Accepting a promotion in the workplace is never easy task. One must take on a higher level of responsibility, carry out new job objectives, and must quickly form new working relationships with colleagues at the office.
Taking on the role as a newly-branded doctor after years of being a medical student is no different in this aspect from becoming a junior partner in a firm. And as I quickly discovered, forming strong working relationships with the nurses that are involved in my patients' care has become one of the most important objectives since becoming a physician.
Many studies and literature reviews have touched upon the dynamics of the doctor-nurse relationship in a hospital setting (see here, here and here for more on this). Even so, I found that by simply asking my nurse friends straightforward questions about what irks nurses the most about their workplace relationship with doctors, I got most of the answers I needed to start self-improving on this vital component of patient care.
Below are two most common issues that have come up during such conversations that only break the surface of what we as physicians can work on when it comes to enhancing the relationship between nurses and doctors.
This is an obvious and continuing issue that nurses have with doctors. So much so that I imagine a few jaded reader comments are already in progress describing in detail how I'm wasting their treasured coffee break. However seamlessly evident this may be, the fact that subpar communication still remains a matter of concern to many nurses implies that we as physicians have room to improve.
Here are some simple steps that I've picked up in the hospital that have proved priceless in advancing communication between myself and the nurses that care for my panel of patients:
Step 1: Involve nurses in bedside rounds if they are available to do so. Period. If the nurses are busy at this time, a two-minute phone call to the nurse after seeing the patient will make the patient's plan for the day run that much smoother.
Step 2: Always inform nurses as soon as possible if any of these patient objectives are modified or reversed. This includes any new imaging, labwork and any other new insights to the patient's goals of care. FYI: Signing an order is not sufficient communication. Call the nurse or swing by the nurse's station on your way to the patient bedside to relay this information.
Step 3: The greatest challenge and the ultimate goal is to create a friendly and personal environment where nurses and doctors are able to question each other's decision-making without fearing an angry or defensive response. Even the greatest nurses and best-trained physicians make mistakes. In order to mitigate these potential medical errors, nurses and doctors must obtain a level of communication where it is okay to question a medical decision or provide productive feedback on any aspect of patient care.
To do this, doctors must take time to do the obvious: Know the name of nurse you are working with, take time to meet him or her face to face, and realize that patient care comes before personal pride when receiving productive feedback.
It is common for physicians to go through medical training not understanding one iota of what it might be like to be a nurse working on the same patient team. Having this lack of knowledge is not only inefficient when it comes to carrying out effective patient care (e.g., ordering scattered labs throughout the day instead of in sets), but it also creates a series of unreasonable expectations (e.g., having a nurse come to unkink an IV that you can do on your own).
Basic understanding of what nurses are meant to do on the job can jumpstart an effective relationship with the care team that you work with. For instance, a lot of physicians forget that, like doctors, nurses care for multiple patients at a time. Thus, do not expect specific patient care tasks to get done the minute something is ordered on the computer or paper chart. (Remember, if a plan needs to be carried out "stat," a simple phone call to the nurse relaying this information can get things moving that much faster.)
I have also found that doctors tend to underestimate the clinical training that many nurses carry via years on the job and/or through advanced education. Engaging them on their thoughts of the patient case as well as getting their angle on how the patient is reacting to your choice of medical interventions will most certainly improve patient care. This undoubtedly rings true for brand new deer-in-the-headlight physicians like myself.
Although I am at the bottom of the physician totem pole, I am hopeful that my career will continue to have promotions within the field of medicine that bring on new challenges and responsibilities. And as long as these milestones involve bedside care, it will always be a goal of mine to go beyond having a functional working relationship with the nurses I work with.
With a few simple considerations to keep in mind we doctors can foster better rapport with the nurses caring for our patients. And what comes with this stronger bond likely involves improved patient care and satisfaction.
Next up -- what nurses can do to improve this working relationship. I'll leave that for another writer.
Special thanks to my good friend and colleague Le T. for voicing these issues.
For more by Brian Secemsky, M.D., click here.
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