? What are my priorities? The next six, the full 60 days and then the 90. What I find is really helpful, and I think you guys would agree that um if you if you take big challenges like the first 90 days, my gosh, how do I tackle that and make it smaller? When you take big challenges and make them small, you're able to plow right through it, right? And just build upon it, build that momentum. So break it down. If 90 days seems overwhelming to you, look at it in the in the sequence of 30 days, 60 days, and 90 days and prioritize things during that timeline. Um, learning goals, quick wins, those kind of things that will motivate you to get through it. So during the first 30 days, what we recommend is that you learn the clinic flow, right? Learn the clinic flow. I've seen NPs go into a practice thinking they're hot stuff, right? And you've earned that degree. You are hot stuff and you're brilliant. But this is not the time to show that. This is the time to be humble, go into a practice and learn. And who do we learn best from? The nurses that we work with, the med techs that we work with, those people that work on the front lines. So put the ego to the side. Yes, you're an NP, but you're still a nurse out there. We all are, and respect the roles and the differences between them, but ask them. I'll tell you what, when I worked in the ED, I was so overwhelmed initially. And I worked in like the uh the lower triaged area where it was more walk-in patients. But I have to say, I learned so much. The person I learned the most from was not a physician, not an NP colleague, but the LPN that I worked with. They they taught me everything about the nuts and bolts of flow and how to handle certain things in the department. And it was wonderful. So, so 30 days, your priority is to learn the clinic flow, learn that electronic health record. That's obvious. And hopefully you have a lot of time spent with the I um the IT department to get a good orientation on EHR and ask the questions because this is your time to ask those questions. This is your time to play dumb and be like, I don't know this really well. Can you help me out? Because a year from this time, or even after that 90 days, they're gonna expect you to know this. So make sure you ask all those questions. And EHRs out there are very complex, very complex. So ask those questions. And then your top 10 visit types, look at what type, what are the top 10 visits that you're gonna encounter in your practice? If it's primary care, look at the list of the most common diagnoses that are out there. Be very comfortable with those. This is a great opportunity, that 10-minute time with your clinical mentor to go over cases with them and ask them what are the top 10 most common things you see patients coming in with, and then be very comfortable with that during your first 30 days. And then escalation pathways, who do you call for what? I use that example in our last podcast about the um paritonsular abscess and me being fearful that I would puncture the carotid artery, right? And thankfully I chose not to do that, even though I was advised to try it. But escalation pathways, what are you going to do in those situations where you're faced with emergencies or things that are unexpected? Know that ahead of time. So when you're faced with those, you make the appropriate choices. You make the appropriate choices, and it's a big safety issue. What would you suggest during the first 30 days are a priority, Vanessa? In addition to these, anything else that stands out to you?

Vanessa Pomarico 8:50

You know, just getting comfortable with one thing, you know, every week, because if you look at that whole laundry list of things that you need to master, it becomes too overwhelming. And you've mentioned this in our previous podcast is to give yourself some grace. So maybe the first week you really learn the clinic flow, like who does what? Who what role does each person in your office play? Who can help you get to where you need to be at the end of your day? And then maybe the next week, learn more of the nuances of the electronic health records. And every week set a little bit of a goal for yourself so that you're not trying to do too much at one time.

Jason Gleason 9:30

Love that. Love that. Christopher, do you have any priorities for those first 30?

Christopher Gleason 9:34

I think in that for the first 30 days, and it kind of goes with what you were saying earlier about clinic workflow and things of that nature, I think it's important to get to know your teammates. Because that they can be, you know, they can really help you sink or swim in in in practice or in general. Um the other aspect is in those first 30 days and in your practice in general, remember you don't know what you don't know. In th in those first 30 days, do not try and take on monstrous tasks or or things that you may have done once or things that you may not have done at all. You know, rem remember your scope of practice, remember that you are a new NP and you know, remember your own boundaries.

Jason Gleason 10:10

I love that. Uh and I love the fact that what you brought about getting to know your teammates. This is your time to shine, but it be human. They want you to be you. So go into a practice being you, authentic human being, right? Because they're there to support you. They get it, they get it that the things are overwhelming. So just be you. But be appreciative and really get to know your team. You know, it's funny, my the the not my, because that implies ownership, the wonderful registered nurse, I get the honor of working with, honestly, because that's how I feel genuinely about her. She's amazing, one of the best nurses on the planet. I cannot speak more highly of anybody else. But um, but for a while there, she would kind of have be a little honri in the morning, like until about 10 a.m. It'd be like, boy, I know not to approach her in this time. You know, what's going on? Did I make her mad? Is something going on? And she told me, do not bring anything challenging to me, please, until after 10 a.m. after I've had my coffee, because I'm gonna give you the mama bear eyes and I'm gonna growl. And she's the most kind, wonderful. And I tease the heck out of her about it. Oh, yeah, it's not 10 a.m. yet, right? Yeah, but uh tease each other, make it light, but get to know your team and let them get to know you and your family and make it real. You're a human being, right? So take down the guard. Don't worry about the shine and polishing up every day. Be real, be you during those first 30 days. And like Vanessa, I love that you said tackle one thing at a time. Don't be overwhelmed. Because if you tackle everything at once, you're not gonna learn anything about anything. And then this time, this wonderful time zone that you're in right now of those first 30, 60, 90 days, that's gonna bypass very quickly. And then you're gonna be expected to know all this stuff, and you're not gonna know a whole lot. So take your time, but be real, be you and and look out for those mama bear uh nurses and uh med techs that you work with. But they are amazing, amazing. So during your next is during the 60 days, excuse me, during the 60 days, you want to build on the 30-day momentum, build a repeatable workflow. This is where you're looking at your templates now, your order sets, dive into your EHR, create those templates for specific conditions. Like on my EHR, I have a template specifically for patients with diabetes, hypertension. That'll save you time with your documentation. One thing that I notice about myself and then my NP colleagues, whenever I see a new NP come into our practice, I always see this during that first year where they're really getting to know their patients and connect with them. During that first year, they're usually there until after hours, right? Documenting and stuff. The templates, the order sets, those things are gonna help you get home quicker in the evening hours or whatever time your shift ends. So use those tools, but spend the time and resources building those up initially because it's gonna pay off later. You know, I worked with one colleague that was there until like 6:30 at night every evening that they were there for that first year. It was so frustrating for them. But that second year, they reached, they reached their plateau and they reached altitude and they did great. And they were out of there on time. They had the templates going, the order sets, but it does take a while. So be easy on yourself, but work on these things during that 60 days. And then start owning follow-ups and review one to two cases weekly with your clinical mentor. Again, carve out that 10-minute chunk of time with your clinical mentor and more administrative stuff with your administrative mentor. And then again, hold that career mentor on tight because they're the one that really inspires you and check in with them. And here's the deal with the career mentor, they get it too. They've been where you're at. So if you have a crappy day, call them up and say, what do you do on these days that just turned to shit? Right? What am I going to do on these days that are just total garbage for me? How do you stay with it? How do you stay in the game? They'll give you great advice. They'll give you great advice. Any uh anything to build upon that discussion in the 60 days, Christopher?

Christopher Gleason 13:47

I'd have to say one of the things, kind of touching on the templates idea, is most EHRs have what they call dot phrases, and they are a lifesaver. Basically, it's for anything that you see on a on a regular basis. Uh like if you're if you have a similar plan for your for hypertension and things of that nature, you can use these dot phrases and it just, you know, dot uh, let's say for hypertension, dot HTN, and it it just um implements this uh template for you, which is just a huge time saver. I use it for um when I'm doing education on on tobacco or I'm doing education on alcohol, doing education on pre-diabetes, I have all of these dot phrases and it saves a huge amount of time. The other thing I would say is too, if you have the availability, uh using dragon uh dictation, it can be very, very helpful. But also um be very cautious when you use dictation because the a lot of the times it'll pick up words that you never meant to say, and you'll go back through and read it and you just question everything. One time I was using it and it came up with a pizza order, so don't ask me how that happened, but it did.

Jason Gleason 14:43

So pizza order, and one funny element with that, I'm so glad you brought that up. We have a physician called Dr. Guter in our practice in our area and a wonderful oncologist, brilliant, brilliant specialist, and wonderful provider. But in Dragon Speak, which is our dictation software, every time I say Dr. Guter, it comes up as Dr. Cooter. And I'm just thankful that he's not a gynecologist, right? Yeah, imagine that, right? Yeah. So double check your dictation. You never know what's going to show up in there. Yeah. Vanessa, how about you? First 60 days.

Vanessa Pomarico 15:17

Uh I I would say exactly what Christopher said. You know, when I first joined the position that I'm at now, and we're part of a large health system. Um, I spent the first weekend on my computer developing my dot phrases and my templates. And, you know, it just is a ton of time saver. Um, I don't do well with dictation. I don't know if it's how I speak or I'm not sure, but it doesn't pick up good words. I probably would end up with pizza orders and a lot of other things in my notes. But it's more, it's an investment in your time to develop those dot phrases and those templates. And I'll just give you an example. We had our regional medical director come in and do their regular, you know, every few months they come in and kind of hang out in the office. And she said, you know, let's open up. We were, people were complaining about the inbox. And so she opened up and she looked at my, she says, let me, she was sitting at my computer. So she opened it up and she said, Every one of your notes is closed from yesterday. And I said, Every one of my notes is closed when I leave at the end of the day. And she was shocked. And I said, I utilize templates and dot phrases because I don't want to have to do this when I go home. When I go home, I'm with my my house and my husband. Um, I don't want to have to spend two and three hours writing something that I can't read. I'm gonna lose the details. So it's so important to have invest in that time. You can use templates from other people, but customize it so it's something that you're comfortable with. And those dot phrases, you I can't say enough good things about the dot phrases.

Jason Gleason 16:53

Excellent. And isn't it exciting where we're at now with technology? Because I know there's all this talk of AI and there's great dictation uh services through AI devices now. Like at the VA, they're just rolling this out where in the room with the patient, AI will listen to the conversation that you're having with the patient and then start dictating your note for you. But even then, we're in the early stages of this, so it's so important you double check everything. And some patients aren't comfortable with that. Plus, I think it's a little weird to be, you know, talking out loud to the air, you know, and realizing something's dictating. My son went to a cardiologist uh once, and the the cardiologist acted kind of funny throughout the whole visit, like he was like talking to the air. And then at the end of the visit, he said, and that's a wrap. And it's like, what does that mean? Oh, I just dictated the whole visit, you know, and he didn't have to type anything or anything. So that's where we're headed. It's pretty cool stuff, but again, it's in the early stages, but great tools ahead.

Vanessa Pomarico 17:47

So um I just wanted to ask a question. You talked about AI, and and I just want to bring this up. How do you and Christopher feel about you know, to today's students using AI and not using critical thinking to describe maybe a rash that they're seeing or to develop uh, you know, a note. They're not using that part of their brain or developing the part of their brain that they need for their practice. How do you feel about that with AI?

Jason Gleason 18:14

If you don't use it, you lose it, right? Absolutely.

Christopher Gleason 18:16

I think I think AI has a potential to be a great tool. But getting back to your point, Vanessa, if you're if you're using it for everything, you're using it to just to describe what what you're seeing, then you use that critical, uh, critical thinking skill. And as a result, your clinical practice goes downhill.

Jason Gleason 18:32

Absolutely. You gotta have that foundational knowledge, you know. Great tool, but yeah, don't let it take the place of you. Because I'll tell you what, if it takes the place of you, you are no longer needed. And eventually healthcare will get there, right? AI will catch up to that, and we will all be out of jobs. So you don't want that. So true. Great point. So when we look at this section of our podcast today, 30 days, here's your priorities. And again, this is all in the show notes, so don't take notes. Just enjoy your time listening to our podcast, hopefully. But in the first 30 days, you're gonna learn the clinic flow, the EHR, you're gonna focus heavily on that and the training that goes along with that. You're gonna ask your clinical mentor, remember the triad, the triangle of mentors, clinical, administrative, and career. You're gonna connect with your carve out the time and connect with your clinical mentor and talk about the top 10 visit types, diagnoses patients come in. What are the top 10 and be very familiar with those? Have a firm grasp on those because those are the ones you're likely to see on a frequent basis. And then escalation pathways. If you work in primary care in a clinic setting, know what to do in the case of a clinic emergency, right? What are where what's the protocol? What what what pathways does your clinic have in place for those times when unexpected things happen? And then build upon it in the 60 days with the great conversation that we had among the three of us. Build a repeatable workflow, those templates, the order sets. I love what you brought up, Vanessa. Don't reinvent the wheel. Ask your clinical mentors and administrative mentors, gosh, do you have some templates already made up for this stuff? And then just alter them, personalize them to your practice. But most of these are already done somewhere else. And how does that look practically? Hey, Joe, I love your notes. I've reviewed some of your notes. Um, can you tell me, can you just send me your template? Sure. They copy their template, right? The template, put it in a word file, send it to you an email, you copy the word file, you plop it into your template and save it. Piece of cake, right? And you make little changes to tailor it to your practice. Order sets are important, as we mentioned. And then start owning follow-ups and review one to two cases weekly, that 10-minute chunk of time, several days a week with your clinical mentor. Be sure to do that. And again, focus on those top 10 most common diagnoses or health problems those patients come in with. And then in 90 days, at this time, you want to stabilize your schedule, tighten documentation and coding, and set one quality improvement goal for your panel. How cool is that? Now you're really at that point of critical thinking and you're really evolving into your practice, growing into your role, being more comfortable and confident, where you've got this. You move from, what am I even doing here, right? Day one, to I've really got this to the point, where now you're looking at quality improvement. That's such a great concept. So have fun with this and enjoy it. What are your thoughts on the 90 days, Vanessa?

Vanessa Pomarico 21:18

So, you know, I love the idea about the quality improvement, but you know, remember in larger institutions, the metrics people will be sending you those emails to say, you know, you didn't do your A1Cs on the diabetics who haven't been here for a year. So, but it is it is important for your own clinical knowledge and for your own practice to make sure that you're staying on top of those types of things. Um, but again, you you know, make sure that you're setting a growth pattern for yourself, that you're not stalling after 60 days and that you have something to work toward in those 90 days and then the months following.

Jason Gleason 21:53

Excellent. Excellent.

Christopher Gleason 21:54

I think in your first When you're working towards your 90-day mark, I think it's important just to revisit what you what you've accomplished in those first 30 and 60 days and impressing upon yourself that how successful you have been you have been in those in that time frame. Because I think as you're as you're progressing that that 90-day time frame, you can kind of stall out and you can get a feeling of being overwhelmed. And that feeling of overwhelming can, you know, kind of just maybe even push you out of the practice. So I think taking the time in those in those first 90 days, and especially towards the end of those 90 days, and just reviewing what you've accomplished in that time frame can be very important.

Jason Gleason 22:34

One other thing that I would add is start keeping a journal, a clinical journal, or I'd say a career journal. That's more of what it is. But you know, eventually you're going to be evaluated. Your annual evaluation is going to come up, and this is your time to shine. But often what happens is, especially with new NPs, I know I was in this boat, is you look back at your year, okay, well, what did I accomplish? And then it's hard to remember all the great details of all the wonderful, amazing things you did, like quality improvement projects or seeing this number of patients and having these metrics, you know, these quality metrics pan out. And EHR systems will all give that information to you. But kind of keep a journal along the way. Take some notes. It doesn't have to be anything extensive, just little bullet notes that you can take. That way, when that annual evaluation comes up, you can say things like, gosh, here's day one. Look at how much I progressed since then in one year, right? And look at all that I've accomplished this first year. Here's day one, here's where I'm at now. That's what employers are looking for. Those are the people that get the raises, right? And the grade and step increases if you're a federal employee. So it's so important to keep a journal of all your successes and also of your challenges and lessons learned, you know? So that is your 30, 60, and 90 day schedule. Let's talk about your schedule itself. Protected learning time, even 30 minutes twice weekly. So growth does not rely on free time. What does that mean? That means you carve out time in your schedule and talk to your boss, talk to your employer, say, hey, you know what? Will you allow this? And honestly, if you ask for it, a lot of employers do. The VA allows us administrative time where you can focus on catching up on your uh computer-based training, you know, credentialing, all that kind of stuff, the administrative stuff, the CE stuff. But ask for that time. That way you're not stuck in the office to like nine o'clock at night catching up on all this administrative work that you need, but ask for it. At least you can ask for it. Some employers may say, no, we don't do that. Sorry. But you might be surprised. And if they push back on it, say, you know what? I want to be a safe, effective, quality-driven NP. Use those keywords that employers love and that you really mean you want to be safe and effective in a quality-driven NP, and that that time is an investment in order for you to accomplish those things, which is going to benefit the practice, reduce liability, and improve productivity. So carve out that time in your schedule, not just for patient visits, but at least you can ask if you, and it's not free time, it's not vacation time, none of the negative connotations that go with it. It is an investment, an investment in your development. And that's so important, especially during the first year, during the first year. So, what recommendations would you give to a new NP or an NP transitioning into a new specialty or practice regarding building a connection with mentors? Vanessa, how do you build a connection with mentors?

Vanessa Pomarico 25:19

So, you know, a lot of times people are much more comfortable building or maintaining a relationship with somebody who might have been their preceptor. But I have to put a little plug-in for AA and P. As I had mentioned in a previous uh podcast, that we actually have a free mentorship program for any AA and P member. And it let's say you want to learn how to write a journal article. We have a fellow of the American Association of Nurse Practitioners who's experienced in that and they can help you do that. Let's say you want to be more involved in health policy. We have experienced fellows that would help mentor you. So if you can't find someone that maybe was a previous preceptor or somebody within your practice, go outside of your network and engage with somebody. But it I can't say it enough. It's so important to have that mentor. That first year is the hardest. We talked about this a number of times, the three of us. I remember that first year. I don't think I slept through the night the first year because I was convinced that the CBC sitting on my desk was going to kill somebody, you know, or I was waiting constantly for somebody to come tap me on the shoulder and go, What are you doing? You're not supposed to be doing this. You know, that whole imposter syndrome. So it's really important to have that mentor that you can go to, you know, just to be able to bounce something off of them or just to get a little bit of reassurance.

Jason Gleason 26:45

I love that. I love that. Christopher, how do you connect?

Christopher Gleason 26:49

I think one of the most important things is just being honest with them. You know, letting them know what what your experience is, letting them know what your background is. And that in and of itself is going to build that connection with that mentor and you know, hopefully build a connection for the future as well.

Jason Gleason 27:04

And I would say that is such a great point. And it's so important because you don't want to fake your way through things, right? You don't know what you don't know. So it they they understand this. We all get it, right? We all were there once, and we don't expect you to know everything as a new NP, uh, just joining a practice and the profession. So don't pretend at all. Do not act fake. Don't say, oh yeah, I knew that. If you don't know it, you don't know it. And everyone can't know everything, right? So so be real. They get that. But the point, the the times when you're not real and you try to fake your way through it, that's where patients get injured, mistakes get made, liability issues go up, and you might be out of a job. So be real, be real, be you, right? When you go into these instances and working with mentors, because they get it. All of us get that. And if you have a mentor, because that this will happen too, I think, Vanessa, would you agree and Christopher? There's bad mentors out there. Some mentors have forgotten what it's like on day one as a new NP. And they're all full of themselves and they're just strict and they're harsh and they're very critical. That's not the mentor for you. That you need to go to somebody else. So pick your mentors well. Would you agree, Vanessa? Have you ever had a bad mentor?

Vanessa Pomarico 28:12

I can't say that I've had a bad mentor. Um, I I I actually chose the people who were going to be my preceptors, and those are the people that I really, you know, I was very fortunate to get in with. But as you have mentioned, there are some bad mentors out there. And some of them do it because they get paid. Some organizations will pay for you to mentor somebody. I don't know what those organizations are because it's not where I work. Um, but there's some people that just give bad advice and then we'll have a new nurse practitioner that'll say to me, you know, my mentor told me this, but it didn't really sit right with me. And I think to myself, why would you have told a new nurse, an impressionable new nurse practitioner that? And so I've actually had to confront those other mentors, and I hate to use the word bad, but you're right, they're just inappropriate, um, to say, why, why would you say something like that to somebody when that's not what, you know, what is true and what is real? So I think we have to make sure that our that everybody that's listening, you know, trust your gut. If you feel like your mentor is not a good match for you, find somebody else. And again, you may need to go outside of your own organization to do that.

Jason Gleason 29:19

Yeah. And it might even be something as simple as like personalities just don't mesh. You know, who knows, right? What the deal is. But if you're experiencing that, seek out a different mentor. And if you're in a situation where an employer has assigned you a mentor, go to your boss and say, Hey, can I just have a different mentor? It's just here's the issues I have, concerns I have. And and realize this too. When we mention a bad mentor, these are not bad, evil, horrible people that we're villainizing. They're people that maybe are not good at mentoring, but they're really good at other stuff, right? And as Vanessa said, they might be getting paid. What about the situation where you know an employer says, hey, you need to mentor so-and-so? And let's say you're really quiet and you're more introverted and you're not, that's not for you. They may not be a good mentor, but they're not a bad person. So we're not saying that at all. And that's not what Vanessa meant by that or what I meant by that. But some people are just not good at mentoring, you know. Christopher, do you have any experience or wisdom on that?

Christopher Gleason 30:08

Actually, funny story, yes, I do. So when I was doing my clinical, my clinical practice, the uh one person I was speaking on earlier, my uh NP mentor who was amazing. There was another NP that was working in that same clinic who is um I did some uh clinical time with as well. The and she made me feel absolutely horrible. So I was doing an assessment on a patient. This patient patient had an ear infection, and they were doing um they had done hydrogen peroxide solution to kind of help uh do an ear lavage. And I had gone in to assess to assess the the patient and looked in the ear after they had done the done the lavage, and I didn't really see a whole lot, but there's still you know some suds left from the hydro hydrogen peroxide solution. But um, so I had gone out and talked to this this one person and she had gone in and and she basically had gone in and saw the patient, came back out, and she chastised me because she said I missed a a raging ear infection. But no, it to me as an as a new I wasn't even a new NP at the time, I was an NP student, so it can really be disheartening and kind of you know push people out of the practice. Luckily, I had the uh my true NP mentor was amazing, and she just let me do finish my clinical hours with her. But you know, it's it's experiences like that that can really push people out of the practice.

Jason Gleason 31:18

Yeah, that's tough. That's tough. Again, good people at a core, but yeah, just not the best at mentoring. So moving on here, more tips for our friends, and again, don't write these down because these are all in our show notes, you'll find them there. But these are great platinum gold tips for you, especially as new NPs or those NP switching specialties or into a new practice that you're just kind of timid and not the most comfortable with. So, how to ask for feedback without feeling like you're bothering somebody because that too, and if you feel that way, you're not gonna ask. And that's where mistakes happen, right? If you keep it all in and you're not being real and open and transparent about what you don't know, you're never gonna bother anybody. And sometimes a busy day and it's a crappy day, and mentors have crappy days too, but find that time. And how do you find it? By planning ahead, by talking to your mentor and saying, hey, clinical mentor, remember the three mentors we talked about. The clinical mentor, can you spend 10 minutes in your schedule? Let's carve it out in the schedule on these days out of the week so we can talk about cases. Would you mind doing that? That way you don't feel like you're bothering them because that's schedule time for the two of you to meet, right? So plan that out. I cannot stress that enough. And then what do you want to ask your mentors? I think this is a great tip. Ask two questions every single time you're with them. You can ask more than this, but at a minimum, these two questions. What should I keep doing and what should I change next week? Not what am I doing wrong and what I'm doing right, because that implies judgment, right? And none of us are perfect. But what should I keep doing and what should I change next week? Those are two so important questions. Because you could run into this situation where you think you're doing great, like you're hot shit, right? You're the most amazing NP, new NP to the practice. You think you're that good, and you don't see anything otherwise showing you any of your mistakes or faults. And then you find out like three months later, like you made all these mistakes, right? So nip that right in the butt, right? What should I keep doing and what should I change next week? And there's no negativity to this, there's no shame in it, there's no stigma with it, right? Like, oh, I'm doing these things horribly. What should I change? What can I improve on? And what am I doing really well? So focus on that. And then bring one focused case. Here's my assessment, here's my plan. What would you do differently? Is there anything you do differently? And be open to that, open to that, right? So that's another important question. And then separate feedback from identity. I cannot stress this enough because you know, the world, life in general is filled with so much shaming and negativity, and all of us are packing way too much weight on our shoulders already, right? So don't beat yourself up in this. Take it easy, be easy on yourself, give yourself grace, as Vanessa mentioned in multiple episodes that we've we've done already. But separate feedback from your identity. If you have, if you have things to work on, if you have some challenges, don't give up, don't give in. Stay on the field, stay in the game, and separate feedback from identity. You are not your note, you're not your plan, and you're not your last patient interaction. All of us have crappy interactions, crappy notes. I'm I'm here to tell you, even to this day, Christopher and Vanessa, I hope I'm not the only one, but I screw up. I screw up. Every week I screw up on something, right? But it's that that drive to always improve those things and fix those things. But it's okay. So be easy on yourself, but don't do not join your feedback with your identity. Don't do that because you're an amazing, brilliant NP who is really good-hearted and you want the best for people, and all of us make mistakes. So separate the two, separate the two and keep it keep staying motivated and moving forward. And then write down the feedback and turn it into one small action for the next shift or next week, right? So write it down. Just don't blow off what your mentor's telling you because they'll pick up on that quick. If you ask them what I need to work on, and then you're not working on it, they're gonna pick up on that. And that's not a good thing. So make sure you take action in the very next week or the next shift, the next day, whatever it is. So what are you what are your guys' thoughts on would you offer, or I'm sorry, what would you offer on how to build a healthy, high quality mentoring experience? What what are the things that stand out from a very high quality mentoring experience?

Christopher Gleason 35:24

I think for me to develop that high quality mentoring experience is is just sitting down with that person when you when you when you're assigned as a mentor or when you're chosen as a mentor, sitting down with them, you know, as I touched on earlier, making sure that you know what their strengths are, what their weaknesses are, you know, what their what their background is, if they're coming from a different specialty, what what specialties they were in before. And letting them know, you know, that this is a this is a team effort. You're there, you're there to work with them if they have questions that you're approachable, um, and just really kind of building that that um that solid foundation, I think that's really key.

Jason Gleason 35:56

Excellent. Vanessa, what stands out to you?

Vanessa Pomarico 35:59

Uh again, Christopher and I are kind of on the same wavelength. So two things choose your words carefully, whether you're the mentor or the mentee. And so, like in Christopher's case, I'm sure Christopher handled it beautifully, but instead of like, and I'm I'm not saying that you did this, Christopher, but let's just say you you went to the mentor and said, I don't like what you said to me, that I missed something. That's going to put that person on the defensive. Or as the mentor, Christopher, I can't believe that you missed that ear infection. Change how you say it in a way that is, it makes it into a teachable moment. Christopher, let's talk about the ear that we saw. And how can we improve this for the next time you you are seeing a patient, especially if you're on your own? And then the only other thing, when you said so important, Jason, about the feedback, you know, separating it from your identity, change the chatter in your head. Instead of taking that feedback and saying, I stink as a nurse practitioner, I should have never gotten into this profession. I don't know what I was thinking, change it again into a teachable moment to say, all right, I made a mistake. I think as nurse practitioners and as nurses, we forget we are human and we're going to make mistakes. And I tell patients all the time, medicine is not an exact science. So, yes, I know the appropriate things to do, but sometimes it's not the thing that works. So we might have to try something else. And so I turned that into a teachable moment for my patients as well. So realize how what you're saying and how you say it, whether you're the mentor or the mentee, and then changing the chatter in your head so that you don't make it about you, but about what you can do to improve that.

Jason Gleason 37:48

I love that. Absolutely. I love that so much. And it really speaks to, you know, and honestly, some listeners out there, people watching us, and you know who you are right now, right now, wherever you're listening to this podcast, you feel deflated, discouraged, you feel like you're a nobody, you feel like you don't bring any value to a practice. Maybe you've screwed up and made mistakes like all of us have, right? And and you're trying to learn from them, but you take it personally. You start to build it into who you are as a person, and then you start to become depressed. And mental health, there's a huge stigma with that. But providers have one of the highest prevalence for depression and anxiety and all these mental health issues. And often we suffer in silence with that. So reach out to friends, family, providers, you know, your career mentors, so to speak. Reach out to people because we're all here for you. And so don't be deflated, don't be discouraged, pick yourself back up and recognize that that very next day you show up to work, you're showing up to work, right? And you're there. And that that's the biggest step that you can make. And it's a new day and it's a new day to shine. So be encouraged, be encouraged and know that all of us go through this. All of us go through this. It's not exclusive to just you out there and you bring tremendous value and you are brilliant and you're worth it. So keep showing up. That's so, so important. So another element I think is really important is protecting your mentor's time. Because when you show up late for a meeting or for work, or you know, you're late at all to any events, right? Where that mentor's counting on you to be on time, that's extreme disrespect for them and their time. And often they're volunteering their time. Often they're staying over time into the evening hours, you know, because they get backed up because of the time they're giving you. So it's such an investment, but totally respect that. You know, for me, it was so eye-opening. Talk about screw up. One of one of my biggest challenges and how I messed up is I mentioned my service in the Air National Guard in the Air Force, and for guard drill, for a while there until I moved, I would have to travel 150 miles from my hometown to where my guard drill was at. And sometimes I was in the middle of winter, 40 below zero, a blizzard, whatever, right? To get there. And so there were a number of times where I was late for roll call because the guard drill kicks off with roll call where they ask for your name in front of everybody, 50 other people. You know, is Gleason here? Oh, Gleason's not here. Oh, he's not here again, he's late again. And here I come through the door strolling, right? Where everybody else there, they're in uniform, they're ready, they're ready to go. You know, that's respect. And so on those times I was late, though, life sucked for me. I was driving through a blizzard to get there, right? And I'm thinking, I know I'm late, but they should be really grateful that I'm even showing up for this. I'll never forget my leadership. I so admire this that she talked to me in this way and brought this to my attention. She said, you know what? I know your circumstances are real. I know safety is a big deal, right? You're gonna drive slow. You're not gonna rush to work through a blizzard, and that's gonna make you because of that, you're gonna be late. I know that. You know that. You know the reason why you're late, and so do I. But those 50 people out there, or in this case, we're talking about mentoring, that mentor, they don't know why you're late. They just know that you're late and you're not respecting their time. So respect time. That is so important. So I'd even encourage you to show up early, early for meetings and events with your mentor. It's so, so important to do that because it's not their job to know why you're late. And it might be for a legitimate reason, but it's disrespectful when you don't show up on time. So be sure to show up on time. Great, great things we're working through. So, can you recall a time when a mentor asked you to do something which you didn't feel ready to tackle or you felt the advice may be incorrect, so you didn't carry it out. Christopher, how about you? I think we've talked about a lot of this already.

Christopher Gleason 41:23

Yeah. I was gonna say, No, you definitely have a story. Yes.

Jason Gleason 41:27

Um don't stick a needle in the carotid. Don't do it.

Christopher Gleason 41:31

Um I can't ever remember a time that I was actually asked to do something that I felt would have been out of my scope or made me feeling uncomfortable in doing it. I think some of my mentors tried to um like I remember one instance, I was working with an amazing physician and he was doing a uh laceration repair. So, and I had never sutured before in, you know, this a lot of that's on-the-job training. So, and he wanted me to suture. So he was he was kind of pushing me to to suture, not in the sense that it would have been something that was unsafe, but something that it was something I needed to learn and something that I didn't necessarily feel comfortable with at that moment, but he was he was doing it as an educational thing more than anything else.

Jason Gleason 42:09

So yeah, excellent. Vanessa, anything to add to that?

Vanessa Pomarico 42:13

So I I just remember when um I was in a uh general gynecology practice, and same thing, you know, or along the same vein as Christopher's story, um, they wanted me to insert an IUD, and I hadn't even taken a class on an IUD. And all I knew that is if I put it in too high, I would perforate somebody's uterus. And I said, I'm not comfortable doing that. I don't have the appropriate training behind me. And I think it was really the first time that I stood up for myself and I was already, you know, ready to graduate. And I remember the person that I was with, the doc that I was working who wasn't my regular mentor, and said, Well, how do you ever expect to learn anything if you're not willing to try? And I said back to them, I am willing to try, but uh not at the patient's expense. I want to get the appropriate training and not just pop something in there. Um, and it I remember shaking in my boots, and that's when I went home and was beating myself up about the feedback that I was getting. Um, my preceptor knew when she came back, obviously they had told her about it, and she was a midwife and she totally got it. She understood my hesitancy, but the physician didn't. And that's when I saw a real divide in how the physician looked at nurse practitioners. But I wasn't about to do anything that was going to cost, you know, put the patient at risk for anything.

Jason Gleason 43:34

Yeah, excellent, excellent. And I use the example for those of you that didn't tune in on our previous episode about a ED physician that just told me to go and drain a peritonsillar abscess using a 14 gauge needle, but don't puncture the carotid. Well, of course, I did not do that. I've never done that before in my life, and I'm not going to risk the patient. So I called in the ENT who did the procedure, right, as appropriate. So, but but in that time, you know, what goes through your head is well, how do I tell this? Person? How do I tell them that I'm not comfortable with this, right? Because some of us aren't confident enough yet in our practice or our professional walk to be more bold and say, I'm not doing that. Are you crazy? Right? I'm not going to do that. Yeah. So here's a nice way to do it. And this is in our show notes, you don't have to write it down, but a little scripting for you to get you through those times where it doesn't piss anybody off or make you know make you feel bad, like, oh, I said no to this person and they have a lot of influence in the department or something. Say this. I have not done this independently yet, and I'm very interested in learning more about it. But patient safety is paramount, right? And Vanessa, you spoke to that. I I loved your approach with that. That was wonderful. So thank you. Yeah, excellent. Excellent. So let's move on here down to our other segment of our show. We're going to go into fact or fiction. And this is one of our fun games we play where we're going to cut through the BS and all the fiction out there and give you the facts on some key elements of our topic of your first 90 days. So let's kick in here. So the first 90 days should include measurable learning goals, not just survive.

Christopher Gleason 45:05

That's true.

Jason Gleason 45:06

True? Yeah, I think it's good. Yeah. Measure measurable learning goals. Excellent. A measurement on how you're doing. And I'd say even carry that through your entire first year. And then asking for feedback early makes you look weak.

Vanessa Pomarico 45:19

Fiction.

Christopher Gleason 45:20

Absolutely not. No, that's true. And I think Vanessa would agree with me on that one. Yeah.

Vanessa Pomarico 45:24

We've all been that new person. And I always say I get nervous when our new nurse practitioners or our students don't ask questions because this is the time when you should be hammering me with questions.

Jason Gleason 45:35

Absolutely. This is your time. Not that you're dumb at all because you're all brilliant, but this is your time to learn, right? And not to be expected to be a brilliant expert in your first 90 days. So yeah, asking for feedback is so key. And then it's best to work in isolation until you feel confident.

Christopher Gleason 45:52

Absolutely not.

Jason Gleason 45:54

Totally. Total fixture. That's an easy one, right? Right. All right. So that's our game for the week. Let's dive into our launchpad mailbox. And I have to tell you, we are so delighted for the feedback we've gotten from all of you. We're getting a lot of emails and comments. And here's a few emails that we've received. If you want to send us an email and connect with us with your comments, clinical pearls, comments about you liking the show, things we could work on, and your questions for us, please go to nplaunchpad@ fhea.com. Again, it's on your screen and in the show notes. nplaunchpad@ fhea.com. We look forward to hearing from you. So here's a question we got. What's your biggest fear about your first 30 days? And for us, what was our biggest fear for our first 30 days? And what support did you have or not have? Vanessa, would you like to tackle that one?

Vanessa Pomarico 46:42

Well, again, I was very lucky that the doc that hired me out of school was somebody that I had worked with when I was a nurse on the GYN surgical floor. So she had known me for a lot of years. My biggest fear was missing something. And I was unrealistic in my approach to feeling like I needed to know everything the minute I hit the floor. And it wasn't until the doc actually said to me, Vanessa, not everybody's gonna have cancer. And that kind of set the tone for the next 30 days. But that was my biggest fear was missing something.

Jason Gleason 47:17

Missing something. How about you, Chris?

Christopher Gleason 47:20

Um I think my the my biggest fear during that first 30 days was the you know, kind of the imposter syndrome that we touched on earlier. You know, having that and you know, Vanessa and I, you you and I've had this conversation before, going from that expert nurse to that novice NP. You know, that that it's a real transition and it can be a really scary transition. So I think during during those those first 30 days, it was a lot of what am I doing? Why am I why am I here? And how did somebody give me a license? There you go.

Jason Gleason 47:49

There you go, right? And then you move from that, what am I doing here to I've got this, right? And you do that safely. You do that safely. For me, I'll tell you what, that first 30 days was brutal. Vanessa, Chris, I can totally relate to what you're going through. And so many of our listeners and watchers out there. Um, you know, I I have to say, I was sitting at my desk the first time I wrote a prescription out for real without my mentor co-signing it. And I'm sitting at my desk with the script pad, and the medication I'm prescribing is the super dangerous, very dangerous Lacinopril. Oh my gosh, lacinapril of all things. And I was scared to death to write this script out. That's gonna kill the patient. You know, they're gonna have an abnormal reaction to it or whatever. And so I wrote out the script and I double-checked it 10 times. I think I looked it up three times, you know, and we didn't have fancy phone apps back then like Hippocrates and others, but I looked it up three times and it's like, oh, I hope this is right. And then I double-checked and double-checked. But you know what? It's funny now that I do that because you write scripts now left and right, right? With your experience and your confidence building. But uh, but it's almost like a built-in safety mechanism that we do those things because it prevents us from screwing up. It's a good thing that you double check things initially, right? And you'll get comfortable with things. Now, do I double check insulin? Every single dose, right? Did I double check insulin? Do I double check with Cintopril? No, because I've written it so many times I know what I'm doing with my eyes closed. But initially, don't sweat it. Don't beat yourself up because you're double checking things. That's a good thing. It means you're a safe, safe provider, a safe NP. So another question here is how do I how do you ask for feedback from a precept or supervisor without feeling like a burden? How would you ask them? We talked a little bit about this, didn't we? Chris?

Christopher Gleason 49:32

Again, I think it goes back to just being just being honest with them. And if you have that that really good, solid relationship with your mentor or with your preceptor, then they're going to be willing to give you the feedback and they're going to want you to succeed. So, and part of that success is going to be getting that feedback from them. Excellent.

Jason Gleason 49:48

Vanessa, anything to add on to that?

Vanessa Pomarico 49:50

You know, as nurses, we were always getting feedback from our nurse managers. And when we become nurse practitioners, it's a little bit different playing field. So I think you just have to be honest and say, you know, I'm new at this and I'd really appreciate some constructive feedback, you know, to let me know how I'm doing. And I don't know anybody that wouldn't take the time to give that or respond in a in a positive way.

Jason Gleason 50:15

Excellent. Excellent. And again, don't be afraid of getting feedback. It's so important. You know, what am I doing correct? What could I work on next week? And and most of all, do not internalize it and make it your identity, right? Do not make it your identity. Fear keeps you humble. Yeah, absolutely. So those are our questions for this week. Again, thank you for submitting those. And if you have a question, comment, concern, you hate us, you love us, please don't send us hate mail. But go to nplaunchpad at fhea.com. It's right on your screen and in the show notes. We love to connect with you because it's genuine and we're friends and colleagues. You're not just an audience to us. So let's wrap things up for this episode. So, three take-home tips that you have that we've covered over and over again during this episode. You want to write a 30, 60, and 90-day plan. And it doesn't have to be something complex. Make it simple and review it often and turn it into action. Just make sure it's not just a piece of paper that's sitting there. Do something with it. And I'll tell you what, you want brownie points with your boss? Show your boss your 30, 60, and 90-day plan. They're going to think you're brilliant. Brilliant, brilliant. Because you know what? A lot of your colleagues do not have that plan. They haven't even spent the time to do it. You will be a standout. You'll be a standout and gain respect from day one. So be sure to share it with your supervisor. And then identify one go-to teammate for each domain. Remember the mentorship triad that we talked about, the triangle, your clinical mentor, your workflow or administrative mentor, and then your career mentor that inspires you. Make sure you have those in mind and pick those out and pick good ones. And if you don't, if you think that, oh, well, it didn't turn out they weren't so good for me, not a bad person, they weren't. They were not a bad person, but they just didn't gel well with me. Go to another one. Find another one. So, and then pick one quick win or skill to master, like hypertension visits or those top 10 things you're going to talk about with your clinical mentor and track it for two weeks and see how you're progressing and how you're improving, right? And then NP practice project. This is your homework for the week. You're going to, again, make that 30, 60, 90-day plan and ask your supervisor to review it with you and actually give you some feedback on some measurable goals that they'd like you to set out. So that's our episode, everyone. I can't thank you enough for tuning in once again. We really respect your time. And I know the last few podcasts, our goal is to do 30 to 45 minutes. We've been running a little over just because we have such great chemistry and we hope that this information is so good for you. And uh we just can't thank you enough for tuning in. Again, Vanessa, Christopher, Jason here, please reach out to us, nplaunchpad at FHEA.com. And please do us a favor because we want to build this community, build the momentum, because the more of us that are engaged and involved, the stronger we all are. So please share this podcast. The things that you can do right now, right now, before you turn off your computer or turn away from your phone, give us a five-star rating because we truly want to be five stars for you. If we're not, let us know why and how we can get there. Hit follow, tap subscribe, and most importantly, this is most important, here's your homework for the week beyond anything else. Share this podcast with a friend, colleague, family member, post it on your bulletin board at work. Check out this amazing podcast because, again, we're not in it for the clicks, the likes, you know, the ego strokes. We're in it because of you, because you matter and we care about you. We've got your back, we're your colleagues, we're your friends. And the more in our community that we're building, the more momentum we will build, and we can all help each other. So thanks so much, everyone. We'll uh we'll take off for now and we'll see you at our next episode. See ya.

Voiceover 53:46

You've been listening to NP Launchpad, presented by Fitzgerald Health Education Associates. Like, subscribe, and share. And for more tools to power your NP career, visit FHEA.com.