Getting What You Need: What to Do If Your Practice Is Not Providing What You Need to Do Your Job

There are things that you want for your practice and things that you need to do your job. Some hygienists would argue that these are 2 ways of saying the same thing. However, your dental practice isn't always of the same mind.

So, which things do you need, how do you get them, and what do you do if you hit a brick wall? We found out from a few experts in the dental hygiene field.

An Extra Set of Hands

Katrina Sanders, RDH, BSDH, M.Ed, RF, a practicing dental hygienist, dental hygiene educator, and international speaker, says hygienists' needs have changed since she began her career. The hygiene field has experienced a paradigm shift regarding how to treat patients and the technology used to do it.

For example, Sanders says hygienists examine more tethered oral tissues and screen for more pathologies in the mouth than before, as well as discussing sleep, airway, and TMJ complications. Also, aging patients require complete dentition maintenance as the older population lives longer and hangs on to all their teeth. Hygienists also have infection control and sterilization to consider. Furthermore, patients present with advanced disease from conditions that worsened from delayed treatment during the pandemic and now need care.

Hygienists are constantly adapting to those changes and demands, taking on additional duties while still handling the old ones, Sanders explains. Hygienists are catching up and seeing new layers of disease, new lesions, and new inflammation in their patients, trying to reframe the patient experience based on what they see. What they need is another set of hands.

Sanders has an assistant in her clinical practice that works alongside her, allowing her to deliver the standards of excellence expected from hygienists today. Her assistant is:

• Preparing and auditing charts for future appointments, noting who needs imaging or advanced imaging
• Taking medical histories and inputting them into the electronic health record (EHR)
• Handling tasks like perio charting, intraoral and extraoral photos
• Scribing clinical notes during the patient appointment
• Managing patient correspondence for the hygienists
• Retrieving equipment so Sanders doesn't have to change personal protective equipment (PPE)
• Priming Sanders regarding patient care triggers, like queries regarding applying fluoride varnish or locally delivered antibiotics in specific areas of disease
• Communicating with the dentist about initial findings or exams needed

"To provide that level of care needed by the community of patients, hygienists need an assistant," Sanders says.

A Safe and Supportive Working Environment

Speaker and presenter Caitlin Parsons, RDH, C-IAYT, wellness and ergonomic professional says hygienists need a safe working environment for practitioners and patients, from infection control protocols to the cords and equipment in the operatory, making their work safe physically, to feeling safe to express themselves regarding concerns about operations at the practice.

"If you don't feel safe to go to your doctor or manager and bring up challenges, then that practitioner is unhappy, doesn't feel supported, and probably can't do her job properly," Parsons says.

In addition, Parsons thinks good ergonomics and equipment are essential. For example, is there a protocol and budget at the practice for replacing equipment? She also feels that hygienists also need to feel there is a trusting relationship there, autonomy to do their job, and support from the practice stakeholders.

"That goes for everyone in the office," Parsons says. "The hygienists want to feel supported by the front office person, but also, it goes the other way."

Courage to Make Changes

Brandi Hooker Evans, RDH-ER, MHE, speaker and consultant with Stellar Outcomes, says hygienists need the courage to challenge the status quo before addressing any product, training, or adjunct they want for their practice. In addition, hygienists should feel confident about their performance in the past so they can plan for their future possibilities.

However, the future also requires good ergonomics. So, Hooker Evans thinks operatory equipment that keeps hygienists' bodies feeling good is essential, which includes magnified vision.

"A lot of hygienists still are not using loupes, and we know that can be huge," Hooker Evans says. "Even more so, the ergonomic loupes that have taken the world by storm where we don't have to lean our head forward is an incredible investment in our body."

However, investing in the future doesn't always mean buying something. Hooker Evans suggests hygienists alternate between seated and standing positions when delivering patient care. She thinks this free option is an excellent way to improve ergonomics and challenge the status quo of how they provide treatment.

"A third thing is to pick a new topic that applies to their patients. It doesn't have to be their teeth, but anything that has to do with their patients or their day at the dental office that is new and exciting that they can geek out on through the internet," Hooker Evans says. "Follow a new Instagram account about sleep apnea, take nutrition or a movement course, or learn about myofunctional therapy. One of the reasons we bet so burnt out is because we never expand our horizons."

Moreover, hygienists can help the patient take responsibility and accountability for their health. By giving patients the tools and changing the conversation, hygienists allow patients to diagnose their gum disease and own the behavior changes needed to treat it.

"Hygienists need the courage to empower their patients to be in charge of their own health," Hooker Evans says.

Work-Life Balance

Tim Quirt, DDS, Senior Vice President of Clinical Operations at Heartland Dental focused on hygiene operations and development, says hygienists need work-life balance. The repetitive nature of clinical hygiene requires a good environment that supports work-life balance to be successful.

Also, viewing dental hygiene as a career and not a job is essential. Dr Quirt recommends plotting a path for career growth on the work side of that balance, so hygienists don't get bored doing the same procedures all the time.

"There are other ones out there that you should learn and should be a part of your developmental opportunities," Dr Quirt says.

These opportunities also require a robust hygienist-doctor partnership. Therefore, hygienists should find a doctor with whom their clinical philosophies mesh so that the doctor can support the hygienist in their career growth and work-life balance.

"Self-care is a big thing, too, because it's not going to be easy, and you will be doing it for quite a long time," Dr Quirt says.

How To Get What You Want (Need)

Getting what you want or need requires some strategy. Sanders thinks the first step is recognizing an appropriate time to discuss getting things done, which isn't when the dentist just finished a complicated treatment.

In addition, she thinks having an ownership mindset is essential. The hygienist should research and present what they want and be prepared to defend why it is critical to the practice goals.

For example, suppose the hygienist is looking for a supportive hygiene assistant. In that case, they should be prepared to report the going rate, have a working start to the job description, and be able to clarify where the new assistant could help not only financially but also in elevating patient care.

"So, it should be things like, 'Doctor, I see that there are opportunities to do more perio. My hands are currently tied; I'm struggling to gather the correct assessments and educate patients in one sitting. But, with the use of an assistant, I believe I would have the ability to gather all of these pieces and educate the patient while empowering my assistant to get that person scheduled for treatment,'" Sanders says. "Then, the doctor, or practice owner, can see that the dental assistant becomes an extension of the hygiene team, helping to support the patients."

Parsons agrees that emotional asks are not as successful as good communication skills and research why this ask is necessary.

For example, Parsons describes herself as a people pleaser early in her career that didn't want to make waves at the practice. However, she couldn't express herself about not having what she needed, and she regretted how these frustrations ended up coming out later. Therefore, she learned to process emotions and discuss her concerns with the practice stakeholders conversationally.

Also, hygienists need to have realistic expectations about what the doctor provides. Parsons says that getting what they need might require hygienists to invest in themselves. Seeing that commitment to their career and the practice through self-investment could enhance the doctor-hygienist relationship, making the dentist more amenable to supporting the hygienists' requests.

"That collaboration allows for more freedom and less stress and confrontation," Parsons says.

In addition, Parsons thinks hygienists should research and connect with other professionals through networking groups or social media. By discovering how other hygienists manage their work environment, hygienists can advocate for themselves.

"It can feel lonely when we feel like we have no other options. But, often, there are other options that we don't think about," Parsons says. "Sometimes it's a matter of being patient and putting in the time for getting what you need. We build that trust and put in the work for them to do that for us."

For new hygienists, Dr Quirt says hygienists should know how they want to spend their clinical days and their practice philosophy. For example, is it working in a busy practice that emphasizes the prevention and treatment of periodontal disease or one that works with many kids? Or all of the above? Once hygienists know these details, finding a situation and physician that supports that philosophy of care is more straightforward.

By contrast, seasoned hygienists will want to build that physician-hygienist relationship and leverage that to get a work environment that meshes with the hygienist's philosophy. When hygienists know what stresses them out and what feels healthy, they can communicate that to the practice stakeholders.

"Especially now when it's an employee environment. You can shop around and make sure that the practice is a great fit for you," Dr Quirt says.

Hooker Evans says that hygienists first need to roll up their sleeves; none of this change is coming to your email inbox.

"When I want to change my life, my go-to step is to decide what it is I want and then, second, see if someone else has it. Then, if they do, I figure out how they got it," Hooker Evans says.

She also recommends combining the power of virtual and real-world communities. For example, use the web to find a book, blog, or article or search for an online community about your areas of interest. Also, visit with the team to find like-minded team members. When you have 3 or 4 people excited about something at the office, it gets momentum, Hooker Evans says.

"It snowballs if you allow your team to get on board with you, which is also how you're going to get it to come to fruition," Hooker Evans says.

When It Isn't Going to Happen, What's Next?

The demand for hygienists is still high after the pandemic. Dr Quirt says that hygienists are in an empowered situation right now, which isn't bad. If a practice is not meeting hygienists' needs, they can find one that does, Dr Quirt says.

"If it's not a fun office or not busy enough, or you don't feel like you are achieving the next level in your career, then it's time to consider a career move," Dr. Quirt says. "It might require finding something that's a better fit. It could be private practice, a small group, a dental support organization practice, or it could even be teaching and training. So, there's a lot out there. But, first, you've got to go back to your philosophy and determine what is making you unhappy with where you are right now."

Moreover, Dr Quirt thinks hygienists have more opportunities today than ever. There are more resources available and more types of practices to join. Hygienists could also consider getting their degrees and becoming a dentist.

"The world is your oyster right now," Dr Quirt says.

In addition, Heartland Dental has locations in more than 38 states, making it easy to migrate elsewhere in the country. Heartland has built-in support, education, and different ways of compensating employees, including bonuses. There are also career growth opportunities as regional hygiene mentors or as operations and education professionals. Dr Quirt says they have many options at Heartland that are not necessarily patient facing.

"We try to target whatever a hygienist wants, even on the work-life balance side. So, if you're looking for part-time or temporary, we are open to any and all options for hygienists," Dr Quirt says. "And you have freedom of movement. So, if you don't like one office for any particular reason, you can move within the family of practices. So, it just makes it easier."

Sanders also thinks hygienists should be open to investing in the equipment they need to do their jobs if a practice is unable or unwilling to provide it for them. While not a popular option, Sanders thinks taking control of the situation can be beneficial. However, she also thinks hygienists should seek clarity on what is needed to get what they want.

"This insight gives you a lot of information about some of the challenges or pain points for the practice," Sanders says.

Moreover, having these conversations has the added benefit of communicating to the practice stakeholders how invested the hygienist is in the practice and its vision. It also shows them what is important to you, she says.

"It shows that you're a 'partner' in the practice and that you're emotionally and mentally invested in excellence within the practice," Sanders says.

If a practice consistently doesn't give a hygienist what they need, Sanders says it could mean that the core values and philosophies are not in alignment. After careful consideration, Sanders would encourage hygienists in that position to find another opportunity.

"My hope is that a practice owner who has been afforded the opportunity to give you the things you need but chose not to would acknowledge that this is a decision that you made to preserve the longevity of your career and your joy and passion for it," Sanders says.

Parsons agrees that if it isn't happening, standing up for what you believe and deserve is essential, no matter how difficult that might be. Moreover, it is critical to leave a toxic work environment.

"People have bills, though, so if you can't jump out of a job, start looking and putting feelers out there," Parsons says, adding that the networking groups can be an excellent place to find new opportunities. "Temping is a great way to see different offices, what you like and what you don't, or how other people are doing things. Then, try the new office and see what works. You never know if you can get a permanent position from temping, especially these days.

"Parsons also likes Cloud Dentistry, a dental staffing platform that connects practices with dental professionals for permanent, part-time, or temporary positions.

"You can put in your specific preferences, whether it's hours or type of office or how far it is from you, so many different things, which is nice," Parsons says.

Sometimes, it requires introspection, too. Hooker Evans thinks that hygienists that are not getting what they need should reflect on their role in the failure. For example, have they been clear in their intent, expressed what they are hoping for, and delivered it with kindness? If not, maybe modifications in these areas could change the outcome.

"See if there's something you can do from inside of you to benefit and support the team and elevate everyone as a whole," Hooker Evans says.

However, she says it might be time to leave when you have done all that and still don't have what you need. Trying a new office as a temp might be a path to new possibilities. Hooker Evans likes TempStars for connecting offices and dental professionals.

Some hygienists decide to leave clinical hygiene. Hooker Evans works with hygienists that are now yoga instructors, myofunctional therapists, marketing business owners, and sleep specialists. Some move into nutrition or life coaching. In all of these cases, their background in dental hygiene has been foundational to their success. Hooker Evans believes that there is a place everyone is supposed to be, and while it's scary to move on, it might be the best thing for the hygienist's career.

"What's on the other side of staying stagnant," Hooker Evans says, "is often exhilarating and beautiful."