How to Give Feedback to Your Medical Assistant
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Show notes:
Have you found yourself needing to give feedback to your MA or support staff – with no idea where to start? You’re not alone. As an NP, your role is unique; you’re not the boss, yet you are expected to give some level of guidance and leadership. And when what a staff member is doing isn’t working, you are probably the person who is the most acutely aware and the most impacted. It makes sense that having this conversation would fall to you.
Let’s talk about how to give feedback to your MA or support staff in a way that is constructive, positive, and won’t leave either of you feeling like you want to crawl under a rock.
How to Give Feedback as a New NP
In this episode, we have a real-world example of a tough conversation with an MA – and a step-by-step approach for how to handle it.
We’re covering:
✅ A framework that will give you confidence when giving feedback
✅ The right time to have these conversations
✅ What to do when the conversation doesn’t go so well
✅ When to involve other team members
Being prepared is a major part of any delicate conversation. Learn these actionable tips before you need to have this talk so you can take away a lot of the stress – and get to the good stuff, coming up with a solution without feeling any of the cringe.
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WEBVTT
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Hey there, welcome to the Real World NP podcast.
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I'm Liz Rohr, family nurse practitioner, educator and founder of Real World NP, an educational
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company for nurse practitioners in primary care.
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I'm on a mission to equip and guide new nurse practitioners so that they can feel confident,
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capable and take the best care of their patients.
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If you're looking for clinical pearls and practice tips without the fluff, you're in
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the right place.
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Make sure you subscribe and leave a review so you won't miss an episode.
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Plus, you'll find links to all the episodes with extra goodies over at realworldnp.com
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slash podcast.
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So this episode, I'm going to be talking about how to give feedback.
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And this can feel like a very cringy, uncomfortable, awkward AF thing to do.
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However, it will get better with time.
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So what we're going to talk about is a very specific case that a nurse practitioner
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mentor that I'm working with brought to me and part of our conversation.
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And so the context of the situation is that she wants to give feedback to her medical
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assistant.
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A couple of things I want to say before we jump into like how to have those conversations
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with your support staff, whether it's a medical assistant, someone who works at
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your front desk, someone who works in the nursing department, etc.
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I just want to acknowledge that this is this is a skill and it takes a long time.
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Well, it doesn't necessarily take a long time, but it takes practice.
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And it's usually uncomfortable.
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It can be cringy.
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And the other complicating part is that when we are specifically talking about nurse
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practitioners communicating with their support staff, they are not necessarily their kind
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of quote unquote true boss.
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Part of our role is to give feedback because we are like directly working with them.
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And also, they have a separate boss.
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This is kind of it's been complicated.
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I found this a bit complicated myself.
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And just just very transparently, this is something that I am practicing.
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I'm not an expert, and hopefully I'm getting better and better at it.
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But what I want to share with you is like the example of the situation and kind of
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the ways to approach it so that you can feel more confident.
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And part of it that I really appreciate is that it's very structured.
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It's a very structured way of approaching these conversations.
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And you still have to practice them, right?
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So I just want to normalize that.
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And then the other thing I wanted to share is that like I didn't have to start really
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doing this until I started this company, Real World NP, because I'm actually the boss
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now, right?
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Instead of when I was a nurse practitioner, I wasn't truly my support staff's boss.
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So I didn't really feel like I had that like ownership to step into like full authority,
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right?
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And so again, I just want to normalize that this can be very uncomfortable.
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And also, there's a lot of mindset stuff in there where it's like people are just
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nurse practitioners are typically worried about like saying the wrong thing or
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Yeah, I mean, there's just like a lot of worries about it.
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So just want to normalize that.
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And also, there's a longer conversation that I had in an interview with Jackie Kindle,
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really dear friend of mine, who is an executive and leadership coach where we talk about
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how to delegate.
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So if you haven't caught that episode yet, definitely check it out.
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I'll put it in the notes below.
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But anyway, let's jump in.
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Let's let's jump in and get to some very pragmatic, practical specifics, right?
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And I'm going to take a peek at my notes if you're watching instead of listening
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to the podcast.
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So the example I want to talk about, this is what we talked about on our call.
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So very common situation.
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So this nurse practitioner works in a primary care office, and she is paired
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with a medical assistant.
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They work as a medical assistant and nurse practitioner team pretty consistently.
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Sometimes they switch and they work with different people.
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One thing that she's noticing is that this medical assistant takes about 15
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minutes to bring the patient into the room to get their history,
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do the medication reconciliation and the screenings.
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And some of the other medical assistants in her office are doing it in much faster time,
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two minutes, five minutes.
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So she wants to have a conversation with her medical assistant and talk about this.
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The other part of it is, and actually I should have clarified this, but
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the preference of the nurse practitioner and the perception of the nurse practitioner
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is that she's spending too much time on the history.
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And she gets a very thorough history.
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She's very thorough.
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But one of the things that she notices is that because of her licensure,
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she has to confirm this history.
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And what's happening is, number one, it's not only taking longer for the patient
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to get in the room.
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It's backing up the other patients.
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It's putting her behind for her next patients.
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And it also is causing frustration for patients because they ask this nurse practitioner,
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why are you asking me these same questions again?
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So it's not only a time, it's a quality issue all around
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because it's time for everybody and it's also frustration of patients.
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The other thing that I should have maybe clarified with this person is she said to me,
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I really want her to focus on medication reconciliation and screening.
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So I didn't clarify with her if she's not doing that currently,
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but I'll include both of those options, right?
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So if this sounds familiar, welcome to primary care.
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So I have to say again, just normalizing that it was very hard for me to have these
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conversations when I first started as an MP.
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And one of the things that I think we don't really realize until we're on the job is
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that we're not only thrown into the medical management of patients,
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but also we're thrown into this leadership role that
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there is some learning we can do to prepare ourselves.
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And there's also like a lot of practice on the job.
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So just let me know.
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Okay, so how do we approach this conversation, right?
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So first of all, deep breaths.
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It's okay.
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I think the first place to start is just recognizing that whenever it comes to
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either feed delegation or feedback conversations,
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there's like always assumptions, right?
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There could be assumptions on either side, other party's conversation, right?
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So just thinking, just being really mindful of like,
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what are the assumptions I'm making here, right?
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So I'm just going to make some up.
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If I was in this situation, this is what I would think.
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Like maybe, you know what, maybe this person,
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maybe this medical assistant thinks that I want a very thorough history.
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And that's the most important thing to me.
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Maybe this nurse practitioner, sorry,
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this medical assistant's favorite part of their job
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is to take this history, right?
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And have these conversations with her patients.
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Maybe this person could be
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realizing that she takes a very long time to room our patients
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and the history is taking a long time
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and she's not sure what to do about it, right?
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Those are very different perspectives.
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We have no idea, right?
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We have no idea where this person is coming from.
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So like, that's the number one thing to be mindful of is like,
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we just don't assume what the person is thinking
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or feeling or any of that stuff, right?
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So first, that step one is like, check your assumptions, right?
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The next thing is using,
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it's from the Center for Creative Leadership
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and it's called, there's a model that they use for feedback.
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So if you practiced as a nurse before,
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you're probably familiar with SBAR,
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that SBAR tool of handoff situation, background, assessment,
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and can't remember what the R stands for,
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recommendations, I think.
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So that's the handoff tool that we would use
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to communicate in the hospital when I was a staff nurse.
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So this is very similar, only it's SBI
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and that's from the Center of Creative Leadership.
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And so what it is, is the situation,
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the specific behavior,
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the impact that it had.
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So instead of SBAR, it's SBI.
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And then actually, I'm adding on an R here just to improvise
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because there's also a request.
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The other thing about the I is that it could be,
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after you get into impact,
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you can get into a conversation about intentions
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as well as request, right?
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So what does this look like, right?
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So the biggest thing that I've learned about giving feedback
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is that I'm kind of never specific enough.
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And I think that's just a learn through time of like,
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you're not going to get it right the first time
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and that's okay, right?
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When you get things back from people,
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you just go into, oh, okay,
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I was thinking that I was asking for this
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and this is how this person interpreted it, right?
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So you're not micromanaging, you're not stifling people,
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you're just being clear, which is kind,
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which is what Brené Brown says, right?
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So, okay, so let's get into this example.
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So here's a situation.
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So, and just also for context,
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when you're having these conversations,
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you have to do a separate,
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hey, can I talk to you for a second?
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Do you have some time?
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Beginning of the shift, end of the shift, right?
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Not in the middle,
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not in front of a lot of people,
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it's a separate conversation, right?
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Hey, I just want to talk to you about something.
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I had some questions for you
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and I have a request for you.
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And most of the time we can assume
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that people want to do a really good job.
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So I think if there's one assumption
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that perhaps to hold onto
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is just assume the best of intentions, right?
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Because most people assume the worst of intentions.
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I don't know if you've ever been receiving end of that,
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but it does not feel good, right?
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So we assume the best of intentions.
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This person really wants to do well,
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wants to work hard, all that stuff, right?
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So let's have some time, right?
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So you sit down, have a conversation.
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So, hey, you know, this is the situation part.
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So, you know what?
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Yesterday in clinic, all of our patients,
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or this specific patient,
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I noticed that by the time the person arrived
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and by the time they got into the room,
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it was about 15 minutes.
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You're very thorough in your history taking.
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And I noticed that you,
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for this specific patient,
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you can just start with that, right?
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You have very thorough history
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that you've taken on the person.
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You reconcile their medications
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and then you did their screenings.
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And that was, and those two things,
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medication reconciliation and screenings,
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that is like the most important thing to me.
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So that is so beautiful.
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And this kind of like, it kind of like,
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it's not always like one, two, three, four, right?
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So it's like, that's the behavior
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and the situation at the same time.
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So what happened though is that
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I got into my visit about 15 minutes late,
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which really impacted my visit
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with the second person that I was going to see.
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And what they said to me, actually,
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this patient that you roomed,
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because your history was so thorough,
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it was wonderful.
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And also one thing that I noticed is that
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because of my licensure,
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I need to actually verify all of the history.
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And so what ends up happening,
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even though it's really thorough,
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I need to actually re-ask the same questions again.
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And what happens is that the patients,
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that patient in particular reflected to me
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that they did not feel heard
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and they were frustrated.
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They're like, why are you asking me
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this question again?
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And then just like one other thing that I,
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this is a pretty common experience that I've had
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is that even when I have nurse practitioner students
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go in and take a history
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before I go in as their preceptor,
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the patients sometimes will withhold the full story
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until I get in there as the provider.
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And so let's just pause there for a second.
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So that's kind of like, and again,
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like I'm not like, I'm improvising here.
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This is an improvised conversation, right?
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00:11:34.200 --> 00:11:35.500
Which it can be improvised, right?
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So kind of in that situation,
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I've talked about the situation,
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the behaviors, the context,
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00:11:41.600 --> 00:11:43.680
and then I started to get into the impact.
250
00:11:43.740 --> 00:11:45.320
So the impact, right?
251
00:11:45.320 --> 00:11:46.400
It doesn't have to be one, two, three, four,
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00:11:46.480 --> 00:11:47.560
can all be kind of woven together
253
00:11:47.560 --> 00:11:49.280
as long as you're talking about those main points.
254
00:11:49.640 --> 00:11:50.680
So that really the impact
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00:11:50.680 --> 00:11:53.080
of you taking a very long, thorough history
256
00:11:53.080 --> 00:11:56.500
and taking 15 minutes is like bottom line
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is that it pushes the second patient,
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the next patient's back.
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00:12:00.160 --> 00:12:03.000
It impairs my ability to manage my time effectively
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00:12:03.000 --> 00:12:04.460
so that I can get out of clinic on time
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00:12:04.460 --> 00:12:05.660
so I can go pick up my kids.
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00:12:06.360 --> 00:12:09.680
My own time management is my responsibility.
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You're not responsible for me picking out my kids,
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but this would, you know,
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this impacts my ability to do so, right?
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00:12:15.640 --> 00:12:18.320
So this part you can kind of see.
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You can see how the conversation is going.
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00:12:20.500 --> 00:12:22.860
Sometimes people can be defensive
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when it comes to feedback,
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but I think it depends, right?
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All of this is a little bit fluid.
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It might feel kind of clunky at first,
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but the next piece that you want to get into
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is like the intention and the request.
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So I have a pretty easy going,
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pretty collegial relationship with my support staff.
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So I can say, what are your thoughts about that?
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What are some things that you could do
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to help reduce that time
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and be more concise with your history taking?
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What are your thoughts about that, right?
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Not necessarily what the thoughts are
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about the situation,
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but just kind of getting from that.
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What do you think would be helpful?
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My goal is that we get our patients to,
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so the cross tier is kind of woven in as well.
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The request here is that I would like our patients
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to be in the room,
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to practice getting them in the room
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00:13:08.900 --> 00:13:10.120
in about five minutes.
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00:13:10.620 --> 00:13:12.310
So what are some things you can think of
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00:13:12.310 --> 00:13:14.850
that would help you do that?
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00:13:15.050 --> 00:13:16.650
And the reason you're opening it up to them
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is it's not only, it gets into their,
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they can share their intent,
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intention behind what they were doing.
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You get more of the story.
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They get to come up with their own suggestions
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and have ownership, right?
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Versus us just saying like,
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00:13:28.030 --> 00:13:29.890
you need to practice this by, right?
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00:13:30.010 --> 00:13:32.210
Because then the other thing you can get in,
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00:13:32.350 --> 00:13:34.230
they will likely share is like,
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00:13:34.370 --> 00:13:36.390
so I'm actually like, I'm not sure.
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00:13:36.750 --> 00:13:39.010
And then if they seem like they're kind of like hesitant,
307
00:13:39.050 --> 00:13:40.410
I also say like, if you're not sure,
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00:13:40.430 --> 00:13:41.750
I have suggestions, right?
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00:13:41.750 --> 00:13:43.670
One is like, here's how you could make it
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more concise in the history.
311
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Ask these three questions, right?
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00:13:47.810 --> 00:13:50.510
Or again, they can come up with their own suggestions.
313
00:13:51.850 --> 00:13:54.110
So yeah, so that's, again, just as a recap,
314
00:13:54.290 --> 00:13:55.510
so it's the situation,
315
00:13:57.950 --> 00:13:59.490
the specific situation, right?
316
00:13:59.490 --> 00:14:00.430
Like not like last week,
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00:14:00.510 --> 00:14:02.850
like this particular patient visit, right?
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00:14:02.890 --> 00:14:04.270
So if you can think of an example
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00:14:04.270 --> 00:14:05.310
that happened in the last week
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00:14:05.310 --> 00:14:06.450
of a patient getting frustrated
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00:14:06.450 --> 00:14:08.470
because you re-asked the same history questions
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00:14:08.470 --> 00:14:10.190
and that you were late to leave clinic.
323
00:14:10.190 --> 00:14:12.290
Maybe they're the same, maybe they're different,
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00:14:12.290 --> 00:14:12.970
but you can kind of say,
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00:14:13.090 --> 00:14:14.570
this is also a pattern that I've noticed.
326
00:14:14.870 --> 00:14:16.730
But this is the specific situation
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00:14:16.730 --> 00:14:17.610
that I'm talking about.
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00:14:18.310 --> 00:14:20.530
On this day, at this visit,
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00:14:21.190 --> 00:14:24.110
the behavior was, it took about 15 minutes
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00:14:24.110 --> 00:14:25.710
to room the patient
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00:14:26.270 --> 00:14:27.650
and there was a very long history
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00:14:27.650 --> 00:14:29.010
that I had to reconfirm
333
00:14:29.010 --> 00:14:34.130
the medication reconciliation was missing or et cetera.
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00:14:34.450 --> 00:14:36.650
I love that the medication reconciliation was completed.
335
00:14:36.650 --> 00:14:38.490
That is the most important thing to me.
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00:14:38.490 --> 00:14:41.390
Medication reconciliation and screening tests.
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00:14:41.970 --> 00:14:45.350
The impact is that it delayed the next patient.
338
00:14:45.750 --> 00:14:47.670
I was able to leave clinic on time
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00:14:47.670 --> 00:14:49.510
because I wasn't able to see the patients
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00:14:49.510 --> 00:14:51.090
at their scheduled visit time
341
00:14:51.910 --> 00:14:53.970
and the patient was really frustrated
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00:14:53.970 --> 00:14:55.350
because they felt not heard
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00:14:55.350 --> 00:14:57.410
because I had to ask the questions again.
344
00:14:58.310 --> 00:14:59.310
And then the request is,
345
00:14:59.390 --> 00:15:01.630
I really would like to work on our visit times
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00:15:01.630 --> 00:15:04.210
being five minutes or less are roaming
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00:15:05.010 --> 00:15:06.950
and what suggestions do you have
348
00:15:06.950 --> 00:15:08.450
or what supports do you need
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00:15:08.450 --> 00:15:09.310
to get that done?
350
00:15:10.670 --> 00:15:11.930
It's all a bit fluid
351
00:15:11.930 --> 00:15:13.290
but those are the types of questions
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00:15:13.290 --> 00:15:14.410
that I typically ask
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00:15:14.410 --> 00:15:16.210
depending on the response of the person.
354
00:15:17.130 --> 00:15:19.150
And again, it's putting it in that perspective
355
00:15:19.150 --> 00:15:20.530
of they want to do a good job.
356
00:15:20.550 --> 00:15:21.410
They want to do well.
357
00:15:21.610 --> 00:15:23.590
They have no idea what's going on.
358
00:15:23.610 --> 00:15:25.890
Maybe they think that you want those thorough histories
359
00:15:25.890 --> 00:15:26.450
and they think,
360
00:15:26.730 --> 00:15:28.150
or maybe you had asked that before
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00:15:28.150 --> 00:15:29.630
a couple months ago when you were a brand new grad
362
00:15:29.630 --> 00:15:29.870
and you're like,
363
00:15:29.910 --> 00:15:31.850
can you really help with asking all of these questions?
364
00:15:31.870 --> 00:15:33.270
And now you're like, no, I'm actually good
365
00:15:33.270 --> 00:15:34.990
because this pattern is happening
366
00:15:34.990 --> 00:15:36.050
that I didn't anticipate.
367
00:15:36.570 --> 00:15:37.050
Right?
368
00:15:37.970 --> 00:15:40.190
So anyway, hopefully that is helpful for you
369
00:15:40.190 --> 00:15:42.410
to use as like a script, as a framework,
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00:15:42.750 --> 00:15:44.070
something to start practicing.
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00:15:44.110 --> 00:15:45.490
And again, it might be ugly.
372
00:15:45.810 --> 00:15:46.930
It might be awkward.
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00:15:47.890 --> 00:15:48.750
I was like various,
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00:15:48.910 --> 00:15:50.190
like even in this video, I'm like,
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00:15:51.110 --> 00:15:52.810
just thinking about actually doing it.
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00:15:52.810 --> 00:15:54.190
I'm still practicing, right?
377
00:15:54.410 --> 00:15:55.790
But those are the things that
378
00:15:55.790 --> 00:15:58.130
hopefully will help you start to practice
379
00:15:58.130 --> 00:16:01.370
and keep those assumptions in check and in mind
380
00:16:01.370 --> 00:16:03.410
so that you can just,
381
00:16:03.550 --> 00:16:05.190
everyone wants to do well, right?
382
00:16:05.190 --> 00:16:06.990
And then I guess the other part of it is,
383
00:16:07.130 --> 00:16:09.230
is that I'm much more comfortable doing this now
384
00:16:09.230 --> 00:16:11.350
because I'm in progress, right?
385
00:16:11.430 --> 00:16:12.650
I'm more comfortable doing it now
386
00:16:12.650 --> 00:16:14.230
because I'm actually the boss.
387
00:16:14.570 --> 00:16:15.810
But like in those situations
388
00:16:15.810 --> 00:16:17.590
where you're not actually someone's boss,
389
00:16:18.590 --> 00:16:20.170
I would recommend actually,
390
00:16:20.210 --> 00:16:22.890
I tend to tag in whoever their boss is.
391
00:16:24.410 --> 00:16:26.010
Whether it's the MA manager
392
00:16:26.010 --> 00:16:27.330
or it's the office manager,
393
00:16:27.650 --> 00:16:28.570
I just let them know,
394
00:16:28.670 --> 00:16:29.630
hey, I'm having a conversation
395
00:16:29.630 --> 00:16:30.690
with this person about this
396
00:16:30.690 --> 00:16:31.610
and here's what I requested
397
00:16:31.610 --> 00:16:32.650
and here's what I recommended.
398
00:16:33.050 --> 00:16:35.170
Just because like they need to be in the loop too
399
00:16:35.170 --> 00:16:37.190
and they can also be your backup support
400
00:16:37.190 --> 00:16:39.010
if things are not going well.
401
00:16:39.290 --> 00:16:40.230
Because in the next part of
402
00:16:40.230 --> 00:16:41.130
when you give someone feedback
403
00:16:41.130 --> 00:16:42.470
is you do have to follow up
404
00:16:42.470 --> 00:16:44.370
and you have to be consistent, right?
405
00:16:44.390 --> 00:16:45.670
And that's a hard thing
406
00:16:45.670 --> 00:16:46.970
is like when you want to like swoop in,
407
00:16:47.050 --> 00:16:47.970
you're like, oh, no, nevermind,
408
00:16:47.970 --> 00:16:48.730
it's fine, it's fine, it's fine.
409
00:16:49.030 --> 00:16:51.270
Like that's not how it goes.
410
00:16:51.690 --> 00:16:53.170
We do have to stay consistent.
411
00:16:53.570 --> 00:16:55.050
We can either at the end of that meeting,
412
00:16:55.050 --> 00:16:55.670
you can kind of say,
413
00:16:55.670 --> 00:16:57.270
maybe we'll check in at the end of the week
414
00:16:57.270 --> 00:16:58.450
or the end of the day.
415
00:16:59.390 --> 00:17:00.370
When would you like to check in
416
00:17:00.370 --> 00:17:01.310
and see how it's going?
417
00:17:02.050 --> 00:17:03.110
And this takes a lot of like,
418
00:17:03.150 --> 00:17:04.270
you have to like own your stuff.
419
00:17:04.270 --> 00:17:07.349
You have to be like in leadership mode to do this, right?
420
00:17:07.369 --> 00:17:08.730
So it is intimidating sometimes,
421
00:17:08.730 --> 00:17:12.410
but you want to be able to circle back with that person
422
00:17:12.410 --> 00:17:13.990
and not just let it be one conversation
423
00:17:13.990 --> 00:17:15.329
that falls off the face of the earth
424
00:17:15.329 --> 00:17:17.310
and then the behavior goes back again
425
00:17:17.310 --> 00:17:18.450
and then it's not working, right?
426
00:17:18.730 --> 00:17:20.010
Some people, they need to practice.
427
00:17:20.030 --> 00:17:21.650
They need to be reminded and that's okay.
428
00:17:22.849 --> 00:17:24.349
So hopefully this is helpful.
429
00:17:24.790 --> 00:17:27.609
Let me know if this is like a type of topic
430
00:17:27.609 --> 00:17:28.990
that you like to hear about.
431
00:17:29.070 --> 00:17:31.610
I really am getting more into like leadership type of stuff.
432
00:17:31.610 --> 00:17:33.190
This kind of like hidden part
433
00:17:33.190 --> 00:17:35.890
of the role transition of nurse practitioner life.
434
00:17:36.350 --> 00:17:39.030
So please let me know if you have specific requests
435
00:17:39.030 --> 00:17:40.870
as it relates to that kind of role transition
436
00:17:40.870 --> 00:17:42.130
or leadership type of stuff
437
00:17:42.130 --> 00:17:43.850
because I love talking about it.
438
00:17:43.870 --> 00:17:44.770
I love learning about it.
439
00:17:44.810 --> 00:17:45.970
I love getting better at it.
440
00:17:46.590 --> 00:17:49.190
So yeah, thank you so very much for watching.
441
00:17:50.150 --> 00:17:51.270
Hang in there and I'll see you soon.
442
00:17:55.110 --> 00:17:56.690
That's our episode for today.
443
00:17:56.810 --> 00:17:58.590
Thank you so much for listening.
444
00:17:58.990 --> 00:18:01.330
Make sure you subscribe, leave a review
445
00:18:01.330 --> 00:18:03.210
and tell all your NP friends
446
00:18:03.210 --> 00:18:06.170
so together we can help as many nurse practitioners
447
00:18:06.170 --> 00:18:08.950
as possible give the best care to their patients.
448
00:18:09.430 --> 00:18:10.830
If you haven't gotten your copy
449
00:18:10.830 --> 00:18:13.370
of the ultimate resource guide for the new NP,
450
00:18:13.830 --> 00:18:16.950
head over to realworldnp.com slash guide.
451
00:18:17.350 --> 00:18:19.210
You'll get these episodes sent straight
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00:18:19.210 --> 00:18:21.990
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453
00:18:22.350 --> 00:18:24.070
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454
00:18:24.070 --> 00:18:26.210
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455
00:18:26.590 --> 00:18:28.170
Thank you so much again for listening.
456
00:18:28.370 --> 00:18:29.550
Take care and talk soon.
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