EP 6: Finding Your Flow—Clinic Workflows & Templates

Struggling with charting overload, inbox chaos, and never-ending clinic days? In Episode 6 of the NP Launchpad Podcast, Vanessa leads a high-impact conversation on optimizing clinic workflow, building smarter EHR templates, and creating a sustainable schedule as a nurse practitioner. Joined by Jason and Christopher, this episode breaks down practical systems to help NPs design their day with intention—using strategic time blocks, buffer slots, same-day appointments, and protected admin time to prevent burnout.

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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.

Vanessa Pomarico 0:29

Hi everyone, and welcome to episode six of the NP Launchpad Clinic Workflows and Templates. My name is Dr. Vanessa Pomarico, and I'm delighted that you have all joined us for this particular episode. And today we're going to talk about clinic workflow and templates. And I'm so happy to be joined by my friends and colleagues, Dr. Jason Gleason and the soon-to-be Dr. Chris Gleason. Welcome, guys.

Christopher Gleason 0:53

Thank you, Vanessa.

Jason Gleason 0:54

Thanks, Vanessa. Great to be with you again.

Vanessa Pomarico 0:57

Thank you. So I know that I'm dating myself, but I remember the days of paper charting and going through charts that were as thick as Bibles, you know, just to find one result, spending hours writing and my hand hurting and going through so many pens, you know, just because everything was handwritten, you had to write everything out, so much documentation and things that I had to document based on my own knowledge and not have a computer do it for me, which we had talked to in one of our last episodes. So now the vast majority of us are on electronic health records, and that's been a huge game changer for many of us. But again, it's not without its own set of issues. And we've we've alluded to some of these things in our past episodes, but today we're going to do a deeper dive. So, Jason, I want to talk a little bit about how you design your day. Like what do your schedules look like in terms of appointments? Do you have any buffers that are built in for appointment time? And most importantly, how do you protect your sanity when your day just seems to fall apart?

Jason Gleason 2:00

You bet. That's such a great question. It's so, so important so you don't get burned out, right? In the long term. So I love what the VA does with their schedule. Um we have about 14, 15, sometimes 16 patients a day, which doesn't sound like much to some of you out there that are burning through like 20, 25, 30 patients a day. But I'll tell you what, our patients, our veterans, they deserve the best care out there. They truly do, like any patient does, right? But our patients have very high acuity, a lot of mental health stuff. Talk about being a mental health care provider, right? We have excellent mental health services at the VA, but we work in conjunction. Primary care works in conjunction with them. So often, you know, there's a mental health component, which is huge. Lots of acuity there because of the horrible things that our veterans have been through and their service and sacrifice to our incredible country. And then all the physical health issues. I don't know about you and those listening or watching out there, or Christopher, but veterans are tough as dirt, especially those older veterans, Vietnam, Korea, World War II. We still have a few of them left, thankfully, but they're dwindling down in numbers. Um, the Gulf War, Afghanistan, all of them, every single one of them is tough as dirt. And so because of that, they often come in in a crisis. Like, dude, what are you doing here? You're having a heart attack. Why didn't you go to the ED? Well, I wanted to check in with you first to make sure I was okay. I trust you. It's like, get your butt over to the ED, right? I I worked in the ED as I shared in our previous podcast, and um, and I and I tease EMS when they come to our clinic. I say, I see you guys more here at the primary care clinic than I did at the ED, right? Yeah, so they're just tough as dirt, but that makes a very high acuity day. So what do I do? Find those little moments. You know, it might be a five-minute break, it might be a walk. I love to go for a walk during the lunch hour, which is good. I should say lunch half hour or 15 minutes. It's not nearly an hour. And then just spacing time out. One thing that the VA does with their model of care and primary care, which I really appreciate and love, and I wish the clinics across the country, civilian clinics, would take on, is administrative time. They really respect our administrative time. And every VA system is different and clinics different, but they allot a chunk of time for us to just work on computer-based training or getting caught up on charts and coding and all that stuff that we have to do. It's such a great buffer for that. So that's what we usually do. But how about you, Christopher?

Christopher Gleason 4:21

And I think going back to your point about you know just taking that time out of the day. I do my best, and it doesn't always work well, but I do my best to at least get that half an hour luncheon. And normally what I do is it's just a time for me to step away from my computer. You know, I I'll take a walk, I'll sit in my car, listen to music, things like that. Just something to get you away from that, get you away from the clinic for a little bit and you know, kind of do that reset for your mind. And it it it's very, very helpful, I find.

Vanessa Pomarico 4:50

So, in in terms of the actual like appointment template, do you get longer time for a new patient slot versus somebody who's coming back for a blood pressure check? And do you have what do you do for those same-day call-ins? So I know on my schedule, you know, I have uh an appointment in the morning and two in the afternoon. So when patients call first thing, we have at least three appointments on my schedule, and other providers don't necessarily subscribe to that in my practice. Um, but they're booked the same day. My staff knows that if they can't book it with a follow-up or anything else, they have to be open for that day, especially during you know, cold and flu season when we know that people are going to be calling. Chris, do you have that in your particular um appointment template that you have that ability for same-day appointments?

Christopher Gleason 5:37

We really don't uh work in same-day appointments. How it works for the VA is for so for like our new patient appointments, we get an hour hour with them. And for our um just regular follow-up appointments, chronic um disease appointments, it's about a half an hour. Uh, we do get walk-ins. Technically, the where we work is not supposed to be a walk-in clinic, but our veterans do, you know, drop in from time to time. And a lot of times what happens is our RN will go out and they'll triage the um the veteran when they walk in, and then they'll come and talk to us about that. If it's a if it's something that we need to see, then we'll take the time to go see them. If it's something in the case of, you know, they're they're with um something that needs an antibiotic or something like that, then we'll write them the antibiotic and things like things of that nature. So that kind of really helps us um keep on task and keep on schedule with that.

Jason Gleason 6:23

And accessibility, you know, Christopher alluded to this, but uh it's kind of unique. And this this took some getting used to on my part because I was used to working in the civilian clinics out there. Moving to the VA, you have a schedule of, let's say, 14 patients, but we also do take walk-ins. We do. We will never, ever, ever turn away a veteran. And some of you out there, because we're all patients, right? We've we've all needed health care at some point in our lives, but some of you out there know of patients, or you were a patient, or your family member was, where you call the provider's office and they say go to the walk-in, right? Well, we are the walk-in. We we don't do a lot of that at the VA. We will see those patients. If they walk in, we will see them. Will we send them to the ED a lot of times, or will we send them to the walk-in clinic if we don't have like stat labs that we can get back right away or an x-ray that we need, we don't have radiology on site. For those uh few instances, we'll send them to walk-in from our clinic. But otherwise, we make it a priority to improve access, to see every single patient that comes to the door. Now, as a provider, is that frustrating? I told you we'd all be real with you, right? It drives me bananas because then you get behind and then it's disrespectful for the patients that have appointments there. But it's the reality, and I think we manage it very well to keep things on task. So the people that have appointments, they are pretty much kept on time. And then we we work those other patients to walk-ins in between wherever we can fit them in. So it's a good system, but accessibility is so important, and we don't want to be sending patients other places if we don't have to.

Vanessa Pomarico 7:50

So it's interesting that contrasting and comparing, you know, the VA to what I do, oh yeah, you know, we we don't we have walk-ins, and honestly, there are five or six walk-ins that are urgent cares that are literally within walking distance of my office. Um, but we don't do walk-ins as a rule because you know, we have patients that have had to arrange to take off from work or get a babysitter or you know, whatever, whatever it is. And so, you know, when I get patients who come in and and I'm seeing, you know, a couple and they're like, well, could you just squeeze me in? And I think to myself, and like you said, I need to be real with everybody right now. I that, you know, that kind of makes my blood boil because I'm like, no, because the person I have coming behind you had to move heaven and earth to get time off from their job, or they had to pay a babysitter when they're barely making their rent every month. And now you didn't think to call the office and you thought you were going to just kind of dovetail onto somebody else's appointment today. And now that's gonna make it hard for the rest of the patients that have had to take time off. So our I have to say, our walk-ins, you know, it's really nice because our patients have gotten used to the fact that if we don't have those same-day appointments, but we do make every effort. If somebody does walk in and it's obviously a problem that can't wait, we'll work them in. But we kind of have that conversation with them about, you know, listen, you know, this is how it works. And in the future, it's just better if you call because Vanessa has room this afternoon and her schedule to see you. But the thing is, I also don't have the same team that you have. I don't have a nurse to triage. You know, we don't have all of the management people that you have on your team. It's me and my medical assistant and who was ever making the appointments. So I think when you have the support there, it makes it a little bit easier to do some of those walk-ins. But these are some of the really valid questions that our listeners have to consider when they're taking a job, because are you going to be responsible for the walk-ins and urgent add-ons on top of your schedule? And are you going to be double booked? You know, you have to remember at the end of the day, if you're spending three hours of your own time documenting, that means you're not getting paid for those three hours. So when you're when you're interviewing for a position, and we're going to get into this in a future podcast about all of this, but those are the things you need to consider that if you don't have that protected admin block to catch up and do phone calls and refills and finish your documentation, then when are you doing them? And are you doing them on your own time? Because now if you think about two to three hours every day, five days a week, at the end of the year, that's a lot of money that you're losing out of your own salary because you're not being paid for that. So great points there. Um how about um creating templates and macros? We talked a little bit about this in one of our previous podcasts. You know, these are things that are um speed without cutting the corners. Uh, do you either one of you find them helpful? I'm going to start with you, Chris.

Christopher Gleason 10:50

I find them absolutely helpful. When I first started at the um at the VA, there was a um nurse practitioner who works in the on the same team before I did. And I actually took a lot of his templates and started utilizing them. One of the main templates that I use is uh I call it a lab letter. And what it does is it imports um their most recent labs and it puts them into a letter format for me. And then the when the patient's reading through the letter, it it highlights what their current labs uh stats are, and if they're you know marginally bumped one way or the other, it'll actually give them tips and tricks on how to how to change that, you know, where cholesterol is found, how important exercises, things like that. And that that's huge because there are times when you're uh when our veterans will come in and they won't have their labs done. So that creates another appointment because you either have to review the review it with them on the phone or have a face-to-face with them. But this lab letter, um, it allows me to send this letter out. And then I always tell my patients, you know, if you have any questions regarding your labs, if you have any concerns regarding your labs, please make sure to reach out to me. And I don't always use it either because there's some there's some patients that you have that are so they have such chronic illnesses and so many cold morbidities that you don't want to give them a letter. You want to follow up with them because you want to make sure that everything's going right for them. But in that case, it's it's been a game changer for me.

Vanessa Pomarico 12:03

How about you, Jason? What do you think about them?

Jason Gleason 12:06

And I would say um again, don't reinvent the wheel. Ask your colleagues for those templates and then tailor them specifically to meet your practice needs. But yeah, they're already developed out there. Many of your colleagues already have them, just ask them to share them with you. Yeah, it's easy.

Vanessa Pomarico 12:19

So and it's it's even in our health system, you know, I had mentioned in a previous uh podcast that we had our medical director um and she looked at my my physical template, my you know, annual physical template, and she said, Can we use this? I said, take it. And so we share it, and everybody, I just put it out there. So within our Epic system, we happen to be on Epic as our electronic health system, um, it's available to anybody that wants to, you know, use it and then kind of fine-tweak it for whatever they want. And then sometimes I'll see what they have and I said, oh, I hadn't thought about that. Let me put that into mind. And so it's nice to have that community of templates that you can get into. And like you said, without reinventing the wheel. But Chris, you had mentioned about the dot phrases. Even if you're using a dictation system, having those dot phrases with the dictation system is really a time saver. But there's also a caveat to all that because now we're saving time, we're not writing everything, we're dictating, we're using dot phrases that administration can then say, well, it's only taking you 25 minutes instead of 45 minutes. So we're going to put more people on your schedule. So, you know, you have to be careful about, you know, how much ease you're doing and how that's going to translate into what administration is going to think that they can add onto our schedule, right?

Christopher Gleason 13:36

Absolutely. Absolutely.

Vanessa Pomarico 13:37

Absolutely. All right. So let's talk about the inbox. You know, this is the bane of all of our existence. You know, what advice do you have regarding that workflow friction points? Because let's face it, we have patients that, you know, again, with the electronic health system, uh, patients will email us and they think we're going to answer them at two o'clock in the morning. And um, it happened to be um a holiday weekend, and a patient had sent, I left the office at 4:30 on a Friday. I happened to not be on call that weekend, and we had that Monday off from work. And the patient was getting angry because I had a litany of messages from them that started at 5.05 on Friday, then another one at 7 o'clock Friday night, nine o'clock uh Friday night, another one on Saturday, and it was getting increasingly more agitated that by the time they emailed me on Monday, they practically fired me as their primary care provider because I hadn't returned their message. And I had to say to them, even though we have a disclaimer that says non-urgent messages only, and they will be uh um responded to within 24 to 48 working hours. How do you handle that? What do you say to the patients?

Christopher Gleason 14:52

I think you just have to be upfront and honest with them, to be honest, you know, and just just like you did, Vanessa, you have to explain to them, you know, I'm not in the office at all hours and I don't take my work home with me. So as a result, you know, it may be two to three days before I get back to you. And that's just and that's just the reality. Right. And and as you alluded to, patients are instructed that this is for non-emergent issues. If you have an emergency, then you need to seek emergency care. And like really kind of imparting that on them and just making sure that they know that I'm not in the office 24-7, so there may be delays in in answering your messages.

Vanessa Pomarico 15:29

Jason, you have anything to add to that?

Jason Gleason 15:31

I agree. I I actually love our messaging service with our patients. And what I love about it, it keeps me on task because every every system's different. But on our system, if a patient messages us, we have so many hours to respond to them. Otherwise, we get another reminder. And then eventually, if we don't answer it after a few days, it's going to escalate to administration and it'll warn you. They'll say, This is now getting ready to be escalated. Please do something. So it really, the prompts are there, right? And we don't ignore those messages, but we're people are just busy, right? We're busy taking care of patients. But I like the reminders because it makes sure you don't get lost in the system. So for those listeners or watchers out there, our friends and colleagues, check that out. That'd be a great question to ask during your interview at the very end of the interview. Tell me about your EHR. Tell me about messaging with patients. What software do you use? What are the caveats to it? What are the benefits? What things do you not like about it? What can I expect as a new employee? You know, those kind of things I think would be so important. But yeah, it's a great tool. Utilize it. And for me, it keeps me on task. It keeps me on task.

Vanessa Pomarico 16:32

I also think we need to um educate our patients about what is considered portal safe, because now that we have messaging from our patients, many of them feel like they don't need to come in for a visit, that they could just send me three and four messages and send a bunch of pictures, and I'm supposed to diagnose them based on the pictures. And that that's not something that we do. We always say, you know, for these kinds, if you have any, if you think you need a visit, you probably do need a visit. How do you handle that?

Jason Gleason 17:02

Being straightforward and honest, you know, you've got to come in for this stuff. And I and I think some patients want to do it for convenience, what you just described. Other patients, though, want to do it because they think, oh, this is cheaper. I won't get a bill this way. And that's not fair to use the provider or the practice, right? Yeah. I I've had patients that uh have insisted that I keep prescribing their lectenopril and I haven't seen them in two years. It's like, no, thank you. You got to come in and see us, right? Yeah, yeah. And it's a big safety issue. So don't fall for that. Don't fall into that hole of make sure they come in when it's appropriate. It's tough though, but it's an honest conversation. And I usually have that from day one when there are new patients seeing me or see me for the first time.

Christopher Gleason 17:39

So absolutely. And I think it's it's so important to impart on them how critical the visit is, especially when you're prescribing medications. You know, those visits oftentimes are used for uh getting lab values and things of that nature. And if you're on these medications that are, you know, excreted through the kidney or excreted through the liver and cause that extra workload, you're gonna want to know those renal values. You're gonna you're gonna want to know those um liver values. And if you can't rely on the patient to be there on a um on a routine basis to get those lab values, then you can't um I don't know, safely prescribe really.

Vanessa Pomarico 18:12

Right. So you know, just as an example, um I had a patient not too long ago that had sent pictures of a rash on their leg. And the patient is a is a wonderful patient and and you know happens to work in IT, so so gets the whole thing. But then a few hours later sent me another message saying this rash is getting worse. And and, you know, I look at my messages, but honestly, I I work through lunch, and that's when I really look at my patient messages and respond to them. So one came in at six o'clock in the morning, the next one came in at like 11. And I said, You need to come in. I need to see you. And it turns out I sent the patient to uh dermatology because I was very concerned about this particular rash. It turned out the patient had vasculitis and was direct admitted from dermatology.

Jason Gleason 18:56

Wow.

Vanessa Pomarico 18:57

So, you know, again, patients like to use it for convenience and not have to pay um, you know, their copays, but they also have to understand that there's limits as to what's considered safe and not safe. So, you know, Jason, you mentioned about the the refill on the blood pressure medicine and having, you know, really when in terms of refills, having a consistent policy. So I tend to to prescribe medications and give my patient enough refills to get them through their next visit. And I tell them that, you know, Medicare rules say you need to be here every six months. So six months for a blood pressure check, once a year for a physical and as well as a blood pressure check as long as you're stable. And it, you know, when they I'll give them enough to get them through. But if they then start canceling their appointments or they know show and then they want more, then I start doing 30-day refills. And if they don't make an appointment to see me in 30 days, I cut it down to, you know, two weeks. And then I say to the pharmacy, no further refills. A patient hasn't done labs or seen me in over a year. How do you handle that at the VA?

Jason Gleason 20:02

Boy, I I love that. I love that approach. And and I follow something similar, you know, for most of my patients. Um, I would say I give them a 90-day supply and then three refills to get them through the whole year. And what I tell them is, okay, let's say they come and see me in July for their annual visit, right? And I see them throughout the year too for rechecks and other issues that come up. But for their annual visit, I see them, let's say, every July. So I tell them July is going to be a renewal month. But I'll tell you what, if they start doing stuff like you mentioned, like not showing up for the other visits, then I I think it's a great tool and resource to kind of prompt them to come in because otherwise you're not gonna get your meds, right? One of the areas where I really see it effective is like that I've seen over the years, is that for contraceptives, right? They want their contract. Can you just renew it? Nope, not till we get you in. You know, we gotta get your health check done and everything else, your labs, and it kind of prompts them to come in. Otherwise, and and I think there's this element to it, again, healthcare is very expensive, as we all know. And patients want to save money and they think, well, maybe if I just call or send a message, that way I won't get that that fee for that visit. Don't fall into that hole. Don't try to be nice to your patient by doing that. Sometimes the best medicine is to say no, you need to come in because it's their safety, right? Yeah, so that's what I do. What do you do, Chris, for your refills and renewals?

Christopher Gleason 21:15

Um, I actually follow Vanessa's philosophy. So, you know, again, at their annual visit, I'll do their 90-day fills with a or excuse me, 90-day uh fills with three refills on it. And then if they don't come in for their annual follow-up, I'll do the I'll do the 30 days. And then, you know, like Vanessa said, go down to the two weeks. And the um I've actually had a patient recently that I had to do that with because they consistently cancel their they'll make the appointment, the annual appointment, um, so they can get their refills, but then what they'll do is once they get their refills, they'll cancel the annual appointment. So as a result, you just you don't have any up to date lab values, you have no idea what what their you know true state of health is, so it just makes it really sticky for prescribing practices and for the safety of the patient as well.

Vanessa Pomarico 21:59

And don't you feel that Patients really have to own some of the responsibility for their health care.

Christopher Gleason 22:03

Oh, absolutely. Absolutely.

Vanessa Pomarico 22:04

You know, they have to show up. Absolutely. So, in terms of our inbox, you know, and labs and results, you know, we have to decide who's going to call the patient, who's going to message the patient, and how are our abnormal results going to be tracked. So, you know, we do an awful lot of documentation when we call the patient, how many times we call the patient. And then this way, if they call, you know, the office, they'll say, I'm returning Vanessa's call. Anybody in my office can open up the patient's record and say, oh, she was calling you about your results. And if they're normal results, my medical assistant will give them normals and I'll say, you know, everything is normal, recheck the A1C and the lipids again, fasting in six months. And they're going to send them a lab slip. If they're abnormal, then they'll say, Vanessa will give you a call in a little while. Sometimes I have those patients that again, the results come in at 2:30 in the morning. And by the time I get into work in the morning, they're like, Could you please call me? I need to talk to you about my lab results. It's like, okay, I haven't even had a chance to look at them yet. So, you know, and I'm I'm sure that you you've seen those as well in terms of those patients that get a little bit hyper-vigilant about it.

Christopher Gleason 23:12

Especially, you know, electronic. Go ahead. I was gonna say, just especially with the nuance of patient portals, and oftentimes they'll get the results before we can get back to them. So they're calling, asking for these results and explanations, and you're like, I haven't even looked at them yet.

Jason Gleason 23:26

Oh, and their doctor Googling, and of course, the worst stuff comes up on after Google. Right. And I get it. Of course. It's scary, especially if you don't have a handle on what those lab results mean, right?

Vanessa Pomarico 23:35

The one thing I always laugh about is when they say, I sent get a message that says, I have a question. My MCHC is abnormal. And I'm like, okay, the rest of your CBC was fine.

Jason Gleason 23:45

Can we just the MCHC?

Vanessa Pomarico 23:48

It's just the MCHC. Like this is, I'm not worried about it. Really not worried about it. And and you had mentioned earlier, too, about you know, the escalation. You know, how do how does that look in terms of you know handling urgent critical labs and safety concerns? Do you have mechanisms in place in in the VA that like let's say somebody's potassium came back at nine, you know, how does how does that happen? Chris, tell me how like what kind of system do you have in place there?

Christopher Gleason 24:18

So for critical lab values, especially ones that come in overnight, the um they have a physician at Fort Harrison is our main hospital system, and critical lab values will be sent to them, and they're uh tasked with actually calling the patient and making them aware of those critical lab values. And if they uh if they feel that they're critical enough that they need you know emergent care, they'll actually often refer them to to the ER to get that care. And then we're notified the next, the next working day, we're notified that the uh of the patient's lab value, you know, that the patient was notified and that they were inf instructed to go to the ER.

Vanessa Pomarico 24:51

Okay, that's good to know. So it's a little bit different, you know, out in the community. Um, when you're on call, I'm the one that gets that phone call from the lab in the middle of the night. So for our our new nurse practitioners, or perhaps those who are listening that may be returning to clinical practice after taking an absence, you know, my suggestion would be, my advice would be is if you get that critical lab, make sure that you have your resources at home as as well as at your job so that you could look it up and you know figure out what you need to do at that point. Another little tip that I have for some of our newer practitioners is before you leave at the end of the day and you're maybe it's your first night on call, make sure that you have somebody that's your backup that you can that they can call you. I mean, I always tell when we had our the nurse practitioner that we hired a few years ago, I said to her, you know, if you're on call tonight, just call me if you have any questions. And it was just so that she had a little bit of a buffer, a little bit something that she can run something by. But before we leave for the weekend, we all still do this, even though we've all been in practice for a lot of years. On Friday before we leave for the weekend, who's ever on call, they'll say, Is there anybody I need to know about? You know, because if the call comes in, I need to know. Or if I know that I have somebody that's going for a CT scan and I know what's going on with the family, I'll say, Listen, if you get a phone call from Mr. So-and-so, just call me and I'll take care of it because I'm already in mesh and I don't want you to have to figure out, you know, going through everything and figuring everything out. It's just easier for me to handle it. Um, is does the same hold true for the VA when you get like something like that, you know, after hours, maybe it's not a lab, but maybe it's, you know, one of the diagnostic imaging?

Jason Gleason 26:32

Yeah, they're pretty good. You know, at the VA system, we don't have call. Like we're not on call in the evening hours or anything like that. Okay. But uh let's say a patient goes to the ED at the VA hospital and they notice a critical value, they'll call the provider or the call center and then they'll put a note in the patient's chart. So the first thing in the morning, we can look at that. But in the meantime, they'll also that provider will call the patient and check on them themselves and determine if they need to go to the ED or not. You know, so usually like if if a critical lab value came back on, let's say routine health screening labs, something came back as a red flag, an emergent condition, the lab person would then call the ED provider and the ED at the hospital, and then they would call the patient and determine, you know, triage, do you need to come in? Is this something that can wait and those kind of things? One thing I would say though is because some people out there will do it, some knucklehead out there will do it, they get a call on their phone and it's from their organization that they work for, their healthcare facility, and they don't answer it. I'm off, I'm not gonna answer that, I'll take care of it in the morning. You know, I do expert witness work, and if you have a critical lab value and that lab tech is trying to call you about it, you know, after hours even, it is no defense to say, yeah, I was off. You know, that's no defense, right? And that lab tech is gonna testify that, you know what, I tried to call five times and they never replied back at all. Nobody called me back. So I did my job, they did not do their job. And in this day and age, you cannot say, well, I didn't know they even called because everything is tracked on your cell phone. So if you get a call, answer the phone. Answer the phone. That's right. The other thing I would recommend, Vanessa, this is such a good topic. For new NPs out there, or let's say you're moving to a new community, go to the radiologist because they live in a cave, a literal cave, for hours out of the day, a dark cave. That's they don't have much interaction with other human beings, right? Except their family and maybe a few colleagues. But go to them and say, hey, I'm I'm new to the community, I'm a new nurse practitioner, I'm launching into this practice at this clinic. You know, I just wanted to introduce myself, put a name to a face, and can you tell me how do you handle those critical things? Who do you notify? Can you tell me your procedure for doing that? That would blow them out of the water. Because number one, nobody ever does that. We lose sight of personal connection these days. Everything's texting, right? Go and introduce yourself. You would gain so much respect in that community. And if you have the respect of that radiologist, because you want to keep them as your buddies, right? Because they're gonna call you, they're gonna be in contact with you. And so introduce yourself to them. Go to the lab and introduce yourself to the lab manager and say, hey, I'm new to the community. I'm so happy to work with you. Can you tell me what do you do after hours if something comes back with one of my patients? I just want to know what the process is. And it's so good to meet you and thank you for the work you're doing. You'll garner so much respect. You'll blow their minds out of the water. They will respect you so much.

Vanessa Pomarico 29:14

What a great suggestion that is. Perfect. So I want to talk about the 80-20 clinic template upgrade. Um, we had mentioned that in a couple of the other previous um podcasts, but I'm wondering if either one of you would want to talk a little bit about the 80-20 clinic template upgrade and whether that's something you do with the VA or you don't. Hi, Chris.

Christopher Gleason 29:38

I'm gonna have to divert it.

Jason Gleason 29:39

Yeah, I'm not familiar with that, Vanessa. Yeah, I don't.

Vanessa Pomarico 29:42

So what it does is it actually it's the um your favorites list, your orders list, your dot phrases, your your common plan templates. So it's kind of things that we've already talked about. You know, you have a template for hypertension, you have a type template for diabetes follow-up and that kind of thing. And having the um the visit flow checklist. So that's like the intake, you know, whatever the particular exam plan is going to be, um, your education and your follow-up. And again, a lot of that is sometimes it's already built into the electronic health records. So the majority of it is you, and then maybe the other 20% of the template um might be something that you pull in from um, you know, from the common template information. So one of the things that we have in our particular area is uh let's say you have somebody that's coming in that has um diverticulitis. And rather than having to write everything out on your own, there's a little bar uh under patient education, and you just put in diverticulitis and it comes up in every conceivable language that you can think of, which is really great. Yes, it's wonderful. And I don't have to recreate the wheel, it just makes it a lot easier. And I just have to put that in and it automatically puts it in. So when the patient checks out, they have the patient education piece there. And you could do it for anything. I mean, you can do it for diabetes, although we do have a diabetes educator, so I don't use that a lot. But like somebody with gout, um, migraines. Um, we even have um a list that has uh the local, um, all of the mental health providers in our area that are accepting new patients. It's updated regularly. So I don't have to keep typing everything out. I just have to put in my initials, psych, and it automatically populates. So it's 80% of what I'm doing and 20% of what I'm pulling in from other resources, which is really, really helpful.

Jason Gleason 31:38

Wow. So I love that. What a great concept!

Vanessa Pomarico 31:41

Thank you. All right, you know, time to play my favorite game, factor fiction. Are you ready?

Jason Gleason 31:46

We have prizes yet. Where are the prizes yet?

Vanessa Pomarico 31:49

We don't have swag yet. We're gonna have to talk to the uh to our admins about the swag, but we're gonna have to get that. Just for now, just know that you walk away a winner.

Jason Gleason 31:58

Yes, there you go.

Vanessa Pomarico 32:00

Pat on your shoulder, Christopher, a good template can improve both speed and quality. Fact or fiction.

Christopher Gleason 32:06

Fact. Absolutely fact.

Vanessa Pomarico 32:08

Jason?

Jason Gleason 32:10

Oh, fact, totally.

Vanessa Pomarico 32:12

Good. All right. Copy forward notes are always safe if you're busy. Fact or fiction.

Jason Gleason 32:18

Fiction fiction. Yeah, that is a huge trap to fall into. Yes, it is.

Vanessa Pomarico 32:23

And why is that? Because we really didn't touch on it um much at all. But can you talk just a little bit about copying and forwarding notes?

Christopher Gleason 32:30

Well, it can be a huge liability issue for one, because if you're copying a note from another patient's chart into um, not copying not from another patient's chart, but if you're copying from one visit to another visit, there could be things in that previous visit that you didn't even discuss in that in in the new visit. And there could be information that you know didn't even didn't even get um reviewed. So in in that in and of itself is a liability issue. Especially if those charts are ever reviewed and taken to court.

Jason Gleason 32:57

And once you start that habit, because all of us are pressed for time, right? We know why people do this, they're not bad people, it's just we're pressed for time. But once you start that habit, you're gonna miss something. You are that's right.

Vanessa Pomarico 33:08

And did you ever read a note from somebody else? And I love this when I'm reading another note and I'm thinking you just copy and pasted everything and it didn't make sense the first time.

Christopher Gleason 33:18

Yeah.

Vanessa Pomarico 33:18

Yeah. All right. How about buffer time is a luxury, not a necessity? Fact or fiction.

Christopher Gleason 33:25

That's fiction. I mean, I I think there's a lot of places that you're not going to get that buffer time, unfortunately, but I I do think it's a necessity. It should be, yeah, absolutely.

Vanessa Pomarico 33:35

And it should be. We all are due our admin time. We should not have to be doing any work on our own time because we're not getting paid for it. And that's, I think that is uh a standard that we it's becoming a standard that we need to break because it's been allowed for so long that more people have to negotiate that buffer time into their into their schedules and into their contracts that they're going to get it. Now, whether you decide you want to, if you have your protected admin time and you know a patient needs to be seen and you want to take that admin time and put a patient in there, that's entirely up to you. But it should be a hard stop on your schedules for sure. Yep. All right, one more. Macros can reduce errors when used intentionally, fact or fiction.

Christopher Gleason 34:19

Fact.

Vanessa Pomarico 34:21

Right. So macros are the, you know, in the templates, sometimes they have what they call macros. Christopher, are you familiar with using macros? Do you use them in your templates?

Christopher Gleason 34:30

I don't use them in my template currently. Um when I was previously working in um family care, we had them though.

Vanessa Pomarico 34:37

You did. So sometimes they're built in, um, and it can actually help to reduce some errors if you're using them correctly. Excellent. All right, so we're gonna do some audience QA here, and I invite you to send your questions to nplaunchpad.fea.com. And that uh that address is also up on the screen here, but it's nplaunchpad at fhea.com. Please send us your questions, your comments, um, and uh we would be happy to answer those possibly in a future uh podcast. So I have a couple of questions here. What part of your day burns the most time? Is it charting, inbox, refills, or rooming and workflow? Christopher.

Christopher Gleason 35:20

I think it's a combination of um charting and inbox, to be honest with you. So we have we don't necessarily call them inbox at the VA, we call them alerts. And we can get inundated with them. And it's basically all your lab values, it's results from imaging studies that you've had done, uh messages from patients, kind of a conglomerate of all of those things, and that can be very, very time consuming. But charting can be time consuming as well. And that's why I really, really advocate for using your using those templates, using those stop phrases, because that can really save, be a huge time saver for you.

Vanessa Pomarico 35:53

So true. All right. If you could build one perfect template or macro, what visit type would it be for? Jason.

Jason Gleason 36:00

I I Oh, I would say the ones that I use use most often are the annual visits for men and women, right? Yeah, because they're so they're so different. Diabetes, hypertension, hyperlipidemia, mental health is a big one. Because in in in the template, I think the most important part about your template is your review of systems when you're creating it for different health issues, whether it's mental health or physical health, because you don't want to miss anything. And I use that review of systems as a reminder during the visit so I actually don't miss a thing. So those are the templates I use most often.

Vanessa Pomarico 36:33

Excellent planning for you.

Christopher Gleason 36:36

So I use one for that's an annual template, and I tend to use that for not only my annuals, but I'll I'll utilize it as a as a base template for my new patients as well. But I also have one that's just an urgent care kind of a follow-up visit. That way, that one's less in detail, and it just is very, very focused. And I I think that saves me um a huge amount of time because I'm not having to recreate the wheel each time.

Vanessa Pomarico 36:59

Exactly. And it's so important again, especially for our new providers who are listening, that they really do understand the tips and tools of the trade. And these are the things that are gonna help you survive, especially those really busy days. Absolutely. All right, so we have a couple of take-home tips today. So the first one, you're gonna your homework for this week is gonna be to build two starter templates, which we just talked about, a new patient and a common follow-up. Maybe it's a follow-up on hypertension or a follow-up on diabetes, and then test drive them in your clinic during the week. You want to also create a one-page workflow map. Those are things for refills, labs, and referrals. And again, it's just to help streamline your day to make it flow a little bit easier. And then think about building, if it's not already in your electronic health records, a three macro starter pack. So that would be like an upper respiratory infection, a hypertensive follow-up, and maybe a med refill. And then try to iterate that weekly so that this is how you start to build your template library, if you will. So build that usable note template and test it at some time during the next clinic day. So before we close off this particular episode of NP Launch, we're going to ask that you go to the five-star launch, drop the five stars if you think we did a good job and we hope that you did. Hit follow, tap subscribe, and then share this. This is the most important part. Share this with another nurse practitioner or somebody's thinking about becoming a nurse practitioner who might need a little bit of help, and maybe they need some solid guidance on how to navigate the whole process of clinic workflow and for templates. So that's a wrap on this episode of MP Launchpad. Thank you again for joining us. And be sure to tune in for our next episode when we talk about one of my favorite topics uh negotiation and offers. So until next time, thank you.

Christopher Gleason 38:53

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