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Teaming up in North Dakota

Jan. 1, 2001
For almost 19 years, Dr. Mark Nelson and chairside assistant Carla Schneider, CDA, RDA, have worked as a team in a general practice in Hettinger, N.D.
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For almost 19 years, Dr. Mark Nelson and chairside assistant Carla Schneider, CDA, RDA, have worked as a team in a general practice in Hettinger, N.D. When Dental Equipment & Materials went looking for the dental team that would grace its first tabloid cover, our magazine wanted to find a doctor and assistant who were active in the dental community and worked together closely. Nelson and Schneider fit those criteria to a tee.

In Hettinger, a town of 1,300 located in southwestern North Dakota near the border of South Dakota, Nelson and Schneider reach out not only to the local community, but patients who make as much as a 100-mile, one-way trek to the practice.

"The type of dentistry we do in the practice covers all aspects of dentistry, which keeps everything interesting and never boring," Schneider said.

Schneider and Nelson have served not only the local community, but also on the state and national level. Nelson is a former president of the North Dakota Dental Association, while Schneider has served as the president of the North Dakota Dental Assistants Association and the American Dental Assistants Association.

But all of the national and state leadership couldn't have happened without Schneider and Nelson first meeting in 1982.

"We live in a small community, and I happened to be in the right place at the right time," Schneider said. "When I was 15, I applied for a part-time job at the local dentist's office. My friends were looking for jobs as waitresses or in nursing homes, but I wanted to do something different. I just did odds and ends around the office, like cleaning up and pulling and filing charts. I worked one Saturday a month, after school, and during the summer. I did that for a couple of years, but when we moved after high school, I didn't think about going into dental assisting.

"We moved to Hettinger, and, when we got there, we heard that the local dentist was looking for an assistant to replace the one who was leaving. A friend of mine knew the dentist and told him that I had worked in a dental office in high school. The dentist hadn't advertised the job; he called me and asked if I was interested. This is a very rural area, and there were no certified or experienced dental assistants from which to draw. I was apparently the only one around who knew the instruments and basic office procedures, so the next day he called me to tell me I had the job.

"Having a little experience certainly helped. I am an on-the-job trained dental assistant. That's part of my training, along with numerous continuing-education courses.

"Each state has its set hours of continuing education that you need to maintain your credentials," she continued. "Dr. Nelson and I both exceed those hours every year. We try to attend education courses that will enhance our practice. Did you notice that I said 'our practice'? Maybe that is why our relationship is so successful. I take ownership in the practice, in name only. Our practice and its success are very important to me. Our office consists of one dentist, one hygienist, and one receptionist. Being efficient is the key to success. We work four days a week, for about eight hours each day. Every once in a while, we will work five days during the week."

Of course, Schneider believes the relationship between them also is a big key to the practice's success.

"Our relationship is open to suggestions from both sides of the chair," Schneider said. "After working together for almost 19 years, we know most of the time what the next step will be. Every once in a while, we get fooled. We always try to be prepared for the unexpected, but sometimes something can, unfortunately, catch you off-guard. There are angles in the mouth that are not easily visible from one position or another. We help one another in matters of sight, sound, and expression. Many times, we consult with one another on the best treatment for our patients.

"Most important, I believe, is the need to anticipate what the dentist's next moves are, sometimes before he or she knows. We need to know every instrument being used and exactly how each one will be used. We need to know the purpose of all of the materials that might be used, how to mix them, and the amount of placement time required. We need to know when to rinse out a tooth, when to dry out a tooth, and when to change a bur. In general, we need to know what is coming next. Keeping one step ahead of the dentist is the main thing. I watch (Dr. Nelson) carefully, because he can communicate with just a facial expression or a nod of his head. Fortunately, I've been with him so long that I have a pretty good idea of what is coming next."

So what advice would Schneider give to doctors and assistants to reach the relationship level where she and Dr. Nelson are?

"What it takes is commitment, self-confidence, and respect for each other," Schneider said. "As in any job, it's just a job unless you make it your career. A job is something you go to every day, and that's just the way you feel. A career is a job that you choose to make your life's occupation. Believe in yourself and be the best you can be. Be happy and satisfied with what you accomplish. Sure, there are days that are not fun, and those days can be very stressful. Try to keep those days to a minimum. Schedule your patients so that each day you have a few patients whom you enjoy seeing and they enjoy seeing you. Have fun with your patients. If you can't remember special days or events in the lives of your patients, make a special note and keep it in their charts. They like being remembered and acknowledged. It always feels great when we can make someone laugh or make his or her day a little more special."

When asked for what advice she would share with doctors regarding how they can keep good chairside assistants, Schneider's eyes get an unmistakable gleam in them as she prepares to give the answer.

"Doctors and assistants need to respect one another and support each other in their efforts for better dentistry," she said. "Consult with one another. Compliment one another. You are a team, and, together, you can do anything. If your chairside assistant is a great assistant, you support each other's values, and you think that person would be hard to replace, reward your assistant not only with a great salary, but also with benefits and praise. Many dental assistants want respect from their employers. By respecting your assistant - and staff for that matter - your patients will have more trust in the office team. Your productivity will increase (because of less wasted time and each team member being educated through continuing-education courses), and you, as the employer, will have a loyal office team because each member feels valuable. Each person knows that he or she is an integral part of the team."

Schneider knows her role on the team, and she knows that role begins long before a patient sits in the chair.

"Any given day starts the previous evening before I leave," Schneider said. "I review the next day's schedule - set by the receptionist, who makes all of the appointments - so I have an idea of what's going to happen the following day. I try to get to the office about 45 minutes before the first patient and review the charts, so there will be no surprises regarding the techniques and treatment plans.

"On a good day, I can judge each patient's procedure time well enough not to keep anyone during the day waiting for more than five to seven minutes. Of course, this sometimes takes a bit of trickery. We know which patients come a half-hour late, so we tell them to be at the office a half-hour before their appointments.

"Also, we have to keep in mind the anxiety level of the patient and allow for any apprehension there might be regarding the treatment, including any anticipated pain. This way, we can determine just about how much time we need to spend with each patient. This is all noted on the patient's chart. Some patients have no problems whatsoever, but others have their blood pressures go up, and some even become asthmatic. We have equipment available to handle such situations if an emergency arises."

As for her future plans, Schneider simply replied, "I plan on living where I'm living for a long time, and I'm going to be a chairside assistant forever - getting better at it as time goes on, if I can. I wish I had gone into a dental-assisting program, but it didn't work out that way. It's probably taken me a little longer to do some of the things I wanted to do, but I've loved everything that I've done."