Nurse Faculty Scholar Discusses Need for Nurses and Physicians to Learn Together in Order to Work Together
Imagine your grandmother or someone you love falls and breaks her hip, arriving at the hospital in excruciating pain. She desperately needs pain medication and the nurse or medical resident on duty calls a senior clinician to request it. But the clinician says she’s busy and can’t see your loved one for at least an hour. How would you feel if the nurse or resident passively accepted this response? Alternatively, what if they challenged it?
Nurses and early career doctors regularly encounter thorny scenarios like these. Unfortunately, many hesitate to challenge senior colleagues, even when a fragile patient urgently needs help. Senior clinicians may even berate perceived subordinates for challenging their authority.
At New York University, we are part of a growing movement that aims to change these pernicious patterns. Marc Triola, MD, and I co-led a project to give nursing and medical students the training they need to work better together.
In our project, NYU3T: Teaching, Technology, Teamwork, we used the scenario above, as well as others, to teach nursing and medical students how vital it is to communicate effectively about patients’ needs. We hope that teaching nursing and medical students together will help them to develop the skills they need in order to work together in a system that is increasingly reliant on team-based care. My colleagues and I believe that this interprofessional collaboration will result in better communication between providers, fewer medical errors, less duplication, lower costs, and greater clinician and patient satisfaction.
What do our students think?
“It’s easy to feel isolated in your own profession...but I don’t think that’s good for the patient,” says Meriel McCollum, one of my nursing students. She says that learning and working together helps to reduce tensions and alleviates anxiety about speaking up when concerns arise. “This project helped me feel more comfortable and know that I really do need to speak up for the patient’s safety.”
In one simulation, Meriel and a medical student each wrote a care plan for a patient with heart failure and other health problems. Meriel’s plan directed the patient to monitor daily fluid intake and report weight changes. Those items were missing from the medical student’s care plan. But the medical student directed the patient to change medications to avoid possible complications, which Meriel had not included in her plan.
“Together, the medical student and I were able to produce a holistic care plan that addressed all aspects of the patient’s ongoing treatment and activities of daily life,” she says. “Had the patient received only my plan, or only the medical student’s plan, he or she would have received only half of the recommendations for high-quality care for heart failure. No one wants patients to be left half-treated, or half-healthy. This exercise reinforced that we are on the same team, with the same goal: to provide high-quality, compassionate, and evidence-based care to our patients.”
Meriel notes that when physicians have a fuller understanding of the roles and responsibilities of nurses, they will be more likely to utilize nurses to the full extent of their training and expertise—and that will benefit both nurses and the patients they serve.
Another participant, Brent Dibble, an MD/MBA student, found interprofessional education so critical that he believes it should be mandatory for all medical students at all schools. “As a physician, I’m going to be working in teams for the rest of my life,” he says. “Often I’ll be the team leader, but sometimes I won’t be. Understanding each team member’s capabilities is a really useful skill. I can’t imagine treating a patient without that knowledge.”
Before taking our course, Brent had worked with students from other health professions but had not developed a full understanding of how “the different cogs in the wheel work together.” For example, he didn’t fully understand which levels of education nurses need in order to assess and evaluate patients, write prescriptions, and more. He said that having that knowledge will enable him to function better on a health care team.
New Ways and New Programs
Interprofessional education, of course, is nothing new. More than four decades ago, the Institute of Medicine (IOM) called on educators to train health professions students to practice as members of health care teams. In 2010, the IOM released a report on the future of the nursing profession that echoed that call. The same year, the federal government enacted the Patient Protection and Affordable Care Act, which pointed to interprofessional collaboration as a way to improve the quality of care while containing costs.
All along, innovative educators have been coming up with new ways and new programs to prepare health professionals to work as members of high-functioning health care teams. My colleague, Judith Haber, PhD, APRN, FAAN, is one stellar example; she is overseeing a pioneering program called Teaching Oral-Systemic Health (TOSH) that teaches advanced practice nursing, medical, and dental students about the interconnection between oral and general health.
RWJF is committed to spreading the word about the importance of collaborative practice, and released a white paper in March that aims to do just that. Many of us understand the value of interprofessional education. Our challenge is to make sure all our nation’s educators and providers do. Not nearly enough health professions schools are teaching students to work as members of teams—to work, in other words, in the health care system of the future.
Maja Djukic, PhD, RN, is an assistant professor at the New York University (NYU) College of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2012-2015).