EP 13: Team Playbook — MAs, RNs, Front Desk, Care Managers

In this episode of NP Launchpad, we break down how nurse practitioners can build and lead an effective clinical team from day one. Learn how to collaborate with medical assistants, RNs, front desk staff, and care managers to improve workflow, reduce burnout, and enhance patient care. Our hosts share real-world strategies for setting expectations, running productive team huddles, and creating a supportive practice environment. Whether you're a new graduate or transitioning into a new role, this episode delivers practical tips to help NPs thrive in team-based clinical practice.

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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 0:31

Welcome back, everybody, to NP Launchpad. This is Jason. I'm here with my friends Christopher and Vanessa, and we are thrilled to be with you once again for another episode. Thank you for tuning in. We we don't see you as uh an audience out there, but really as friends and colleagues, and that's that's where we want this podcast to go. We want to equip you with our stories, and and boy, do we have some stories, don't we, Vanessa? Yeah, Christopher. We have a lot of stories. I have to say, during our last episode, I think half of us needed Zyprexa afterwards. What a downer that was. What a downer that was. Would you agree? Yes. Yeah.

Vanessa Pomarico 1:03

Yeah. Thanks for signing that one to me, Jason.

Jason Gleason 1:07

And you're usually pretty happy. You're the optimist out of all of us, right? So, but no, it was a great episode. I hope our audience out there got a lot out of it because I certainly did interacting with the two of you. So, in this episode, we're going to talk about something a little lighter. Teamwork makes the dream work, right? Yeah, teamwork that really works for you in your office when you get launched into your practice. You know, how do you set up your team and different roles and responsibilities? And this is vital to know. So I really want all of you out there to pay attention to this, especially if you're going into a new practice, because not only to set up your team to see what flows well and works, but because you may not have a team out there when you start a job. Because some clinics, some organizations out there see you as an NP and also as the nurse, right? Completely different roles. So if it make sure during a job interview, I would say step one is to make sure you actually have a team. Ask them who am I going to be working with? Because there are some expectations out there. Well, you can do it all. You can check in the patients, see them, you know, do all the case management work that you need to do, and and you know, get them out of the office all in the same same visit. So make sure you have a team to work with. I would say that's step one. What are your thoughts on teamwork and team building, Christopher?

Christopher Gleason 2:18

So I think one of the key things is making sure at least for my practice. Um for my practice, when I'm working with a team, I make my I make sure my team knows that I'm not above them. This is this is a team. They're not my patients, they're our patients. You know, and and I think that's really key because you don't want the your team thinking, well, you know, for my instance, you know, Chris won't do this because he's the quote unquote provider, you know, and he and having them think that you're above, you know, doing whatever task it is. Because if you truly are a team, then you should work as a team. And if you're if your nurse is busy and you can you can do you know a y X, Y, and Z task, then do it. You know, it's not it's not a huge thing. I mean, obviously for providers, we're very busy. We have uh, you know, a lot of things on our plate and things like that. We need to remember that so do our other team members.

Jason Gleason 3:07

Kicking things off, Vanessa, do you have any advice on this topic?

Vanessa Pomarico 3:11

So I I I agree with Christopher. You know, you just everybody works together as a team. I don't care how much education you have, we're not better than anybody else. We're you know, nobody is beneath us and nothing is beneath us to do things. And and I make that very clear, you know, when I'm working with somebody new, if my medical assistant is out. But you know, Christopher, it's exactly what you said. You know, like if my medical assistant is drawing blood and I need to clean my room, I'm not gonna wait for her to finish drawing blood, stupid. Do all that. I clean the room and get it ready for the next patient. And you know, and she appreciates little things like that. Well, what does it take me? A couple of minutes to do it? It's the little things, and and again, being able to, you know, really talk about your expectations. So if you're working, let's say your medical assistant is out or your nurse because the two of you are so spoiled, um, your nurse is out on vacation and you're working with somebody new. It's always good to say, this is kind of how I like my um my schedule to run. These are the things that I'd like to do. So let's kind of talk about how we can make this work so it's easy on you because it's got to be hard for you to walk in and not know what to expect with a new provider. And that just really kind of sets the tone for the whole day.

Jason Gleason 4:21

Yeah.

Christopher Gleason 4:21

And I think that's one reason to in the morning to have huddles. Like I really like having huddles on my team. Yeah. If you have, you know, whether you have a medical assistant, you're working with a nurse, either way, just having just sitting down with them, running through your schedule for the day and saying, hey, you know, is there anything that I need to know about these patients? But it when you're doing that, it kind of builds the expectation for the day. And you know, on our previous episode, we talked a little bit about difficult patients. You're able to kind of read through them and say, hey, this there's a difficult patient here, you know, what are your thoughts on this? Um, is there something specific they need? Things like that. So I really think it's important for team building to have that huddle in the morning.

Jason Gleason 4:58

Yeah. You know, one thing that comes to my mind that I always find myself needing to work on, and it's a little subtle thing, but it's the little things that matter, like you said, Vanessa, is our language and how we how we speak about our team, right? So, and all of us as healthcare providers do this. We refer to the nurse or the the RN or the LPN that we work with or the medical assistant as my nurse, right? Or my medical assistant. That kind of gives this negative vibe of well, you don't own them. I'm they're not ours, right? And you don't mean it that way, but to them they might pick it up that way. So what I've what I've tried to break myself or break the habit in myself of doing is rather than say my nurse or my medical assistant, I'll say the wonderful medical assistant I work with, right? Yeah, because they really are their own individual um, you know, professional on your team. And and it's those little subtle things that make a big difference, I think. So, but it it's a work in progress. All of us have different things we need to work on. I want to remind our friends out there that if you want to connect with us, there's a great way to connect, and we love to connect with all of you. We've gotten some great feedback and excellent questions. So please reach out to us and how do you connect with us? It's easy. nplaunchpad at fhea.com, and we read every single comment and question that comes in. So please, please email us, stay connected with us because we want this to be a two-way relationship. Not just you out there listening to our podcast and hopefully you're getting a lot from it. We want to hear from you because we learn from each other, and and some of your uh thoughts and some of your questions we'll certainly share during the podcast. So thank you for tuning in again and please interact with us and connect with us. So, to our hot topic discussion session, let's talk about some hot topics today. Um, better and a little more uh uplifting than our last episode, I hope. But uh topic one, the clinic orchestra. Who plays which instrument on your team? The medical assistant, the registered nurse, the LPN, yourself, the person up at the front desk that does your scheduling. When you look at that, what kind of um orchestra do you have in place at your clinic, Vanessa? And how does that work? How does it gel together?

Vanessa Pomarico 7:01

So, uh, you know, we're in a state of flux right now. We've had some turnover in staff, and we've had uh you know people filling in from other offices. So it's been a little bit disjointed. But you know, as Christopher mentioned, that morning huddle that sets the tone for the whole day. And we we really once you do that huddle, it can be like a well-oiled machine because everybody knows what their roles are. But they also we've got some really dynamic um medical assistants who are MA2s, they're on the MA2 ladder, they've demonstrated leadership skills. And so they they then will step in and they kind of take a look if we don't have a manager on duty that day. They kind of like make sure that things are running the way that they should, or you know, I'll come out and if the medical assistant I'm I'm that who's assigned to me every day, if she's busy doing something, I'll come out and say, when she's done, could you just let her know that so and so needs labs? And someone else will say, they'll look and they'll say, Oh, will you go and help Vanessa or will you bring so and so's patient in? And so I think everybody realizes that their instrument that they're playing is equally as important.

Jason Gleason 8:07

I love that. I love that too. Equally as important, right? And they each have a role to play, each of us do. I love that. We all do.

Christopher Gleason 8:13

And I and I have to put a plug-in for the clinic that we work with because the nurses that we work with are absolutely amazing. Outstanding. They really will pitch in at any time. You know, if they need to be in the lab, they'll do they'll go to the lab. They've they've oftentimes gone to uh other clinics to help out, things like that. So they they really are a great team.

Jason Gleason 8:31

And I think in part that's because leadership does so many things, modalities in place to build relationship and connection among the team members, which is so wonderful. And and you may not work in a place like that. Let's say you you work in a place where morale is low and people don't work well together. Well, guess what? You can be the light in that situation. Bring up some ideas to leadership and create those teams, you know, that that positive vibe in an institution, because it only takes one spark uh of uh optimism to do that. So yeah, you can be the spark for that. But we're we are very, very fortunate. We are. So, Christopher, tell us in contrast to what Vanessa shared about her team or orchestra. How does the orchestra look at the VA for your team?

Christopher Gleason 9:10

So for my team, um, as I spoke to you earlier, you know, I have an LPN, my I did that. You don't own your LPN? I don't own my LPN. I would I actually say I I would like to say I do own my LPN and my RN because they're amazing. So I do own them. Oh, listen to that. Listen to that. But the um the LPN rooms the patient in the morning. The RN is the case manager, so they really oversee everything, all the care that that is dealt with with a veteran. And then I the um we have amazing MSAs who do the scheduling for the patient, so any follow-ups and things like that. So, you know, Vanessa, you've you told us this before, we were very spoiled. We truly are very spoiled at the VA. It's it's an amazing setup. The packet model is an amazing setup, and truly I hope one day that we could take that model and migrate it into primary care in the civilian sector because it truly is an amazing model.

Jason Gleason 9:59

So and it shows because the outcomes that we see. Some our veterans are some of the best care patients in the entire country, or I would even say the world, and really have great outcomes because of that. Yeah, such a good resource. So definitely your orchestra plays an important role, and it's important to understand the different roles and what instruments people play. But I love what you said. One instrument is not better than the other, right? Absolutely, that's right. I did work, I did work with an NP once that worked as a nurse in the organization, and then she became an NP and worked at the organization. And someone asked her to do something, and her reply was, Oh, I don't do that anymore. Yeah, how do you think that went over, right? Not really. Yeah, so don't be that new NP out there because again, the instrument you play is no better than anyone else's. It's just a little different. It's a little different. And sometimes we even have to pick up the slack and and help out and play other instruments, you know, help the team out.

Christopher Gleason 10:48

So kind of touching on that a little bit too. I remember so I started my nursing career out as a CNA, so I was a certified nurses' assistant when I started out. And I remember working with RNs and the and having that sort of that had that sort of attitude that were, you know, well, I'm not gonna help you wash that patient because I am above that now. And I remember thinking as I kind of you know grew in my healthcare career uh field that I told myself I would never do that. I would never be above any sort of job, and I would never consider any task menial. Because, you know, it it's it's key to being a team player, you know? And it just really helps build a team.

Jason Gleason 11:25

Absolutely. Well, before we go on to our next next topic, and these will be in the show notes for you, but just some key discussion points for this section under this topic of the orchestra and putting together your team and understanding those roles. Number one, clarify the roles, like we talked about, that's so important. Other tools and tips that you can use, use standing orders and protocols where allowed to reduce bottlenecks is so important. Create a huddle rhythm, as Christopher and Vanessa mentioned, that's so vital to start your day off. And it doesn't take long, it can be two to five minutes, right? I I've seen two-minute huddles where just touching bass quickly can make a big difference for your day. Respect expertise. Like Vanessa mentioned, Christopher and I, everyone plays an instrument, and no instrument is better than the other. And we need every instrument to play their best in order to get the best outcome. So we need to be encouraging each other, and your tone sets the culture faster than your credentials.

Christopher Gleason 12:15

Absolutely.

Jason Gleason 12:16

How many of you out there, because and if you're being honest, all of us have had this thought in your DNP program, you're getting close to graduation, you've worked your butt off for this degree, right, as a DNP, a doctor, nurse practitioner, and you're thinking a little bit, I'm a doctor now. How cool is that, right? I'm a doctor NP. And and you kind of get that little little big head on you, and hopefully it deflates quite quickly because reality hits you in the face. But I I think that that's a possibility out there. And if you walk into somewhere like I'm a doctor now, I have all these credentials, a DNP, it it doesn't mean anything to the people you're working with, right? They're glad for you, they're happy you graduated, but at the bottom, at the end of the day, they just want somebody that's going to be a good team player and work with you. Have you guys run into that?

Vanessa Pomarico 12:59

You know, it's funny that you said that. Oh, I'm sorry, Chris.

Jason Gleason 13:02

No, go envy.

Vanessa Pomarico 13:03

So it's funny that you said that because when you were talking about, you know, getting so I don't have a DNP, I have an EDD, but I think it's true of any doctoral program. And you know, as a first generation American, you know, I'm the first kid in my family to graduate from college. And so my parents were really, really proud about that. But my patients, it was amazing. Like when my patients knew that I was going to school, how excited they were. And one of my patients in particular said to me, he used to own a book binding business. He I just saw him last week. And he he's 90-something years old now. But um, and I remember, you know, every time he kept saying, Don't forget, I'm gonna, I'm gonna bind your your your uh dissertation. And I was like, Yep, you you got it. And when he would when when I finally graduated and I had gone to his house because that's where his shop was, and he said, So I'm gonna call you doctor now. And I said, I'm still a nurse practitioner. I said, I'm still a nurse practitioner. And I'm I'm you know, so it like and even I don't even have my EDD on the on the door. Like when you walk into my office, all of the nurse practitioners, we just have A, P, R, N, FMP, or AMP, whatever the credentials are. I don't even have my doctoral one up there because I didn't want them to have to take it down and make a new sign just because of that. So you know, be humble about it, you know. And and again, like you said, you know, your tone is gonna set the culture, not your credentials. We are not we are nurse practitioners. It's great that we have that added degree, but don't get big headed about it. Yeah, no.

Jason Gleason 14:32

Celebrating that's moving on point. But I have to say, since Christopher here is graduating in 30 days for the last year, 30 days, 50 days. 60 days, excuse me. If he graduates, I would add. If he graduated. I've had to refer to him as Dr. Chris around the house. Oh yeah. It's horrible. Terrible. No, no. He's forced me to do that every day. Alright, Dr. Chris. It's Doxy, remember? Oh, doxey, I'm sorry. Doxey. Just like doxycycline. Yeah, exactly. And don't they use doxycycline to treat STIs, Christopher? Yes. It comes to mind. And funny my project was on that, but it was on that. It was on that. Shall we move on to our next topic?

Christopher Gleason 15:07

I just wanted to talking about have not having that big head on your shoulders. And I think one of the things that helped me in my doctorate program is the fact that I worked, you know, I had my master's first and I had my master's for gosh, what was it? It was eight years before I went back to get my my doctoral uh degree. And that really helped me because it kind of gave me that mindset when I was going into it that, you know, like you said, Vanessa, I'm you're still a nurse practitioner. You know, you it's great that you have that extra education, but don't get a big head on your shoulders that you have that doctor in front of it. You know, I always tell my patients, call me by my first name. You know, they'll they'll always ask you. Inevitably, you'll have those older patients that will call you doctor because that's what they know, and it's just, you know, you can tell them ten times over to call you Chris or nurse practitioner or whatever, but they'll inevitably call you doctor. But you know, really having that uh being humble about that, I think, is is huge. Absolutely.

Vanessa Pomarico 15:57

But that's also a sign of respect for a lot of patients. Oh you know, they they they want to give you that respect. But I'll just share something. You know, I I always go back to things that my parents said, and my mother always used to say, be yourself, because when you're alone, that's who you are. And that's so true.

Jason Gleason 16:16

That's very be yourself because when you're alone, that's who you are. I love that. I love that. That's our folks out there should write that down. That needs to be in our show notes. I love that. Yeah. I love that. So all right. So topic number two for this episode, delegation without dumping, how to hand off tasks cleanly to your colleagues. What would you do, Vanessa?

Vanessa Pomarico 16:36

So I you know, I I have no problem delegating because again, it's all in how you present it and sharing the responsibilities. And and it's and I always start off by when I'm interviewing a medical assistant and we're going to be working together, and I always say, you know, here are the things that I need to do, and here are the things that is an expectation of what the medical assistant to do. So let's talk about what you're comfortable doing. And when you put it back on them to set, you know, to give them feedback, then they feel like they're part of the conversation and it really is part of that teamwork. So not just saying I need you to do this, this, and this, but here are the things that I need to accomplish. What are you comfortable doing? And tell me what you're not comfortable doing so we could figure out what to do. So I happen to do a lot of gynecological exams and I take care of a very large LGBTQ practice. And some people, if if I have you know a float for the day, they may not be well versed in it. And so I'll just say to them, if you're not comfortable with this population or you're not comfortable doing uh, you know, a pelvic exam with me, I'll have somebody else come in the room. And again, when you when you acknowledge that there might be something they're uncomfortable or that they don't know how to do, if they say I don't know how to do that, I'll say, No worries, I got you. You know, uh all I need you to do is stand next to me so I can hand you everything. So that this way, right. And so that this way they're not nervous about it. I'm not gonna expect them to, you know, do anything in the room. I'm gonna take care of it, but I need you to glove up, put the caps on everything, and bring it into the lab. And so that kind of that kind of delegation really kind of de-escalates their anxiety as well. How about you?

Christopher Gleason 18:17

Christopher? So for me, I think um with delegation, it's the key to it is building that team. You know, we've talked about that previously, building that kind of a team vibe, you know, if as you were. And I think that's important because if you have that team team vibe, you're gonna be able to delegate and you're gonna be able to say, hey, you know, I'm really busy and I need you to do X, Y, Z. Could you could you handle that for me? And you know, nine times out of ten, they're gonna be willing to do that for you. But I also think when you're delegating something, you also have to be responsible in the in the sense that like for my RN. I see I did it again, my RN. I'm claiming her. We're training you though. We're training you. Um when you're you know, when I'm working with the RN, I will check in with them and I'll say, you know, are you at a point where you can help me with this? Or or you know, can I I don't really use the word delegate, but you know, can I have uh there's a litany of things that I have to do? Can you help me with this? Things like that. But I think it's important to check in because oftentimes they're they have you know a litany of tasks that they're accomplished accomplishing too. So please and thank you go a long way.

Vanessa Pomarico 19:22

Oh, absolutely.

Jason Gleason 19:23

Absolutely. Uh and and coffee, right? Buying coffee, donuts, all that stuff helps do, you know. Bribery, bribery goes a long way. I I would say, like both of you have have touched on communication is so vital when we're talking about this topic. Because let's say you know what you got to get done by the end of the day, and you're busy doing that. It's documentation and all the other things you have to do as an NP on that team. That's the instrument we play, right? But your team may not know all the responsibilities you have. And so they might be thinking in their mind, like, well, I really wish they'd help out with this. Look, they're just sitting on their butt there on the computer all the time documenting when in fact that's not the case, and often we're there till seven or eight at night still documenting if if we get behind. But uh really explaining the different roles, and what I like at the VA is they have this so well down, it's so amazing, and again, it's it's really a model for the rest of the country, is they have training. Like when you when you're a new nurse or a new NP at the VA, you go through team training and they have binders, and here's your responsibilities as the NP, the RN, the LPN, the MSA, it's all spelled out, and it's not a job description, it's actual training. Like, how do you share this with each other and how do you build the team? And and I think a lot of organizations don't do that training from day one, and I wish they did because it would help so much. But I think that's and again, we are spoiled, or we have everything, we have all our ducks in a row at the VA, and we have our challenges too. But I think teamwork is so vital as we've been talking about. So, communication I would say is the number one priority, though. Open communication, so you so you you fully know what each of you are doing on the team. Otherwise, people have the room to kind of think, well, gosh, they're not doing this or they should be doing that. Just be clear and open, yeah, and honest with each other.

Christopher Gleason 21:02

So I think one of the things that helps with delegation in the VA situation. Sorry, V, I know we're spoiled. But we in my situation, I actually sit um in kind of a uh desk of four formation. So the RN's across from me, my MSA uh my again. Anyways, my MSA is across from me, uh LPN's next to me. So I'm able to have those kind of those conversations throughout the day, and it just makes it so easy for me because I'm able to see what they're doing. Right. And I'm able to say, okay, I need this task done, but they're in the middle of 12 things too. So either you can delay the task a little bit or find time to do it yourself.

Jason Gleason 21:40

You know, one thing I hate about our open pod though, the open pod is great for team building because it's easy communication all the time throughout the day. But including myself, many of us have Nerf guns in our drawer, right? And so we will have a Nerf gun fight occasionally. And and I I play they sometimes play dirty, and instead of shooting it up at the ceiling. And it hits the ceiling and then comes down on you. Sometimes they've been known to shoot under the desk. And you can imagine what injury that would cause. So yeah, but Nerf guns in an open pod are not the best thing sometimes. But again, open pods are great. Vanessa, do you have an open pod at your practice?

Vanessa Pomarico 22:15

So we we have a very unique um office. We are in the basement. They call it the garden suite, but there's nothing yet to be found. Yeah, the garden suite. If you look out one of the windows in the corner, you might see a weed growing. But anyway, so we have we have an um the providers, uh, four providers, we call it the dormitory, share um an inner office, and then our medical assistants are all in the central area, and that's more for patient flow. So we have all of the medical assistants in the center, we have our um two checkout people that are on uh at a desk or a checkout desk on the side of that, but they all oversee one another. So it's a really great setup for them so that they can say, like if if my medical assistant, and I'm saying mine because you know we we work as a team, if she's on the phone doing a prior authorization, she will she'll hear that you know, our our receptionist has checked in my patient and she'll say to somebody else, could you bring Vanessa's patient and I'm doing a prior off? And so they have that allows them to have better communication. There's no Nerf guns allowed in our office, but they do have better communication. Come on. Yeah, no.

Christopher Gleason 23:24

It's a great stress for the thing.

Jason Gleason 23:26

I think it'd be fun even funner if we had squirt guns. Wouldn't that be fun? That'd be a blast, wouldn't I imagine? That would not go over well. Let's scrub in the patient room, probably not a good idea. So key discussion points under this topic number two to take home, and this will be in your show notes, is delegate with clarity what you want by when and what to do if something is abnormal, and also seek the the uh clarifying points from those other team members what they want from you as well. It's a two-way street, right? Use closed loop communication, that's so vital, and confirm the message was received and understood by your team members, and and they should use that with you as well. And then create standard work, refill protocols, result routing, and referral checklist. That's so important. Vanessa, on lab results or x-ray results, do you call that the that information to the patient or does the nurse you work with, how does that work in your practice?

Vanessa Pomarico 24:19

So I'm not a prince of the VA. We don't have nurses. Um I'm gonna have to get you crowns. So what happens is all the results come to me first, and then if it's normal, if I had a chest x-ray, then I'll just send it to the medical assistant to say, please call the patient. Chest x-ray is clear, no pneumonia, follow up with me in a week. Um if it's something else, you know, like something abnormal, then I usually will call the patient myself.

Christopher Gleason 24:47

Nice. Very nice. So I'm kind of curious, Vanessa, in your practice, if you have like a critical lab value, uh, is that called to the person that's on call at night?

Vanessa Pomarico 24:57

Yes. So so we get we got a they have a multi-system uh check. So what happens is the critical lab will come to our inbox. I'm seeing patients. I may not get to my inbox for an hour. I do check it in between patients, but they also will call the office and say we have a critical value, and then after hours, whoever the person is on call will get the critical value. And so, yes, when I'm on call, I do get woken up in the middle of the night and have to fire up my computer. But we don't fortunately we don't get a lot of them.

Jason Gleason 25:26

That's a good thing. Yeah. So here's a tip for our listeners out there, and I I found that this has worked very, very well and it covers yourself from a liability standpoint as well. With closed loop communication, of course, I'm talking verbally with my team throughout the day, but nothing beats documented communication, right? And so let's say I have a patient where I need to have records sent to a specialist that I'm referring that patient to. What I will do is I'll finish my note, sign it, lock it, you know, in your system, but then I'll do an addendum on the note, and it in that addendum it's a brief paragraph, and I'll put uh team LPN, team RN, whoever I want it to go to, and I'll write in there, please fax these records, specify specifically what you want done, right? Communicate clearly, please fax these records and actually call that office, talk to the nurse, not the receptionist, talk to the nurse or that provider, and let them know the fax was faxed to them. And this is on important stuff that you don't want to miss, right? And then I'll finish that off with please document in the record when that was done. And then you you put that in the system, you sign it, you lock that, but then you also have to don't forget this part, this is vital. Make sure you CC that person on that note so they know it's in there, right? That has to be done. And then let them know, you know, I I put this little reminder in there. Because you can do reminders and different EHR systems have those, but those can be missed. But usually a progress note addendum, that'll never be missed unless they until they sign it, right? And so that that just covers your butt out there and it makes sure that things don't get dropped. So that's what I do. Any special things like that that you do, Vanessa?

Vanessa Pomarico 26:57

Uh no, so we pretty much do the same thing. Um, once we fax something over, then I or if the medical assistant calls a patient and I'll say, you know, a follow-up or I want to order such and such a test. And if the patient, whatever the patient outcome is, the medical assistant documents that. So we have it in the medical record to say the patient declines getting whatever test, um, the patient doesn't want to take the medication or whatever it is, or when they fax something, if it was received, then they automatically put it in there once I've sent the order off, and they'll document um patient called, patient notified, you know, office notified, referral done. Um so we're closing all the loops.

Jason Gleason 27:43

Closed communication. Very good. Well, two last uh take-home points here, and again, this is in your show notes, so you don't have to write these down. Avoid drive-by orders, incomplete instructions create rework and frustration, obviously. And then lastly, if you delegate, remember you still own the outcome. You still own the outcome if you delegate. So again, documentation is follow-up is vital. I want to touch on that just a little bit.

Christopher Gleason 28:06

One key point do not take verbal orders or do not give verbal orders if you can help us. The um that just that just opens you up, uh opens up a can of worms for you. So that's right. The always if you have orders for your uh for your nurses, for whoever you're working with, yeah, make sure to write them down.

Jason Gleason 28:23

Yeah, absolutely. Good idea. And a good nurse on our team, they won't do the order unless it's written down. And they will drive me bananas, like, okay, I'll get to it. Nope, you must do it now, otherwise I'm not doing it. Yep. Right. And that's how we work. I mean, it's teamwork, teamwork, right? And they do talk to me like that because I'm not anything special, right? They're respectful, but but uh but yeah, so they they will tell you a good nurse or MS or MA that you work with will insist that it's written down before they do something just to cover them and it's it's good care, right? Nothing gets missed. All right, so topic number three for this episode building trust fast, respect, clarity, and gratitude. How do you show gratitude to your team, Vanessa?

Vanessa Pomarico 29:04

Uh well, like you said, donuts always help. Um so but you know what, uh every day when I come in, I say good morning to everybody. Before I leave at the end of the day, I obviously, you know, huddle with my my medical assistant before I leave, but I say thank you to everybody. I always say thank you at the end of the day to everybody so they know that I appreciate them. Um, you know, sometimes we'll buy them lunch, sometimes we bring I tend to make a lot of cakes or just treats just to say thank you. Uh and they really do appreciate things like that. Um sometimes, you know, we'll um you know go out like we had a bowling night where you know our manager brought everybody bowling for the night. So we try to do we don't do it a lot because let's face it, people have their own lives and they spend the majority of their day with us. So they don't want to be with us after work.

Jason Gleason 29:50

Um, right? Yeah.

Vanessa Pomarico 29:52

Right, right. But you know what? Sometimes and they've told us this that when we go out after work, everybody lets their hair down. You know, that you can see them in a completely different light. You know, you're not in your scrubs and your your lab coat, you're in regular clothes, and you can have normal conversations, and we're not talking about patients. And and doing that a couple times a year really goes a long way. Like our staff really likes our holiday party because we always go to a restaurant, we get a room, a private room, and we sit in a square so that everybody gets to look at everybody else. We don't sit at one long table because then you can't see what the other person's doing at the other end of the table. But we sit in a square or a U shape, and then we get up and everybody rotates. So you're not talking to the same person. I love you. You know, but we yeah, and that was actually one of the medical assistants made that um that suggestion. So those are those are the things that I do to show gratitude. And sometimes I leave little love notes. You know, if somebody's having a bad day, I mean I've ordered these little things online and they're little cards and it has a little saying on it, might have a little, you know, a little heart or you know, a little charm or something. And and if they're having a bad day, I just leave it on their desk when they're not looking. And so they, you know, those are the little things I do to show the gratitude. I I try to surprise them, but they always go, Oh, Vanessa did that. That's very how do you show gratitude to your to your staff?

Jason Gleason 31:12

Chris does a great job at this with his team.

Christopher Gleason 31:14

Um actually it's the same thing as you you do, Vanessa. Uh at the end of the day, I always make sure to thank uh my team. Um on um on our team, the LPN leaves at you know uh four four o'clock. So before she leaves for the day, I always make sure to say, hey, thank you for all that you've done today. Thank you for all your assistance today. And when the RN and I leave at the same time at 4 30, I always make sure to stop them and say, Thank you so much for your help today. It was truly appreciated. But I also have this habit of when I go on vacation somewhere, I'll bring back my team little trinkets. Like this last time when I was um came back from a cruise, I went to Florida. I I saw these little change purses. I don't know what they're gonna use them for, but I thought they were cute. So I brought back change purses for them all. They just said Florida. And had some sort of screen uh scene on them.

Jason Gleason 32:01

So I mean you could bring them a cup of sand back. It's it's it's the thought, right? That goes into it. Yeah, it's wonderful to do and it's the little things. It doesn't take much, right? Yeah, so very good.

Vanessa Pomarico 32:13

The other thing that I do too is that you know, if we've had a very difficult patient or if the medical assistant has gone above and beyond, I will thank them. But then what I do is I write an email to the practice supervisor.

Christopher Gleason 32:26

Yeah.

Vanessa Pomarico 32:27

And I CC the medical assistant, and I just want the practice supervisor to have it documented. You know, hey, this is what happened. They went above and beyond today, and they really saved me. So that's that's always really very, very well received.

Jason Gleason 32:41

That's a big deal, and it actually can be worked into their annual reviews and all of that. Yeah, exactly. It really counts for something. And the VA has eye care as their program to recognize, you know, colleagues, and it's wonderful. Yeah, and and really it's a it's a serious thing to do. So yeah, very nice. So when you screw up, and all of us screw up out there, and our listeners out there, you will screw up. You will screw up. How do you remedy the situation? How do you make nice when you screw up? But what what do you do, Christopher?

Christopher Gleason 33:10

Apologize. I mean that's the big thing. Take take ownership of it. If you've made a mistake, and like you said, all of us make mistakes, yeah. Um take but take ownership of it. If you've made a mistake, go to that person, say, apologize, say, you know, I'll work I'll work on you know being better in the future, things like that, but definitely take ownership of it. Yeah.

Jason Gleason 33:29

Any thoughts on that?

Vanessa Pomarico 33:31

Just be authentic in that apology. They're gonna know if you're not being authentic, but just say, you know, I'm so sorry. Thank you for so much for saving me. Um you know, but thank you. I appreciate it. You know, it's because of you that nobody got hurt or something didn't break or whatever it is, but be authentic.

Jason Gleason 33:48

Absolutely. Yeah, being because they'll pick up on it if you're not, right? Yeah, yeah. Same thing here, you know, when when I screw up and it's like, oh, the first thing I do is I analyze it. Like I don't I don't overthink it, and you don't want to be hard on yourself, but when you screw up, own it, right? That's step one. And and and ask yourself, well, why did I respond that way? Why did this happen in the first place? And learn from it. Otherwise, you're gonna repeat it. That's number one, I would say. And then apologize, be upfront, and and in real time. Don't let things fester for three weeks, right? But real time. Recently in this last year, I did screw up with one of our staff because there was a misunderstanding and miscommunication, honestly. And I and I was a dork about it, honestly. And um, and I'll tell you what, the very next day, that that colleague, that friend of mine, because I I see my colleagues at work as friends, she had so many plants on her desk. I wanted to buy a T-Rex because it looked like a jungle, right? Yeah, it was crazy. A little T-Rex could come out. There were so many plants on her desk because she loves plants. But but just apologize, be real, authentic. We're all human beings, and and we all recognize that each of us screw up, especially when we're working with people for 40 hours a week. We see them more than we see our family. There's gonna be tension in those moments where you disagree or you just have an argument or you're having a crappy day and you don't respond the way you want to. But make sure you own it and don't. And here's a big piece of advice to our listeners out there: don't just wish it away and pretend like it didn't happen because things will fester. Things will fester and that'll destroy your team. So open and then be easy on yourself because we all mess up. We all mess up and plants and donuts and and little trinkets, they'll help.

Vanessa Pomarico 35:22

So yeah, that's right.

Jason Gleason 35:24

All right, so say thank you out loud when someone else saves your day. We talked a lot about that. Own mistakes quickly, we mentioned that. Give credit, share wins, and protect staff from unnecessary blame. Again, stand up for your staff and advocate for them. One thing on that that I find myself falling into, though, is you don't want to be the person in your office where you know you're reactionary because the people around you will know that you're reactionary and they'll go to you with any little complaint or kind of bitch session that they have, any little complaint or concern, because they know it's gonna upset you and you're gonna be very reactionary, and you're gonna go to the top, and you're gonna be the advocate for anybody in the clinic. Don't become that person because that's all you'll be doing all the time. So you got to pick your fights and advocate for people when there's real purpose to it, but don't be that person where everybody comes to you and complains, and then you take it further because you get so upset and you're gonna fix the system and you're gonna fix everything because you're not gonna fix anything. Have you ran into that, Vanessa? The fixer in the office?

Vanessa Pomarico 36:21

Yes, and and I found myself that all of them, all the staff were coming to me when they weren't happy with something, and I would always say, You need to go and speak to your provider, you have to work with them. You know, I'm I'm very big on heading things off with the pass. I don't like things to fester. If, you know, if we all have bad days, we all have days where we're off, and my team knows that. You know, that if, you know, like you know, I'll I'll just give you an example. When I was in my doctoral program, I was stressed. I was working full-time, I was still the the uh program director for the nurse practitioner program at the university, and I was doing my doctoral degree, and I was taking care of my parents who had a lot of health problems. So, you know, there were days when I was not the best person. And I recognized that when things were stressed, I'd come in and I'd say to my team, I'm gonna just tell you today I am not myself, my dad's in the hospital, whatever, so please just bear with me. And that transparency really turned the tables because they knew that my mood wasn't dictating what they needed to do, but they had more empathy for the fact, like, okay, we're gonna give her a little bit of grace today. Yeah, you know, so you're human. I all of us are yeah, we are, we're human. Yeah.

Jason Gleason 37:32

The nurse, the wonderful nurse that I work with, register nurse, she is amazing. I've never met a nurse like her on the planet. She really is solid and just a wonderful human being. But I noticed that she's a little owl in the morning, and she actually told me, you know, before 10 a.m., I'm a mama grizzly. And you just gotta know that about me. And so if I have a lot of questions, I don't want to bombard her, and and she it works her butt off before 10 a.m. as well, right? But I know that if I have something sensitive to bring up to her, I gotta ask her for some some favors throughout the day to help with some some patients, I know after 10 a.m. is the time I need to wait. And and it's just her, right? Every everybody has their their issues and and little quirks. So yeah, so finding out who the what the quirks are of your teammates, that's so important. Because you spend, again, probably more time with those you work with than your your own family, even. So yeah. So a strong team is the best burnout prevention strategy. Would you guys agree about that? Absolutely. Yeah, absolutely. Yeah, excellent. All right, so resources to share on air, and these are in your show notes. These are great resources for you out there. Again, they're in your show notes, so you don't have to write this down. But check out the Agency for Healthcare Research and Quality, Team Strategies and Tools to Enhance Performance and Patient Safety. Team Steps, they call it, they refer to it as it. And there's the exact website that you can go to. It takes you right to the link. I'll tell you what, the AHRQ website is fantastic, tons of information, but you can easily get lost in that. So the benefit of these this information in the show notes is that this link will take you directly to what we're talking about. All right, my favorite part of our episodes fact or fiction, right? Fact or fiction. Are you all ready for this one? So ready. All right, let's talk about this. Vanessa, let's let's head it up with you first. Clear role definitions, reduce errors, and reduce burnout for the whole team. Fact or fiction.

Vanessa Pomarico 39:23

Fact. Everybody knows what their duties are, and everybody knows you know that it's time to pull together as a team. When you when you share the burden, there's less likely to be burnout.

Jason Gleason 39:34

Love it. And what a song that can be played from that orchestra, right? When all the instruments are tuned in. So excellent. All right, Christopher, you're up. Are you ready? Here we are. Are you ready? Ready to be to win no prize. No prize for this. Delegation is unsafe because the NP is responsible for everything. Anyway, we've got to do it all.

Christopher Gleason 39:54

That is absolute fiction, and it is a uh fast way to burnout, to be honest with you. If you're not able to delegate your some some of the responsibility and share the workload, then you are going to get burnt out very, very quickly.

Jason Gleason 40:04

Know your team, know their weaknesses and strengths, but do not become the micromanager, I would say, right? Absolutely. Yeah, burnout is is coming up for you. All right, Vanessa, back to you. Front desk workflow problems can create clinical safety issues.

Vanessa Pomarico 40:18

I say fact to that because there's that ripple effect. When there's an issue at the front desk and somebody doesn't pick it up, it's gonna have that ripple effect all the way through the team.

Jason Gleason 40:29

Absolutely. Absolutely. Our next segment is one of my favorite, the mail drop, because we have an opportunity to connect with you, our friends and listeners out there. This is where you can send us any comments, questions, anything that you want us to share on air. We may share it on air. So please connect with us at nplaunchpad at fhea.com. That's how you reach out to us. We have two questions in our mailbag this week. And the first one is this where does teamwork break down most in your clinic? Messages, refills, referrals, and rooming? Christopher.

Christopher Gleason 41:04

I think it can potentially be um all of them. I mean, if you're not communicating clearly with your team and and closing that loop, then there's a potential for any any one of those things to have a breakdown.

Jason Gleason 41:16

Excellent. Vanessa, anything to add to that?

Vanessa Pomarico 41:19

Yeah, I I agree. You know, especially when you're short staffed or you have floats who don't know how the workflow, they don't know the templates, you know, that's where things start to break down. So as the provider, it's one more stress that we have to constantly police our schedule, you know, or police our inbox and and make those changes. So again, transparency and good communication is going to be your best friends.

Jason Gleason 41:42

Great communication. I think that's the theme, if you guys would agree, of this episode is communication is vital, right, to all of this. So yeah, clear communication. And then how do you delegate without feeling guilty or like you're dumping work on others? That's another question we have. How do you delegate without feeling guilty or like you're dumping work on others?

Christopher Gleason 42:02

I would say that the big thing is um just remembering knowing your own limits, for one. The at some point you're going to have to delegate responsibility to somebody on your team. Because if you don't, again, it kind of, you know, touching what we said earlier, it leads to burnout. You cannot be that sole person in the team and and expect to be able to do everything and not expect to delegate any sort of responsibility, because if you do that, that will truly lead to burnout. B, what do you think on that?

Vanessa Pomarico 42:30

I I agree with you, Christopher. I don't feel the least bit guilty delegating. You know, that's part of being on a team, that's part of their job, but just speak respectfully and set the ground rules from day one that it's an expectation and there'll be no surprises. But you know, again, be respectful.

Jason Gleason 42:47

Respectful. I would say, and I think our audience will agree, our listeners out there and our friends, that those people pleasers find this one very challenging because you're afraid of confrontation. Yeah. So I would say the first part of this is to analyze yourself, ask yourself, boy, is this an issue for me? Because usually you know it, it's probably something you've dealt with your whole life, you avoid confrontation. Because you see even a simple thing like asking somebody to do something for you to delegate as a confrontation, and it really isn't, and the other person doesn't see it that way, but you do. So kind of check yourself, analyze you know what you think about stuff and and why you respond the way you do, and I think that would be really helpful. So yeah, don't be that people pleaser to the point where it limits you know your functionality on your team because your instrument's gonna be out of tune, right?

Christopher Gleason 43:29

And one thing I would add to that too is share delegation when you can. If you have if you have multiple people that are on your team that can do the whatever task you need them to do, then then share the wealth. Don't don't always give uh delegate to that one person. Yeah. They're just gonna get um overwhelmed and burn out as well.

Jason Gleason 43:48

Well, coming up to our wrap up, the landing checklist, so to speak, for this episode. We got some more information here for you. Three take home tips. So here are your tips, and again, these are in your show notes. Define Rolls for refills, labs referrals, and messages in writing. Work on some of that. Start a five-minute weekly what's breaking huddle and fix one thing about it that you could fix and make it easy on yourself and your team. Clarify who does what for refills, labs, referrals, and messages. If that's not already being done, work on that. You can be the light in your office, right? You can be that spark of optimism that changes an entire organization. That'd be wonderful. Your homework for this week, ask your MA or RN that you work with what slows them down most and fix one thing together. I love that homework. I think that's I'm going to do that this week. Yeah, that's amazing. Ask your MA or RN what slows them down. Just one thing and how you can fix that together, to work together to fix that. I think that's great. And so as we close, I got to ask you for a favor out there. I mentioned we love to connect with you. We want this to be the best podcast in the entire world, obviously, because we want to be helpful to you and we want to connect with you. You are our friends and colleagues out there. So if you think we deserve five stars, and I hope we do, please drop five stars. What does that do in the podcast world? That that boosts the podcast invisibility, right? So more people can know about it, they can uh tune in, they can hopefully get a lot of information from it from us that's helpful, and they can also share and connect with us. So drop five stars for us if you think that we deserve it. And if you don't, please email us at nplaunchpad at f. Also, this is so important. Hit follow, tap subscribe, and most importantly, most importantly, please, and I mean this from the heart, share this podcast with your NP colleagues and friends or physicians or other healthcare professionals, because we all learn from each other when we connect, empower, and inspire each other. So thank you so much for tuning into this episode. And one last thing, who doesn't love to save money? And I'll tell you what, this is a great deal. If you go to our website and you use the code when you're purchasing any continuing education through FHEA, Vanessa, is it NP LAUNCHPAD20? I think that's what it is, right? Yes. If you use that code when you're when you're checking out, you will save 20% on continuing education products through FHEA. So please take advantage of that. Amazing savings. I know that it's very useful to all of you. Who doesn't like to save money? So all right, everyone. Well, we'll catch you next time on our next episode. See you later. Have a great weekend.

Christopher Gleason 46:23

Bye, everyone. Thank you.

Jason Gleason 46:25

Thank you.

Voiceover 46:28

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.