96 - How to Decrease Burnout and Build Morale Among Your Nursing Staff, an interview with Sima Taghi Zadeh

It’s safe to say that fertility nurses play a vital role in the success of any clinic in our field. But nursing burnout can happen quickly causing staffing shortages and even a reduction in conversion to treatment rates. To combat this, clinics need to remain proactive in their efforts to manage nursing overwhelm. So how do you do it?

On this episode of Inside Reproductive Health, Griffin talks to Sima Taghi Zadeh, the Director of Nursing at Pacific Fertility Center of Los Angeles. Sima began her career in fertility as a Medical Assistant, then went on to continue her education and work up the ladder to her current role, all while being a fertility patient herself. Sima’s perspective gives insight into what clinics can do to retain their nurses through empowerment, building morale, and preventing burnout.

Learn more about Sima Taghi Zadeh and Pacific Fertility Center of Los Angeles by visiting https://www.pfcla.com/.

Mentioned in this episode:
14 - Dr. Serena Chen
89 - Drs. Serena Chen and Roohi Jeelani
Monica Moore
MRSI

To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com.

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Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field. 

Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.

JONES  2:29  
Mrs. Taghi Zadeh. Sima, welcome to Inside Reproductive Health.

TAGHI ZADEH  2:33  
Thank you very much, Griffin, it's an honor to be here.

JONES  2:36  
You and I've been connected for a while and it was just interesting to me that you were a fan of the show because you're in a nursing role. And this is a business podcast and I have brought on nurses in the past--where my interest lies is that I, as a firm, have to get involved into everything that can lead from initial patient acquisition all the way to how people convert and there's so much of a role that nurses play in that people don't care about new patients in the door. Most of the people listening have more new patients than they know what to do with, but how you actually get people to convert to treatment. There's so much on the shoulders of the nurses and we're going to talk a bit about that. First, maybe give us a state of the union with what's happening the last six months in a post-COVID world in fertility clinics, since we all open back up again, what's the state of nursing in the IVF clinic right now?

TAGHI ZADEH  3:32  
Well, with a lot of teleconference and telemedicine starting after COVID you know that a lot more patients have access to schedule a new patient, they reach out to physicians, there's a lot of emails going back and forth. Meanwhile, not a lot of nurses and nursing teams can be in the clinic. So a majority of the people who can work from home are working from home, so we don't have a lot of help in the clinic. But we have the benefit of telemedicine bringing us a lot more new patients. Alongside with that, we have shorter hours, physicians come to the clinic within shorter periods of time. We can’t have all four physicians in the clinic because of COVID. We want to reduce the traffic in the clinic. So it's a little bit more intense for the nurses that they're doing much more in less time than before and it's just hectic. It is very hectic right now.

JONES  4:31  
From just your anecdotal experience, but also talking to other people in the field that are in your position, anecdotally, what is burnout like now compared to what it was a year ago?

TAGHI ZADEH  4:46  
It's similar to a little bit worse. Right now nurse burnout is more than what it was last year. Like I said because there are more patients coming in. There are more questions, more emails, more phone calls involved because people are working from home, they have more time to reach out. And alongside with that, we have less nurses working. Through the very first few months of COVID, we had a lot of furloughs, a lot of people were not able to work. So we had to do more work with minimum support. And that all has caused all of the nurses to be a little bit more stressed, we have less access to the physicians because they also have personal life, they have a lot of changes at home as well, they have their kids at home, they need to spend more time with the family. And these all have caused nursing teams to be a little bit stressed right now, a little bit burnt out. And let's also not forget that the pandemic every so often one of your team members is going to be affected or exposed and other members have to pick up the work.

JONES  5:57  
And that's been happening at so many clinics where--there are some clinics that actually might have herd immunity right now--if you’ll pardon the tongue in cheek--because COVID has really ripped through some of those offices and that's caused logistical challenges. Where I have this interest is that everything that needs to be done from a business development has to lead back to conversion to treatment. Because if we aren't helping as many people move towards treatment, that should and can be--not everyone moves forward to treatment--but everyone that should and can be--and that's an important distinction. If we don't achieve that, then we have less people getting pregnant, less people starting their families, less people getting the help that they need, less money to the clinic, less buffer there is to support staff when things happen. So conversion to treatment is really important. How does nursing burnout, in your view link to conversion to treatment?

TAGHI ZADEH  7:00  
Oh, it has a huge effect. It has a negative effect on the burnout, on the conversion. And that's because when you have nurses who have a huge caseload--they have a lot of patients coming through, they have so many phone calls and emails to respond to--they don't have that extra time to put in that extra touch to follow up, to call the patient and say, ‘Hey, if I sent you this lab information last week, have you done it? Do you have any questions? I sent you the consent form? Have you done it? Do you want to add anything to this? Do you have any questions? This is your next step.’ If they don't do that, you see that patient fall through the cracks, as I know you'll have. I've heard this on your show before—I think it was Dr. Serena Chen that said one of the most important reasons for a patient not getting pregnant, is just drop out if they don't continue treatment. I mean, we have reached that state in fertility that if you commit to treatment, you get pregnant. And when the nurses don't have that extra compassion when they don't create that rapport with the patient with the first appointment with a new patient visit, the clinic loses those patients. Another thing that you know is that and everyone knows this fertility physician facility of patients shop around, they schedule appointments with different physicians in the area. They go in they check out the clinic for work now with telemedicine, they have more time to have to research the clinics, research to physician, research the nursing team. And they actually test that the clinic to see how many times that the nurse reached out did they call me that they asked me for any follow-up. And when you don't have that touch, you lose the patient.

JONES  8:53  
For everyone listening about that touched—there's some of this that's on the operational side quite a bit. But it's not all entirely on the operational side. And what I mean by that is, to the extent that expectations are set more properly, this is what people need to focus their marketing on marketing cannot just be about new patients in the door. If you don't have you don't convert people to IVF they're not happy or to the treatment that's best for them. That's an important distinction because not everybody should move to IVF but to the treatment plan that is best for them, which often will be IVF. If we don't do this, then the marketing is for not and to the extent that we're setting expectations properly and resetting them again and again, that needs to happen in each four of the patient journey phases. And so what you're talking about Sima is when these expectations fall on the nurse, this is also what people are judging the clinic on what they're writing reviews about. It's how you're gonna affect on the Net Promoter Score. And we know that if you're zero to six on the Net Promoter Score, people are detracting from you, if they're seven to eight, they're just not seeing anything. And they only recommend you if they're nine out of 10 on the Net Promoter Score, and that delta between satisfaction and expect expectation minus delivery equals satisfaction, I believe is one way that that's described is kind of setting up for what you're talking about on the nursing side. And so when you have these expectations from patients that they're going to, that they're going to get a contact at a certain amount of time or information at a certain amount of time. Is it in the possibility for the nurses to be able to reset those expectations and continually recalibrate them so they're realistic? Or is it too late by the time they get to the nursing team?

TAGHI ZADEH  10:49  
Absolutely, I think nurses can reset any kind of expectations. But you have to do it within a window. You don't want to do this three weeks after the new patient visit, or four weeks, but you don't want to do it two days after the new patient visit. You know that as the new patient is that there's a lot of information—a huge load of information that's given to the patient. And physician already gives them a lot of information. And then they get moved to the financial counselor, financial counselor gives them a lot of information and the nurse comes in, you want to talk about pharmacies and medications and consent forms and lab requisitions and everything that needed to know, patient leaves with that huge information overload. And they don't know what to do. Sometimes also, it happens that you meet with a physician, you just don't click or it's just something that you feel like, Okay, this physician wasn't what I expected. Maybe I can switch that physician to another physician still in the center—you want to keep the patient in your center, when the nurse reaches out and says, “Hey, what happened? How was the visit? Is there anything that I can add to the— I sent you this in PDF format review, and let me know what you think. If you have any questions—” You can see sometimes like if they didn't have that good connection with the physician, even they can talk about it to the nurse and the nurse can help switch the physician. It doesn't happen that often. But still, if it happens, a nurse can still keep that patient into the practice in the center. Sometimes it's even the nurses, it might be the financial counselor, that the patient just didn't have that great rapport with. And you can still if you have your financial counselors also reach out to the patient from the financial part and say, “Okay, I ran your insurance and this is what can be covered. This is what cannot be covered. These will be your responsibility. Do you have any other questions? These are the compassionate care program or all these financial benefits and financial assistance programs so you can reach out. How was your connection with your nurse? How was your connection with your physician?” When you reach out to the patient through different departments, you will be able to keep that patient satisfied from all different departments. And that makes it'll be a benefit that not all of clinics have that not all the clinics do that.

JONES  13:18  
Let's talk a little bit about that follow up to because there is a balance that is delicate and that follow but to move people towards treatment, follow up is absolutely critical coming from the center not waiting for the patient to do this. And I really take this stance because some of our clients are already doing it when we then some people aren't. And part of the reason why people aren't is because they don't want to be pushy and you can be pushy, you can definitely do the wrong follow up. So what is the cadence of follow up that nurses should have after the new patient visit? Who should be doing it? And in your view, what should it entail?

TAGHI ZADEH  14:02  
If you set that expectation, right? So let's say as a new patient visit, the patient meets with a physician. And there is a question that the patient asks a question about so and so the physician says “Okay, I will let my nurses know to reach out to you.” And when the nurse meets with them, he or she says, “Okay, these are all the information I need you to review. I will reach out to you in one week or two weeks and I will go over all of these with you again. In the meantime, if you have any questions reach out to me,” financial counselor should do the same. Financial counselors should sit down with a patient and say “Okay, let's talk business. This is the cost. This is what your insurance might or might not cover. We're gonna run it. This is going to be your responsibility. So let's do research on this and these are the companies you can reach out to for financial assistance. And once I get more information I will reach out to you.” So the patient is waiting for that follow up from the nurse, from the financial counsellor, and you're not bombarding them with emails and follow up calls and surveys, because you know, when you go as a new patient you go in, we all know that everybody has electronic surveys that's going to be sent out to the patient. So you don't want to bombard patients with so many different platforms trying to get feedback. But when you set that expectation with a patient with a nurse and the financial counselor, and sometimes even the physician say, “Hey, there's something that the patient asked me that I want to follow up and go look up that research, and I'm gonna actually reach out to you and talk to you about that.” And that will be a good follow up. But a patient is expecting that. So you're not going to sound so pushy.

JONES  15:45  
That framing of expectations is critical. As long as the patient knows that they're going to be reached out to then you're not bothered that the message still matters. But the expectation of how it's delivered is absolutely paramount. If people aren't doing it, they need to have a process for being able to do that. So we can see how nursing burnout is affecting conversion to treatment in that sense, but what about morale? Like when was burnout due to morale? And then what does that do to conversion to treatment, like, nurses’ attitudes, and I see some perspectives of that are very from the old school, or we just have a lot of Type A people in our field that are worker bees that are workhorses that have no problem working 70-80 hours a week, and just pushing themselves—

TAGHI ZADEH  16:38  
To send them send their resumes to me!

JONES  16:42  
Well, I know a lot of them are physicians. I know that there are nursing workhorses, too. But I think sometimes people that are from that ilk have the mo of saying, just get on with it. And so yeah, if and then I also think that there are people that are soft that are there's not a lot in our field, but there's probably some I think just I think in society, there's a lot of soft people not really speaking to the fertility field, but it's that thinking that they need all of the self-care in the world. And it's like, brother, we're not going to get anything done if that's the case. So where do you see that balance? And what do you see the actual practical implication of burnout to morale and, and how that practically plays out? So we don't have to say, yes, you're being softer, or you're being old school, but rather, what are the practical implications of morale, and how and how burnout affects that to conversion to treatment, and other ops.

TAGHI ZADEH  17:40  
Let's look at it this way. Imagine for a second that you're the nurse that has been working since 7:30. In the morning, have been setting up rooms or helping amaze in the clinic, helping physicians, so many questions, so many emails, so many phone calls, in its 2pm physician walks out with this new patient or to telemedicine, they give you this patient and say this is a new patient, she needs the center all the information for all of these four different topics. requisition financial, financial counselor will reach out with everything you send prescription, you will need to send consent forms, you will need to send follow up research about single embryo transfer, and you're already still tired, you already have reached that level through the day that you have talked to so many people, let's say you've called two negative pregnancies already. And now you're going to have to have all of this repeated to this new patient but you are responsible to create this rapport with the patient who just walked in through the center. And if you are that burned out, what are you going to do? You're just going to brush it off and say okay, here's all this information review was Call me if you have any questions. Let's say you lost that patience and simple as that. When the nurses attitudes affect patient conversion this much and it affects the health of the clinic so much. You want to see what is what are the things that can change that attitude for you. What are the things that simple, little simple thank you from the physician, you assisted a procedure with a physician, a physician walks out and just simply says, Hey, thank you or good job on that ultrasound or say thank you for reaching out to that patient for me. That sets the morale to change. But, yes, morale burnout attitude of the nurses is going to have a huge impact on the number of patients that will stay in the clinic conversion rate. And like I said, like you said type A personality patient. nurses that you have will always be a successful nurse but how many of those Can you have

JONES  19:58  
For the people listening, the operational side of the operational marketing that they can do is the lowest hanging fruit for anyone that wants to have more volume on the procedure level, the lowest hanging fruit is on the operational side. But that does not mean it's the easiest. It can be the hardest, because you're asking people that are already doing a lot to do either more or to do something else. So when we're helping people do this, before we have them do something more, we need to see, we need to cut things out because there's only so many hours in the day. And there are only there's only so much bandwidth that people have. So what follow up should nurses not be doing?

TAGHI ZADEH  20:46  
Nothing financial. And this is a very famous topic that all of the nursing teams always say that and even management knows that nurses should not be involved with anything financial payments, business, any of that money talk at all nurses shouldn't be involved with that, because I feel like the rapport and the relationship that the nurses have with a patient is it's something that pure that you do not want to kind of get a tainted with payments, because you know, patients get frustrated with bills, they get frustrated with the business administration of the money payment plans, and they get upset with that. And you do not want to have your nurses being involved in that because it will damage their relationship with the nurses. And I think the second thing that the nurses shouldn't be involved is the embryology record. I feel like for the nurses to reach out to the patients and talk about the fertilization report or embryology report. It's something that should be done either by the embryology team or the physician not that the nurses don't have the knowledge of this or they can't understand the grading system. Or information on how the fertilization occurs, where the names and with the lingo of the embryology they understand it and they're very good at it. But I don't think that they are the best person to reach out to the patients and explain to them what happened with a fertilization other than these two, I think any other kind of follow up whether clinical or even just they just patient just need someone to listen to them. Any other follow up or anything needed in the journey of fertility nurses can handle and nurses should be involved because of the relationship that they have with a patient.

JONES  22:36  
Okay, so we know what nurses should not be doing. We know what nurses should be doing and why. How do we keep them engaged?

TAGHI ZADEH  22:46  
One of the very good things for the nurses to be engaged is education. Education is one of the really good topics that's always interesting for nurses. Fortunately, in a fertility clinic, there's so many different positions and so many different degrees as I can say, like you have a physician, you have a nursing as a nurse practitioner, or ma their receptionist, there's so many different positions that you can have at a fertility clinic. And you can grow. And I don't know if you know, but that's how I got here, I actually was a medical assistant at a fertility clinic. And I started with just helping in the or I was just technically just cleaning bill or after every surgery. And then I went to went back to nursing school and I got LVM. And I got my Rn, and then I got my master's degree and I just moved along so many different positions. One of the things that it really gets nurses engaged is to put them in that path, teach them more the fertility technologies, so rapid growing, and there's so many technology and knowledge added to it everyday that if you keep your nurses involved in that knowledge, whether it's from, let's say, embryology or even protocols or medications, stimulation protocols, it keeps them engaged in the sense that they see a growing tasks, they see that they can grow in their position in their even daily tasks. And a lot of physicians do that very well. They encourage the nurses to learn more when they discuss something with the patient and you have the nurse in the room with you. They walk out and they say well, did you learn that I was talking about let's say vitamin D. And these are the reasons that you want to always check vitamin D level. So next time when the patient calls and the nurse has this knowledge and understand that they're asking about vitamin D. It gives them so much satisfaction. They're like hey, I reached her level that I can answer a question about vitamin D. This is one of the reasons that you want to generally educate nurses constantly. You don't want to stop them. It has to be constant, you have to have meetings at least once a month, even a simple half hour, one hour seminar from one of your own physicians that can educate nurses about uterine anomalies or anything, anything that you deal with on a daily basis. It gives them so much satisfaction.

JONES  25:18  
I want to give a plug for some nursing education. I'm not a nurse. So I'm just getting feedback from many nurses who've told me these things, and they're not paying me to do this. So if you don't like it, I don't care. The first is a mutual friend of ours, Monica Moore, who I know many practice owners who have retained her as a consultant and a trainer. And it really given me outstanding feedback on both of those. And the second is I've heard a lot of people talk about the Midwest Reproductive Symposium Conference. And not everybody knows about that, because it's not ASRM, but it does draw people from everywhere. It's in Chicago. It's Dr. Beltos's baby. So for Dr. Beltsos and Nikki Pappas, if they're listening, this is a plug for MRSI. I've just heard a lot of good things from nurses. If people are thinking about what types of education there are others, and probably a couple angry emails of saying, Why didn't you mention me, those are just two that I've gotten a disproportionate amount of feedback on. And I want to say the second thing that you were talking about, about with burnout and encouraging people longer, you're talking about education to motivate, but there's also something else. And when we work with marketing teams, if we're doing training for marketing teams, one of the things that they struggle with is how do we get the buy-in of all the docs, especially if it's a big multi-lab, multi-state, several dozen doctors, they have a hard time getting those people to buy in, or the nurses or the other staff, I say you need to encourage at every single level. And inevitably, on social media, somebody's going to say something like Sema was just the most wonderful person that we've ever worked with. And we would not have had this journey with that we wouldn't have been able to get through this journey without her semen needs to see this. So for those listening, I don't care if you're on the business side, your clinical team needs to see this. This is one of the ways that the lanes of marketing swim back the lanes of clinical operations, and vice versa. So I hope it's not too tangential for the motivation that you were talking about from education. But those success stories really need to be shared with the clinical team as well.

TAGHI ZADEH  27:31  
Thanks, actually. And there's also another part to that may I add to this is that you want to be transparent with your nursing team. If you are receiving any kind of feedback from your patients on the survey, because you know, these surveys go to the managers, they don't go directly to the nurses. When you feel these positive, you want to be really transparent and share that with a nursing team. As majority of the time managers when they receive a negative feedback, the very first thing you do is you go to the nurse and say, Hey, this is a negative, we received the value what happened here? How did this happen? How can we fix this, but we don't see the positives being forwarded to the nurses. So that's that's a very good point, you want to always be transparent with the negative and the positive. That also keeps them engaged. Absolutely.

JONES  28:20  
And managers also need to be trained on how to use feedback surveys, because there's a there's a couple of myths. One is that people live leave more negative reviews, they only leave reviews when they're negative, that simply isn't true. But it is true that it's not the same as having your total sample size or close to it. reputation management is different from patient satisfaction, even though they overlap. And so having people that can report on the aggregate is important because the customer, the patient singular, is not always right. That's a failed axiom. What is true is that the customers, the patients plural, the market is always right. It has to be taken on the aggregate because anyone can have a home run or a bad day. 

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JONES
How else do we get nurses engaged? You talked about when we were emailing back and forth, you mentioned let nurses have fun--what is fun, Sima? How specific can you be with that? Because otherwise, it's just kind of the hippie-dippie abstract concept, like how actionable can you get with that,

TAGHI ZADEH  31:01  
One thing that I really want to mention is I being a facility nurse is very stressful, it is very stressful, to be there to deal with a lot of bad treatment, sad diagnosis, day in and day out. And some of the fertility nurses are fertility patients themselves. So they feel inside and out. It's stressful, it's really hard to like, day in and day out, talk to patients and sometimes give negative news. In we feel the same. We've I think this is one of the things that Monica always says--Monica Moore--we genuinely care about the patient. So we go home thinking about what could have I said to make this easier to the patient, how could I change my vocabulary to reach out to the patient, say something that hurts less a little bit. And that's stressful doing that constantly, every day, day in and day out? It's very stressful. So you want to allow a little bit of fun. Fun is having the nurses get together, do stuff outside of the office, start teams of sports teams, that they can bond outside of the office or even inside of the office. When you're scheduling nurses, you want to allow a little bit of extra time here and there. You don't want to schedule two, three new patients back to back to one nurse within two, three hours. That's when you get the burnout. And that's when you lose the patients. Because we're all human. It's very stressful. And you don't want to have to feel that pain constantly. Some of other things that I can mention about allowing fun is that I have always seen that when nurses work with a physician who is happy, who comes in and jokes around, nurses do better, as opposed to physicians who come in and they're a little bit, I don't want to say grumpy, but serious. They come in and they're serious. They're there to do their job. They don't want to bond, they don't want to communicate with anybody else other than the patient. It gets a little bit difficult and challenging to keep the nurses engaged. You want to be involved in a nursing team where the physicians are even happy and funny. And they walk in and they joke with everybody. And even just like I said, simple thank you or how are you, how's your daughter, how's your son, that personal coach will make it a little bit easier for the nurses to tolerate all the stress and pain that they go through every day.

JONES  33:34  
Kind of made me think of something and I want to ask about how the physicians might consider that type of bonding, but it makes me think of an ASRM probably five years ago, and there was a physician that who we all know and I was walking by and we had met each other a few times. And we'd become friends since but we're probably acquaintances at that point. And he said, as I'm walking by, he says, There goes the happiest guy I know. He's talking about me. And I was thinking if the 12 people in my life that are more score, you know, those core friends and family don't feel that way about me. And if my employees don't feel that way about me before an acquaintance perceives me that way, then I feel like there's a real incongruence and I wonder if there's an incongruence sometimes where physicians can take the profile that you've described of being upbeat and a little bit more relaxed and engaging with patients, but then maybe not with their staff how common or not is that?

TAGHI ZADEH  34:37  
That happens—I don't know. I've been very fortunate to work with all of the physicians that I've worked with throughout these 12 years.

JONES  34:46  
Don't get me wrong. I don't mean like Dr. Jekyll Mr. Hyde, where they're putting on a facade. But I know it myself like I'm in one mood when I'm talking with clients and then and then when I'm back with the team, I'm just I'm a dog on a bone and I'm okay. We like we have to accomplish the objectives. And I'm always thinking about the objectives. And I need to remind myself, okay, you need to allow your team to experience some of that happiness, some of that happy go lucky, some of the rapport building a little bit more casual at times. And I need to actually remind myself, so that's what I'm referring to.

TAGHI ZADEH  35:20  
Yeah, well, it is very common, you know that the physicians have a different relationship with the patients and the relationship they have with the nurses. And it's just as they enter into the exam room, they're a completely different person, because you want to have that patient also be happy, you still don't know how that patient is going to react to this. Unless you have a third patient that you know, for years, or you know that they're okay, and you continue joking, and you walk in making fun and all of that it works out. But the majority of the time physicians are more serious with the patient than they are with the nurses. That is very common.

JONES  35:58  
Let's talk a little bit about decision making. We've been talking about how, in nursing engagement, if we don't do this right is going to cost us IVF volume, it's going to cost us in conversion if we don't tend to burn out. So what does decision making play in all of this? What autonomy should nurses have, where they're just accountable for their seat, and not every micro-decisions, here are the decisions that you are allowed to make, we'll review your overall performance over time, but we're not coming in and saying, oh, now you need my approval for this decision. And what decision making belongs solely within the purview of a good IVF nurse?

TAGHI ZADEH  36:42  
If a physician has been working for that with that nursing team for quite some time, and they understand what the nursing team is capable of doing. And they describe a protocol. Let's say there's so many little things that you can describe to the nurses and say her like stimulation, always start a patient on day two, stimulation is for like four days, five days, this dose is always the dose that I will pick, here's what you do, and bring him back on day five. And you don't have to go to the physician for that decision, when the nurses have tiny little autonomy to make those decisions for the patient and say, Okay, let's solve on Saturday. So I'm just going to bring you on Friday instead of Saturday. And if physicians are okay with that, that gives them some satisfaction, like you explained the protocol for, let's say, I'll mentioned this again, but vitamin D. So like if the vitamin D is below this, give them this much vitamin D, but that much vitamin D. And when they make those decisions, and they don't have to go to the physician for every single thing, slowly. One thing is that they learn, it gives them that satisfaction that I have this knowledge as much that I can handle this without reaching out to the physician. And also they don't have to reach out to the physician so many times throughout the day, because it's challenging. physicians are busy and you want to respond to the patients, but you send out an email or you send the text message or task or portal message and the physician is not going to be able to respond to you within maybe an hour or 20 minutes, 30 minutes. But you want that answer when you don't have to do that so many times throughout the day, keeps nurses engaged.

JONES  38:23  
So what do you feel does not belong in the purview of nurse’s decision making? What decisions should they not be making that maybe sometimes they are?

TAGHI ZADEH  38:35  
Yeah, that's another thing. treatments, there are so much more to what we see from outside to a patient treatment that the physician can understand whether it's switching them to do IVF or IOI. Sometimes the nurses assume, because I saw that other patient who was doing this and the physician says you can do IVF with ICSI and PGT I'm just going to assume that he's also going to say that this patient is going to do this, he or she's going to say that this patient is also going to have the same protocol and you give information about that, that you shouldn't be this. This is a decision between the physician and the patient, what kind of treatment they want to do when they want to start, and these are the decisions that the nurses shouldn't be making. Otherwise, you fall into this situation that the nurse will say something and the physician will say something else and the patient will call the manager. What's going on. I hear something from the nurse. I hear something from the physician and this is why I've always mentioned that nurses shouldn't be involved in making decisions for the treatment. And I think a lot of nurses agree with me on that.

JONES  39:43  
Sima, how would you want to conclude with our audience about how burnout is costing clinics in conversion to treatment or anything else that we really need to know about the way we manage our IVF nurses as well?

TAGHI ZADEH  39:59  
For the business part of it that you really want to keep the patients in your practice and you, you spent so much money on advertising to bring these patients and may come in, you want to keep them you want to convert them to treatment. Aside from that business part of it, you really want to keep and retain your staff. One of the very important things is that I really want the physician to get along physicians and a center should get along. And if there's something that they cannot agree on, the staff should know about this. And because that causes the nurses and the entire staff to have problems and that problem will fall into another problem is transfers to the patient. And that causes damage. Physicians should get along management team leadership team should be always transparent for the nurses with the nurses, you should have nursing meetings when there's a problem, you should predict the problem, schedule a meeting with all the nurses and say, Hey, I heard that this is going to happen and we're gonna have a problem so and so it's going to be out of office, and we're gonna have a two week three week period that the work is going to be a lot. What do you think we should do? What do you recommend we should do to work as a team involve the nurses in the decisions that are decision making that is involved in their daily tasks daily life, you want to keep your nurses happy, you want to check the caseload, you always want to manage to make sure that the caseload is spread out. Equally. Among the nurses, sometimes you also want to look at the group of the patients that you are giving to a nurse, if you want to give all of the complicated cases to one specific nurse and all the easy cases to another nurse that causes also a problem, you want to always manage the caseload that you're giving to your nurses. And everyone knows that it's really difficult to hire fertility nurses to train particularly nurses. So you want to retain your staff. When a patient walks in through the door and you introduce them to this nurse who has been there in your clinic for 15 years for 20 years that sets a standard for the patient to understand that this practice is very successful that the nurses have been here for 20 years is there, they know what they're doing. And these are all key points that the patients pay attention to when they're picking good practice. And I always want to advocate for nurses as, as a nurse manager, I request all the physicians to be nice to nurses. Be nice to your nursing team, your staff, clinical assistance, medical assistance. Just a simple Thank you just a simple, how are you? How's your day, even a tiny smile will make their days different.

JONES  42:56  
I hope that that request is well heeded. Sima Taghi Zadeh, thank you so much for coming on Inside Reproductive Health.

TAGHI ZADEH  43:03  
Thank you so much. I really appreciate it, Griffin. I'm happy to be here. Thank you.

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You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.