Time Management for Nurse Practitioners: Inbox
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Show notes:
There’s SO much to manage as a new nurse practitioner, on top of developing your clinical knowledge, making a thousand decisions a day and becoming a leader in the healthcare space. The better your time management, the more time to get your work done and ACTUALLY rest at the end of the day.
Time Management Tips for New NPs - Inbox Management
In this week’s video, I’m covering the rest of what we do in a day in the life as nurse practitioners-- inbox management and the time management strategies to make it all easier.
I go over:
The types of documents and tasks we need to manage when we’re not seeing patients
How to prioritize them, and how to use your EHR to support YOU
What to look for, what to ask for, and how to bring suggestions to your team if it’s not going well
Lab Interpretation Crash Course
As always, if you want help with your lab interpretation, you can join us inside the Lab Crash Course! It covers CBC, CMP, Urinalysis, Dipstick & Microscopy, TSH, Lipids & top Endocrine labs in primary care, and comes with lifetime access and continuing education credits! Learn more here.
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Hey there, welcome to the Real World NP podcast. I'm Liz Rohr, family nurse practitioner, educator,
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and founder of Real World NP, an educational company for nurse practitioners in primary
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care. I'm on a mission to equip and guide new nurse practitioners so that they can
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feel confident, capable, and take the best care of their patients. If you're looking for
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clinical pearls and practice tips without the fluff, you're in the right place. Make
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sure you subscribe and leave a review so you won't miss an episode. Plus, you'll find
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links to all the episodes with extra goodies over at realworldnp.com slash podcast.
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So in this week's video, I'm going to be talking about inbox management. So this
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is basically all of the stuff that is outside of seeing patients, direct patient care in
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the primary care setting, and how to manage it. The triage approach that I recommend to
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managing it, as well as sometimes saving strategies. So I didn't realize this as
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a brand new nurse practitioner, that I was going to be responsible for lab results,
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imaging, consultation notes, medication refills for patients I'd never seen before.
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So that was a little bit nerve-racking for me, and that's the typical scenario. So when I was
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hired as a new nurse practitioner, I was replacing somebody who I'd left, who had their own panel
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of patients, and I was absorbing that panel of patients. Depends on the practice setting and
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the culture that you have, but you typically will either take somebody else's patients or
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share a panel with somebody else, and regardless of that scenario, most of the time
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you'll also be starting in that similar situation. And so I've only ever worked with an
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electronic health record. This same triage approach applies if you have paper charts,
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but again, I've never worked with those in my career. So in terms of the electronic health
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record management, all of the extra stuff, I'm going to go over the categories and the kind
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of like pearls of practice to approach them and make them a little bit easier for you to
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manage. So ours is called a desktop or inbox. It depends on the EHR that you're using,
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what it's called. Basically it has a number of categories of items. So lab results,
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imaging results, so CT, MRI, X-ray, medication refills, internal communication documents. And
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so depending on the EHR that you use, there's potentially something called like a flag,
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they all have different names, right? But there's a way to internally communicate with other
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providers or medical assistants or nurses that is not a permanent part of the patient's chart.
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And then there's another way, ours are called phone notes, that is a permanent part of the
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actions taken for a patient outside of an office visit or a nurse visit, et cetera, et cetera.
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And so for us, that is like the main way that we communicate, say I call a patient or
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a patient is calling in or a provider is calling in or a consult is being called in or a
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specialist is calling back, things like that, right? The next one is consultation notes. So
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when a patient goes to see a specialist, say they got referred to GI and the GI office will
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send you back the information of what they assessed, what the plan is, what the follow-up is,
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and then sometimes they'll also put in there things that the primary care is responsible for.
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For the most part, my kind of good culture of the specialists that work in our area that
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we refer to and get information back from is that they will communicate with us more
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directly via a phone call or something like that to the nursing staff, which will get
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communicated with us, to us through phone notes, right? But I've also found that in
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consultation notes that there's recommendations of what primary care should follow up on. So
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that is important to keep in mind when you get those. The last one is outside records. So when
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you get a patient brand new to your clinic who has transferred their care from another place,
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you want to request those records and then they will come into your inbox or desktop,
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et cetera, et cetera, for review. And so for me, when I was a brand new grad,
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I would look at my desktop and I get completely overwhelmed and very nervous. And so
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I was actually talking with a mentee the other day and for her system, unfortunately,
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it's only by date and she doesn't have the functionality of sorting by category,
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which is again, like kind of pearl number one is that you can identify something that would
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help your workflow a little bit better. You always have that opportunity to reach out to
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your supervisor, your colleagues in the IT team. Even if you don't have an onsite IT team,
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whoever gives you your EHR is likely motivated to keep the company's business, right? And so
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if you have suggestions about how to optimize it for your experience, you can bring that to your
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supervisor who can bring it to that company. And then you can see if there are more options
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to make it more user-friendly, right? So my first approach is to sort by category so
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that I can triage. And basically what I've told you already is the route that I use
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for triage. Number one is labs. So labs have the most potential to be harmful or dangerous
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in a shorter period of time. We have a safeguard at my current clinic where the
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hospital that we send our labs to has a list of labs and reference ranges that they are,
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that is a trigger for them to call us and physically get somebody on the phone.
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We have nurses that are on the triage line and then they get a phone call and then they
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generate a phone note, which goes to a provider. If it goes to me, if I'm onsite,
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but if it's my patient and I'm not onsite, then it goes to an onsite provider to triage
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themselves to see if it needs action right now or if it can wait for me to assess when
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I come back in the next day, right? So not everybody has that option. And so I've worked
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at other clinics or shattered at other clinics that did not have that safeguard in place.
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That is a potential suggestion you can make. It's working really well for us. It makes
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me feel a lot more comfortable not being plugged in on the days that I'm not in clinic
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mentally. And it also alleviates the burden on my colleagues so that they don't have to
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manually check in on my desktop to review labs for me, right? So anyway, so labs are
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number one. Number two is phone notes because those can be more urgent pieces of communication.
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We actually have a triage system set up internally, which I highly recommend if you
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don't already. And sometimes you might have to bring these suggestions as an opportunity for
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your clinic to consider implementing, right? It's not necessarily our job if we're not
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in leadership to implement these things, but we can always bring suggestions. So for phone
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notes, my previous job had three levels of urgency. One is to be dealt with in 24 hours,
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excuse me, to be dealt with in four hours. So very urgent. The next level was within 24 hours.
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And then the third one was as you got to it, right? So we had that internal communication
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set up because what was happening is that we would be seeing patients in clinic and we would
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constantly be interrupted with, I need this right now. But then what we did was we set that
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barrier of expectation for patients. It's going to be about four hours until you get that
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for this thing, unless it's truly urgent, right? And then obviously anything truly
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health-wise urgent gets dealt with immediately, right? But that really helped cut down on the
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interruptions during the day because really any context switching makes a big difference,
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right? If you're seeing patients, it's really important to focus on that versus if you stop
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and then you're getting interrupted or you're looking at your inbox or desktop, then it
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kind of throws you out of your habit at that point. So yeah, so I definitely recommend
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implementing or suggesting a triage-based system for communication so that everybody's
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day goes a little bit more smoothly. The next one is medication refill. So our policy is 24
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to 48 hours of a refill. There's always opportunity to bypass that if there's an
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urgent or emergent situation or unexpected circumstance, but it's really important. We
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communicate that at the front desk. When patients call, there's a sign out front so
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that it's very clear people need to request their medications 24 to 48 hours in advance.
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Actually, I think we moved it to 48 to 72 because it takes so much time for all of
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the staff members to be able to do that and help them out with that. The reason
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we can make exceptions, but it's really important to stick to your boundary because
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if somebody is continually violating it, then that's out of agreement of what you're
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trying to do to help each other out the best, right? It's a cooperative agreement,
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right? So the next one is imaging. So the reason that imaging is not the most pressing
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in terms of the number one is because for the most part, depending on your clinic and
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depending on your hospital system, if there's something urgent, they're going to call you.
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The radiologist is actually going to call you with a wet read or a preliminary result
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before they send it over. Ours had a triage system where it was like red, orange, yellow
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that they would tell us right away, hey, there's this finding on exam, right?
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So the imaging that's in there definitely needs to be dealt with, but anything really
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has been called already, most likely, right? You want to check and see what your clinic does.
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The next one is consultations. So we don't want to ignore those for a very long time
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because they take the most time and they are the least urgent typically,
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but we do want to do a quick look, if we can, to see if there's any recommendations
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for primary care. It's pretty uncommon and you can have those conversations with your staff
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members and your supervisor, your colleagues and your supervisor to get a sense of what the
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culture is of the specialist that you refer to, because if that's becoming a problem,
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that's not a really strong workflow. It doesn't really support the patient.
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It doesn't support all the providers. And so if you find that that keeps happening,
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that might be worth the conversation as well. But for the most part,
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consultation notes are really just updates of like, this is what we did,
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come back in three months, right? And so that's important for us to review,
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to know, to update the chart and just to make sure that we're following all the steps
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we need to. But also really, it's so helpful for learning. It's so, so helpful to see what
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is actually happening after you hit that referral button. And then outside records,
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those usually can take, you can take the longest to review those typically.
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It just depends if you're waiting on something, but typically they'll send you all the kind of
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historical information, immunizations for some patients if they had a PAP exam, if they had
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a colonoscopy, a mammogram, et cetera, et cetera. Any significant family medical history
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forgot to mention, things like that. History of all their conditions. Our nurses at my current
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clinic are all amazing. And sometimes they will be helpful too with inputting immunizations.
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If I give them a sheet, if they have some downtime, if I'm in the middle of seeing
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patients, I have this record and they can update, help me with that little update in
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there. So those are the main kind of like pearls with triage management.
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A couple of other things to think about. One was that I, this may be like a duh thing,
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but for me, like I was constantly checking my inbox when I was seeing patients, like in between
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to like see if I was missing anything. I think that was actually before we came up with that
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phone note, kind of four hour turnaround triage rule, but I was always worried about it. And
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that context switching was so frustrating. And so what I started doing instead was that I would
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check all of my desktop items at 8 a.m. before I started seeing patients. I check it
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at noon again. So I'm in that four hour window saying integrity with what we decided upon as a
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clinic. And then I check it again around four right before the end of the day so that we
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could make sure that I wasn't missing anything, but also so that I could really focus on what's
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in front of me, the patients in front of me, finishing the notes, all of that,
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stop putting in the right orders, all of those things. The only other thing that I recommend
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is using quick texts as best as you can. So our EHR has the functionality that we can have
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inside of a phone note. So when I'm reviewing lab results and somebody has high cholesterol,
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but it doesn't warrant a medication, I have a quick text in Spanish, Portuguese and English,
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actually, that gets sent out to either as a letter home, but also as a phone note to the
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nursing staff. If I expect that there's going to be questions from a patient that are medical
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questions, that is not an in-depth conversation that I would need to have with them,
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I can give that information to the nursing staff. They can make that phone call if that is
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appropriate, right? And also they're set quick texts if I send a note to a medical assistant.
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So it depends on the structuring of your clinic, but certain messaging to patients
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and other providers go to different staff members. So those are all my tips. I would
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love to hear what yours are for your EHR management and your time management. If you
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are struggling with your lab interpretation, definitely, definitely, definitely come join us
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the lab interpretation crash course. It's at realworldmp.com slash labs. It comes with 8.7
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hours of continuing education through AANP. And if you have an ANCC certification, it also
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counts. But yeah, check that out if you were struggling with labs. But other than that,
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thank you so much for watching and I hope this video was helpful.
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Hang in there and I'll talk to you soon. That's our episode for today. Thank you so
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much for listening. Make sure you subscribe, leave a review, and tell all your NP friends
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so together we can help as many nurse practitioners as possible give the best
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care to their patients. If you haven't gotten your copy of the ultimate resource guide for
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the new NP, head over to realworldmp.com slash guide. You'll get these episodes sent straight
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to your inbox every week with notes from me, patient stories, and extra bonuses I really just
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share anywhere else. Thank you so much again for listening. Take care and talk soon.
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