Time Management Tips for New Nurse Practitioners
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Show notes:
Another day hits 5 o'clock and you wonder: how did you end up bringing so many charts and lab results home? Where did the day go??\
Whether you have 15, 30 or even 60 minutes for each patient visit, it still feels like a short amount of time to get it all done - the history, exam, plan and everything you need to do in between visits.
Time Management Tips for New Grad NPs
In this video, you'll learn my top time-saving hacks: before, during and after the visits, so you can get your work done and have more time at home in the evenings and weekends not working.
PLUS: I made a cheat sheet of sample "quick texts" that I use for my HPIs and my plans of care to help save time charting. Download it below this video!
Quick Texts Cheat Sheet
This episode comes with a quick text cheat sheet to help make your visits faster. Download your cheat sheet here!
If you liked this post, also check out:
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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
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confident, 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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Well, hey there, it's Liz Rohr from Real World NP and you're watching NP Practice
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Made Simple, the weekly videos to help save you time, frustration, and help you learn
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faster so you can take the best care of your patients.
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So I've been asked a lot about this topic and that's the topic of time management
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and how to manage your time better as a new nurse practitioner and I have a lot of insight
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to share so hopefully it's really helpful for you.
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In this video, I'm going to break it down in terms of the different ways to save
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time before the visit, during the visit, and after the visit and hopefully the different
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kind of hacks I have to share can be really helpful.
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Also, if there are things that I haven't shared in this video that you do that
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are really helpful for you, I'd love to hear from you as the other nurse practitioners
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who watch these videos would as well.
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So jumping in before the visit, the main thing that I did when I was a new nurse practitioner
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is looking patients up the night before if you're lucky enough to be in primary care
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and not seeing urgent care patients to kind of look and see what the patients are
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coming in for.
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You can do a brief review of their chart so looking at their, I kind of do it
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in this very systematic way so I will look at their problem list.
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We have a problem list in my EHR.
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My last job just had their active diagnoses, however it looks for you, but whatever
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their diagnoses list says or their problem list says, their past medical history, past
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surgical history, family history, just taking a quick peek at those, and not going super
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into depth because you probably have 20 patients on your schedule and that's a lot of work
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to do the night before, but kind of just briefly looking at what are their problems,
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when were they last here, when were their last labs, taking a quick peek at preventatives.
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I mean, again, like this may not be at the top of your priority list when you're
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brand new, but in terms of holistic care, doing the best you can looking at their
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If not, just focus on why they're there.
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The next thing is to kind of think about what are the different measurement parameters
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that you have for the reason that they're coming in.
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So most of the time, it'll be like a follow up for diabetes or hypertension or
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something like that, and kind of looking at like what are the parameters you're
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looking for?
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Are you looking at their A1C?
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Are you looking at their renal function?
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Are you looking at their blood pressure?
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Like kind of just looking at those markers and thinking ahead, like kind of
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making a cheat sheet for yourself of oh, this patient's coming in for this, so
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things like that.
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So one quick note about appointment notes.
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So a lot of times if you can look the night before at your chart, this is
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variable throughout any different clinic that I talk to people about.
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So if you look at their reason for a visit, it's very variable if they're
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number one, if there's going to be something written.
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Number two, what it's going to say.
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So it's probably going to, it may be blank.
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It may say follow up, follow up for what?
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I don't know.
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And then it may say things like blue urine, which is a true story from when I was
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a brand new grad, that's a long story, but it wasn't a physiologic, there's
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nothing that can cause you to have blue urine as far as I understand.
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But she, it was a mental health related issue.
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But anyway, when you look at the reason for a visit, it may or may not
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be accurate, you know, and that comes down to a number of things patients
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don't want to say on the phone.
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And you're also asking non-clinical staff to ask clinical questions.
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So that can be a little bit challenging.
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So people really endeavor to ask those questions, but sometimes things
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come up, right?
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And then the other alternative scenario is that someone comes in and they have
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decided that the problem they came in for is resolved and they have something
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else to share with you, which happens like every single day, which was really
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stressful for me as a new grad.
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But you kind of just, that's just how it works.
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And you can hopefully work with your staff, working with your office to see
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if you can consistently have a reason for a visit written down so that you
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can prepare the night before.
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Like, okay, so someone's coming on with shoulder pain.
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What are the things I'm going to ask them?
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If it's diabetes, what am I going to ask?
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If it's, you know, things like that.
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But yeah, that's the really hard part about appointment visit notes that
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they're usually not that consistent.
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So a couple of other notes before the visit.
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So if you work with a medical assistant team or you work with your
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own medical assistant, like that is a dream.
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And I loved that in my last job.
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Rose was amazing.
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Love you, Rose, if you're watching this.
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She is so good.
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So I would work with her and we would have a kind of come up with
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the system.
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So she knew me.
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She got to know me and what my preferences were.
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But we also just had like a general system, right?
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And so hopefully your medical assistant can ask to save you some time in the
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visit.
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You know, they're smoking alcohol, drug use status, reconcile the
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medications if they feel kind of like they have the knowledge and
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skills to do that.
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Or just kind of like go through a list with patients and kind of check
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off or cross off early request to mark if the patient's not sure.
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And then another thing they can do is like once they get to know you or
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if there's standards that you have in your in your clinic, you can have
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them do a urine dip.
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If you have somebody with abdominal pain or an HCG urine pregnancy test
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or somebody coming from contraceptive, just like right off the bat without
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even asking questions.
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Another thing to think about is like PHQ2 screening.
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Like what are the things you can kind of come up with in terms of like the
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standards of practice of your clinic to have them help you with that?
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Because it's I mean, keeping in mind that that takes a lot of time to do.
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But in that way, like you can be doing other things that are more like
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NP related while they're kind of doing that stuff to help you.
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Another thing to think about is not really pertinent in my clinic
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because most of my patients have illiteracy and low health literacy.
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But really depends on the clinic and the type of patients you're working with.
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But if you can have forms that patients can fill out, like past medical history,
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family history, medications, if they can kind of fill that out while they're
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in the waiting room, that can definitely save you a lot of time too.
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So that's it for the before visit.
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So in the visit, a couple of things that can save you some time.
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So I would get sucked into my visits were 20 minutes when I was a new grad
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and I would get sucked into a conversation for the full 20 minutes.
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So don't do that.
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So one of the things that was just kind of like an aha, but it makes complete sense,
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is that one of my colleagues had recommended five minutes for your history,
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five minutes for your physical exam, five minutes for your plan of care,
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and then five minutes for your note.
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In reality, I did not take five minutes to write my note.
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I never got my notes done during the day when I was a new grad.
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But I could at least break it down such that I was keeping very mindful
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of how long five minutes was because that's not very long at all.
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And that really kind of helped cut down on like the chattiness
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and like the kind of like winding conversations that you're having
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and kind of keeps you a little bit more pointed and directed
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when you've kind of not had that self-imposed urgency.
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And it may feel rushed at first when you first start doing it,
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but the reason it's so wonderful to do is because
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at least when I was a new grad, I would ask the history questions,
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do the physical exam, come up with a plan of care,
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which I made a whole video about that,
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but I would excuse myself from the room because I never knew what to do.
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I'd go look it up and I'd come back in
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taking at least five minutes to do that.
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And when I came back in, I'd realize that I had other history questions
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I didn't ask about that I should have asked regarding shoulder pain
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or eye pain or something like that.
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And it also gave me the time to have that discussion with the patient
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and they would reveal their doorknob questions
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like all the questions that they were kind of saving for the end,
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even though I had to ask them three different times
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if I could help them with anything today,
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if they have any questions or concerns.
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So the doorknob questions typically happen when your hand is on the doorknob.
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So that saves some time.
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Another thoughts are about the ROS.
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So if you're doing especially physicals,
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physicals can be really overwhelming.
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I do 10 physicals a day in my new job,
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which I didn't really realize going into it, but it's fine.
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I'm used to it now, but it's kind of a lot to do a physical rather.
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So people think that their physical is to kind of unload all of their issues
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that have ever happened to them in the last year
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or in the 10 years since they've seen a doctor.
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That is not the time and place.
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However, that's what people expect.
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What you can do, and I talk about this in how to make a plan of care,
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is kind of setting some limits with them,
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but also just making the decision of like,
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you know what, if you have multiple problems to address today,
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we can just do a problem-based visit
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and then the next time we can do the full physical exam.
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And people don't necessarily like to hear that.
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However, it's reasonable and it's not fair both for you and for them to address that,
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which I talk about in that video, so I won't get into it too much.
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But you can make that decision.
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If it's a physical today and you address too many problems,
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just have them come back for another physical.
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Another thing to think about in terms of the physical is that
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the R.O.S., the review of systems,
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I definitely do a full R.O.S. in terms of all of the body systems.
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And if you saw my video from before where I gave that patient visit cheat sheet,
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I wrote out all, like, complete R.O.S. by system.
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I do not, I'm going to give a disclaimer,
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and I really should have done this when I sent out that video,
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but my huge disclaimer is I do not ask all of those questions.
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I ask all of the systems, but I do not ask all of those questions
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because there is not enough time to ask all those questions.
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And also, it brings up a lot of stuff.
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And so this is kind of a consensus with experienced clinicians
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is that if patients have something that is really bothering them,
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they're going to bring it up.
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So if you're, for example, you're doing like a cardiovascular review of systems,
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you know, you're having chest pain, palpitation, syncope, edema,
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like those are pretty important to ask.
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And so I ask those.
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But if somebody's having nosebleeds, especially if they're frequent,
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or even if they're infrequent, they're going to be like,
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you know, I'm having some nosebleeds.
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But if you go like, oh, do you have any epistaks?
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It's like, it's just you have to come up with your own philosophy.
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But typically, that's not just me.
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That's kind of like a shared mentality of like,
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let's ask about the most dangerous, most common items on the ROS.
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And then if people have something further,
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they can kind of volunteer that.
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Another thought about kind of like really long visits
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are if you have a new patient with multiple chronic comorbidities.
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So they have heart failure, CAD, they have diabetes, they have IBS,
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they have gout, like the list just goes on and on.
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Like they have like 10 to 17 chronic problems.
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Like the way that I work around that is that
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those things all need to be documented, right?
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So there's a past medical history section,
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which depending on how your system works,
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even if you have a problem list or a past medical history section,
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whatever, I would kind of put that in.
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And I do put it in like the problemless section.
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Anyway, I put it into my EHR and I make notes about like diabetes,
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diagnosed in 2010, taking insulin,
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variably controlled, has not seen endocrine, blah, blah, blah.
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That's in my PMH section.
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So I've asked all of those questions and it's documented,
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but I don't necessarily have to address it
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unless I'm doing something about it at that visit.
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Does that make sense?
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So for diabetes, I'd probably include that
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because I'm asking about those alarm signs and symptoms
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because again, it's like a triage thing, right?
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So if somebody comes in with diabetes,
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like what are your blood sugars?
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Anything above 300, less than 70?
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Do you know the signs and symptoms of hyper and hypoglycemia,
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et cetera, et cetera?
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So you're kind of like taking the most important scary things
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and making sure that you're addressing those at that moment.
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So if it's totally controlled,
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you've asked all those history questions,
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you can still put that one in the HPI.
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But like IBS, for example,
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unless you're talking about dietary modification,
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going into big explanations,
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you're adding peppermint oil for them,
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something like that, that goes in the PMH.
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You can talk about it,
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but just kind of like brief updates
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about like what's going on with each of these things
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and like what's out of control right now.
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And it's hard because if you only have 15 minutes
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or even if you have 30 minutes
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and they're a really complicated patient,
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like it's hard to ask all those questions,
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but just kind of doing your best of like
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only addressing in the HPI and the plan of care
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what you're gonna do for each of them.
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And that's a philosophy thing.
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Like other people have different philosophies.
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Like I see notes sometimes
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that I address seven plus problems,
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but I really try to keep it four or less
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in terms of my assessment and plan
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because those need to be broken up.
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I mean, that's just my personal opinion.
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And honestly, like in terms of billing,
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like it doesn't matter
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if you do more than four problems at a time.
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It's gonna be a four anyway.
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I mean, that's an aside,
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but that's something to think about
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in terms of the chronic care.
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Always, I always go to the alarm signs
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and symptoms for all those problems,
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especially if there's multiples.
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We're kind of like making sure
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that everything is safe right now.
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What is the one or two things
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I'm gonna do for you today?
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And when am I gonna have you come back?
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So if that person has multiple chronic comorbidities,
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their blood pressure's out of control,
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their A1C's out of control,
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you know, they are having a gout flare.
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That's really hard.
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Like you do have to address all of those problems.
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However, like the other things,
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if it's just the diabetes that's out of control,
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maybe the blood pressure, address those today,
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come back in a week, come back in a month
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for a full physical, whatever your plan of care is,
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and then just kind of take it from there.
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I'm not very good at time management.
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I have to work very hard at it.
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So one of the systems that I came up
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with my medical assistant at my last job
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is that she would close up the visits for me.
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So I would go in, do the history, exam, plan of care,
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step out of the room, order any medications
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or lab tests or anything like that,
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and either review the plan of care with them
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or if I hadn't reviewed it already,
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I'd go back in and tell them.
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But if I had done that kind of all at one time
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in the visit as I got more experience
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and I didn't have to excuse myself
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to come up with that plan of care,
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she would come back in and do kind of a checkout form.
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So we'd have a checkout form
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that'd go to the front desk and say,
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you know what, follow up in a month,
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follow up in three months, physical.
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And I hopefully have said that already to my patient,
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but it's just kind of reinforcement
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because sometimes patients need things said multiple times
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and they're gonna have questions for you.
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Where's the pharmacy?
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Where do I check out?
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Where is the lab?
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When should I come back?
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There's gonna be a lot of questions
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that are not necessarily NP specific
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that if you can team up with your medical assistant
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and they can come in and help you with that,
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then hopefully that can be really helpful
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in terms of saving you some time.
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Another note about after the visit is the notes,
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of course, the notes, the notes.
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I don't love writing patient notes,
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but I am obsessed with templates and QuickText.
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So that is my number one tip for notes.
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So if you don't have QuickText or templates
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or something that's pre-saved
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where you can input something in terms of the HPI,
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like a blurb of all the questions you would ask
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for diabetes, hypertension, physical, stuff like that,
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or like a blurb you can put in
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for your plans of care for each of those patients,
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I highly, highly, highly recommend making those.
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And as a nice bonus to this episode,
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I actually have a cheat sheet you can download
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that has my sampling of the QuickText that I use
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and the assessment and plan frameworks that I use
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for kind of like the main problems.
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You're welcome to use those and adapt them as you'd like.
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And then the other thing is just getting it done.
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Honestly, I would agonize.
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I would take forever to write my notes.
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I wish I had written it down.
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I remember I was precepting a new grad
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at my former job and we were talking about,
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00:14:52.700 --> 00:14:52.860
and they're like,
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00:14:52.860 --> 00:14:54.280
oh, how long do you take to write your notes?
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I was like, I try to like two to five minutes or less.
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And they were like, oh.
355
00:14:58.860 --> 00:15:00.820
And I'm like, really, that's how long I take now
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because if I'm seeing 20 patients a day,
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like I don't have that time, you know,
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I have to spend that time doing all this other stuff.
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00:15:06.360 --> 00:15:07.540
But when I was brand new,
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I'd probably spend at least 20 minutes on the note.
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You know, I did 20 minute visits, 20 minute note,
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00:15:11.420 --> 00:15:12.700
like, and that's just not sustainable.
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And most of the time I was agonizing.
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00:15:15.800 --> 00:15:16.920
And if you're not agonizing,
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it's probably because you don't know what to do with them,
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in which case really you need to reach out.
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00:15:20.600 --> 00:15:23.020
And I'm such a broken record when it comes to mentoring,
368
00:15:23.080 --> 00:15:25.760
but definitely set that up if you don't have that already.
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00:15:25.760 --> 00:15:27.000
And I really, really hope
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that your supervisors are open to that
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and they're willing to talk with you and meet with you
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and set aside some of that golden time
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so that you can save so much of your time agonizing
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over charts, looking a million things up
375
00:15:38.120 --> 00:15:39.940
that are just not necessarily there
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00:15:39.940 --> 00:15:41.060
that are clinical judgment things
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00:15:41.060 --> 00:15:42.300
that you might not find in the notes,
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like that kind of stuff in your resources.
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00:15:45.440 --> 00:15:49.420
But anyway, I had my top three survival tips
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for the first year.
381
00:15:50.280 --> 00:15:51.280
I talk a little bit about that,
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how to set that up mentoring for yourself.
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One more bonus tip for notes
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is that people,
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00:15:56.500 --> 00:15:57.720
whether or not you have something fancy
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00:15:57.720 --> 00:16:00.080
like a drag-in software where you,
387
00:16:00.080 --> 00:16:00.980
I think that's what it's called,
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00:16:01.100 --> 00:16:03.140
where you voice record your notes.
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00:16:03.700 --> 00:16:05.180
Some people I've talked to have used
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just on their phone an app.
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00:16:07.040 --> 00:16:08.680
I use Evernote, I really like that.
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00:16:08.960 --> 00:16:10.360
Or you can use a text document.
393
00:16:10.540 --> 00:16:12.560
I'm not an iPhone person, but on the iPhones,
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00:16:12.600 --> 00:16:14.280
I guess they have their own note recording thing.
395
00:16:14.460 --> 00:16:17.300
You can do a voice text where you're kind of like,
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doing your HPIs at least that way
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and kind of copying and pasting.
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00:16:20.240 --> 00:16:21.440
Did you like this video?
399
00:16:21.540 --> 00:16:23.280
If so, hit like and subscribe
400
00:16:23.280 --> 00:16:24.460
and share with your NP friends.
401
00:16:24.460 --> 00:16:26.680
So together we can reach as many new grads as possible
402
00:16:26.680 --> 00:16:28.700
to make their first years a little bit easier.
403
00:16:29.100 --> 00:16:30.000
And don't forget to sign up
404
00:16:30.000 --> 00:16:31.260
for the ultimate resource guide
405
00:16:31.260 --> 00:16:34.080
for the new NP over at realworldnp.com.
406
00:16:34.480 --> 00:16:36.560
You'll get these videos sent straight to your inbox
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00:16:36.560 --> 00:16:38.000
every week with notes from me,
408
00:16:38.260 --> 00:16:39.900
patient stories, more helpful insights,
409
00:16:39.960 --> 00:16:42.260
and bonus content that I just don't share anywhere else.
410
00:16:42.680 --> 00:16:44.360
Definitely make comment below this video.
411
00:16:44.800 --> 00:16:47.480
What are some of the time-saving hacks
412
00:16:47.480 --> 00:16:49.860
that you're using in your primary care practice?
413
00:16:50.320 --> 00:16:51.640
I'd love to hear them.
414
00:16:51.780 --> 00:16:53.760
And so would be your other NP colleagues
415
00:16:53.760 --> 00:16:55.400
who come and watch these videos as well.
416
00:16:55.640 --> 00:16:57.560
And if you'd like that cheat sheet
417
00:16:57.560 --> 00:17:00.280
for my kind of like quick tech templates that I use,
418
00:17:00.300 --> 00:17:01.240
it's not comprehensive,
419
00:17:01.240 --> 00:17:03.600
but it's kind of a sampling of the things that I use.
420
00:17:03.640 --> 00:17:05.400
And if you like it, definitely let me know.
421
00:17:05.420 --> 00:17:07.400
But you can download that below this video as well.
422
00:17:12.569 --> 00:17:14.170
That's our episode for today.
423
00:17:14.290 --> 00:17:16.050
Thank you so much for listening.
424
00:17:16.450 --> 00:17:18.790
Make sure you subscribe, leave a review,
425
00:17:18.950 --> 00:17:20.670
and tell all your NP friends
426
00:17:20.670 --> 00:17:23.609
so together we can help as many nurse practitioners
427
00:17:23.609 --> 00:17:26.410
as possible give the best care to their patients.
428
00:17:26.410 --> 00:17:28.290
If you haven't gotten your copy
429
00:17:28.290 --> 00:17:30.870
of the ultimate resource guide for the new NP,
430
00:17:31.310 --> 00:17:34.430
head over to realworldnp.com slash guide.
431
00:17:34.850 --> 00:17:37.330
You'll get these episodes sent straight to your inbox
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00:17:37.330 --> 00:17:40.330
every week with notes from me, patient stories,
433
00:17:40.530 --> 00:17:43.670
and extra bonuses I really just don't share anywhere else.
434
00:17:44.050 --> 00:17:45.610
Thank you so much again for listening.
435
00:17:45.830 --> 00:17:47.010
Take care and talk soon.
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