EP 17: Inbox Zero(-ish) — Labs, Refills & Messages

What is the best way to stay on top of administrative communication as an NP? In this episode, our hosts teach you how to keep your cool when messages start piling up—and how to ensure your responses are both quick and error-free. You will learn how to maintain patient satisfaction and trust, work synergistically with coworkers, and keep lines of communication clear. These tips are perfect for those who struggle with time management, clinical accuracy through written communication, and logistical organization. 

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Transcript

Speaker 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. Welcome back, everyone, to NP Launchpad. This is Jason and my good friends Vanessa and Christopher, and we are here again, your colleagues and friends, to help you along launching into your first job as an NP, or if you're a nurse practitioner switching specialties over to a different one and you're starting fresh, we're here for you. And we're your friends and colleagues. We're so delighted that you're with us again and that and truly honored. Honestly, each one of us, you're so honored that you've chosen to spend this time with us because your time is so valuable. So this episode that we're gonna talk about the inbox 101. Everything you have to know about messaging with patients, with staff, managing your emails so you don't miss anything. It's a big deal, especially with all the technology we have out there now and patients messaging messaging us all the time. And then uh, you know, those emails that you never want to miss from your organization colleagues and friends as well. So we're gonna do a deep dive on the inbox and how do you manage your inbox as a new NP coming into a practice. So, Vanessa and Christopher, how are you doing? I am doing well. How are you, V? I'm doing great. Thanks. This inbox, though, the never-ending inbox. I'm telling you. I am telling you what. Crazy. So let's dive right in here. So I want to let you all know that if you want to interact with us, and that's so important because we are so excited to get your feedback, your questions, anything you need from us, reach out to us by emailing nplaunchpad at fhea.com. That's nplaunchpad at fhea.com. So a quick disclaimer for y'all out there, and we mentioned this at the beginning of every episode. We are here as your friends and colleagues. We're not here to give you clinical advice or legal advice. We're here as your friends and colleagues. So if you truly have clinical questions or if you have um, you know, legal matters that you need advice on, seek out professional help. We're your friends and colleagues here providing you with a lot of good education that's hopefully helpful to you. So our hot topics, let's dive into these. So the first hot topic we have is the inbox triage, urgent today versus needs a visit versus delegate versus I would add, throw in the trash right away. So let's talk about this. Vanessa, how do you manage your email box and your messaging from your patients? Tell us about it. So I will say that it has gotten much better. Um we have a medical, we all have a medical assistant who's assigned to us. And the medical assistant that I work with on a regular basis, she is the one that goes through and will kind of sort things out as they come in. So she'll send me um prescription refills and that goes into a different inbox. Uh, some of the other messages, you know, if it's something that the patient needs an appointment, she takes care of it and doesn't even send it to me. Um but then we have the ones that the patients send the messages with the pictures and they don't want to come in and they think that I can diagnose this rash and an unidentified part of their body with some really bad pictures. Um and those are the ones that it's like, you know, you just need to come in for this. So they triage a lot of it out. But, you know, on the weekends, if I don't check on Sunday night, and this is just me because, you know, we all know Monday mornings are usually really busy and we hit the ground running. So I like to go in on Sunday night, do my refills that came in over the weekend, look at any of my results and send them to my uh medical assistant so that all of that is out of my inbox so that I'm start Monday. Yeah. Now, how many hours on Sunday night do you go in? Like how long does that take? I don't I don't work for hours. Uh, you know, I might have mentioned this in a previous podcast. My notes are closed at the end of every day. It is a rare, rare time that I don't close. If like I leave the office and I'm waiting for a result to come back, I might leave my note open, like like a chest x ray or something that I'm I'm gonna leave open. But 99.9% of the time my notes are closed. So I usually spend about 45 minutes on a Sunday night uh just going through everything. And and it's really sometimes it's a lot less than that. It all depends on what comes in, you know, over the weekend. But that's just because I like to start my Monday fresh and not feel like I got all these things that came in on Friday and it's gonna take me an extra 45 minutes to an hour. I love that. Now, now, Christopher, you go into the office early too, don't you? Yes, yeah. So um I go in about 30 to 45 minutes um early in the morning, and that's really helpful for me because I'm able to go through my alerts, look at them, say, hey, you know, I have to address these right now, but this, you know, this may be able to wait, or this I can um delegate to my RN or what have you. So and it's actually really helpful for me. Yeah. Yeah. And you know, during our last one of our previous podcasts, I think it was two podcasts ago, we talked about the importance of delegation and the orchestra, and everybody has an inch like is an instrument in the orchestra and allow the instruments around you to play. Don't take all this on yourself. I love what both of you said. You know, delegate some of this out to your team members because they're certainly capable of doing that. And and I I do that on my team. I'm so grateful for the registered nurse I work with. And at the VA, some would say we're spoiled because of the model we have, but thank goodness that model's in place because it works so well and it's such a great resource, and we need it, and it really is a best practice model for the rest of the country. Every provider at the VA in primary care, at least our clinic, and most of them out there, it's it's the model of care is you have an LPN that checks in your patients. We have an RN that does case management, managing all the messages, those kind of things that come in, and a lot of other case management work. And then we have a MSA, who is the administrative person who does the scheduling and and kind of triages patients as far as the schedule goes. And it's such a great format. But on my team, the registered nurse does a lot of the messages, and then she she collaborates with me throughout the day. She sits right next to me, and so in real time, you know, she's asking me about different messages that come in or she'll forward them to me. Our messaging service, one thing I I love about it and I hate about it because it drives me bananas, but it keeps me on task, is that the VA, if you don't answer a message within such a certain amount of time, like a day or two, it escalates. And if it escalates, it goes up to administration. And you don't want that. So then you get a nasty. Yeah, it'll give you little verbs. You know, this message is about to be ready to be escalated, so you better jump on this. So I I love that too. So nothing gets missed or lost. So it's quite a good system. I do the same thing with my team. My RN is um, I work really closely with my RN. Uh she does a lot of the triage um when messages come in. If it's something that really needs my attention, she'll, you know, she'll stop me right there, then and there, and say, Hey, you know, this really needs your attention. If it's something that can wait, she'll send me a message in Teams and just say, hey, this is just a heads up sort of thing, which is extremely helpful. Oh, it's vital. Right. Excellent. So let's talk about some key points when we when we think about messaging and email services and those kind of things. And all this is in your show notes, but let's go over a few key things here. So key recommendations that the three of us have come up with that we'd recommend for you is number one, sort your messages into three bins if you can. If your system allows you to do this, urgent today needs an appointment. And if you don't have email, like because you'll you'll you're if your desk is like mine, you get messages on the computer, you get post-it notes, you get you know, letters that you have to read off paper. There, there's an assortment, but make sure you have some kind of organized system so you don't miss a thing. And especially urgent or today, you've got to handle this right now. You don't want to bury that or miss that in any way. And then know what the garbage is and hit delete right away and get rid of those so they're they're off your desk, they're out of your email box. So sort your messages by priority and then create standard response windows, same day for urgent, 48 to 72 hours for routine. Set the expectations, and I would say even let your patients know, you know, what those windows of time are. And a lot of practices will do that, like we'll get back to you in 48 to 72 hours, that kind of thing. Um, and I would also say with messaging, when you're setting up your messages and telling patients about it, please don't message me that you're having chest pain and shortness of breath, right? Yeah. We don't want that. You need to go right to the ED, right? And I always hear that disclaimer when I call my provider, and I hear on the messaging service for the phone, you know, if this is an emergency, don't call us, go right to the ED. It's so important you delineate that with your patients as well. Any thoughts on those key points, Vanessa? Well, we what we have, which is one of the nice things, is that when you go to message your provider, it automatically comes up and it'll say non-urgent message. And then when you click on that and you choose whatever provider from your team, uh, let's say they they so they select me, it will say, this is for non-urgent matters. The clinician will get back to you within 48 to 72 hours. And I mean, I've had patients that have emailed me in the middle of the night on a Friday night. Well, after five o'clock, I am not in my inbox unless I'm on call. Right. And and then and then they start escalating it. You know, you haven't answered me, you haven't answered me, you haven't answered me. And by Sunday, now I'm getting really nasty messages. And I normally will wait until Monday morning because I'm not going to feed into that behavior. Um, because if I call them on a weekend, then I've now set the precedent, like, well, if I escalate it enough, she's gonna answer me. So I wait until Monday morning and then I call and say, I received all 25 of your messages. Um I'm exaggerating, but it can be as many as 10. Yes. Um, and uh, and our messages are truncated. They can they can't put missives in there, they can only put a certain uh word count in there before it cuts them off. But then what they do is they go to the next one, you know, and then you get the next one and the next one. Um, but then I'll just say to them, you know, please remember if it was something urgent, we have somebody on call 24-7. You could have called us Friday night for this. Um, and just remember it says, as soon as you click on there, it says this is for non-urgent. And I am not sitting at my computer at two o'clock in the morning on a Saturday night waiting for patients to message me. Because some of them think it's like, well, your phone is next to your bed. Do you not hear it beeping? Right. No, because when I'm not at work, I shut all of my alerts off for work. Yeah. But patients think that, you know, because everything else they can get at the touch of a button. Well, Vanessa should be at my my best room call for the touch of a button. 24-7, right? Exactly. I worked with a provider once and she gave out her personal cell number to all our patients. Never, ever, ever. Even if you think it's a sweet old grandmotherly type that'll never call you, never give it out. Absolutely not. Because patients do abuse that. And then again, they're not bad people. It's just, well, I got this resource. Why don't I use it? You gave me your number, right? Don't ever do that, ever, ever do that. Have any of you ever ran into the therapy? I would I would call them the therapeutic writer, where writing to you the long diatribes of emails is therapy for them. And you can obviously tell that there's a lot of mental health issues going on in these notes, you know, and they just blow up our email. Any have you either of you run into that? Yeah. And that's um, luckily my RN kind of diverts those for me. If there's if she has any questions, I mean, obviously she'll approach me about it and we'll have a discussion about it. But um, yeah, I have I have a a few patients that will write, you know, three, four pages worth of information. And the crazy thing about our our uh message system is it doesn't have a cutoff. So like yours V is, you know, whatever your cutoff is, whether it's two hundred and fifty words or whatever, ours that they can keep going and going. Ours could be another series of the Harry Potter series. Yes, exactly. No, no, no. You know, I I I lose interest after about the first paragraph after that. It's like this is too long. You need an office visit. Please come in and see us. We want to talk to you about your important concerns here. And again, these people that write us like that over and over again in long messages, they're not bad people. And some of them have really good points, and some of it is therapeutic for them. Like they want it, like us, whenever we write a letter and then we delete it, we don't send the letter we'd like to send, we send the one we should send. You know, same thing for our patients. But yeah, make sure you set limits, I would say. Never give your phone number out to patients. And then we talked about this in a previous episode, I think two episodes ago. If a patient tries to approach you on social media, do one of two things. Never respond. That's the best. And I think you recommended that, Vanessa and Chris, for you agreed last time. If you do respond on socials, make sure you do it appropriately. You cannot even mention in a message that you're messaging someone back on socials that you're their provider. You can say something very vague like, you know, in my role at such and such facility, I cannot talk to you on this platform. Please reach out to me in another way. But you can't even imply that they're your patient because it's not hippoprotected communication, right? So just be careful out there, set your limits, I would say, and maintain your sanity, right? Maintain your sanity. Right. Yeah. You know, I just want to make one mention. You mentioned about the the the uh don't give your patients your cell phone. Um, very recent in December, I actually had a patient call my cell phone. And I thought, why are they calling my cell phone? And so I immediately called. Yeah, I was very angry because, you know, I spend a lot of hours at work. There's enough time during the day, and when I'm on call for patients to reach me, they don't need and I'm thinking, how did they find my cell phone? Little caveat for our listeners out there today. My IT guy got on there and he said, Your cell phone is all over the internet because when I was applying for um during for my dissertation, and when I had to go through the IRB, I had to have a phone number on my application. But once that phone number is out there, it can be replicated. And I had to pay a scrubber to get rid of my all of my information. And I I'm now gonna have him do it every few months. It's sad. You know, you usually have an attorney on retainer. I have an IT guy on retainer. But he he actually scrubbed it so that my cell phone doesn't appear anywhere. And I don't have a house phone anymore. So uh the only time, like if you if you Google me uh will come up um is my work number. So and my staff is, you know, they're good about, you know, um obviously not giving it. But but do be aware of that, that your cell phone can be on uh the internet and that gives patients carte blanc because they'll Google your name. And if that's the first thing that comes up before your office, you're kind of screwed. So get a scrubber. Yeah. And I would say Google yourself, see what's out there. Because many of us don't do that and we're horrified. And one thing I would touch on too with you know so socials and your phone number, it can be a huge safety issue. If patients can find you, I mean, if you have a patient that has um has a grievance with you for whatever reason, and they have your cell number or they have, you know, your your social media contacts, it can be a safety issue. So you want to make sure that you're protected that way too. Well, and here's a real world example of that. In our community a few years ago, we had a patient that uh saw a surgeon once, post-operative operatively did great, but still had some chronic pain. And this patient had obviously some mental health issues as well. So he did find out where the surgeon lived and he intended to go to the surgeon's house and kill the surgeon. Well, the surgeon wasn't home, thankfully, but unfortunately his wife was home. And this gentleman took his wife hostage in the house at gunpoint, but she was like a ninja. She kicked him right in, you know, in the naughty parts and got out of the house immediately. Well, he proceeded to burn down their house and then shoot himself in the head in their yard. So that that's the most horrific story I've ever heard about somebody finding out your address, but it can happen. So protect your information. I would, like you said, Vanessa, I'd even pay an IT professional, a service out there. And you hear them advertised all the time, these services that can scrub the internet of your information. I would sure invest in that. Yeah. And just Google yourself, you know, make it a habit, maybe once a year, Google what information's out there on you and and definitely know that because there is a lot of stuff out there. All right, let's go on to another hot topic here: preventing errors and refills and results management. When you get a lab value back, and let's say a patient is messaging you through the the protective messaging service you have with your patients, the secure messaging, what system do you have in place to release information, to review lab results, those kind of things? Any novel tips that you give our listeners out there? So in terms of refills, we have a um we have a kind of a rule in our office that we don't refill medications and we don't give out narcotics uh after hours. So when the office is closed at five o'clock and then we are on for the weekend, we do not refill them. Now, there's always extenuating circumstances. You know, you have an elderly person, they ran out of their diabetes medicine or the mail order didn't come in time. Can you call it to a local pharmacy? Those are extenuating circumstances, but um though those are our refill rules. And in terms of labs, you know, remember 100% transparency for our patients. They think that we're up at two or three o'clock in the morning when they get those results in there. And and I have to, we have our answering service that now says, if this is routine labs, you'll have to wait until Monday morning for your provider to call you. And and we hold to that. We I I've only had a handful of times, and one was very, very recently where a patient uh called at 2:30 in the morning and I was on call and they said, I just got my labs and I need to talk to somebody. And the answering service said, you'll have to call on Monday. And they gave the answering service such a hard time that the answering service said, We've worked with them long enough. And I said, Could you please, I'm sorry to wake you up, but could you please talk to this person? Well, if you're gonna wake me up in the middle of my sleep, you're gonna know that I'm not gonna be happy, especially for something that's routine. And so I had to fire up my computer, and of course now the lights are on, and now I'm wide awake at 2:30. And I'm looking at it, and of course, it was the MCHC was was uh abnormal. And the patient was completely unglued about this MCHC. And they said, When I when I got on the phone, I said, uh, I understand that, you know, you want to talk about your labs. And they said, Yes, I'm very upset about this this lab result. And and I Googled it, and it means that I have some horrible type of cancer. And I said, Oh, you're killing me. Right. And so, you know, though that's an extenuating circumstance, but that's really where we have to have these rules in place so that patients can't call us in the middle of the night and think that we're going to just entertain them because it's a convenient time for them. Right. Right. Here's a question in that scenario. Did you then prescribe her some trazodone so she could sleep on a more regular basis? What are you doing out in the middle of the night looking at your labs, right? Yeah, like and I, you know, I very nicely the patients said, well, you I'm sure you saw these results come in. And I I have to remind people that our our our electronic health systems are not a crystal ball. So when patients come in and say, Well, everything should be in there, right? Well, no, because if your provider's not on my electronic health records, I'm not going to see it. And again, when I'm on call, it's not like I'm wide awake waiting for somebody to call me. We're sleeping. We're sleeping for emergency. And when you call our answering service, it actually says, and most answering services will say that this is for emergencies only. So when I get somebody that's calling because they have an abnormal MCHC, I say to them, you know, this is for emergencies only. Could you tell me what it is that you're so upset about? Um, and you know, again, they think that instant gratification, that's the biggest issue we have in this country. Yeah, they have to know. Yeah, exactly. Right. Exactly. Yep. I think one of the problems is too, and we touched on this in a previous podcast about the um the act that allows patients access to their medical records. And a lot of times now we have patient portals that, you know, they they have the result before we do sometimes. Yeah. Or have at least have looked at it sometimes before we have. And that can cause real problems. I mean, if you're doing if you've done a CT scan because you're you're questioning, you know, some sort of abdominal carcinoma and the results come back positive for that and the patient reads that before you even have a chance to read it, that can cause some real issues. It sure can. Yeah, absolutely. So close the loops. Every abnormal result needs documentation of action and patient notification. What system do you have in place, Christopher, so you make sure that that happens, that you close the loop. I think mostly um it's talking with my RN because if I have if I have labs that come back that are really need my attention, she'll definitely reach out to me. Um one of the great things that we have in place too, and I know we're spoiled, V. Um if we have a lab that comes back um at night that's a an abnormal lab, and a significantly abnormal lab, there's um there's providers that are on call and they'll actually touch base with our patients, which is huge. And we'll get like we'll get notes, which helps to close the loop on those. So Well, within our VA system, those calls actually go to the emergency department. Yeah. To the provider that's working, you know, which is so nice. Which is so nice. So close the loop and make sure you document all of that in the record, because if it wasn't documented, it wasn't done. Um use two identifiers to reduce wrong patient errors and refills and results. Do you do you follow that premise, Vanessa? We do. Um, you know, any abnormals, I usually will call the patient myself. And as I'm talking to them, I'm typing my telephone encounter so that I'm not wasting time and I'm doing it as you know, I'm talking to them and I'm I'm not distracted from what they're telling me, but I'm just typing everything in there so it's all documented. Um, because let's face it, you know that it's a never ending inbox. So we have to make sure that everything is documented, but and that's pretty. Much of what we do. And then if I send normals to my medical assistant to call, or if it's, you know, let's say I started a patient on a statin and I I want them to repeat their labs, I'll say, you know, tell the patient labs are stable, stay on the same dose, repeat the labs in however long. And then she documents her telephone encounter. So and then I have to double sign that. She'll send it to me for double signature. Double signature. Now when a patient's messaging us, that's pretty easy because it's obvious who it came from and it's documented, you know, the return address and things. But when you're calling a patient, how do you identify that you're speaking to the patient or their family member that that's legally able to speak to you on the phone or to review results with? How do you verify that the patients who they say they are conscious? I always verify uh last name and date of birth. I always ask them for last name and date of birth. Yeah, and that's pretty basic. And I I know I do that too, and we're really good at documenting that. Start your note off with that. Even I would say, you know, when you do a phone call to a patient for results, that I confirm their identity by, you know, whatever way that you did that, make sure that that's documented. And Vanessa, any tips on that? Same. You know, I I know my patients pretty well like you guys do. But um, and most of the time when I'm calling, I know if I'm calling the you know, the child or the significant other or whatever. And I always say, could you just verify the date of birth? Um in the beginning when we had a when electronic health system first came out, patients were like, why are you asking me this? Nobody ever asked me this before. And I think now it's just it's you know, we've been doing electronic health records for so long that they get it. And so I don't get a lot of pushback. But the same thing, date of birth is usually what I go by. Which is very nice. And at the VA, we're pretty stringent in the sense that um we in their demographics, we actually have a list of family members that we're allowed to share information with. And if they're not on that list, and and we've run into this where you know you might have a a daughter, a son, a sibling that wants the information, they live out of state, so maybe they forgot to get on the list. And it's like, sorry, we can't share that with you until you get on this list. And it's an easy process. They just request that the patient, you know, call in or something and ask that that happen. But yeah, we're pretty stringent about who we share information with. So and and I would say, especially for sensitive tests, like you would never call a patient, you know, with an STI result, for example, and not definitely confirm who they are, you know, and that you're getting that information to the person that really needs that information. One of the other things that I would suggest too is um that if you're even if you call and they say, well, I'm, you know, so-and-so's significant other or I'm their child or whatever, uh, you know, go ahead and click or look to see if they're on HIPAA. And I have no problem saying I really need to speak with the patient because I don't see that your name is on here and legally I'm not able to speak with you. And don't be afraid to just say, just have them call me when they come in. But don't assume just because it sounds like, you know, your nice 92-year-old, you know, woman and her significant other, oh, just that's okay. You can give me the message. No, I can't. Yeah. Yeah. So you have to stick to it. Sorry, your husband has syphilis, and you probably do too. Even though you're 92, right? It's on it's on the rise in the older adults. It's right. It sure is. It sure is. Yeah, so always be careful with that. Let's move on to our next segment, fact or fiction. This is where we have a game trying to test each other's knowledge. Fact or fiction, Christopher, you are up to bat. Most inbox overload is a systems issue, not a personal failure. Fact or fiction. Fact and I would almost say some fiction a little bit. And the the only reason I say that is because the onus comes back to the provider at some points too. Sure. If you're not, if you're not staying up to date on your on your inbox or your alerts or what have you, and you have those, you know, those urgent alerts that come in that you're not addressing, then that actually falls back on the on the provider. Excellent. All right. So, Vanessa, regarding medication refill requests through messaging, a ref a refill protocol can reduce both workload and errors, fact or fiction. Fact. Absolutely. As we just talked about, having a protocol in place is really going to help decrease the amount of work you have to do, but also any errors that can go along with it. Absolutely. And train your patients well. Train your patients well on all of this stuff. And then, Christopher, patients should be able to message you anytime and expect an immediate response. You'll drop everything, or it's 2 a.m. You'll wake up gladly and take their call. That is absolute fiction because I'm sleeping at 2 a.m. I would say we need to uh forward. So is V. Well, I would I was gonna say we need to forward all calls to Vanessa. Forward all calls to love that impression. I really enjoy being woken up at 2 o'clock in the morning. She would torch us right then, right? Yes, yes, indeed. So my sleep is very important. Absolutely. Well, let's move on to our mailbox. And we call this the mail drop, and we are so excited about this segment because we get to interact with you out there, our friends and our colleagues from across the country. Please email email us with any comments and especially any questions you have. No question is dumb. We we appreciate all of them. And some of them we may actually read on air. So nplaunchpad at fhea.com is where you want to send any comments. Or if you have a question for us, please send that in and we'll likely read it on air. So here's two of our questions that we received this week. How many portal messages do you get on a typical day, Christopher? And what's your biggest inbox bottleneck, Vanessa? So typical messages in a day, it depends on what you're talking about. If you're talking about from our secure message service, that can be between 10 to 20. Not bad. However, if you're talking about our alerts that come to us, which is our lab results and things of that nature, that can be upwards of 50 to 70. It's pretty intense. I cleared 150 uh alerts out one day. But yeah, but direct messages from patients, I think there's like 10 to 15. Vanessa, what would you say number what's the number that you get? I think you're asking me on a bad week because yesterday, I think I had 14 messages when I went into work. Oh, wow. 14. And that and I cleared out on Monday night. And so by Tuesday morning I had 14. Um, and I think by the end of the day, I could be upwards of 25 to 50 messages a day. Yeah. That's tough. That is tough. You know, one important factor we didn't bring up is with messaging, and I know at the VA it's built into the system that our EHR is that you can actually bill for messaging too with your patient. You have to make sure you follow all the rules, don't commit fraud, but if you meet the criteria, you can actually bill and generate income. So make sure that your EHR uh system is doing that for you, and they give you different options and you code it and everything at the end. But yeah, and then another key tip, I think, to messaging with your patients is our EHR gives us an option, save this to the medical record or not. You always want to save any messaging with the patient to the medical record, just to protect yourself. So those are key things here. All right. So another question what's one message you wish you could automate because you send it 50 times a week? I probably send it 50 times a day. Um I would say I would say, please call the office to schedule an appointment. I cannot address concerns via a my chart message. I I must write that at least 50 times a week. Nice, nice. Christopher, how about you? It says something similar. It's it's when um their routine routine lab results, routine results in general, and they want their answer now and not later. So it's a it's a simple message. You know, when I get a chance, I will look at your results and contact you as soon as I can. There you go. How about this situation where you you get a message, you reply, and then the patient's obligated to say thank you, have a good day. And then it goes on and on. And then you have to actually say, okay, you don't need to reply to this. Thank you. Right? Yeah, the niceties of life, right? Yeah, sometimes that drags it out. So I agree with both of you. I would automate both of those as well. So here's an important plug that we like to mention to all of you because we know as nurse practitioners and as human beings, we all like free stuff or discounts out there, right? So we appreciate all our listeners and colleagues out there. So we once again want to offer you the special code. So if you go to fhea.com and want to purchase any of the CE products, memberships, courses, anything like that, you can get 20% off the total cost of those. That's a big savings. Here's the code. Write this down, and it'll also be in the show notes for you. Launchpad 20, altogether, launch pad 20 for a 20% discount off all CE and memberships through Fitzgerald Health Education Associates by Calibre. That is our gift to you. So please use that code and share it with your friends as we want you to share our podcast with them as well. So as we wrap up, this is your landing checklist for this episode. Here's three take-home tips for you. Number one, set five inbox macros and a triage ladder. We talked a lot about triaging your messages. Urgent today, I have to handle this right now versus, you know, I can do this later in the week, or this belongs in the trash. Find some kind of method to really triage your messages, not only the electronic ones, but the post-it notes that show up on your desk, all the different things you have to deal with. Make sure you have a system so it doesn't get chaotic for you. Create a refill protocol with clear time frames and visit those triggers, it is important. And your homework for today is organize your email boxes to improve your efficiency. So work on that throughout the week. And here, I'd like to share this with you as we wrap up. Please do this for us. As I mentioned in the past, we we don't see you as customers out there or an audience. We we honestly we see you as colleagues and friends. We're here for you. We got your back. 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Thank you for tuning into this episode. We will see you at the next episode. In the meantime, reach out to us by nplaunchpad at fhea.com. Thank you, everyone. Have a great week, everyone. See you later. Bye, everyone. 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.