Thursday, May 10, 2012

#NursingWeek: Have physician-nurse relationships improved? Apparently not much

Have physician-nurse relationships improved?

April 11th, 2012

by Jonathan H. Burroughs

My daughter Serena will graduate from Oregon Health & Science University School of Nursing in September and I wonder if things will be different for her than for the nurses I worked with more than thirty years ago when I entered the healthcare industry.

When I was a new emergency department medical director at Valley Regional Hospital in Claremont, N.H., I was running a code and asked for epinephrine and atropine (we used atropine in those days!) and the new nurse told me she didn't know what those were or where they were kept. In my most caustic and superior tone I told her so that everyone could hear, "If you don't know what epinephrine and atropine are, you should not be here; please send me a nurse who knows what s/he is doing." She left the unit in tears and we completed the code without her.


The next day, the chief nursing officer (CNO) came to see me and asked to speak with me privately. Being a wise manager she began by saying, "Jon, I'd like to apologize to you for sending you a nurse who was not properly prepared to assist you in the code. It won't happen again."

I was feeling pretty vindicated at that point and puffed out my chest, smiled and returned, "I appreciate that."

And then she went on, "I am concerned that she was so humiliated by the experience that she and the other nurses in the hospital are worried that they will not be able to work with you due to a lack of professional respect and we all hope that you will be able to help us to rectify the situation." She then quietly turned and left the room.

I didn't get much sleep that night and realized with much sobering reflection that part of my training at some of the nation's most prestigious academic institutions was wrong. Treating people with disrespect and shame will not improve human performance nor will it help patients to have better outcomes.

The next day I went to the CNO and said, "I thought a lot about our meeting yesterday and would like to do two things: train all nurses who are interested in advanced cardiac life support (this was a radical idea at the time, as only physicians were trained in the technical aspects of resuscitation), apologize to the nurse whom I disparaged in front of her colleagues and let them all know that it will never happen again."

The CNO smiled and said, "I appreciate that Jon; it will go a long way towards helping the nursing staff to heal." As a thank you, the next week she brought me in a "bird of paradise" which I kept for a long time to remind me of human fallibility and how we all are vulnerable to misinformation as a part of our professional indoctrination.

And so I wonder, will my daughter have to go through a similar traumatic episode on the firing line? Are those days truly over or is there a residue of the perfect physician overseeing an imperfect world and having to defend himself or herself in dysfunctional ways? Can we move towards a world of physicians and nurses working together as functional teams or is that still patient safety rhetoric? Has our professional world evolved sufficiently over the past 30 years or is it still the same?

What do you think?

Jonathan H. Burroughs, MD, MBA, FACPE is a certified physician executive and a fellow of the American College of Physician Executives. He is president and CEO of The Burroughs Healthcare Consulting Network and works with some of the nation's top healthcare consulting organizations to provide "best practice" solutions and training to healthcare organizations throughout the country

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Like Dr Burroughs I can recall many instances of unprofessional behavior on the part of my clinical colleagues. But it was one of early bosses that set the tone and provided me with guidance on the relationship between doctors and nurses (and in fact everyone else in the hospital).

There was never a time when you would not see JK holding a door open for any staff member approaching a ward and I recall vividly him opening the door for the ward domestic on his way in for an early morning ward round.

Not only did he demonstrate the professional values and respect to everyone he was also at pains to highlight the importance of the nurses and all the other ancillary members of the team on every ward round. We never had a ward round without the nursing staff and if at all possible the ward sister or charge nurse if they were available. He went to great lengths to explain to me as a junior inexperienced doctor that the nursing staff were my best friend to help navigate the challenging world of medical care - as he put it

"Most times the nurses know more than you do so heed their advice or better yet ask their advice"

Sage advice to a young 22 year old House Office (PGY1 equivalent) who may have passed his medical finals but knew little about the management and care of patients on a busy ward. In fact I made such good friends with the nurses I married one (she is a nurse, midwife and health visitor).

The general consensus of comments is that things have been improving albeit slowly but the road is long and still littered with fall out from some who perpetuate old school notions of inequality. This review on Fierce health focused no the comments and as they rightly pointed out: recent research found that hospital training programs aimed at increasing physician-nurse communication and teamwork helped reduce surgery-related complications, including blood clots and infections. Moreover, hospitals that used teamwork training saw a 15 percent decrease in patient deaths, compared to a 10 percent drop at hospitals that didn't use the program, according to a December 2011 study in the Archives of Surgery.


I'm looking forward to my discussion with Karen Kirby, RN, MSN, NEA-BC, and Kathy Douglas, RN, MHA on #VoiceoftheDoctor on HealthcareRadioNow this Friday at 2:30 ET

Hope you can join us then

Posted via email from drnic's posterous