Trisha Williams (Host): Hi guys. Welcome to the third
season of the Advanced Practice Perspectives. I'm Trisha William.

Tobie O'Brien (Host): And I'm Toby O'Brien. This is a
podcast created by Advanced Practice Providers for advanced practice providers.
Our goal is to provide you with education and inspiration. We will be chatting
with pediatric experts on timely key topics and giving you an inside look of
the various advanced practice role at Children's Mercy.

Trisha Williams (Host): We are so glad that you're
joining us today. So sit back, tune in and let's get started. today. We are
pleased to welcome Dr. Gladesia Tobert. Dr. Tolbert is a pediatric nurse
practitioner at the Children's Mercy Teen Primary Care Clinic in the Children's
Mercy Clinic at Operation Breakthrough. Dr. Tolbert is also adjunct faculty for
the pediatric nurse practitioner program at the University of Missouri, Kansas
city. She's a certified pediatric primary care mental health specialist and a
certified life coach. Welcome to the podcast Dr. Tolbert.

Dr. Gladesia Tolbert: Oh, thank you so much for that
warm welcome. I appreciate you guys having me here and I'm looking forward to
talking with you all today.

Tobie O'Brien (Host): Gladesia, should I call you?
Well, I'm gonna call you Dr. Tolbert. You deserve it. So that little
introduction was really impressive. Tell us more about yourself.

Dr. Gladesia Tolbert: Okay. So I actually love
telling the story of how I progressed to my current role as an APRN and an
educator. I actually started my nursing career at Children's Mercy as a care
assistant back in 1999. I was at the Children's Mercy, South Urgent care. This
was back before I was a full fledged hospital I was in nursing school at the
time at St. Luke's and I graduated from my BSN from there, and I continued
working at Childern's Mercy as an RN after graduation. then I went back to
school to get my master a couple years later.

I actually walked the stage with when I was pregnant seven
months pregnant with my youngest. Who's now 18. Had a send her off to KU for
college and I have a 21 year old too. So, me and my husband Terrance are
basically empty nesters now, which. Pretty exciting different new chapter of
our lives. But I just remember being a full-time graduate student and working
as a nurse back in PCC and how much I'd really admired the wealth of knowledge
the nurse practitioners had. And I just always dreamed of that day.

Hoping that day would come, which I would have that degree
of knowledge and experience. I didn't expect to enter into teaching at the
stage in my life, but after obtain my doctorate five years ago, the opportunity
arose. And it's been a true blessing, really just to get back to my profession
and educating the future generation of providers. I really just love what I do
and work in the teens and the operation breakthrough, which is such a unique
setting, working in an early child care center where I'm seeing patients from
the community as well, infants through adolescents. As well as the work I'm
doing in team clinic.

Tobie O'Brien (Host): Well, we are so glad to have
you on, I wanna talk a little bit first about your role as the adjunct faculty.
I know that I've been lucky enough to have some of your students. In the past
in the E T clinic, but with the fall semester approaching, I know so many of us
will have the opportunity to work with some of the students that you have. So I
wondered if you could talk a little bit about your most ideal way that we could
precept these students to provide the best experience for them?

Dr. Gladesia Tolbert: That's a really great question,
Toby and I'm happy to answer that. so I've been doing this for 18 years as far
as been a provider, and I've been precepting for the majority of my career
before I was even a faculty. And so I like many other people who are
precepting. I remember not really knowing what level they were in their
education, what all they need to know during that time. And just really having
that understanding of being in those other shoes as a preceptor. Is that From
my perspective, the ideal experience is when both the preceptor and the student
are giving and also receiving.

So, if the student is challenging the preceptor to maybe
learn more, some updated information, maybe they hadn't thought about, or
students are really inquisitive, hopefully. And so the preceptor's challenged,
but then the student's also challenged to learn more and to go home and pull out
a book and go on the internet and research something on up to date that they'd
never seen before. That's when it's truly a win-win situation when they're
inspiring each other and challenging each other.

Because we really want that inquisition and each semester
and each course has those written objectives. So of course that's important to
if the student can reach those objectives, that's definitely a goal, but it's
not a race. it is a marathon. And so this is a experience that just continues
on and on in their program progressing each semester. And then of course, when
they graduate. I think it's, important for patients, the students to see
patients of course, but I know that there's times when the preceptor may feel
overwhelmed, they may have.

Many patients that the student cannot see all of them,
that's totally okay. And that's understanding, but we want them to see patients
and patients. We want them to observe their preceptor. We want discussions to
happen, to the point that each learning experience connects that peg of that
ladder to the next one and their constantly adding on to their knowledge each
week that they're with that preceptor. And each week that they're in class. So
I just really want students to use their common sense, use their nursing skills
and those things that they already have within them that they probably are
burying now because they're so afraid in clinicals.

And that confidence level sometimes can be an issue because
this is a new environment for them. This is a new level of something that
they've never done seeing patients, especially when you get them in their first
semester of clinicals. So, just trusting in themselves. It's okay for them to
be wrong. And letting them know that it's okay to be wrong. Go ahead and offer
those differential diagnosis, encourage your students to think, use your
critical thinking skills and really be motivated to learn. Another thing that I
want to point out is just to make sure you give them feedback throughout the
semester.

And I ask that you not wait to, until the very end of the
semester when there's just not enough time to improve. And there may be some
adopted bad habits. So, we really just want you to offer that ongoing feedback
and talk to your student throughout the semester, that is really ideal. And
that's really those main things I can really think of. I mean, I mentioned not,
feeling obligated for the student to see each patient, as preceptors, we need
to allow ourselves time to catch up as well, and also the student may need to
take, that mental break and catch up as well on the thoughts on what they're
learning and documentation and so on and so forth.

So that's totally understandable and expected for them to be
at a slower pace and not to have that them feel pressured or you to feel pressured
for them to be learning every single thing that you're doing and seeing every
single patient that you're seeing in that clinical.

Trisha Williams (Host): I love what you said about
being a mutually beneficial experience. I can relate to that. I love to
precept. I love everything about it. I feel like it forces not forces us, not
really the right thing. It feels like it allows me the opportunity to grow
within my own practice and as a human when I teach students.

Dr. Gladesia Tolbert: Definitely.

Trisha Williams (Host): So I love it. I think the
challenge with where I currently work is that I work in a very subspecialized
department. And so it's not like I'm primary care and I, we can have the
students for 300 plus hours that they need for their clinical rotation, but I
get them for a short period of time. So I think about what's the biggest impact
I can make when I have them for the a hundred or the 160 hours that I have
them. And so I think that sometimes in a subspecialty clinic we're busy and we
don't think we have a lot to offer, or we don't have the bandwidth or something
to that effect. So what would you say to those regards, like in subspecialties,
how do we maximize our opportunities with our students to kind of teach them
the basics to build upon their knowledge set?

Dr. Gladesia Tolbert: Thank you so much for that. As
APRNs and providers, I think one thing that sticks out that we all are so aware
of is that the most important part of diagnosing and management of patient is
the history taking. I mean, you're gonna get so much information just from that
conversation with the family. I mean we can talk and just ask all the right
questions and make, we can pretty much form a diagnosis many times with just
that history and interview. And so even in the sub-specialty area, I think
that's a key highlight to focus on with students is really mastering those
interviewing skills.

 And just getting more
comfortable with communication with the patients through bedside manner. And
everyone has something to offer. Everyone has something to offer. So no matter
what specialty you're in, you have a gift. You have resource, you have
information, you have knowledge that you can give to that student. So don't
ever minimize what you're doing in primary care. Gosh, I mean, we rely on the
specialty care so much when we have questions and there's so many different
things that come about with patients and illnesses and different areas.

And you guys had the expertise. And so that information that
you're providing to that student, they can take with them, if they do work in
primary care or any other setting that they work in. They also use that
opportunity to really hone in on their health assessment skills and just
listening to the heart and getting comfortable with the heart sounds. If
they're able to look in the ears, even if the patient's not here for that
reason. The more ears they look, the easiest going to be, to find that
abnormal.

The more normal hearts they listen to, the easier it'll be
to notice an abnormal heart sound. So, I think every single APR in this
hospital has something of value to offer. And no matter if you can just precept
45 hours, if that's all you can do. Oh my gosh, that's amazing. If you can
commit to 160, that's equally amazing. We need the preceptors. We all were
students once before, and remember how much and how important our preceptors
worked for our learning. And so now we have that opportunity to give that back
to the future APRs that may even, we may even worked with as colleagues one day
in the future. So I think that's really cool.

Trisha Williams (Host): I see it as a professional
responsibility.

Dr. Gladesia Tolbert: Gosh. Thank you for that.

Trisha Williams (Host): Definitely. Yeah.

Tobie O'Brien (Host): Yeah. I like to think about the
people who precepted me. I mean, those poor souls, but they made it through.
And I mean, but truly like I'm so grateful. And I think back to, without people
doing that, where would our future be? So it is really so important. And even
though we're busy, like I do think we do learn so much cuz it does force you to
think back through why you're doing stuff. Because so much of what we do
sometimes can be muscle memory. But when we have actually like explain why
we're doing something. I think it's so good to kind of refresh our memories and
be like, oh yeah, that's because of this or this update. And so I think that's
an important thing to think about.

Trisha Williams (Host): And nothing is more rewarding
when your student comes to you in a sub-specialty field and they're like, I had
a patient in the primary care clinic, and I knew exactly what to do because we
just talked about it the other day. And my preceptor was like, well, I don't
really know let's call ENT. And I'm like, oh no, no, I know what it is. And then
you're like, I'm like so proud.

Dr. Gladesia Tolbert: Yay. That makes me so happy.
That's definitely what we want to see occur. I love that. I love it. And I've
been that preceptor where my student was also in that sub-specialty and was
like, oh, when I was in endocrinology, I learned this. I'm like, oh, wow. Let's
look that up.

Trisha Williams (Host): I know, I love. I love it. I
think I'd like to also remember when I have students, is that this model in
nursing of novice to expert, right? So we're a novice when we start out and
then we're an expert. So when we're all nurses. And I know we have physician
assistants that also listen to this. So I don't want to just specifically talk
to nurses, but when we start our career as a nurse we train ourselves up until
where we're the experts in the top of our field and in practicing our nursing
skills on our own. And then we go back to school and then we start all over
again at a novice. A novice to expert journey is hard, but the expert down to a
novice journey is even harder.

Dr. Gladesia Tolbert: Definitely you're right on
point there. So that confidence is a huge thing for students. And as a
preceptor, as an instructor, that's something that we have to help them with to
remind them that they don't have to have the right answer every time. And it's
okay to have the wrong answer. This is their time of learning. We also want
them to be, great providers when they're done and we want them to be safe
providers. So if they don't know the answer, it's important to look it up. It's
important to say they don't know.

It's very important that them, that they're honest and that
they are going back and finding the answers to questions. They may not have
definitely. Very good thing to do. and the confidence will come. And we're here
to support them. We're here to encourage them and let them know that you don't
have to know everything right now. And that's okay. But just keep trying and
keep working towards it.

Tobie O'Brien (Host): Well, I think this is some
great information. So hopefully all of you out there would be willing to precept
some more students. I know I need to send an email after I get off this podcast
and say that I will. I think I already sent that, but I need to do that again.
So well, I wanna talk, I wanna switch gears though. Gladesia. I would love to
know more about how you say to get your mental health specialist certification
and become a certified life coach. That is really great. I'm sure you use those
skills. Often. So tell us about that.

Dr. Gladesia Tolbert: Definitely, yes, in primary
care there, these skills I do use on a daily basis. I decided years ago to
obtain my pediatric mental health specialist certification through PNCB, really
to challenge myself as a mental health provider, I was seeing lots of patients
with mental health disorders, specifically, lots of ADHD, anxiety, and
depression, and I am an avid lifelong learner. And so I was like, okay, you
know what, I'm doing this. So I want to make sure that I'm doing it correctly.
That I have all the tools that I need.

That I'm studying. And so I just did that to challenge
myself and I've obtained it. And now I keep up on the certification, which is
really good because I have to obtain CEUs for my research, every few years, so
that I'm making sure that I'm have current knowledge and information. And I
feel more confident when caring for those patients, because I know that I have
that additional knowledge and certification. So it does help with my confidence
and ability to provide their care for sure.

So as far as being a certified life coach, this is something
I decided to do really after learning more about life coaching, I actually took
an executive life coaching sessions that Children's Mercy offered years ago,
where I was the recipient of coaching. And I thought that was really beneficial
for me as I become more of a leader in what I do. And so as I continue to work
more with adolescence, and offer teen education programs I felt like, you know
what? These teens could benefit from this too.

They could have but how can they have a support they need to
continue to make health good choices for themselves? Maybe have guidance, how
to work through problems or issues? How to make sure they're on the right
trajectory, in life/ as a mom of teenagers myself back then, I know how
challenging it is for parents to have their hands in really every area being a
parent, having that balance with working and making sure that their teens.

To have everything they need for organization, for college
preparedness. And again, just have making those choices that they need that are
the choices that won't negatively interfere with their lives. So I did do life
coaching training and became certified in life coaching in 2016. And so really
truly, it just helps me be a better educator. It helps me with my group
education sessions that I provide through the breaking through team program. I
started this a couple years after I began an Operation Breakthrough and with
that program, what motivated me was in the patient examination room, there's
just so much time we have during patient visits. We have these four walls. We
have 20, 30 minutes and that's it. And there's so much more that they need. So
I started the breaking through teen education program and I offered group
education sessions with the teams at operation breakthrough at De Lasel. I've
been at Crossroads, Academy at Lafayette. I've been to Girl Scout camps.

So, this is an area that's needed. Teenagers just need more
knowledge, need more education. And that's really my true north is educating,
people, whether that's, teenagers or DNP or MSN students. So I really enjoy
that. I enjoy empowering them, because really in this population of the urban
core, where we see they may have good examples or good role models or people
that have succeeded and met their goals. So just something as simple as setting
a goal. For their academic success, their safety those are things they may not
have ever thought of.

And so that's where I come in to really help them really
think about managing their healthcare, making good choices for their lives so
that they can be healthy adults.

Trisha Williams (Host): it sounds like an amazing
program that has offered to the teenagers in our area. What are some, you
mentioned goal setting and healthy lifestyle living. Like what would a typical
class, that program look like and what would be a topic of discussion? I wanna
hear more about it. I'm very interested.

Dr. Gladesia Tolbert: I'd love to talk more about it.
So I've had several different, educational sessions. I've had like a whole
eight week curriculum on HIV prevention, which included being assertive in
situations and how to communicate with a peer. Also, there was STIs covered in
that and substance abuse and prevention. So, that was a whole eight week program
where I used focus on youth curriculum to teach that group of youth, in an
eight week session, at Operation Breakthrough,.

I've done one hour segments just on sex ed, where we're
talking about STIs and contraception. I've spoken about puberty to 11 year olds
and 10 year olds, just the basics of puberty and what to expect and all those
things that you may remember us having, we were younger, some schools don't
offer those services. So, that's where I come in to offer what they need
because they need to have that information. I've been asked to do group
education on vaping several times.

So been at several schools and talked about vaping and
reducing those risks of substance use and just what vaping does to the body and
how addictive it is. So just various topics sometimes I'll, just get an email.
A school leader, saw a need there's maybe something going around or some
rumblings in the school with some risky behavior. And they'll just ask me to
come and speak out about a specific topic. So I love it. it's just the best
feeling whenever I'm done with an education, session. Oh my gosh. I just can't
explain it. I just, it just feels amazing. So that's just really something that
I enjoy doing for sure.

Trisha Williams (Host): Is this a program that you
solely developed? Like you came up with the idea, you pitched it, you developed
it, or is this a program that is going nationwide that we, that you just
included into our community?

Dr. Gladesia Tolbert: Good question. So this is my
program before I was back at Mercy for probably the second time I was at
[inaudible] health as a nurse practitioner. Seeing lots of teens in primary
care there. And I myself and a nurse there started a totally different program,
but similar concepts where we educated teens and we'd have a room full of teens
every time it was so much fun that would come to these sessions. And so, when I
started an Operation Breakthrough, of course the need was still there.

And I did develop a business plan, not just to offer
education sessions, but to begin offering contraception at Operation
Breakthrough, STI testing to full reproductive health. Previously, those
services were not available in that clinic. And I'm still the primary provider
that provides those services. I'm able to check wet mounts like under the
microscope and do those things that we need to do for vaginal exams. And
whatnot. So, this is just this local program that I started. That's my baby.
And I just look forward to continuing it in the future. It's been great.

Tobie O'Brien (Host): I love that. I love how much
you love teens. And because I really think like I have a 13 year old right now,
and I just think like so many times they get such a bad rap. But really like
they can be so loving and engaging and they wanna know these things, right?
These things that you say they like, maybe they have to rely on their friends
to get this information. I would way rather her hear it from you. So, I think
like really having sources of actual truth from people like you is so
beneficial to our kids.

Dr. Gladesia Tolbert: Oh, my gosh. I wish I had this
when I was a teenager. I'm right here from Kansas city. I graduated from Ruskin
High School. We had a daycare right there at our school. So we saw lots of teen
pregnancies and things and I honestly, I'd learned on my own. But gosh, I
remember seeing a provider that just stood out to me and I'll just never forget
her. And she just was instrumental, with not just me learning more about
health, but me being a nurse practitioner, because she's a nurse practitioner
and I'm just glad that things are different.

And we do have people now that give back to the community
and there's still so much lacking. We still need more. providers and volunteers
people who are interested in working with teens and doing more for them because
they really just need the information, they need someone to believe in them.

Trisha Williams (Host): Absolutely. The impact that
you have on our teens is. Impressive. I'm honored to know you. I'm wondering if
there is any, I'm a research nerd, so I'm always looking at like impactfulness
of programs and things to that nature. Have you looked at like any measures,
like any objective measures to show impactfulness of your program? I mean the
subjective and the personal growth and the love from this teens and stuff is
definitely enough. I'm just, I'm a research nerd.

Dr. Gladesia Tolbert: I'm glad you brought that up
because I've had to begin to put on my research hat more because truly my
reward is what I see, is in with those patients, with those students, but
you're right. Like, we need to document things more. I don't talk a ton about
what I do, which is another just thing about me that I need to do better with.
And just so people know that this is going on. And I have data that I collect.
And so that's something that I monitor and keep track of how many patients
we're seeing and how many teen patients I'm seeing at Operation Breakthrough.

I do post, course evaluations and things. So like I know
what topics they're interested in and how they well, they learned, but
otherwise that's probably about it. I mean, I had IRB in my DNP program which
was focused on comprehensive reproductive services in a primary care. . And so
that was just a retrospective study that I performed back then, but I would love
to look at data more and just even for my own evidence based curriculum is a
goal that I have.

Tobie O'Brien (Host): Now if one of our listeners
like has, or are thinking like, wow, like I know a school or I know a group of
kids that could benefit from this. I mean, is there like a formal way they
would go about Enrolling or would they maybe reach out to you for more
information about maybe some curriculum that you're currently teaching? What
would you recommend?

Dr. Gladesia Tolbert: They can definitely send me an
email at GTolbertscmh.edu. Also we do have with our community benefit
department, our school based healthcare team, a request that you can submit for
education in certain areas in the, of the community. And so those will match up
with me if there are adolescent programs and then I would get a notification
that way. And that should be somewhere on the scope, but definitely email me
and I can direct you to the right place.

Tobie O'Brien (Host): Okay. Well, we are so thankful
that you were able to help us today and visit with us. We, I really enjoyed
talking with you. We end each episode with the same question and so we wanna
know what is a way that you love to encourage your colleagues?

Dr. Gladesia Tolbert: I think the way I love to
encourage my colleagues is by being an example of truly finding a balance. I
remember being earlier in my career being. Mom of toddlers been working full
time and like, oh my gosh. I always, thought about, oh my, I just can't find
the balance. How do people do this? We work so hard being providers of our
patients and taking care of our home lives. We forget sometimes to take care of
ourselves, and sometimes our daily load of seeing patients. And all we take on
mentally, can be exhausting. But it's important to find that motivation to
still want to do more, give back, join committees, community service,
activities, precept.

So just remember your, the love that you have for what you
do and taking time for yourself. And I just encourage people to find their true
north education as mine. I really love to give back in that service to others
in education. So just try to find your true north. And I just encourage my
colleagues to do that, not just pick up activities and just doing busy work or
becoming the yes person, truly do things that you enjoy doing. So like you're
one step in the direction of working towards your purpose and enjoying the
journey while you're on that road.

Trisha Williams (Host): That's fantastic. Find your
true north and enjoy the journey. That's fantastic. Well Gladesia, or shall we
say Dr. Tolbert? I love it. Thank you so much for joining us today. If you have
a topic that you would like to hear about, or you're interested in being a
guest, you can email us at TDObrien@scmh.edu, or TWilliams@scmh.edu. Once
again, thanks so much for listening to the Advanced Practice Perspectives
Podcast.