Celebrating PA Week &
Emergency Nurses Week

Transforming Healthcare Coaching Podcast — Episode 77: Celebrating PAs and Emergency Medicine Nurses. A conversation between co-hosts Lillian Liang Emlet, MD MS CHSE CPC ELI-MP, and Klaus Grim, PA-C CPC ELI-MP.

Lillian Liang Emlet: Welcome Welcome to the Transforming Healthcare Coaching Podcast, and this month we are super excited to be celebrating Emergency Nursing Week and also Physician Associate Week. So we figured we just combine it with this episode and I'm super excited to be able to talk with Klaus today, who is a physician associate in emergency medicine.

So it's like a two for one.

Klaus Grim: I know this is a perfect one because obviously I work with, , many PAs. I also work with emergency nurses, so this is a perfect episode, I think, to to honor both professions.

Lillian Liang Emlet: Yeah. So I think the other thing to that we're sort of riding the high of is last month in September with the Emmys, the PIT really was able to highlight and feature so many aspects about emergency medicine. And bring back the excitement for emergency medicine in general and all the different people that work in emergency medicine.

And so, I guess curious, and you probably get this question all the time, , what's one thing that you would like to say to your colleagues who practice in the department for this month?

Klaus Grim: O One thing I wanna mention is I still haven't seen the pit.

Lillian Liang Emlet: Oh, that's okay.

Klaus Grim: I, I, no, but I, I, I hear such great things actually on my, on my to-do list to go listen to. But what I would say to the, the colleagues that I have in my department is, is first off, I think would be to be proud of the work that you do. I think it's so easy to forget why we got into medicine in the field that is so fast-paced, dealing with critical illness.

Oftentimes being shouted at that are beyond your control. A lot of moral injury as a result of practicing in this field. Oftentimes feeling like you may have limited resources and I work in a community setting, so having that is its own unique challenges. With working with constant different staff.

And I would encourage my, my colleagues just to remember the work that you do is so important and that you have such a, breadth of knowledge and skills that are amazing and powerful and unique. You are able to. See a patient come through the ambulance bay or walk in and be able to just look at them oftentimes and say, sick or not sick, and make quick decisions to start their workup, figure out what's going on, or start administering treatment before you have results back.

I think it's just. Powerful. And it, it is a scope of medicine that I think doesn't get the attention that it needs. I can imagine where my consultants come in, they're like, oh, you're calling me about this. But, , I think what they don't see is the, the times that we're making these decisions without them as well, because we are forced to in critical times.

Lillian Liang Emlet: I really like that. The, the reality is I hope everyone can wear their crown a little bit higher because we are at the front door 24 7, 365, and , I think about myself when. The many times that I've had to go be a patient either for myself or my daughter or my loved one, is through the emergency department. I'm always amazed by the understanding speed. , There are issues right there. There are issues in terms of sometimes you have to wait and at the same time like, yay. So I get to wait. I'm not actually one of the critically ill patients. So, we are all going to use the emergency department at some point in their life or know someone that has and to be the safety net 24 7 365.

I hope that everyone who is working a shift and can recognize that they should be really proud of the, of the work that they do, whether it's small, single coverage, emergency department, urgent care out in the rural communities, all the way to the big ACA academic center, level one trauma centers.

They're different and they're both really vital for everyone's care.

Klaus Grim: Yeah. And, and I like that you mentioned urgent care. I think that they deserve a shout out too. I think they're oftentimes unrecognized. In a lot of the care and oftentimes are our bridge between primary care, emergency, emergency care, and sometimes are helping to, bridge that gap and alleviate the burden of the emergency room.

And I think they deserve an applause too because, , you're you're also, , practicing medicine with limited resources and, and doing your best for the patients to to hopefully, , try and save them an emergency bill, but also to get them the quick follow up with either with a specialist with their primary care, if it's something that needs that attention.

Lillian Liang Emlet: I know there's so much negativity and complaints sometimes in terms of how the system works and how the system runs, and yet when you take a step back like you and I are doing right now, I mean it's, everything should be celebrated. We're really glad to have the entire gamut of care and nps, PAs, physicians, nurses who.

Techs, EMTs, volunteers, students. I mean, that's who we hang out with, and actually also police and fire. We hang out with a whole bunch of people in the emergency medicine world and I think we're lucky that we get to do that. It's a much more pragmatic way of seeing the world and we don't really care who or where you come from,

you can be an immigrant, you can be undocumented, you can be a wealthy V-I-P-C-E-O. You could. Be the mom of your friend's soccer team's coach, you could be anyone in the community and we're gonna take care of you. So I think that's the most magical thing about the entire continuum of care for emergency medicine.

Klaus Grim: Yeah. And that, those connections that are very important to build and it's so easy to get caught up in oftentimes this environment that can seem very negative, the workplace culture in emergency medicine and emergency medicine can sometimes be very dark humored or very negative where we're complaining about.

, Many different things. And so it's important to remember that fact that you just said, there's so many different connections that we can build with, , different colleagues maybe not direct colleagues as you mentioned, police, fire, EMS and, and to be proud of the work and the system that we've created for ourselves.

And granted. We are, are oftentimes probably very upset about the big overall s system, but all we can change is ourselves in that moment and, and remembering that we can, we need to stay well ourselves in the process.

Lillian Liang Emlet: And so I'm curious, , you are still clinically practicing physician associate Plus you are a preceptor and you teach and you're in education realm for new students.

I'm curious and then you're also a coach for he healthcare professionals and leaders. And so I'm curious how your frontline experience being a physician associate and in emergency medicine has shaped your perspective on what healthcare leadership can look like.

Klaus Grim: That's a great question. I think it just comes back to everything you just mentioned. I, I really needed to take a step back during COVID and see things from many different perspectives from a patient perspective. Right. And remembering that I was becoming very negative myself about the system and how things were happening.

And, and it was a shared, , energy among all my colleagues and many of my colleagues left the field entirely as a result. And that's what led me to my own coaching journey was saying, I know I need something different. And as a result, I realized. I know we all need something different and how to do so in a way that says, I'm not controlling that aspect, but I'm offering people the opportunity to make those changes in their lives and within the system.

And so that's kind of prompted that, that journey and, and then, so, as a result of that stepping back approach that we do as coaches and doing the work for myself to say, I'm not well, I need to get well, how do I do so for myself, I've really realized that , a lot of people can benefit from this outside in approach and.

And I think that is probably what led me to work with a lot of healthcare leaders. And so, and, and same thing with working with students is just having a broad perspective. And, and obviously I, I for a while I never really resonated with the leadership role. I had never felt like I was a true leader.

But. When I started to realize that I am a leader within my own life as well as in my profession, I have a voice to make positive changes. I think that's what offered me the opportunity to say, , healthcare leaders could, could also benefit from some kind of, from this perspective.

Lillian Liang Emlet: I like that. , Both of us have really evolved from seeing it ourselves as just clinicians to understanding our broader impact and all the different roles and responsibilities. Like you said, being a leader of your own life. And I'm curious what, how did that shift happen? , Because I know there's a lot of people listening who. May not have any position or a title or they're just wondering, I'm sort of curious about what is this coaching thing that everyone keeps talking about a little bit. Like, , you don't need to come get in my business. Kind of attitude. I'm curious what the shift looked like and how, how did this sort of evolve?

Klaus Grim: Well, it took time. I'll start with that. And 'cause it's so easy to be like. Pushing it to the side saying, oh, it's the system that needs to change. It's my leaders that need to change. It's not me. I'm not the problem. It's so easy to say it's somebody else or something else. And I think I was caught up in that for a while myself.

Right. And, With the continued work that I was saying, I'm not well, I need to change, and I started to make changes in my own life, both personally and professionally and really remembered why I stepped into medicine, I think was a very big thing. And I think we often forget that as healthcare professionals.

So I took that approach and remembered who I am authentically. I think that was so important. And as a result of that work and figuring that out, I started to have an appreciation of other roles and the greater system and then the challenges that they have that are oftentimes not as transparent. So I think, for a healthcare leader who's listening to this

Klaus Grim: is, is,

Klaus Grim: is transparency is so important, of understanding what your challenges are because a lot of healthcare leaders feel like the need to, , stand up straight and say, I got this all, , I have an answer for everything. When sometimes not having the answer is okay, and just saying, and, and even offering a, a question to your, to your team and saying.

I don't know that what to do for this next step. I would love to hear some other insights. Because , more heads in, in, in, in a challenge oftentimes lead to a greater solution and quicker. And, and there's nothing wrong with it. It doesn't say you're a bad leader. I think if anything it says you're a great leader, you're offering my insights and that I can make those positive changes and.

I think as a healthcare leader too, or even just as a healthcare professional, oftentimes we think we're just, we're just our role. I'm just a nurse. I'm just a pa, I'm just a physician. But we're more than that. We are the work environments that we're in. We are the, we are the person we know, the professional, experiencing the day-to-day life and are noticing the changes that need to happen.

And so our voices are so important. And so I think that's what. Over time. That work for myself seeing, still practicing clinically full-time, seeing the challenges and just being able to say, I have a voice and I can do so in a professional manner. And I think that's where that leadership unleashed, is saying, wow, I am a leader.

I have a voice. How do I make it heard in a way that's professional and I don't need to have a leadership title to say that I'm a leader. And, and when I started to embody this whole leadership, I'm like, oh my gosh, everybody's a leader. Like, , the nurse that is managing my patient, they're a leader.

I hear them, they're answering all the questions for my patient, and

Klaus Grim: she,

Klaus Grim: if she doesn't know, she comes and she asks me. And that's what makes a leader. A leader is knowing what they know and knowing what they don't know, and then getting the answers in a way that is collaborating with with the team for the best possible patient care.

Lillian Liang Emlet: So many good nuggets in there in terms of the fact that, , we all have the opportunity to, to be the leader that we. The system, the the patients our teams need us to be. And really the leaders with the titles are

to co, co-create with you the environment that it's okay for everyone to have a healthy discourse and solution testing.

Because I think the reality is we always complain about solutions not being frontline generated. I guess the question is, well, did you suggest your idea, And, and I think the other hard thing is, , a lot of times people think, well, I suggested and no one took me up on it. Well, there's also 50 other people and there are 50 other great ideas.

Everyone's turn will come, if anyone's been through one of those brainstorming sessions, like all those post-it notes of ideas, one, at some point the right idea will happen, the right time in the right way. And it's still really important that you suggest the things that need to happen because. I, I get to see some of these projects come to life now, like a year later, people have been suggesting something for a little while, and we try some pilots, but then everyone's get their, everyone gets their turn in the sun. So I think that's the one thing I probably would wanna say to people is that you're, you'll get your chance, like one of these ideals will hit and it's all good.

Klaus Grim: I think a lot of the healthcare professionals come for us or come to us for a lot of those reasons is, , they want to make these changes and they do, they say them to their, , teams. 'cause what healthcare leaders I don't think understand too is that. Most of their employees want to be there.

They're proud of the organization that they work for. They're wearing their, your organization on their scrubs or on their jackets, and they're showing up every day. And I think the problem with a lot of what we do as healthcare professionals about sharing our insights is we don't know how to, as you just mentioned, and, and then if it gets rejected or it doesn't happen immediately, we're, we feel defeated.

Oftentimes, it's like, well, if this organization's not gonna listen, I'm gonna look elsewhere. And I think that's a big struggle that we're seeing in medicine is that, and why we're struggling with retention is, is people are constantly looking for their voices to be heard or to see. Changes that they, they recommend and if they don't see it with within their organization, they look elsewhere.

Right. Or some of them consider leaving the field completely. And I think that's when a lot of people come to us is, is, is think I don't know what to do, or I'm considering this and I need some better insights. Right. And I, and I think you offered some great advice, was , keep plugging at it.

We know that. Things in healthcare moves at a snail's pace, unfortunately, and I think that actually goes with a lot of big organizations even outside of healthcare, but it does. But if you can do so in a, in a very professional way and, and stay at it, if you truly believe at it, you can make those changes.

Lillian Liang Emlet: And I think that's the reason why we've seen with

Klaus Grim: coaching

Lillian Liang Emlet: different professions and different people in the leadership team, that it is a dyadic experience in terms of being heard, setting people up to be heard, and then negotiating and figuring out a solution forward. And so, , when we think about what coaching has taught us, every healthcare role brings unique strengths to leadership, like you've mentioned. So what strengths does emergency medicine focus professionals bring that we really haven't fully celebrated or recognized?

Klaus Grim: Ask me that question one more time if you don't mind.

Lillian Liang Emlet: What strengths do emergency medicine focused professionals bring that perhaps we haven't fully recognized?

Klaus Grim: I think there are so many strengths that those in emergency medicine experience and I think the hard part is we maybe not. We don't voice it enough, or we don't, or we don't say it enough in a, in a, in a correct professional way that gets heard by the people that need to hear it. Because we're so busy with just working and varied shifts, like we may be coming off an overnight and it's like, I can't send an email at seven in the morning about this or call somebody I need to get, I need to prioritize my sleep.

Or I have a shift next day and then it all of again, all of a sudden gets procrastinated and pushed aside. So I think that's a big struggle. But from emergency medicine, like we work with all the consultants, number one, so we we know everybody and we know everybody's style too,

so I'll, I'll consult the cardiology team. I think I know the style of every cardiologist that we consult, and I think there is strength in knowing that, when we're talking to the CMO or we're talking to , somebody in the trustee or the board who's looking for insights about how we can improve I think that's a really hidden insight is that those who practice in emergency medicine just have such a great perspective of.

The way things are seen. Obviously we don't see other things that are happening on the floors, but we are that bridge to the floors and we, we bridge the connections between the hospitalists and the consultants and this, and, and, and I think we. We have some greater awareness that really can, can be powerful in making ch like changes that are necessary for an organization if we can just get our voices heard.

Lillian Liang Emlet: Yeah. I love that. I think also you sort of encapsulated, as I was listening to you talk, was the fact that emergency medicine encapsulates the both and or the Yes. And primarily because it's all good. It anyone's welcome here. We understand a lot of people's different perspectives and we're willing to collaborate.

I think that's the most unique thing about emergency medicine in general. All the people who work in the department

Klaus Grim: can

Lillian Liang Emlet: a solution to be able to be that bridge from pre-hospital care. The doorway to the hospital and the healthcare system for many people, and then onward and inward to get you connected to the right specialist to be able to get you the right care that you need at the right time. And then also knowing when to turf, when to say, what? This is really subspecialize. I am going to get you in contact with the right subspecialist, , to basically say like, I, I'm the mega coordinator, to be able to help you find your right healthcare journey in this, in this time and day.

Klaus Grim: Yeah, it's, it's, it's a lot of fun. I mean, from somebody like me who I guess I could consider myself an extrovert. I love working with other people. I love working with patients. I, I enjoy a very collaborative environment. And , I think for the healthcare leaders here listening, invite your, your emergency medicine, those who may not hold a, , true leadership position, but are leaders within the, their own environments for insights.

If you're looking to make some changes within the greater scape of your organization.

Lillian Liang Emlet: Next question. I wanna turn a little bit towards the future in terms of what excites you the most about the next generation of emergency nursing and physician assistant healthcare professionals, the students, the different fresh perspectives they're bringing, keeping us all young. Curious, what excites you the most about working with all of the different learners in your department?

Klaus Grim: Well, there's so many things, but , there are a lot of things evolving and I think in the emergency medicine field, and I think one of the things that we've talked, we shed light, I think on a, a previous episode was about how COVID though very destructive and, and unfortunate shed light on healthcare professionals.

Burnout and challenges saying something needs to be different. Right. And, and what I'm seeing a lot now is, and even just PA education, is wellness and wellbeing curriculum being built in. So number one, I think that's incredibly powerful and I think that's, that generation who's experiencing that is bringing that into the actual healthcare workforce and saying.

We, we needed an environment that supports ourselves through these challenges because for, , many of us, we didn't get that, you probably could speak to this, , and it's still happening today with residency, they're working a hundred hours a week 24 hours shifts, no breaks.

Lack of sleep, ? And it, and we know that that's not. Healthy. It's, it doesn't, it, it, it opens the opportunity for, errors. It o it, it, it, it's, it, it can be catastrophic to your personal life with your relationships even just, , your physical health. And so I think there are challenging the system in a way that says we need changes to keep ourselves well.

So I'm excited to see how more voices in this, new generations can spark some changes that I think are so needed for many of us to remember that we are also human beings. We can also be patients, as you mentioned, Lilly, and how can we prevent that? I'm a big believer in prevention. And so how can we prevent that by by staying true to the foundations of health and wellness.

Lillian Liang Emlet: I really am looking forward to the ideas. I think that's what I love about every generation that comes forth is that there's new ideas and new, new expectations. I think why I always try to tell, at least my mentees is ask for it. I get the fact that it sort of will be a little strange in terms of the contract negotiations because they just like, well take it or leave it.

So it's, this is the way the contract's written. It's like, well, we'd love to, can we have a conversation about how we can modify some of the terms? It's just normal and the, a lot of times it could be continue to be pushed back because I think there's a lot of systemic bullying that occurs in different HR practices. But there's a lot of also ones that are very healthy where they're like, let's have a conversation about it. And if we just frame it as that, then we can figure out maybe how many hours, what the benefits are, what, what's more important. Because I think a lot of younger generations are recognizing the balance and the ability to balance both the time along with those shifts and the expectations, like what can be considered bonus work and what's considered minimum work is a more healthy standard.

So that. When things do get tough and you might have to pare back a little bit for health reasons. It's not a shock or a scare from both the employer perspective and the schedule maker. 'cause right now we're all just pretending everything's fine, running really lean so that if someone has to go out for six months for cancer treatment. The entire group, literally delaminates. And so I think we definitely have a different way forward if we think about how we have set up this system for success. I'm excited that, that the new generation wants to do something different.

Klaus Grim: I think this I would love to offer an invitation to the. , The physician assistant, or sorry,

the physician associate to the emergency nurse

Klaus Grim: who,

Klaus Grim: or the emergency healthcare leader who's listening to this episode and is resonating to this content and it says, oh, I don't want to be an enveloped in this. Negative environment and culture that I sometimes, I'm in.

And I want those positive changes that you're hearing or that we're saying here and you wanna make changes to your life so that you can prevent, , illness

Klaus Grim: and,

Klaus Grim: and a lot of the challenges that result of working in our environment. To

Klaus Grim: kind of

Klaus Grim: book a call with us because I'd love to help you figure out what your next step is to

Klaus Grim: kind of

Klaus Grim: be being well.

So I'll put that in the link as well.

Lillian Liang Emlet: So I guess to come to a close, , as we celebrate this important these important weeks for celebrating physician associates and also celebrating emergency medicine nursing, what would you like people to

Klaus Grim: understand

Lillian Liang Emlet: about the collaborative nature for the great work that we do in the department?

Klaus Grim: I think I'd like you to know that. And remember that we are a team. We are not. It is so easy to be segregated and say, oh, I'm just a pa. They're just a nurse. We have different supervisors. We have different training. What we can do oftentimes is, is greater than we can do. apart I think is a, is a big thing that I'd like to leave everybody with today and, and that you can be supportive.

As a PA to your nursing team by helping them when you see they're struggling. Right. As the nurses oftentimes do for us when we are running around, also managing like them multiple different patients answering a lot of the questions that. We should be all, we could also be answering, right, that we can support each other by helping each other with, with tasks that we both can do.

Obviously act within your scope of practice. But , I oftentimes will hear patients yelling out like, I need, use the bathroom, I need help or, and oftentimes it's just a question that needs to be answered and they're screaming on the top of their lungs. We all know that feeling of being in the er, when there's, people screaming and it's like. I just wanted water. We could help with that, or help somebody to the bathroom. These are things that we all can do. So remembering that we are a team in, in this collaborative environment,

Lillian Liang Emlet: So I just wanna say thank you to all of our. Emergency nurses and physician associates working in the emergency department this year. And we also want to let that we have a community for people who are interested, a private community, who are

interested in becoming more well and finding their people who want to do something different and be something different.

And that's our MedThrive Group coaching community. It's a private community, so no more Facebook trolling and no more strange bullying that happens in some of those, public forums. This is a private place that's vetted just for healthcare professionals, so check it out. We'll put a link below in our YouTube comments.

Thanks so much, Klaus, for coming on and talking and celebrating physician Associates Week and emergency nursing week.

Klaus Grim: Thank you for celebrating us.

Lillian Liang Emlet: Bye everybody.